II. Health Supervision

Laboratory Tests: Screening for Sexually Transmitted Diseases

At least one-fourth of our nation’s estimated 15 million new cases of sexually transmitted diseases (STDs) each year occur in teens¹, and about two-thirds of those who acquire STDs are younger than 25.² Unfortunately, many teens do not receive STD or pregnancy prevention counseling during preventive health visits.

It is important to help teens identify and understand the risks and consequences of their sexual behaviors through risk assessment, screening, and counseling.

Periodicity and Screening Guidelines for STDs

HealthCheck requires screening for STDs as follows:

Infancy:

• Screen all infants born to infected mothers

Adolescence:

• Screen all sexually active teens annually starting at age 11

Chlamydia and Gonorrhea Screening

Risk Factors

• Having sex with an infected partner
• Having sex with multiple partners
• Infants born to infected mothers

Screening Criteria

• Screen all sexually active teens annually starting at age 11
• Screen females who have symptoms or report sexual assault
• Screen males who have symptoms or disclose high-risk behaviors
• Screen sexually active males who have white blood cells present in microscopic urinalysis

Risk Factors

• Having sex with an infected partner
• Having sex with multiple partners
• Males having sex with males
• Injection drug use
• Household contact with a chronically infected person
• Infants born to infected mothers

Screening Criteria

• Screen all sexually active teens annually starting at age 11
• Screen teens when appropriate (if not adequately immunized or if risk factors are present)
• Screen sexually active males who have white blood cells present in microscopic urinalysis
  

Serology Testing for Syphilis

Risk Factors Having sex with an infected partner Having multiple sex partners Males having sex with males Having a history of STDs Infants born to infected mothers

• Screen all high-risk teens annually with syphilis serological testing
• Screen immediately all teens who have been sexually assaulted, have current symptoms of syphilis, gonorrhea, or chlamydia, or have a recent history of STDs
• Screen sexually active males who have white blood cells present in microscopic urinalysis
• Offer HIV testing whenever syphilis testing occurs

Initial Screening

Because the causative agent of syphilis cannot be cultured, screening relies on serology. A nontreponemal test, usually the Venereal Disease Research Laboratory (VDRL) or the Rapid Plasma Reagin (RPR) test, is recommended for initial screening.

At times, uninfected individuals may have a positive VDRL or RPR. In such cases, use the florescent treponemal antibody absorption (FTA-ABS) test to confirm or rule out the diagnosis.

Risk Factors

• Having sex with an infected partner or a partner at high risk
• Males having sex with males
• Sharing needles and or syringes (primarily for drug injection) with an infected person
• Having a transfusion of infected blood or blood clotting agent (uncommon when blood is tested for HIV antibodies)
• Infants born to infected mothers or breastfed by an infected mother after birth

Screening Criteria

• Offer screening to all sexually active teens if risk factors are present
• Offer HIV testing whenever syphilis testing occurs

Additional Information

CDC provides specific information on HIV detection, counseling, and referral.

HIV Prevention Counseling

"Tips for Working with Teens" in the Anticipatory Guidance module offers suggestions on HIV prevention education.

Screening Criteria

• Offer a Papanicolaou (PAP) smear routinely to all females ages 18 thru 20 as part of preventive health visits
• Screen all sexually active females annually with a PAP smear regardless of age

Screening Criteria

• Offer pregnancy testing routinely to all sexually active females

If pregnancy is confirmed:

• Provide counseling or
• Refer to an organization such as Planned Parenthood

Laboratory Testing during Pregnancy

DC law requires laboratory testing for gonorrhea and serology testing for syphilis for pregnant females during the first prenatal visit and in the last trimester of pregnancy. If the PCP is not properly equipped to perform these services, refer to an appropriate provider.

Counsel both males and females about the prevention of unplanned pregnancy, HIV infection, and other sexually transmitted diseases at each preventive health visit starting at age 11.

"Tips for Working with Teens" in the Anticipatory Guidance module offers information on contraceptive options counseling.

1. Centers for Disease Control and Prevention. Tracking the Hidden Epidemics: Trends in STDs in the United States 2000. Also in Centers for Disease Control and Prevention [Web site]. Cited November 17, 2003; available at http://www.cdc.gov/nchstp/dstd/stats_trends/stats_and_trends.htm.

2. National Institutes of Health, National Institute of Allergy and Infectious Diseases. 1999, July. Fact sheet: An introduction to sexually transmitted diseases. In National Institute of Allergy and Infectious Diseases [Web site]. Cited November 17, 2003; available at http://www.niaid.nih.gov/factsheets/stdinfo.htm.

Resources

Green M, Palfrey JS, eds. 2000. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents (2nd ed., rev.). Arlington, VA: National Center for Education in Maternal and Child Health, Table L-1., Common Sexually Transmitted Diseases: Screening Criteria and Consequences, p. 321. Also available online at www.brightfutures.org/bf2/pdf/index.html [See Appendix L].

www.cdc.gov/std/