Sexually Transmitted Infections

  • Diagnosis
  • Screening
  • Background
  • Lab Tests
  • References
  • Related Content

Indications for Testing

  • Urgency, frequency, dysuria in the absence of a documented UTI
  • Vaginal or penile discharge
  • Pelvic pain
  • Proctitis symptoms

Laboratory Testing

  • Refer to the following ARUP Consult topics for STI testing recommendations for the following
  • CDC – testing recommendations
  • STI testing methods (note: for optimal specimen types and collection instructions, refer to ARUP's Sample Collection for the Diagnosis of STD Using Nucleic Acid Amplification Tests )
    • Wet mount
      • Bacterial vaginosis
        • Presence of clue cells is diagnostic in appropriate clinical setting
    • Nucleic acid amplification testing (NAAT)
      • Preferred for detecting C. trachomatis and N. gonorrhoeae in a variety of specimens (USPTFS, 2014; CDC, 2014)
      • Most sensitive test for T. vaginalis
      • Highly sensitive and specific
    • Culture
      • C. trachomatis
        • Not recommended for routine detection
        • May be considered for anatomic locations for which amplified testing has not been validated
        • May be used in medicolegal settings and to assess suspected treatment failure
        • High specificity; less sensitive than NAAT
      • N. gonorrhoeae
        • Not recommended for routine detection
        • Recommended in combination with antimicrobial susceptibility testing in cases of suspected or documented treatment failure
        • May be considered for anatomic locations for which amplified testing has not been validated
        • Sensitivity dependent on transport time
          • N. gonorrhoeae is fastidious; viability declines rapidly during transport
      • T. vaginalis
        • Not recommended for routine detection
    • DNA probes and DFA
      • Not recommended for routine detection
      • Lower sensitivity than NAAT

Differential Diagnosis

STI screening recommendations for sexually active nonpregnant women (STI/Syphilis) node 1218

STI screening recommendations for pregnant women (STI/Syphilis) node 1192

  • STI screening recommendations for men
    • USPSTF
      • No screening if not engaging in high-risk behaviors
      • If engaging in high-risk behaviors, screen for syphilis and HIV
    • CDC
      • Screen all men for HIV who seek medical care, and then at least annually
      • Routine annual screening recommended for men who have sex with men (MSM)
      • Syphilis serology at baseline
      • Urethral specimen for gonorrhea and chlamydia in men who have insertive intercourse
  • STI screening recommendations for extragenital sites (CDC, 2014)
    • Women
      • No recommendations due to scarcity of published studies; however, available data suggests rectal and oropharyngeal infections are not uncommon in women
      • Consider screening women with known risk factors
    • Men
      • Extragenital infections are common and mostly asymptomatic
        • Most frequent for MSM with multiple or anonymous sexual partners
      • Screening recommended at least annually in MSM
        • Rectal specimen for men who have receptive anal intercourse
        • Pharyngeal specimen for men who have receptive oral intercourse

Sexually-transmitted infections (STIs) constitute a major health burden in the U.S., and reported incidence among adolescents is increasing. These diseases are frequently asymptomatic and are most often caused by viruses or bacteria.

  • Most common viral STIs
  • Most common bacterial STIs
    • Treponema pallidum (syphilis)
  • Most-common parasitic/protozoan STI

Indications for Laboratory Testing

Tests generally appear in the order most useful for common clinical situations.
Click on number for test-specific information in the ARUP Laboratory Test Directory

Sexually Transmitted Disease Panel 1 by Transcription-Mediated Amplification 2006258
Method: Qualitative Transcription-Mediated Amplification

Limitations

Testing of oral and rectal specimens is not recommended

The performance of this test has not been evaluated in adolescents <14 years

Chlamydia trachomatis and Neisseria gonorrhoeae by Transcription-Mediated Amplification (TMA) with Confirmation 2011164
Method: Qualitative Transcription-Mediated Amplification

Limitations

Culture may be required in certain clinical contexts for diagnosing C. trachomatis and N. gonorrhoeae infections

Chlamydia trachomatis and Neisseria gonorrhoeae by Transcription-Mediated Amplification (TMA) 0060241
Method: Qualitative Transcription-Mediated Amplification

Limitations

Culture may be required in certain clinical contexts for diagnosing C. trachomatis and N. gonorrhoeae infections

Chlamydia trachomatis and Neisseria gonorrhoeae by Transcription-Mediated Amplification (TMA), ThinPrep 0060734
Method: Transcription-Mediated Amplification

Limitations

Culture may be required in certain clinical contexts for diagnosing C. trachomatis and N. gonorrhoeae infections

The performance of this test has not been evaluated in adolescents <16 years

Chlamydia trachomatis and Neisseria gonorrhoeae by Transcription-Mediated Amplification (TMA), SurePath 2001551
Method: Transcription-Mediated Amplification

Limitations

Use of transport media other than APTIMA specimen collection kit may result in reduced sensitivity

Culture may be required in certain clinical contexts for diagnosing C. trachomatis and N. gonorrhoeae infections

The performance of this test has not been evaluated in adolescents <16 years

Trichomonas vaginalis by Transcription-Mediated Amplification (TMA) 2005506
Method: Qualitative Transcription-Mediated Amplification

Limitations

Performance of test on self-collected vaginal swab specimens and those from pregnant women has not been evaluated

The performance of this test has not been evaluated in adolescents <14 years

Chlamydia trachomatis by Transcription-Mediated Amplification (TMA) 0060243
Method: Qualitative Transcription-Mediated Amplification

Limitations

Culture may be required in certain clinical contexts for diagnosing C. trachomatis and N. gonorrhoeae infections 

Neisseria gonorrhoeae by Transcription-Mediated Amplification (TMA) 0060244
Method: Qualitative Transcription-mediated Amplification

Limitations

Culture may be required in certain clinical contexts for diagnosing C. trachomatis and N. gonorrhoeae infections 

Chlamydia trachomatis Culture 0060850
Method: Cell Culture/Immunofluorescence

Follow Up

Less sensitive than nucleic acid amplification tests

Two to three days required for results

Amplified DNA testing is recommended for detection of C. trachomatis from endocervical or urethral specimens; refer to C. trachomatis by Transcription-Mediated Amplification (TMA)

Culture may be required in certain clinical contexts for diagnosing C. trachomatis and N. gonorrhoeae infections

Unusual Organism Culture 0060714
Method: Culture

Additional Tests Available

Ureaplasma Species and Mycoplasma hominis Culture 0065031
Method: Culture

Comments

Use to detect Mycoplasma hominis and Ureaplasma spp

Use if clinical suspicion exists and all other testing is negative

Other than lung transplant specimens, this test is not appropriate for adult respiratory specimens

Urogenital Ureaplasma and Mycoplasma Species by PCR 2011172
Method: Qualitative Polymerase Chain Reaction

Comments

Detects and speciates Ureaplasma parvum, Ureaplasma urealyticum, Mycoplasma hominis, and Mycoplasma genitalium; consider ordering for cases of nongonococcal urethritis

Vaginal Pathogen Panel by DNA Probe 0065153
Method: Qualitative Nucleic Acid Probe

Comments

Use to detect common vaginal pathogens associated with vaginitis/vaginosis

For T. vaginalis, preferred test is one of the nucleic acid amplification tests (NAAT)

Not recommended as stand-alone test for sexually transmitted infection testing or screening

Chlamydia trachomatis and Neisseria gonorrhoeae by Transcription-Mediated Amplification (TMA), M4/UTM 0060774
Method: Transcription-Mediated Amplification

Comments

Viral transport media (eg, M4/UTM) are not preferred for C. trachomatis and N. gonorrhoeae by TMA

Use of transport media other than TMA specimen collection kit may result in reduced sensitivity

The preferred test is C. trachomatis and N. gonorrhoeae by TMA or if confirmation of positive results by an alternate NAAT is required, refer to C. trachomatis and N. gonorrhoeae by TMA with confirmation

Refer to Sample Collection for the Diagnosis of STD Using Nucleic Acid Amplification Tests for optimal specimen types and collection instructions

Neisseria gonorrhoea Antibodies, Total 0099685
Method: Semi-Quantitative Complement Fixation

Comments

Not recommended 

Less sensitive than amplification-based methods

Chlamydia Antibody Panel, IgG & IgM by IFA 0065100
Method: Semi-Quantitative Indirect Fluorescent Antibody

Comments

Limited value in the diagnosis of most oculogenital (eg, eyes, genitalia) chlamydial infections

Chlamydia Antibody Panel, IgM by IFA 0065105
Method: Semi-Quantitative Indirect Fluorescent Antibody

Comments

Limited value in the diagnosis of most oculogenital (eg, eyes, genitalia) chlamydial infections

Chlamydia Antibody Panel, IgG by IFA 0065139
Method: Semi-Quantitative Indirect Fluorescent Antibody

Comments

Limited value in the diagnosis of most oculogenital (eg, eyes, genitalia) chlamydial infections

Guidelines

Geisler W. Management of uncomplicated Chlamydia trachomatis infections in adolescents and adults: evidence reviewed for the 2006 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis. 2007; 44 Suppl 3: S77-83. PubMed

Meyers D, Wolff T, Gregory K, Marion L, Moyer V, Nelson H, Petitti D, Sawaya G, USPSTF. USPSTF recommendations for STI screening. Am Fam Physician. 2008; 77(6): 819-24. PubMed

Newman L, Moran J, Workowski K. Update on the management of gonorrhea in adults in the United States. Clin Infect Dis. 2007; 44 Suppl 3: S84-101. PubMed

Recommendations for the Laboratory-Based Detection of Chlamydia trachomatis and Neisseria gonorrhoeae - 2014. Recommendations and Reports, Vol. 63, No. 2. Centers for Disease Control and Prevention. Atlanta, GA [Accessed: Nov 2015]

Sexually Transmitted Diseases Treatment Guidelines, 2015. June 5, 2015, 64(RR3);1-137. Centers for Disease Control and Prevention. Atlanta, GA [Last updated Jun 2015; Accessed: Nov 2015]

U.S. Preventive Services Task Force. Screening for chlamydial infection: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2007; 147(2): 128-34. PubMed

van Schalkwyk J, Yudin M, Infectious Disease Committee, Yudin M, Allen V, Bouchard C, Boucher M, Boucoiran I, Caddy S, Castillo E, Kennedy L, Money D, Murphy K, Ogilvie G, Paquet C, van Schalkwy J, Society of Obstetricians and Gynaecologists of Canada. Vulvovaginitis: screening for and management of trichomoniasis, vulvovaginal candidiasis, and bacterial vaginosis. J Obstet Gynaecol Can. 2015; 37(3): 266-76. PubMed

Zakher B, Cantor A, Pappas M, Daeges M, Nelson H. Screening for gonorrhea and Chlamydia: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2014; 161(12): 884-93. PubMed

General References

Beharry M, Shafii T, Burstein G. Diagnosis and treatment of chlamydia, gonorrhea, and trichomonas in adolescents. Pediatr Ann. 2013; 42(2): 26-33. PubMed

de Vries H. Sexually transmitted infections in men who have sex with men. Clin Dermatol. 2014; 32(2): 181-8. PubMed

Frenkl T, Potts J. Sexually transmitted infections. Urol Clin North Am. 2008; 35(1): 33-46; vi. PubMed

Garner A, Schembri G, Cullen T, Lee V. Should we screen heterosexuals for extra-genital chlamydial and gonococcal infections? Int J STD AIDS. 2015; 26(7): 462-6. PubMed

Gaydos C, Ferrero D, Papp J. Laboratory aspects of screening men for Chlamydia trachomatis in the new millennium. Sex Transm Dis. 2008; 35(11 Suppl): S45-50. PubMed

Hobbs M, Seña A. Modern diagnosis of Trichomonas vaginalis infection. Sex Transm Infect. 2013; 89(6): 434-8. PubMed

Markle W, Conti T, Kad M. Sexually transmitted diseases. Prim Care. 2013; 40(3): 557-87. PubMed

Mishori R, McClaskey E, WinklerPrins V. Chlamydia trachomatis infections: screening, diagnosis, and management. Am Fam Physician. 2012; 86(12): 1127-32. PubMed

Quan M. Vaginitis: diagnosis and management. Postgrad Med. 2010; 122(6): 117-27. PubMed

Verstraelen H, Verhelst R. Bacterial vaginosis: an update on diagnosis and treatment. Expert Rev Anti Infect Ther. 2009; 7(9): 1109-24. PubMed

Workowski K. In the clinic. Chlamydia and gonorrhea. Ann Intern Med. 2013; 158(3): ITC2-1. PubMed

Wright H, Turner A, Taylor H. Trachoma. Lancet. 2008; 371(9628): 1945-54. PubMed

Medical Reviewers

Last Update: December 2015