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Screening for STI - sexually active females aged 25 and older

Should be screened if at increased risk for infection1

Recognizing high-risk behaviors in your female patients—and screening accordingly.

Know which patients are considered high-risk

Both the Centers for Disease Control and Prevention (CDC) and US Preventive Services Task Force (USPSTF) recommended screening for chlamydia and gonorrhea in sexually active women ages 25 and older if at increased risk for infection.1,3 Trichomonas screening should also be considered.

USPSTF identifies risk factors as3:

  • Inconsistent condom use among patients not in mutually monogamous relationships
  • Multiple sex partners
  • Previous or coexisting STI
  • A new sex partner
  • A sex partner with concurrent partners
  • Exchanging sex for money or drugs

Asking the right questions to better assess risk

1.

Do you use condoms: never, sometimes, or always?

 

2.

In the past 12 months, how many partners have you had sex with?

3.

Have you ever had an STI?

Has a partner had an STI?
 

Access insights to help you integrate opt-out:

 

This webinar by Dr. Stephanie Taylor offers tips on how to take a good sexual history

 

Listen to the webinar
Protect your patients today. Contact your Quest Diagnostics representative about how you can make universal screening with opt-out the standard of care in your practice.

Ordering the right test at the right time

Screening for STIs is recommended for women at all stages of their lives. The intuitive tables below can help guide your discussions for patient-focused testing recommendations.
 

Chlamydia/Neisseria gonorrhoeae

Test code 11363

  • Annual screening is recommended for females ages 15-248
  • Screening is recommended for women 25 and over at increased risk8a
  • Panel components can be ordered separately:
    • Test code 11361—Chlamydia trachomatis RNA, TMA, Urogenital
    • Test code 11362—Neisseria gonorrhoeae RNA, TMA, Urogenital

Trichomonas Vaginalis

Test codes 19550, 90521

  • Screening for Trichomonas vaginalis should be performed on women seeking care for vaginal discharge8
  • Screening might be considered for women receiving care in high-prevalence settings and for asymptomatic persons at increased riska for infection
  • The use of highly sensitive and specific tests, such as NAAT, are recommended over less-sensitive methods including wet-mount microscopy8b

Chlamydia Trachomatis

Test code 11363

  • All pregnant women aged <25 years or older women at increased risk for infection should be screened during their first prenatal visits8
  • Those aged <25 years and those at increased riska for chlamydia should be retested during their third trimester8
  • Those found to have chlamydial infection should have a test-of-cure (preferably by NAAT) 3 to 4 weeks after treatment and retested at 3 months8

Neisseria Gonorrhoeae

Test code 11363

  • All pregnant women aged <25 years and older women at increased riska for gonorrhea should be screened at their first prenatal visits8
  • Women found to have gonococcal infection should be treated immediately and retested within 3 months8
  • Those who remain at high riska for gonococcal infection should be retested during the third trimester8

Trichomonas Vaginalis

Test codes 19550, 90521

  • Women who report symptoms should be evaluated and treated appropriately
  • Evidence does not support routine screening for Trichomonas vaginalis in asymptomatic pregnant women

Chlamydia/Neisseria gonorrhoeae

Test code 11363

  • For sexually active individuals, screen at first HIV evaluation, and at least annually thereafter8
  • Panel components can be ordered separately:
    • Test code 11361—Chlamydia trachomatis RNA, TMA, Urogenital
    • Test code 11362—Neisseria gonorrhoeae RNA, TMA, Urogenital
  • Specific testing includes NAAT for C trachomatis at the anatomic site of exposure as the preferred approach

Trichomonas Vaginalis

Test codes 19550, 90521

  • Recommended for sexually active women at entry to care and at least annually thereafter8

Chlamydia Trachomatis

Test code 11363

  • Women and men should be retested approximately 3 months after chlamydia treatment8c
  • If retesting at 3 months is not possible, you should retest whenever your patient next receives medical care in the 12 months following the initial treatment8

Neisseria Gonorrhoeae

Test code 11363

  • Patients with symptoms that persist after treatment should be evaluated by culture for gonorrhea and for antimicrobial susceptibility8
  • Clinicians should advise patients with gonorrhea to be retested 3 months after treatment or when they next seek medical care within the following 12 months8

Trichomonas Vaginalis

Test codes 19550, 90521

  • Retesting for Trichomonas vaginalis is recommended for all sexually active women within 3 months following initial treatment regardless of whether they believe their sex partners were treated8

a People with increased risk are women who have had a history of sexually transmitted diseases (STDs), exchange sex for payment, or use injection drugs; and men and women with a new sex partner, more than 1 sex partner, a sex partner with concurrent partners, or a sex partner who has a sexually transmitted infection.

b When highly sensitive testing (eg, nucleic acid amplification test [NAAT]) is not feasible, a testing algorithm (eg, wet mount first, followed by NAAT if negative) can improve diagnostic sensitivity.

c The use of chlamydial NAATs at <3 weeks after completion of therapy is not recommended because the continued presence of nonviable organisms can lead to false-positive results.2

These helpful resources can provide additional information and guidelines:

American College of Obstetricians and Gynecologists (ACOG)

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Centers for Disease Control and Prevention (CDC)

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American Academy of Family Physician (AAFP)

Learn more

​References:

  1. CDC. Sexually Transmitted Infections Treatment Guidelines, 2021. Accessed March 14, 2022. https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf
  2. CDC. CDC fact sheet: information for teens and young adults: staying healthy and preventing STDs. Accessed March 14, 2022. https://www.cdc.gov/std/life-stages-populations/stdfact-teens.htm
  3. Davidson KW, Barry MJ, Mangione CM, et al; US Preventive Services Task Force. Screening for chlamydia and gonorrhea: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;326(10):949-956. doi:10.1001/jama.2021.14081

 

Test codes may vary by location. Please contact your local laboratory for more information.

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Assessing high-risk patients

With rates of sexually transmitted infections (STIs) on the rise, assessing women who may be high-risk is more important than ever.

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