STI Screening: Who, When, and What to Test For

Sexually transmitted infection (STI) screening is an important component of preventive health care for sexually active individuals. Many STIs have no symptoms, especially in their early stages, yet can cause serious health problems if left untreated. Regular screening detects infections early when they're most treatable and helps prevent transmission to partners.

Understanding STI screening recommendations helps you take control of your sexual health and have informed conversations with healthcare providers. Despite the stigma that sometimes surrounds this topic, STI screening is routine preventive care—just like screening for other common health conditions.

Why STI Screening Matters

Many people with STIs don't have symptoms and may not know they're infected. Without symptoms to alert you, screening is the only way to detect these infections. Early detection allows for prompt treatment, which can cure many STIs or manage them effectively if they're not curable.

Untreated STIs can lead to serious health complications. In people with ovaries and a uterus, some STIs can cause pelvic inflammatory disease, which may lead to chronic pain, ectopic pregnancy, or infertility. Certain STIs increase the risk of acquiring or transmitting HIV. Some infections can be passed to babies during pregnancy or childbirth, causing serious health problems.

Regular screening also helps protect your partners. When you know your status, you can take steps to prevent transmission and inform partners if you test positive, allowing them to get tested and treated as needed.

Who Should Be Screened

Sexually Active Young Adults

Annual chlamydia and gonorrhea screening is recommended for all sexually active individuals under age 25 with a cervix. This age group has the highest rates of these infections, and screening helps prevent complications like pelvic inflammatory disease.

For sexually active individuals with a penis under age 25, screening may be recommended based on risk factors and sexual practices. Discuss your individual circumstances with your healthcare provider.

Adults Over 25

Adults over 25 should be screened based on risk factors. These include having new or multiple sexual partners, having a partner with an STI, inconsistent condom use, exchanging sex for money or drugs, or having a history of STIs.

Men who have sex with men face higher risk for certain STIs and should discuss appropriate screening frequency with their healthcare provider, which may include more frequent testing than annual.

During Pregnancy

All pregnant individuals should be screened for syphilis, HIV, and hepatitis B during their first prenatal visit. Screening for chlamydia and gonorrhea is also recommended for pregnant people under 25 or those at increased risk. Some of these tests may be repeated later in pregnancy, especially if risk factors are present.

People with HIV

Individuals living with HIV should be screened regularly for STIs, as they face higher risk and STIs can affect HIV progression. The specific screening schedule depends on individual risk factors and should be discussed with healthcare providers.

What STIs Should You Be Screened For

Chlamydia and Gonorrhea

These are the most commonly screened STIs. Both can be present without symptoms and can cause serious complications if untreated. Testing typically involves a urine sample or swab from the affected area (cervix, urethra, throat, or rectum, depending on sexual practices).

For people who engage in oral or anal sex, testing of the throat or rectum may be recommended in addition to genital testing, as infections can occur at these sites.

HIV

The CDC recommends that everyone between ages 13 and 64 be screened for HIV at least once as part of routine health care. People at higher risk should be tested annually or more frequently. This includes men who have sex with men, people with multiple partners, people who inject drugs, and those diagnosed with other STIs.

HIV testing typically uses a blood sample or oral swab. If initial screening is positive, confirmatory testing is performed to ensure accuracy.

Syphilis

Syphilis screening is recommended for people at increased risk, including men who have sex with men, people with HIV, people with multiple partners, and pregnant individuals. Testing involves a blood test and may include examination of any sores or lesions.

Syphilis has been increasing in recent years, making screening increasingly important for at-risk populations.

Hepatitis B and C

Hepatitis B screening is recommended for people at increased risk, including those with multiple sexual partners, people who inject drugs, men who have sex with men, and household or sexual contacts of people with hepatitis B. All pregnant individuals should be screened.

Hepatitis C screening is recommended at least once for all adults and more frequently for those with ongoing risk factors. Both hepatitis B and C are tested through blood samples.

Herpes

Routine screening for genital herpes is generally not recommended for people without symptoms because blood tests can't determine whether the infection is oral or genital, and most people with herpes antibodies never develop symptoms. However, if you have symptoms, testing can confirm herpes and determine the type.

HPV (Human Papillomavirus)

HPV testing is performed as part of cervical cancer screening for individuals with a cervix, typically starting at age 30. It's not a routine STI screening test for other purposes, as HPV is extremely common and most infections clear on their own without treatment.

HPV vaccination is recommended for preteens and can be given through age 26 for those not previously vaccinated. The vaccine prevents infection with HPV types that cause most cervical cancers and genital warts.

How Often to Get Tested

The frequency of STI screening depends on your individual risk factors. At minimum, sexually active individuals under 25 with a cervix should be tested annually for chlamydia and gonorrhea. Those with new or multiple partners should be tested more frequently, potentially with each new partner or every 3-6 months.

Men who have sex with men may need testing every 3-6 months if sexually active with new or multiple partners. Anyone diagnosed with an STI should be retested approximately three months after treatment to check for reinfection.

If you have concerns about potential exposure, don't wait for your routine screening interval. Discuss timing of testing with your healthcare provider, as some infections take time to show up on tests (the "window period").

What to Expect During STI Testing

Your healthcare provider will ask about your sexual history, including number of partners, types of sexual activity, and condom use. These questions aren't meant to judge you—they help determine which tests are appropriate and where to test (genital, throat, rectum).

Depending on which tests you need, you may provide a urine sample, have blood drawn, or have swabs taken from your genital area, throat, or rectum. Many STI tests can now be done with urine samples or self-collected swabs, making the process less invasive.

Most test results are available within a few days to a week. Your provider should explain how you'll receive results and what to do while waiting. If you test positive for an STI, your provider will discuss treatment options and partner notification.

Overcoming Barriers to Testing

Stigma and Embarrassment

Many people feel embarrassed discussing their sexual health or worry about being judged. Remember that healthcare providers screen for STIs routinely—it's a normal part of preventive care. Being honest about your sexual activity helps ensure you receive appropriate care.

Confidentiality Concerns

STI testing is confidential. Healthcare providers are legally required to protect your privacy. Test results become part of your medical record but are protected by the same privacy laws as all health information.

Some STIs, like HIV and syphilis, are reportable to public health departments for disease tracking purposes, but this reporting uses codes rather than identifying information and is used solely for public health purposes.

Cost and Access

Many insurance plans cover STI screening as preventive care with no copay, especially for recommended screenings. If you're uninsured, many public health departments, community health centers, and family planning clinics offer free or low-cost STI testing.

If You Test Positive

A positive STI test result can feel overwhelming, but remember that many STIs are curable with antibiotics, and those that aren't curable are manageable with treatment. Your healthcare provider will discuss treatment options appropriate for your specific infection.

Partner notification is an important part of STI management. Your recent sexual partners need to know they may have been exposed so they can get tested and treated if necessary. Some health departments offer partner notification services to help with this process if you're uncomfortable doing it yourself.

Complete all prescribed medication even if symptoms improve, and abstain from sexual activity until you and your partner(s) have completed treatment and any required follow-up testing. Many STI cases result from reinfection from untreated partners.

Prevention Strategies

While screening is crucial, prevention is equally important. Consistent and correct condom use significantly reduces STI risk. Open communication with partners about sexual health, including testing and STI history, supports informed decision-making.

Limiting number of sexual partners reduces exposure risk. Vaccination against hepatitis B and HPV provides protection against these infections. Pre-exposure prophylaxis (PrEP) is available for people at high risk for HIV infection.

Taking Control of Your Sexual Health

STI screening is a normal, important part of taking care of your health. Being proactive about testing, honest with healthcare providers, and communicative with partners helps protect your health and the health of others.

Don't let stigma, embarrassment, or fear prevent you from getting the screening you need. Sexual health is health, and you deserve comprehensive, non-judgmental care.