How Should a Primary Care Provider Screen for Sexually Transmitted Infections?

Columbus, OH — April 2018

Written by Geri D. Hewitt, MD and Katherine A. McCracken, MD, of Pediatric and Adolescent Gynecology; and Steven C. Matson, MD, of Adolescent Medicine

Annual sexually transmitted infection testing is recommended for all sexually active adolescents, even if they are not symptomatic for an infection. We also recommend screening when a patient has a new sexual partner, or any time a patient is concerned about possible sexually transmitted infection exposure.

Testing for male and female patients should include:

  • Physical exam — Examination of the genitals and anus for any signs of an infection, such as rash, discharge, sores or warts.
  • Serology — Testing for HIV, hepatitis B, hepatitis C and syphilis.
  • Urine testing — Testing for gonorrhea, chlamydia and trichomonas. This type of testing is convenient, but is most accurate if it is the first void of the day.

Additional testing for female patients can include:

  • Vaginal cultures — Testing for gonorrhea, chlamydia, and trichomonas using a nucleic acid amplification test. The sample is obtained by swabbing the vagina or cervical os. Performing a speculum exam at the same time to visualize the vaginal mucosa, cervix, and vaginal discharge is preferred.
  • Wet mount — Testing for yeast, bacterial vaginosis and trichomonas. The sample is obtained by swabbing the vagina and looking making a slide with normal saline to perform microscopy. Performing a speculum exam at the same time to visualize the vaginal mucosa, cervix, and vaginal discharge is preferred.

Depending on a patient’s sexual history, swabbing of the anus and/or throat may also be appropriate for sexually transmitted infection testing. We recommend viral identification of any vesicular lesions found.

Sexually transmitted results are confidential; we do encourage open communication between adolescents and their parents/guardians.

Developed by Nationwide Children’s Laboratory Services, download (PDF) this reference chart for collection instructions, appropriate containers and stability guidelines for STI testing.

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