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Sexually transmitted infection screening recommendations by sex and population

Sexually transmitted infection screening recommendations by sex and population
Sex Population Routine screening recommendation Screening frequency Additional screening recommendations and comments
Females Age <25 years Genital chlamydia* Annually If at increased risk, additionally screen for:
  • Syphilis
  • Trichomoniasis
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:
  • Genital chlamydia and gonorrhea*
  • Syphilis
  • Trichomoniasis
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:
  • HCV for those at risk (or if ≥18 years with no prior screening)◊
  • Trichomoniasis for those with HIV
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 First visit
HCV 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.    
Males MSW only without HIV infection HIV At least once If at increased risk§, additionally screen for:
  • Genital chlamydia and gonorrhea
  • Syphilis

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 three 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 (first visit)
HCV At least once (first visit)
MSM with HIV infection Genital chlamydia At least annually More frequent screening (every three 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 (first visit)
HBV At least once (first visit)
HCV At least annually
Transgender and gender-diverse individuals Screening for STIs should be based on an individual's anatomy and sexual practices. Recommendations for genital gonorrhea, chlamydia and cervical cancer screening in cisgender women should be extended to all transgender men and gender-diverse individuals with a cervix. Screening for other STIs should be based on risk factors and exposures.

HBV: hepatitis B virus; HCV: hepatitis C virus; MSM: men who have sex with men; MSW: men who have sex only with women; HAV: hepatitis A virus; 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 one-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%.

§ 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. 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.
Adapted from: California Sexually Transmitted Infections (STI) Screening Recommendations, 2021. California Department of Public Health, Sexually Transmitted Diseases Control Branch. Available at: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/California-STI-Screening-Recommendations.aspx (Accessed on January 24, 2023).

Additional information from:

  1. Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1.
  2. Conners EE, Panagiotakopoulos L, Hofmeister MG, et al. Screening and testing for hepatitis B virus Infection: CDC recommendations – United States, 2023. MMWR Recomm Rep 2023; 72:1
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