Version July 2025
| Sex assigned at birth | Population | Routine screening recommendation | Screening frequency | Additional screening recommendations and comments |
| Cisgender females | Age <25 years and sexually active | Genital chlamydia* | Annually | If at increased risk¶, additionally screen for:
|
| Genital gonorrhea* | Annually | |||
| HIV | At least once | |||
| HBV | At least once (if age ≥18 years and immunity not already documented)Δ | |||
| HCV | At least once (if age ≥18 years)◊ | |||
| Age ≥25 years | HIV | At least once | If at increased risk¶, additionally screen for:
| |
| HBV | At least once (if immunity not already documented)Δ | |||
| HCV | At least once◊ | |||
| Pregnant | Genital chlamydia* | First trimester (if <25 years or at increased risk¶) | Repeat screening for these infections in third trimester if at increased risk. Additional screening at first prenatal visit:
| |
| Genital gonorrhea* | First trimester (if <25 years or at increased risk¶) | |||
| Syphilis | First trimester | |||
| HIV | First trimester | |||
| HBV | First trimester | |||
| With HIV infection | Genital chlamydia* | Annually | ||
| Genital gonorrhea* | Annually | |||
| Genital trichomoniasis | Annually | |||
| Syphilis | Annually | |||
| HBV | At least once (eg, at first visit) | |||
| HCV | At least once (eg, at first visit)◊ | |||
| WSW and WSWM | WSW and WSWM should not be assumed to be at lower risk for STIs on the basis of their sexual orientation. Screening for cervical cancer and STIs should be conducted according to guidelines for women, based on an open discussion of sexual and behavioral risk factors. | |||
| Cisgender males | MSW only without HIV infection | HIV | At least once | If at increased risk§, additionally screen for:
Targeted screening venues for chlamydia include adolescent clinics, STI clinics, and correctional facilities. |
| HBV | At least once (if age ≥18 years and immunity not already documented)Δ | |||
| HCV | At least once (if age ≥18 years)◊ | |||
| MSM without HIV infection | Genital chlamydia | At least annually | More frequent screening (every 3 months) for chlamydia, gonorrhea, and syphilis is recommended in those with risk factors. More frequent screening for HIV, HBV, and HCV may also be warranted.¥ | |
| Rectal chlamydia (if exposed) | At least annually | |||
| Genital gonorrhea | At least annually | |||
| Rectal gonorrhea (if exposed) | At least annually | |||
| Pharyngeal gonorrhea (if exposed) | At least annually | |||
| Syphilis | At least annually | |||
| HIV | At least annually | |||
| HAV | At least once | |||
| HBV | At least once | |||
| HCV | At least once◊ | |||
| MSW only with HIV infection | Genital chlamydia | Annually | ||
| Genital gonorrhea | Annually | |||
| Syphilis | Annually | |||
| HBV | At least once (eg, at first visit) | |||
| HCV | At least once (eg, at first visit)◊ | |||
| MSM with HIV infection | Genital chlamydia | At least annually | More frequent screening (every 3 months) for chlamydia, gonorrhea, and syphilis is recommended in those with risk factors. More frequent screening for HBV and HCV may also be warranted.¥ | |
| Rectal chlamydia (if exposed) | At least annually | |||
| Genital gonorrhea | At least annually | |||
| Rectal gonorrhea (if exposed) | At least annually | |||
| Pharyngeal gonorrhea (if exposed) | At least annually | |||
| Syphilis | At least annually | |||
| HAV | At least once (eg, at first visit) | |||
| HBV | At least once (eg, at first visit) | |||
| HCV | At least annually◊ | |||
| Transgender and gender-diverse individuals | Screening for STIs should be based on an individual's anatomy:
Screening for other STIs should be based on sexual practice, risk factors, and exposures. | |||
HAV: hepatitis A virus; HBV: hepatitis B virus; HCV: hepatitis C virus; HIV: human immunodeficiency virus; MSM: men who have sex with men; MSW: men who have sex only with women; STI: sexually transmitted infection; WSW: women who have sex with women; WSWM: women who have sex with women and men.
* Screening for nongenital infections in females (eg, rectal chlamydial infection, pharyngeal and rectal gonococcal infection) can be considered based on reported sexual behaviors and exposure, via shared clinical decision-making between the patient and the provider.
¶ Factors conferring increased risk for gonorrhea, chlamydia, and trichomoniasis in females include transactional sex, new sex partner, multiple sex partners, a sex partner with concurrent partners, or a sex partner with an STI. Risk factors for syphilis include residence in high-prevalence areas, history of incarceration, or transactional sex work. STI screening may also be considered in high-prevalence settings (eg, STI clinic or correctional facility).
Δ For all adults 18 years of age or older, regardless of risk factors, at least 1-time screening for HBV infection is recommended, unless they have documented vaccine receipt and serologic evidence of vaccine response. Those who are susceptible should be vaccinated. For those who have risk factors for HBV exposure, ongoing screening is warranted if they are unvaccinated or have nonresponse to vaccination. Refer to other UpToDate content on STIs for details.
◊ All adults 18 years of age or older should be screened for HCV at least once, except in settings where the HCV positivity is <0.1%. Repeated screening is warranted for those with ongoing risk factors (eg, injection drug use). Increased risk factors for hepatitis C infection among MSM include HIV infection, high community HCV prevalence and incidence, high-risk sexual behaviors, and concomitant ulcerative STIs or STI-related proctitis. Refer to other UpToDate content on hepatitis C screening for details.
§ Factors conferring increased risk for gonorrhea and chlamydia in MSW include an infection in the preceding 24 months. Screening for chlamydia in young males can be considered in high-prevalence clinical settings (adolescent clinics, correctional facilities, STI/sexual health clinic). Increased risk factors for syphilis may be based on geography, race/ethnicity, history of incarceration, transactional sex work, or age <29 years.
¥ Increased risk factors for gonorrhea, chlamydia, syphilis, and HIV among MSM include multiple or anonymous partners; intravenous drug use; sex in conjunction with illicit drug use, including methamphetamines; and sex partners who engage in these activities. MSM who have not been vaccinated for HBV or have had nonresponse to vaccination remain at risk for HBV infection.
