Screening Tests for Adults (50 and Up)

Chlamydia and gonorrhea can infect the body through the genitals, anus, or mouth. Risk factors include the following: you are sexually active and less than 25 years old; you are sexually active and of African or Hispanic descent; you use drugs; you have a new male sex partner, have had 2 or more partners during the last year, or are a sex worker; you use barrier contraception inconsistently; or you have a history of STDs. Having one of these diseases increases your risk of becoming infected with human immunodeficiency virus (HIV). Many people have chlamydia and gonorrhea infections at the same time.

Older adults
The Association of Reproductive Health Professionals recommends that health care providers assess the risk of these diseases for their older adult patients. Older adults sometimes develop new sexual relationships, after a divorce, separation, or death of a long-term partner, for example.

Women
The U.S. Preventive Services Task Force recommends the following:

• All sexually active females 25 years of age and younger should have a chlamydia test and gonorrhea test each year.
• All other sexually active women who have no symptoms but are at increased risk for infection should be routinely screened.
• If you are pregnant, more than 25 years old, and at increased risk, you should also be tested for chlamydia. If you are pregnant and at increased risk, you should be tested for gonorrhea.

The American Academy of Pediatrics recommends getting tested again after sex with any new partner.

The American College of Preventive Medicine suggests the following for females:

• Have your health care provider review your risk factors at each routine care appointment so you know if you are presently at risk.
• Get a chlamydia test once a year if you have any of the risk factors.

Men
A health care provider should routinely assess your risk if you engage in sexual activity or have had sexual contact. Without symptoms, heterosexual males are usually not screened, even though they may obtain and spread these infections. The U.S. Centers for Disease Control and Prevention recommends the following for males who have sex with males:

• All males who have sex with males should be screened at least once a year for HIV, syphilis, gonorrhea, and chlamydia (and vaccinated against hepatitis A and hepatitis B). Screening at 3- to 6-month intervals is appropriate if you or a partner have risk factors such as multiple or anonymous partners or illicit drug use.

Talk to your health care provider
Some health care providers fail to discuss sexual health issues at all. This leaves the health risks unchecked. If your health care provider does not bring up sexual health topics, you can simply ask for a test or a risk assessment. You can also use confidential services to obtain testing or counseling.

Re-infection is common

• Re-infection is common. If you are treated for these diseases, know when you should be re-tested (usually, after about 3 months, but no later than 1 year).

Sources

American Academy of Family Physicians.  Chlamydia. July 2008. Available on the Internet at http://familydoctor.org/online/famdocen/home/common/sexinfections/sti/204.html through http://familydoctor.org. Accessed 8 Sept 2008.

US Preventive Services Task Force. Guide to Clinical Preventive Services, 2007: infectious diseases. Available on the Internet at http://www.ahrq.gov/clinic/pocketgd07/gcp2b.htm through http://www.ahrq.gov. Accessed 17 Jan 2008.

US Centers for Disease Control and Prevention. Prevent STDs among MSM. Available on the Internet at http://www.cdc.gov/ncidod/diseases/hepatitis/msm through http://www.cdc.gov. Accessed 23 Jan 2008.

US Centers for Disease Control and Prevention. Questions and answers for the general public: revised recommendations for HIV testing of adults, adolescents, and pregnant women in healthcare settings. Last modified 22 Jan 2007. Available on the Internet at http://www.cdc.gov/hiv/topics/testing/resources/qa/qa_general-public.htm through http://www.cdc.gov. Accessed 28 Jan 2008.

US Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2006. 4 Aug 2006. MMWR 55(RR11). Available on the Internet at http://www.cdc.gov/std/treatment through http://www.cdc.gov. Accessed 23 Jan 2008.

US Preventive Services Task Force. Screening for chlamydial infection (recommendation statement). 17 Jul 2007. Ann Intern Med 17;147(2):128-34. Available on the Internet through http://www.guideline.gov. Accessed 23 Jan 2008.

US Centers for Disease Control and Prevention. Chlamydia fact sheet. Last modified 20 Dec 2007. Available on the Internet at http://www.cdc.gov/std/chlamydia/STDFact-Chlamydia.htm through http://www.cdc.gov. Accessed 19 Jul 2004 and 23 Jan 2008. 

Berg AO, for the US Preventive Services Task Force. Screening for chlamydial infection: recommendations and rationale. Apr 2001. Am J Prev Med 20(3 Suppl):90-94. Available on the Internet through http://www.guideline.gov. Accessed 19 Jul 2004; revision of 17 Jul 2007 accessed 17 Jan 2008.

Hollblad-Fadiman K and Goldman SM, for the American College of Preventive Medicine. Screening for chlamydia trachomatis (practice policy statement). Apr 2003. Am J Prev Med 24(3):287-292. Available on the Internet through http://www.guideline.gov. Accessed 19 Jul 2004 and 18 Jan 2008.

American Social Health Association. Gonorrhea (fact sheet). Available on the Internet through http://www.ashastd.org. Accessed 18 Jan 2008.

Psychosocial factors—psychophysical factors: older adults (module 2). In: Reproductive Health Model Curriculum (2nd ed.). Association of Reproductive Health Professionals. Available on the Internet at http://www.arhp.org/curriculum/ModelCurriculum.cfm through http://www.arhp.org. Accessed 26 Feb 2008.