This article waslast modified on June 25, 2018.

You can safeguard and enhance your health, perhaps for many decades, by having certain screening tests a few times in your 20s. The tests are used for early detection of some of the more common and potentially serious diseases occurring in adults, such as sexually transmitted diseases, cancers, diabetes, and heart disease.

Screening tests can find certain conditions in their earliest and most treatable stages, even before you notice symptoms. With information from screening tests, your healthcare provider can work with you to develop preventive measures that will help you remain healthier in your later years. For example, a routine cholesterol test could reveal your risk of developing heart disease, allowing you to take preventive measures—like lifestyle changes—before you develop a serious condition.

The sections below provide information on the screening tests suggested for young adults, up to 29 years old. They summarize the recommendations from various authorities, and there is consensus in many areas, but not all. Therefore, when discussing screening with your healthcare provider and making decisions about testing, it is important to consider your individual health situation and risk factors.

For more information on preventive medicine and steps you can take to keep you and your family healthy, read Wellness and Prevention in an Era of Patient Responsibility.

Not everyone in this age group may need screening for every condition listed here. Read the sections below to learn more about each condition and to determine if screening may be appropriate for you or your family member. You should discuss screening options with your health care practitioner.

Screening Recommendations
  • Breast Cancer

    Breast cancer is the second leading cause of cancer death in American women. Incidence tends to increase with age. About 95% of new cases occur in those who are 40 and older and 88% of breast cancer deaths occur in women 50 and older. Women in their 20s and 30s have the lowest incidence of breast cancer. Between 2007 and 2011, women between the ages of 20 and 34 represented only 1.8% of new breast cancer cases, according to the National Cancer Institute.

    Recommendations

    The American College of Obstetricians and Gynecologists (ACOG) recommends the following for young women with no known risk factors for breast cancer:

    • Women in their 20s and 30s should have a breast exam by a health professional at least every 3 years as part of their regular health exam.
    • Breast self-exams are an option for women starting in their 20s; women should report any changes they feel in their breasts to their healthcare provider.

    Because of the low incidence of breast cancer in women younger than 40, mammograms generally aren't recommended for those of average risk.

    Risk

    Family history and genetics can contribute to a high lifetime risk. Other risk factors for breast cancer include, for example, a personal history of breast cancer, obesity, beginning your period at a younger age, having dense breasts, and alcohol consumption.

    Some of the important factors contributing to a high lifetime risk include:

    • Carrying a mutated BRCA1 or BRCA2 gene, or having a close relative with the gene
    • Having had chest radiation at a young age (between 10 and 30 years old)
    • Certain family histories, such as multiple close relatives with breast or ovarian cancer

    If you suspect you are at an increased risk for breast cancer, you should consult your healthcare provider and consider developing an individualized screening program.


    Links
    Sign up for the American Cancer Society's Breast Cancer Screening Reminder
    American Cancer Society: What are the risk factors for breast cancer?
    ACS: Clinical Breast Exam
    ACS: Breast Awareness and Self Exam
    National Cancer Institute: Breast Cancer Screening


    Sources Used in Current Review

    National Cancer Institute Surveillance, Epidemiology, and End Results Program, SEER Stat Fact Sheets: Breast Cancer. Available online at http://seer.cancer.gov/statfacts/html/breast.html. Accessed on 4/1/15.

    (2013). Breast Cancer Facts and Figures 2013-2014. American Cancer Society. Available online at http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-042725.pdf. Accessed on 4/1/15.

    (2014 October 29). American Cancer Society Guidelines for the Early Detection of Cancer. American Cancer Society. Available online at http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer. Accessed on 4/1/15.

    Smith, R. et al. (8 January 2015). Cancer screening in the United States, 2015: A review of current American Cancer Society guidelines and current issues in cancer screening. CA: A Cancer Journal for Clinicians. Available online at http://onlinelibrary.wiley.com/doi/10.3322/caac.21261/full. Accessed on 4/1/15.

    Mayo Clinic Staff (20 November 2014). Breast cancer, risk factors. Mayo Clinic. Available online at http://www.mayoclinic.org/diseases-conditions/breast-cancer/basics/risk-factors/con-20029275. Accessed on 4/8/15.

    Saslow, et al. (2007). American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography. CA: A Cancer Journal for Clinicians. Available online at http://www.penncancer.org/pdf/MR%20BreastGline.pdf. Accessed on 4/8/15.

    (26 February 2015, Revised). What are the risk factors for breast cancer? American Cancer Society. Available online at http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-risk-factors?sitearea=. Accessed on 4/8/15.

    American Cancer Society. American Cancer Society recommendations for early breast cancer detection in women without breast symptoms. Available online at http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-recs. Accessed November 2015.

    Kevin C. Oeffinger, MD et al. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. JAMA. 2015;314(15):1599-1614. doi:10.1001/jama.2015.12783. Available online at http://jama.jamanetwork.com/article.aspx?articleid=2463262. Accessed November 2015.

  • Cervical Cancer

    Most deaths from cancer of the cervix (the lower part of the uterus, or womb) can be avoided by having regular checkups and and cervical cancer screens. Cervical cancer is slow-growing and can take several years to develop. Most often, cancerous cells are seen in women 40 years of age or older. Routine screening can help identify cervical cancer early on, at a time when it is highly curable. Screening even finds precancerous lesions that can be monitored or removed before cancer ever starts to develop.

    Recommendations

    Cervical cancer screening guidelines for young women from the American College of Obstetricians and Gynecologists (ACOG), the American Cancer Society (ACS), and the U.S. Preventive Services Task Force (USPSTF) recommend that women between the ages of 21 and 29 have a Pap test every 3 years.

    ACOG, USPSTF and ACS guidelines recommend more frequent screening for women with risk factors such as exposure to DES (diethylstilbestrol) in utero, previous diagnosis of a high-grade precancerous cervical lesion or cervical cancer, HIV infection, or a compromised immune system. (See the section on Risk Factors in the Cervical Cancer article.)

    A Pap test for women younger than 21 is not recommended because the incidence of cancer in this age group is very low. False-positive results may occur due to normal cell changes and are somewhat common. The false-positive results may generate unnecessary and costly treatment as well as emotional anxiety.

    Pap tests are available from family planning clinics and public health departments as well as from healthcare providers (including pediatricians, family physicians, obstetrician-gynecologists, and nurse practitioners). Even if you do not need a Pap test each year, for most women an annual well-woman exam is still recommended, reminds ACOG.

    HPV Testing
    In general, screening for the presence of human papilloma virus (HPV DNA test) is not recommended in women younger than age 25 because infections with HPV are relatively common in this age group and often resolve without treatment or complications. However, HPV testing may be used as a follow-up test for women between the ages of 21 and 29 years who have abnormal results on a Pap test known as "atypical squamous cells of undetermined significance" (ASCUS) [see Pap Test Terminology]. Results may be used to determine the need for colposcopy, a procedure that allows a health practitioner to visually inspect the vagina and cervix under magnification for the presence of abnormal cells.

    Significant changes to these recommendations may be on the horizon, however. The Food and Drug Administration (FDA) approved an HPV DNA test as a primary screening tool for cervical cancer, meaning it may be used without a Pap test. Individual health organizations have yet to update their screening recommendations, but an expert panel issued interim (temporary) guidelines in 2015. These guidelines say that:

    • The HPV test may be offered to women aged 25 and older without a Pap test.
    • If initial results are negative, women should be screened again no sooner than 3 years.

    Women interested in this new option should talk to their healthcare provider. The interim guidelines acknowledge that more studies are needed to further evaluate the HPV test and its role in cancer screening. For example, there are still questions about whether age 25 is the best age to start offering it as a primary screening option and how often women should be screened.


    Link
    National Cancer Institute: What You Need To Know About Cervical Cancer


    Sources Used in Current Review

    (Updated 2012 August 13). HPV- Associated Cancer Diagnosis by Age. Centers for Disease Control and Prevention. Available online at http://www.cdc.gov/cancer/hpv/statistics/age.htm. Accessed 6/16/15.

    (2012 March). Screening for Cervical Cancer. U.S. Preventive Services Task Force. Available online at http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm. Accessed 6/16/15.

    Moyer, VA on behalf of the U.S. Preventive Services Task Force. (2012 June 19). Screening for Cervical Cancer: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine, 156(5). Available online at http://www.annals.org/content/early/2012/03/14/0003-4819-156-12-201206190-00424.full. Accessed 6/16/15.

    (Reviewed 2014 March 17). Cervical Cancer Prevention and Early Detection. American Cancer Society. Available online at http://www.cancer.org/acs/groups/cid/documents/webcontent/003167-pdf.pdf. Accessed 6/16/15.

    (Reviewed 2014 September 9). Pap and HPV Testing. National Cancer Institute. Available online at http://www.cancer.gov/types/cervical/pap-hpv-testing-fact-sheet. Accessed 6/16/15.

    Saslow, D. et al. (2012 March 14). American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Available online at http://onlinelibrary.wiley.com/doi/10.3322/caac.21139/full. Accessed 6/16/15.

    Barclay, L. (2015 January 9). New Guidance Recommends HPV DNA Test for Primary Screening. Medscape Medical News. http://www.medscape.com/viewarticle/837832. Accessed 6/16/15.

  • Chlamydia and Gonorrhea

    Chlamydia and gonorrhea are the most common bacterial sexually transmitted diseases (STDs) in the United States today, but many infected people have no symptoms. These infections usually affect the genitals but may also cause infections of other areas, such as the throat and rectum. Pregnant women may transmit the infections to their newborns. Left untreated, these diseases can cause infertility and other health complications. However, both diseases can be cured with antibiotics.

    In the United States, reported rates of chlamydia and gonorrhea are highest among adolescent girls (15-19 years of age) and young women (20-24 years old). However, any sexually active person can get infected with chlamydia or gonorrhea. Many people have both infections at the same time.

    Recommendations for Women

    • The U.S. Centers for Disease Control and Prevention (CDC), the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) recommend annual chlamydia and gonorrhea screening for all sexually active women age 25 and younger. Annual screening is also recommended for women older than age 25 who are at increased risk, such as having a new sex partner or multiple sex partners.
    • The U.S. Preventive Services Task Force (USPSTF) and The American Academy of Family Physicians (AAFP) recommend chlamydia and gonorrhea screening for all sexually active women age 24 and younger and for women 25 and older who are at increased risk.

    For screening recommendations during pregnancy, see Pregnancy & Prenatal Testing.

    Recommendations for Men

    • These organizations do not recommend routine screening for healthy, sexually active, heterosexual men. Health care providers may, however, use their judgment and consider risks, such as prevalence in the community. It is important to remember that an infected man can spread these diseases and even re-infect a partner if he does not complete treatment.
    • For sexually active men who have sex with men, the CDC recommends chlamydia and gonorrhea screening at least annually.

    Risk

    Sexually active young adults age 24 and younger have higher risk of chlamydia and gonorrhea infection than adults age 25 and older.

    Examples of other risk factors include:

    • Previous chlamydia or gonorrhea infections, even if you were treated successfully
    • Having STDs, especially HIV
    • Having new or multiple sex partners
    • Having a sex partner diagnosed with an STD
    • Using condoms inconsistently
    • Exchanging sex for money or drugs
    • Using illegal drugs
    • Living in a detention facility
       

    Because reinfection rates are high, the CDC recommends that both women and men who are treated for chlamydia or gonorrhea infection be retested approximately 3 months after treatment or at their next health care visit, regardless of whether they believe that their sex partners were treated. It is important to continue annual screening for these diseases because reinfection is always possible.


    Links

    CDC: Get Tested, Find Free, Fast, and Confidential Testing Near You 


    Sources Used in Current Review (last reviewed 12/5/2017)

    (2016 October 17, Updated). Chlamydia - CDC Fact Sheet (Detailed). Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm. Accessed on October 2017.

    (2016 October 28, Updated). Gonorrhea – CDC Fact Sheet (Detailed Version). Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea-detailed.htm. Accessed on October 2017.

    (2016 December). Chlamydia, Gonorrhea, and Syphilis FAQ. American Congress of Obstetricians and Gynecologists. Available online at https://www.acog.org/Patients/FAQs/Chlamydia-Gonorrhea-and-Syphilis. Accessed on October 2017.

    Fisher, M. and Schlaberg, R. (2017 July, Updated). Sexually Transmitted Infections. ARUP Consult. Available online at https://arupconsult.com/content/sexually-transmitted-infections/?tab=tab_item-1. Accessed on October 2017.

    (December 1, 2016) Centers for Disease Control and Prevention, STD Risk and Oral Sex - CDC Fact Sheet. Available online at https://www.cdc.gov/std/healthcomm/stdfact-stdriskandoralsex.htm. Accessed on October 2017.

    (September 2014) US Preventive Services Task Force. Final Recommendation Statement Chlamydia and Gonorrhea: Screening. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/chlamydia-and-gonorrhea-screening. Accessed on October 2017.

  • High cholesterol

    Beginning in childhood, the waxy substance called cholesterol and other fatty substances known as lipids start to build up in the arteries, hardening into plaques that narrow the passageway. During adulthood, plaque buildup and resulting health problems occur not only in arteries supplying blood to the heart muscle but in arteries throughout the body (a problem known as atherosclerosis). For both men and women in the United States, the number one cause of death is heart disease, and the amount of cholesterol in the blood greatly affects a person's chances of suffering from it.

    Monitoring and maintaining healthy levels of cholesterol are important in staying healthy. Screening for high cholesterol, typically with a lipid profile, is important because there are usually no symptoms. A lipid profile usually includes total cholesterolHDL-cholesterolLDL-cholesterol, and triglycerides. Non-HDL-cholesterol can also be calculated by subtracting the HDL-C value from the total cholesterol result. Typically, fasting for 9-12 hours before having the blood sample drawn is required; only water is permitted. However, some laboratories offer non-fasting lipid profiles. In particular, children and teens may have testing done without fasting.

    Recommendations

    Since screening recommendations are not always consistent between healthcare organizations, it's important to work with your healthcare provider to develop a cholesterol-screening plan that is right for you.

    • The American Academy of Pediatrics (AAP) recommends routine lipid testing once between 17 and 21.
    • The American Heart Association (AHA) recommends cholesterol testing (a fasting lipid profile) for all adults 20 or older every 4-6 years. More frequent testing is recommended for those at increased risk.
    • The U.S. Preventive Services Task Force (USPSTF) recommends screening for high cholesterol in youths 20 and younger only if they are at increased risk. Currently, there is not enough evidence to recommend for or against routine screening in this age group, according to the Task Force.

      For adults 21 to 39, the USPSTF's 2016 guidelines do not recommend for or against cholesterol screening. This is based on a lack of evidence that screening before age 40 has an effect on cardiovascular health. The USPSTF recommends that clinicians use their judgment when deciding to screen people in this age group.

      The USPSTF advises healthcare practitioners and their patients to go beyond screening for high cholesterol and evaluate a person's overall risk for heart disease to determine who may benefit from treatment with cholesterol-lowering statins.

    Risk Factors

    • Family History: Young adults are at increased risk if they have a parent, grandparent, aunt/uncle, or sibling who has high cholesterol or if they have a family history of cardiovascular disease (prior to age 55 in male relative and age 65 in female relative).
    • Personal Health: Young adults are also at higher risk if they:
      • Are overweight or obese
      • Have a diet high in fats, especially saturated or trans fat
      • Get little or no exercise
      • Have diabetes or hypertension (high blood pressure)
      • Smoke cigarettes or using other tobacco products

    Links
    University of Maryland Heart Center: Heart Disease Risk Calculator
    National Heart, Lung, and Blood Institute: High Blood Cholesterol


    Sources Used in Current Review (last reviewed 7/12/17)

    (2008, June). Lipid disorders in adults (cholesterol, dyslipidemia): Screening. U.S. Preventive Services Task Force. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lipid-disorders-in-adults-cholesterol-dyslipidemia-screening. Accessed June 2017.

    (2015 March 16). High cholesterol risk factors. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/cholesterol/risk_factors.htm. Accessed June 2017.

    (2016 February 9). High cholesterol, symptoms and causes. Mayo Clinic. Available online at http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/symptoms-causes/dxc-20181874. Accessed June 2017.

    (2016 August 9). Screening for lipid disorders in children and adolescents. U.S. Preventive Services Task Force recommendation statement. U.S. Preventive Services Task Force. Available online at http://jamanetwork.com/journals/jama/fullarticle/2542642. June 2017.

    (2016 November 15). Statin Use for the Primary Prevention of Cardiovascular Disease in Adults. US Preventive Services Task Force Recommendation Statement. JAMA 2016; 316(19):1997-2007. doi:10.1001/jama.2016.15450. Available online at http://jamanetwork.com/journals/jama/fullarticle/2584058. Accessed June 2017.

    @2017. Periodicity schedule. American Academy of Pediatrics. Available online at https://www.aap.org/en-us/professional-resources/practice-transformation/managing-patients/Pages/Periodicity-Schedule.aspx. Accessed June 2017.

    Swift, D. (2017 February 17). AAP updates preventive care guidelines, targets HIV, depression screening. Medscape, News and Perspective. Available online at http://www.medscape.com/viewarticle/875950?pa=gzilco%2FMqWtheZwS%2BIv9ew%2F1apM1lJZswxmtf97%2BKCThPQZnAFNU5cYUCO0MrUVvVrJxKJt4DRD8mxYr6kYfOw%3D%3D. Accessed June 2017.

    (Reviewed 2017 April). How to get your cholesterol tested. American Heart Association. Available online at http://www.heart.org/HEARTORG/Conditions/Cholesterol/HowToGetYourCholesterolTested/How-To-Get-Your-Cholesterol-Tested_UCM_305595_Article.jsp#.WUrsWxPyvEY. Accessed June 2017.

    Family History of Early Atherosclerotic Cardiovascular Disease. National Heart, Lung and Blood Institute. Available online at https://www.nhlbi.nih.gov/health-pro/guidelines/current/cardiovascular-health-pediatric-guidelines/full-report-chapter-4. Accessed June 2017.

    (2016 November) Chou, R.C. Screening for dyslipidemia in younger adults, A Systematic Review to Update the 2008 U.S. Preventive Services Task Force Recommendation. Available online at https://www.ncbi.nlm.nih.gov/books/NBK396243/. June 2017.

  • Human Immunodeficiency Virus (HIV)

    HIV is the virus that causes AIDS (acquired immunodeficiency syndrome), a life-threatening disease. Initially, an HIV infection may cause no symptoms or cause non-specific, flu-like symptoms that resolve after a short time period. The only way to determine whether a person has been infected is through HIV testing.

    If the infection is not detected and treated, eventually symptoms of AIDS emerge and begin to progressively worsen. Without treatment, HIV destroys the immune system over time and leaves a person's body vulnerable to debilitating infections.

    HIV is spread in the following ways:

    • By having sex with an infected partner
    • By sharing needles or syringes (such as with intravenous injection drug abuse)
    • During pregnancy or birth; if a pregnant woman is infected with HIV, the virus can be passed to and infect her developing baby.
    • Through contact with infected blood
    • In the U.S. today, because of screening blood for transfusion and heat-treating techniques and other treatments of blood derivatives, the risk of getting HIV from transfusions is extremely small. However, before donated blood was screened beginning in 1985 in the U.S. and before treatments were introduced to destroy HIV in some blood products, such as factor 8 and albumin, HIV was transmitted through transfusion of contaminated blood or blood components.

    Why Get Screening?
    Screening for HIV is now part of routine healthcare in the United States and is an important part of wellness and prevention. This is because diagnosis early in the course of infection leads to timely, effective treatment that decreases the risk of progression to AIDS. A major National Institutes of Health (NIH) clinical trial published in 2015 found that individuals with HIV have a lower risk of developing AIDS and other serious illnesses if they start antiretroviral therapy sooner rather than later.

    Early diagnosis also has important benefits for others and society at large. Thousands of people are diagnosed with HIV each year, and about 1 in 8 people in the United States with HIV are unaware that they have it. An individual can prevent further disease spread by learning their status, modifying behavior and not exposing others to infected blood or body fluids. Pregnant women who have HIV can start treatment to prevent spreading the disease to their children.

    If an HIV screening test shows a person is not infected, he or she can take steps to avoid infection. For individuals who are HIV-negative but at high risk for HIV, the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommend that they consider taking pre-exposure prophylaxis (PrEP), a daily pill to help prevent infection. For people taking PrEP consistently, the risk of HIV infection is significantly lower compared to those who did not take it.

    Know Your Risk
    Several situations put you at high risk of contracting HIV:

    • You've had unprotected sex with more than one partner.
    • You have or have had a sexually transmitted disease (STD), which appears to make people more susceptible to and at higher risk for acquiring HIV infection during sex with infected partners.
    • You're a man who has had sexual contact with another man.
    • You have exchanged sex for money or drugs or had anonymous sex.
    • You use or used injection drugs and are likely to have shared unsterilized needles.
    • You have an HIV-positive sexual partner.
    • You have had sex with anyone who falls into one of the categories listed above or are uncertain about your sexual partner's risk behaviors.
    • You've been diagnosed with or treated for hepatitis or tuberculosis (TB).

    How often you are tested should depend on your risk, activities, and sexual contacts. For example, during a long-term, truly monogamous sexual relationship, you may want just one test. However, if you or your partner have had sexual contact with more than one person in recent months, your risk of infection is greater. If you or a person with whom you've had sexual contact (even unwanted sexual contact) engaged in some risky behavior, you have even more reason to be tested.

    Screening Tests
    Different types of tests are available for HIV screening:

    • Combination HIV antibody and HIV antigen test—this is the recommended screening test for HIV. It is available only as a blood test. It detects the HIV antigen called p24 plus antibodies to HIV-1 and HIV-2. (HIV-1 is the most common type found in the United States, while HIV-2 has a higher prevalence in parts of Africa.) By detecting both antibody and antigen, the combination test increases the likelihood that an infection is detected soon after exposure. These tests can detect HIV infections in most people by 2-6 weeks after exposure.
    • HIV antibody testing—all HIV antibody tests used in the U.S. detect HIV-1, and some tests have been developed that can also detect HIV-2. These tests are available as blood tests or tests of oral fluid. HIV antibody tests can detect infections in most people 3-12 weeks after exposure.

    Various options are available for getting tested:

    • A blood or oral sample can be collected in a healthcare provider's office or a local clinic and sent to a laboratory for testing. In these same settings, a rapid test may available in which results are generated in about 20 minutes.
    • A home collection kit approved by the U.S. Food and Drug Administration (FDA) is available for HIV antibody testing. This allows a person to take a sample at home and then mail it to a testing center. Results are available over the phone, along with appropriate counseling.
    • The FDA has approved an HIV test for home use. The testing kit is the same as that used in many healthcare providers' offices and clinics in which an oral sample is collected for testing and results are available in about 20 minutes. Though the home test is convenient, it has limitations. It is less sensitive than a blood test so the home test may miss some cases of HIV that a blood test would detect and it is not as accurate when it is performed at home by a lay person compared to when it is performed by a trained healthcare professional. Care must be taken to avoid errors when performing the test. (For more, see the article on Home Testing, Avoiding Errors.)

    Screening tests have limitations, so it is important to remember that:

    • A negative screening test means only that there is no evidence of disease at the time of the test. If you have increased risk of HIV infection but negative screening results, it is very important to get screening tests on a regular basis.
    • HIV tests will not detect the virus immediately after infection. Still, talk to your healthcare provider immediately if you think you’ve been infected. If exposure to the virus is recent, then antibody levels may be too low to detect. If an initial test is negative, it may be necessary to repeat testing at a later time with another antibody test or combination HIV antibody/antigen test. In the case of a negative result, the CDC recommends retesting three months after likely exposure.
    • A positive screening test is not a diagnosis. A positive result must be followed by a second antibody test that differentiates between HIV-1 and HIV-2 to establish a diagnosis.

    For more details on HIV screening, see the article on HIV Antibody and p24 Antigen.

    Screening Recommendations

    • The Centers for Disease Control and Prevention (CDC) recommends that everyone 13 to 64 years old have an HIV screening test at least once. The CDC recommends getting tested each year if you've engaged in an activity that can put you at increased risk of infection and spreading the disease. Additionally, men who have sexual contact with other men should be tested be tested every three to six months.
    • The United States Preventive Services Task Force (USPSTF) recommends that all teens and adults ages 15 to 65 be screened for HIV infection. It also recommends that younger adolescents and older adults at increased risk undergo screening for HIV. As for how often, the Task Force says a reasonable approach is one-time testing for all people ages 15 to 65 and at least annual screenings for those at very high risk of HIV, such as men who have sex with men, injection drug users, and those who live or receive medical care in areas where the rate of HIV infection is high. Individuals at increased but not very high risk may be screened less frequently than every year. The USPSTF recommends every three to five years as a guideline. The Task Force points out that risk is "on a continuum" and health professionals should use their own discretion in deciding how frequently to test people for HIV.
    • The American College of Physicians agrees with the CDC that everyone aged 13 to 64 be offered an HIV screening test in healthcare settings. It also recommends that healthcare practitioners should determine the frequency of repeat screening on an individual basis.
    • The American Academy of Pediatrics (AAP) recommends targeted HIV screening for all sexually active youth. In addition, the academy advises routine testing starting at age 16 for all teens who live in areas where prevalence is high; that is, where more than 1 in 1,000 individuals are infected.
    • For recommendations specific for pregnant women, see the article on Pregnancy.

    Aside from these recommendations, certain individuals should get tested and learn their status. These include:

    • People diagnosed with hepatitis, TB, or an STD
    • People who received a blood transfusion prior to 1985 or had a sexual partner who received a transfusion and later tested positive for HIV
    • A healthcare worker with direct exposure to blood on the job
    • Any individual who thinks he or she may have been exposed

    Talk to your healthcare provider
    Don't be surprised if a healthcare practitioner, in any care setting, offers you an HIV screening test, in keeping with CDC recommendations. If your healthcare 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.


    Resources & Links

    For confidential information, you can call the STDs and HIV/AIDS hotline of the CDC: 800-CDC-INFO (232-4636).
    To find a testing site near you, visit National HIV and STD Testing Resources
    KidsHealth.org: HIV and AIDS
    MedlinePlus: Screening and diagnosis for HIV
    Mayo Clinic: HIV/AIDS - Preparing for your appointment
    AIDSinfo: HIV Testing


    Sources Used in Current Review

    Qaseem, A. et al. (2009 January 20). Screening for HIV in health care settings: A guidance statement from the American College of Physicians and HIV Medicine Association. Annals of Internal Medicine. Available online at http://annals.org/aim/article/744218/screening-hiv-health-care-settings-guidance-statement-from-american-college. Accessed 11/6/2016.

    (2011 October 31). The pediatrician's role in preventing HIV infection. American Academy of Pediatrics. Available online at https://healthychildren.org/English/news/Pages/The-Pediatricians-Role-in-Preventing-HIV-Infection.aspx. Accessed 11/6/2016.

    (2013 April). Human Immunodeficiency Virus (HIV) infection: Screening. U.S. Preventive Services Task Force. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/human-immunodeficiency-virus-hiv-infection-screening. Accessed 11/6/2016.

    (2015 May 27). Press release: Starting antiretroviral treatment early improves outcomes for HIV-infected individuals. National Institutes of Health. Available online at https://www.nih.gov/news-events/news-releases/starting-antiretroviral-treatment-early-improves-outcomes-hiv-infected-individuals. Accessed 11/6/2016.

    (Updated 2016 January 22). Working in healthcare and HIV. AVERT. Available online at http://www.avert.org/hiv-transmission-prevention/working-healthcare. Accessed 11/6/2016.

    (2016 May 23). Recommendations for HIV prevention with adults and adolescents with HIV. Centers for Disease Control and Prevention. Available online at http://www.cdc.gov/hiv/guidelines/personswithhiv.html. Accessed 11/6/2016.

    (2016 October 27). HIV and AIDS: Testing. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/hiv/basics/testing.html. Accessed 11/6/2016.

    (2016 June 20). HIV testing. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/hiv/testing. Accessed 11/6/2016.

  • Obesity

    More than one-third of adults in the U.S. are obese, according to the Centers for Disease Control and Prevention. Over the past 20 years, the rate of obesity has increased steadily throughout the U.S. in all age ranges and remains high.

    Obesity is a serious health concern because it increases the risk of many conditions, such as high blood pressure (hypertension), dyslipidemias (high cholesterol and/or high triglycerides), type 2 diabetes, coronary heart disease, stroke, and some cancers.

    Calculating a person's body mass index (BMI) can be useful for assessing their body fat. It is a screening tool for determining if someone has a weight problem. For adults, the following formula and classifications are used:

    BMI = (Weight in pounds) / (height in inches squared) x 703

        BMI < 18.5                  Underweight
        BMI  18.5-24.9            Normal weight
        BMI   25.0 – 29.9        Overweight
        BMI   30 and above    Obese

    Recommendations

    The U.S. Preventive Services Task Force (USPSTF) recommends that healthcare practitioners screen all adult patients for obesity, and the American Academy of Family Physicians agrees. In 2012, the USPSTF published an updated recommendation that clinicians offer or refer obese patients to intensive behavioral interventions, which can lead to weight loss, possibly improving glucose tolerance and other cardiovascular disease (CVD) risk factors. The Task Force is currently (2016) reviewing its recommendations.


    Link
    National Heart, Lung, and Blood Institute: Calculate Your Body Mass Index


    Sources Used in Current Review

    U.S. Preventive Services Task Force. Obesity in Adults: Screening and Management. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/obesity-in-adults-screening-and-management. Accessed October 2016.

    AAFP. Clinical Preventive Service Recommendation: Obesity. Available online at http://www.aafp.org/patient-care/clinical-recommendations/all/obesity.html. Accessed October 2016.

    Centers for Disease Control and Prevention. Adult Obesity Facts. Available online at https://www.cdc.gov/obesity/data/adult.html. Accessed October 2016.

  • Diabetes

    Diabetes is the seventh leading cause of death in the United States and is becoming more common at younger ages. The Centers for Disease Control and Prevention (CDC) estimates that 30.2 million people age 18 and older, or 12.2% of all people in this age group, have diagnosed or undiagnosed diabetes. Of these, 4.6 million are 18-44 years old.

    While most cases of type 1 diabetes are diagnosed in those under the age of 18, the signs and symptoms often develop rapidly and the diagnosis is often made in an emergency room setting. Thus, screening for type 1 diabetes is not necessary. On the other hand, some youth with type 2 diabetes will have no signs or symptoms, especially early in the disease, and screening can be a useful tool. Type 2 diabetes accounts for 90-95% of all diagnosed cases of diabetes among adults. Unhealthy weight and physical inactivity, both contributing factors, have also become national health problems.

    It is estimated that 84.1 million American adults age 18 years or older have prediabetes, meaning that their blood glucose levels are higher than normal but not yet high enough to be diagnosed with diabetes. Detecting prediabetes allows individuals to take steps to stop or slow the development of type 2 diabetes and its complications. These complications include heart attack, stroke, hypertension, blindness and eye problems, kidney disease, and nervous system maladies. More than 60% of lower limb amputations occur in people with diabetes.

    Risk Factors
    Being overweight – having a body mass index (BMI) equal to or greater than 25 kg/m2 – is a major risk factor for type 2 diabetes.

    Other risk factors related to your own health include:

    • Physical inactivity
    • Having high blood pressure (hypertension), meaning blood pressure of 140/90 mmHg or higher or receiving therapy for hypertension
    • History of cardiovascular disease
    • Having a HDL-cholesterol level less than 40 mg/dL (1.00 mmol/L) and/or a triglyceride level greater than 150 mg/dL (1.70 mmol/L)
    • Having a previous hemoglobin A1c test result equal to or greater than 5.7%, impaired glucose tolerance (glucose tolerance test result 140 to 199 mg/dL (7.8 to 11.1 mmol/L)), or impaired fasting glucose (fasting glucose level 100 to 125 mg/dL (5.6 to 6.9 mmol/L))
    • Having other conditions associated with insulin resistance, such as severe obesity and acanthosis nigracans

    Family-related risk factors are:

    • Having a parent or sibling with diabetes
    • Being of African American, Latino, Native American, Asian American, or Pacific Islander descent

    Women's risk factors include:

    Screening tests for men and non-pregnant women

    • Fasting glucose (fasting blood glucose, FBG) – this test measures the level of glucose in the blood after an 8-12 hour fast.
    • Hemoglobin A1c (also called hemoglobin A1c or glycated hemoglobin) – this test evaluates the average amount of glucose in the blood over the last 2 to 3 months and has been recommended as another test to screen for diabetes.
    • 2-hour glucose tolerance test (OGTT) – this test involves drawing a fasting blood sample for glucose measurement, followed by having the person drink a solution containing 75 grams of glucose and then drawing another sample two hours after the person begins to consume the glucose solution.

    If any of these initial results is abnormal, the test is repeated on another day. If the repeat result is also abnormal, a diagnosis of diabetes is made.

    Recommendations
    The American Diabetes Association (ADA) and the U.S. Preventive Services Task Force (USPSTF) recommend the following:

    • Consider screening if you are overweight and have at least one other risk factor for diabetes.
    • Even if the initial screening results are normal, get repeat testing at least every 3 years, say the ADA and USPSTF. If a person is identified as having prediabetes, repeat testing yearly.

    The American Association of Clinical Endocrinologists (AACE) also recommends diabetes screening for asymptomatic people with these risk factors, as well as those on antipsychotic therapy for schizophrenia or who have severe bipolar disease.

    As public health experts work to educate Americans on what to do to avoid diabetes and its serious complications, be aware that healthy eating habits and activity choices can lower your risk of developing type 2 diabetes and of suffering complications from the disease.


    Links
    NIDDK: Preventing Type 2 Diabetes
    American Diabetes Association
    American Diabetes Association: Be Healthy Today; Be Healthy For Life, Information for Youth and their Families, Living with Type 2 Diabetes

    Sources Used in Current Review (last reviewed 9/18/17)

    (2017). National diabetes Statistics Report, 2017. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed on 8/06/17.

    (2015 October). Abnormal Blood Glucose and Type 2 Diabetes Mellitis: Screening. U.S. Preventive Services Task Force. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/screening-for-abnormal-blood-glucose-and-type-2-diabetes?ds=1&s=diabetes. Accessed on 8/06/17.

    (2017 July 27, Updated). What’s New in Diabetes. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/diabetes/new/index.html. Accessed on 8/06/17.

    (2017 July 25, Updated). Who’s at Risk? Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/diabetes/basics/risk-factors.html. Accessed on 8/06/17.

    Genzen, J. et. al. (2017 July, Updated). Diabetes Mellitus. ARUP Consult. Available online at https://arupconsult.com/content/diabetes-mellitus. Accessed on 8/06/17.

    (2016 November). Diabetes Tests & Diagnosis. National Institute of Diabetes and Digestive and Kidney Diseases. Available online at https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis. Accessed on 8/06/17.

    (2015). Screening and Monitoring of Prediabetes. American Association of Clinical Endocrinologists. Available online at http://outpatient.aace.com/prediabetes/screening-and-monitoring-prediabetes. Accessed on 8/06/17.

    Diabetes Management Guidelines, American Diabetes Association (ADA) 2016 Guidelines. National Diabetes Education Initiative. Available online at http://www.ndei.org/ADA-2013-Guidelines-Criteria-Diabetes-Diagnosis.aspx.html#children. Accessed on 8/06/17

  • Tuberculosis

    Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria. TB primarily targets the lungs but may affect any area of the body. It can be spread through the air from person to person through droplets of respiratory secretions such as sputum or aerosols released by coughing, sneezing, laughing, or breathing.

    Most people who become infected with M. tuberculosis manage to confine the mycobacteria to a few cells in their lungs, where they stay alive but in an inactive form. This latent TB infection does not make the person sick or infectious and, in most cases, it does not progress to active tuberculosis. However, some people - especially those with compromised immune systems - may progress directly from initial TB infection to active tuberculosis. People who have HIV are much more likely to become sick if they contract TB. A person who has latent TB and their immune system becomes weakened may then develop active TB. Another increasing concern is drug-resistant forms of TB that are resistant to the antibiotics typically prescribed to treat the disease.

    TB is one of the world's deadliest diseases, although it is relatively uncommon in the U.S. Still, it is a large health issue among at-risk groups. Current guidelines call for targeted screening among such groups.

    At Risk

    • People who have close contact with a person who has known or suspected TB disease
    • People with weakened immune systems such as resulting from HIV infection, malnutrition, advanced age, or substance abuse including alcohol and drugs
    • Immigrants from countries with a high rate of TB disease (many countries in Latin America, Africa, Asia, Eastern Europe, and Russia)
    • Medically underserved people, such as those from a low-income environment
    • Residents of long-term care facilities (such as nursing homes, mental health facilities, prisons, AIDS care facilities, and homeless shelters)
    • People who live in unclean or crowded environments and/or without a healthy diet
    • Healthcare workers who work in any of the above situations or with patients who are at increased risk
    • Laboratorians who work with specimens that may contain TB or with TB cultures

    Recommendations

    The U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force (USPSTF) recommend use of TB tests to identify people who will likely benefit from treatment, including those at increased risk for M. tuberculosis infection or for progression to active TB if they are infected. There are two types of tests that might be performed (see TB Screening Tests):

    • Tuberculin skin test (TST) also called the Mantoux tuberculin skin test, the TST (or PPD for Purified Protein Derivative) is performed by injecting a small amount of fluid (called tuberculin) into the skin in the lower part of the arm. Following this test, you must return within 48 to 72 hours for a trained healthcare worker to measure the reaction and determine if it indicates exposure to M. tuberculosis.
    • TB blood test: also known as IGRA (Interferon gamma release assay); requires a blood sample to be drawn.

    Your healthcare provider will choose which TB test to use. Factors in selecting the test include the reason for testing, logistical considerations, prior vaccination with BCG, and test availability. Generally, it is recommended to be screened with either a TST or an IGRA, but not both.


    Link
    CDC: Tuberculosis (TB)


    Sources Used in Current Review

    Screening for Latent Tuberculosis Infection in Adults. US Preventive Services Task Force Recommendation Statement. JAMA. 2016;316(9):962-969. doi:10.1001/jama.2016.11046. Available online at http://jama.jamanetwork.com/article.aspx?articleid=2547762. Accessed October 2016.

    U.S. Centers for Disease Control and Prevention. TB Testing & Diagnosis. Available online at http://www.cdc.gov/tb/topic/testing/. Accessed October 2016.

  • Hepatitis B

    According to the United States Preventive Services Task Force (USPSTF), approximately 700,000 to 2.2 million people in this country have chronic infection with hepatitis B virus (HBV). Many of these people are unaware that they are infected.

    HBV is one of five "hepatitis viruses" identified so far that are known to mainly infect the liver. It is spread through contact with blood or other body fluids from an infected person, such as during sex or by sharing needles, razors or toothbrushes, and can also be passed from an infected mother to her baby during or after birth.

    HBV infection can be acute or chronic, with the course of infection varying from a mild form that lasts only a few weeks to a more serious form lasting years that can lead to complications such as cirrhosis or liver cancer. According to the Centers for Disease Control and Prevention (CDC), approximately 2,000-4,000 people die every year in the U.S. from HBV-related liver disease.

    The vast majority of those with chronic infections will have no symptoms. A test for hepatitis B surface antigen (HBsAg) may be used for screening asymptomatic people who fall into one of the high-risk categories for chronic HBV. Effective vaccines against HBV are available; however, those who have not been vaccinated or who are at high risk and were vaccinated before being screened for HBV infection may want to consider getting tested.

    Risk
    According to the USPSTF, in the U.S., people considered at high risk for HBV infection include those from countries with a high prevalence of HBV infection, those who are HIV-positive, injection drug users, household contacts of those with HBV infection, and men who have sex with men. Since the prevalence of HBV infection is low in the general U.S. population and most of those infected do not develop complications, HBV screening is not recommended for those who are not at increased risk.

    Recommendations
    In 2008, the CDC revised its guidelines to recommend that the following groups be screened for HBV:

    • Healthcare and public safety workers
    • People born in areas of the world that have a greater than 2% prevalence of HBV (for example, much of Asia and Africa)
    • People born in the U.S. but who were not vaccinated and whose parents are from an area with greater than 8% prevalence of HBV
    • Men who have sex with men
    • People who have elevated liver enzymes (ALT and AST) with no known cause
    • People with certain medical conditions that require that their immune system be suppressed, such as organ transplant recipients
    • Pregnant women
    • People who are in close contact with someone infected with HBV
    • Those infected with HIV

    In 2014, the USPSTF updated its statement to recommend screening for HBV among asymptomatic, non-pregnant adolescents and adults in certain high-risk groups, bringing their recommendations into line with those of the CDC. The USPSTF had previously published the recommendation for HBV screening during pregnancy.

    Why get tested?
    People with chronic HBV can unwittingly spread the infection to others and remain at risk for serious complications of the infection.


    Link
    CDC: Hepatitis B Information for the Public 


    Sources Used in Current Review

    USPSTF Urges HBV Screening for High-Risk People. By Michael Smith. MedPage Today. Published May 27, 2014. Available online through http://www.medpagetoday.com. Accessed June 2014.

    USPSTF Recommends Hepatitis B Screening for High-Risk Groups. By Amy Orciari Herman. May 27, 2014. Journal Watch. Available online at http://www.jwatch.org/fw108870/2014/05/27/uspstf-recommends-hepatitis-b-screening-high-risk-groups?query=pfw through http://www.jwatch.org. Accessed June 2014.

    Screening for Hepatitis B Virus Infection in Nonpregnant Adolescents and Adults: U.S. Preventive Services Task Force Recommendation Statement. Michael L. LeFevre, MD, MSPH, on behalf of the U.S. Preventive Services Task Force. Annals of Internal Medicine. Article published online 27 May 2014. Available online at http://annals.org/article.aspx?articleid=1874740 through http://annals.org. Accessed June 2014.

    Centers for Disease Control and Prevention. Hepatitis B FAQs for the Public. Available online at http://www.cdc.gov/hepatitis/b/bFAQ.htm#statistics through http://www.cdc.gov. Accessed June 2014.

    Centers for Disease Control and Prevention. Hepatitis B Information for the Public. Available online at http://www.cdc.gov/hepatitis/B/index.htm through http://www.cdc.gov. Accessed June 2014.

    Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection. Recommendations and Reports. September 19, 2008 / 57(RR08);1-20. Morbidity and Mortality Weekly Report. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5708a1.htm through http://www.cdc.gov. Accessed June 2014.

View Sources

Centers for Disease Control and Prevention. CDC Prevention Checklist. Available online at https://www.cdc.gov/prevention/. Accessed Oct 2016.

MedlinePlus Medical Encyclopedia. Physical exam frequency. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/002125.htm. Accessed Oct 2016.

U.S. Preventive Services Task Force. Published Recomendations. Available online at https://www.uspreventiveservicestaskforce.org/BrowseRec/Index. Accessed Oct 2016.