STD Screening Guidelines
Sexually Transmitted Diseases (STD) cause substantial social and economic costs. Physicians and other health-care providers play a critical role in preventing and treating STDs. We hope these resources can support you in how to best screen, treat, and manage your patients and their partners.
Chlamydia, gonorrhea, syphilis, and herpes simplex are notifiable conditions for the prevention and control of communicable and noninfectious diseases in Washington. Health care providers are required to notify public health authorities of these conditions as individual cases using procedures described:
Sexual health screening is an important part of an individual's primary health care. STDs are often asymptomatic and routine screening is vital to find and treat infections early. See links below for routine, yearly, or more frequent asymptomatic STD screening for a variety of priority populations.
- CDC STD and HIV Screening Recommendations
- CDC STD Treatment Guidelines
- Washington State DOH STD Treatment Summary
- Routine STD Screening Steps in Primary Care: Webinar
Men Who Have Sex with Men (MSM)
MSM continue to be at the highest risk for HIV/AIDS and syphilis infections. They also have a moderate to high prevalence of asymptomatic rectal and pharyngeal gonorrhea infections, which are missed by urethral-only screening for Chlamydia or gonorrhea detection. (Note: screening of anatomical sites based on sexual history is important for all populations.)
Our updated STD case report (PDF), a fillable form, reflects that providers now have the responsibility to provide partner services for heterosexual cases with Chlamydia infection. Assuring treatment of infected persons' sex partners is a central component of prevention and control of bacterial STDs in order to reduce persistent or recurrent infections. EPT (expedited partner therapy) is a useful option to facilitate partner treatment among heterosexual men and women with Chlamydia infection and/or gonorrhea.
However, EPT is not supported in the routine management of these infections among MSM, due to the risk of missing HIV co-infections or other STDs in MSM or their partners. Furthermore, in Washington State resistance to alternative treatments are found in MSM. MSM and their male partners should receive comprehensive STD screening (PDF) and the first line of treatment.
Taking a Sexual History
Comprehensive STD care requires that providers take a sexual history from patients presenting for STD care or for patients presenting for routine new or annual patient visits. Practice the five "P"s:
- Partners: ask number and gender of partners
- Practices: identify sites from which to collect specimens
- Protection from STDs: identify risk reduction strategies
- Past history of STDs: assess current risk of other infections/STDs
- Prevention of Pregnancy: assess conception strategy
- Asking Patients Questions (PDF): about Sexual Orientation and Gender Identity in Clinical Settings - Fenway Institute, Boston, MA
- CDC Taking a Sexual History (PDF)
- CDC Transgender Health Resources
STD Training Opportunities
- Assist with disease reporting requirements and treatment protocols.
- Available for those who qualify; facilitate access to an STD exam, EPT partner packs, syphilis treatment, and HIV or syphilis testing.
- Follow up with reported cases to assure proper treatment, and assist with notifying sex partners of their potential exposure. However, SHD is no longer providing partner services for heterosexual cases with Chlamydia infection; this is the responsibility of the diagnosing provider.
- Provide on-site training or education, as staffing permits.