Management of Sexually Transmitted Diseases in HIV-Infected Men and Women

  • Author: Jeanne Marrazzo, MD, MPH, FACP, FIDSA (More Info)
  • Editors in Chief: Daniel R. Kuritzkes, MD; Joseph J. Eron, Jr., MD
  • Last Reviewed: 2/8/18 (What's New)

Supporting Assets

Table 1 | Table 2 | Table 3 | Table 4 | Table 5

Table 1. Recommendations for Routine STD Screening in the HIV-Infected Patient

First Visit

  • For all patients:
    • Syphilis: serology tests (nontreponemal test: RPR, VDRL) or treponemal test (EIA, CLIA)*
    • Gonorrhea
      • Men: urethral culture or NAAT; urine NAAT
      • Women: cervical culture or NAAT; vaginal fluid NAAT; urine NAAT
    • Chlamydia
      • Men: urethral or urine NAAT
      • Women: cervical, vaginal fluid, or urine NAAT (especially if sexually active and aged 25 yrs or younger, regardless of symptoms)
  • For women:
    • Trichomoniasis: NAAT culture or rapid antigen detection test of vaginal fluid, saline microscopy of vaginal fluid (inferior)
  • For all patients reporting receptive anal sex:
    • Gonorrhea: rectal culture or NAAT
    • Chlamydia: rectal culture or NAAT
  • For all patients reporting receptive oral sex:
    • Gonorrhea: pharyngeal culture or NAAT

Subsequent Routine Visits:

  • Repeat the tests above at least annually for all patients who are sexually active. More frequent periodic screening (eg, at 3- or 6-mo intervals) may be appropriate depending on patient’s reported risk or interim detection of other STDs. Presence of any of the following risk factors should prompt consideration of repeated STD screening:
    • Multiple partners
    • Anonymous partners
    • Interim diagnosis of new STD
    • Illicit drug use, especially methamphetamine
    • Report of unprotected sex outside of a mutually monogamous relationship
    • Exchange of sex for drugs or money, or sex with a partner who reports these behaviors
    • High prevalence of STDs in the affected patient population
    • Life changes that might promote adoption of relatively risky practices, such as dissolution of a relationship

CLIA, chemoluminescent immunoassay; EIA, enzyme immunoassay; NAAT, nucleic acid amplification test; RPR, rapid plasma reagin test; VDRL, Venereal Diseases Research Laboratory test.
*See Table 3 for alternative approaches for syphilis testing.
Cell culture for Neisseria gonorrhoeae and Chlamydia trachomatis are the only tests currently approved by the US Food and Drug Administration for use at rectal and pharyngeal sites. Many health departments and commercial laboratories have performed their own validation of NAAT for this purpose. Consult local STD program authorities or see for more information.


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