Hepatitis B
Summary of STI Screening Recommendations: Disease Based
Screen all sexually active persons under age 25
Universal screening should be done at any reproductive health visit
• Strong evidence-based recommendation for screening women under age 25 annually
• Insufficient evidence to recommend annual screening for men, but is a best practice
• Genital specimens should be tested using a nucleic acid amplification test (NAAT)
• Patients who report recent receptive anal intercourse should be tested with rectal culture
• Pharyngeal testing is not recommended for men or women
• Urine (first void) testing is preferred for men. Urine testing may be used for women when a pelvic exam is not otherwise indicated.
In low prevalence settings (25, selective screening criteria may be used:
- patient had more than one partner in the previous 90 days, or
- patient had a partner with more than one partner in the previous 90 days, or
- patient had a new partner in the last 90 days, or
- patient had chlamydia or gonorrhea infection in the previous 5 years, or
- patient had a partner with symptoms consistent with or diagnosis of chlamydia including urethritis, epididymitits, cervicitis, or PID, within the past 90 days, or
- patient had a partner with diagnosis of other STIs in the past 90 days (GC, syphilis, trich)
Screen persons at increased risk for gonorrhea.
Risk is not well defined, but includes:
• Women under age 25*
• Men who have sex with men (MSM). Test all exposed sites–genital, pharyngeal, rectal.
• High prevalence of gonorrhea in community or in patient’s sexual network
• High risk sexual behavior
• Diagnosis of other STIs
• Patient had a partner with symptoms or diagnosis of other STIs
Do not screen men or women who are not at increased risk.
In heterosexual college students, the incidence of gonorrhea is very low (2%)
• Sexual partners of persons with chronic hepatitis B infection
Do not screen persons who are not at increased risk.
Previously immunized persons do not need screening unless they were at risk prior to receiving vaccine. If so, screen once to rule out chronic infection. Transmission of hepatitis B occurs by both sexual and percutaneous routes.
Screen for hepatitis C antibody in persons with known risk factors for this infection:
• Injection drug use (current or past)
• Persons who received a transfusion, transplant or blood products prior to 1992
• Persons with liver disease of unknown cause (persistently elevated ALT)
Do not screen persons who are not at increased risk.
Transmission of hepatitis C is mostly percutaneous; sexual transmission is rare. Some guidelines recommend screening MSM regardless of drug use history, but there is no data to support this.
Routine screening for herpes in adults or adolescents is not recommended.
Some organizations and experts recommend that providers consider screening persons at higher risk of having genital herpes including:
• Sexual partners of persons with known genital herpes infection
• Men who have sex with men
• Pregnant women
• Persons with HIV infection
HSV prevalence increases with age and the number of lifetime sexual partners. Testing is more useful when the prior probability of having herpes is high. The prevalence of HSV-2 in young adults under age 25 is less than 10%. In this population, the positive predictive value of a type-specific antibody test is less than 50%. Equivocal antibody tests with EIA values ................
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