Sexually transmitted diseases control branch

California Sexually Transmitted Infections (STI) Screening Recommendations

Content reflects the 2021 CDC STI Guidelines and recommendations from U.S. Preventive Services Task Force, Infectious Disease Society of America, and California Department of Public Health (CDPH) Sexually Transmitted Diseases Control Branch (STDCB). In populations where no recommendations exist, screen based on risk factors and local STI prevalence (e.g., where someone lives or receives medical care). Local health departments can help with confidential notification of sex partners of patients with STIs/HIV. For STI clinical consults, use the online STD Clinical Consultation Network (www.stdccn.org) or contact CDPH STDCB at stdcb@cdph.ca.gov or 510-620-3400.

Included below are the screening recommendations for the following populations:

Non-Pregnant Cisgender Women
Pregnant Persons
Cisgender Men Who Have Sex With Cisgender Women
Men Who Have Sex With Men (MSM) or With Transgender Women
Transgender and Gender Diverse Persons
Persons With HIV

A PDF of these screening recommendations is available for download.

Non-Pregnant Cisgender Women^1,2

Infection	Screening Recommendation	Comments
Chlamydia & Gonorrhea^4,5	Sexually active, <25 years: annually Sexually active, ≥25 years: if at increased risk⁵	Consider screening more frequently if at increased risk⁵ Rescreen for reinfection approximately 3 months after treatment
Syphilis⁶	At least once, repeat if at increased risk Co-test when screening for HIV	Increased risk includes history of incarceration or transactional sex work, geography, race/ethnicity, methamphetamine use
HIV	<65 years: at least once (opt-out), annually if at risk	Test if seeking evaluation and treatment for STIs
Hepatitis C⁷	≥18 years: at least once, repeat if at risk	Except in settings where the prevalence of HCV infection is <0.1%

Pregnant Persons^1,2,3

Infection	Screening Recommendation	Comments
Chlamydia & Gonorrhea^4,5	At first prenatal visit <25 years or at increased risk; retest at 3rd trimester⁵	Conduct test of cure 4 weeks after treatment for chlamydia Rescreen for reinfection 3 months after treatment
Syphilis⁶	First prenatal visit 3rd trimester (ideally 28-32 weeks' gestation)⁸ Delivery unless low risk & negative 3rd trimester test	Increased risk includes limited prenatal care, unstable housing, meth use, incarceration (within past year), new STI diagnosis in pregnancy and lives in area with high congenital syphilis rates³
HIV	At first prenatal visit (opt-out) At 3rd trimester if at increased risk⁹	Rapid testing should be performed at delivery if not previously screened during pregnancy
Hepatitis B⁷	First prenatal visit of each pregnancy At delivery if no prior screening or if at increased risk	Test for Hepatitis B surface antigen (HBsAg). Increased risk includes injection drug use, new STI in pregnancy or HBsAg+ partner.³
Hepatitis C⁷	At first prenatal visit	Except in settings where the prevalence of HCV infection is <0.1%

Cisgender Men Who Have Sex With Cisgender Women

Infection	Screening Recommendation	Comments
Chlamydia & Gonorrhea	If at high risk	Consider routine chlamydia screening in high prevalence settings (adolescent clinics, correctional facilities, STI/sexual health clinic)
Syphilis	Screen asymptomatic adults at increased risk	Increase risk includes history of incarceration or commercial sex work, geography, race/ethnicity, and age <29 years
HIV	<65 years: at least once (opt-out), annually if at risk	Test if seeking evaluation and treatment for STIs
Hepatitis C⁷	≥18 years: at least once, repeat if at risk	Except in settings where the prevalence of HCV infection is <0.1%

Men Who Have Sex With Men (MSM) or With Transgender Women

Infection	Screening Recommendation	Comments
Chlamydia & Gonorrhea	Annually at sites of sexual exposure (urethral [urine], rectum, pharynx) regardless of condom use; every 3-6 months if at increased risk	Increased risk includes patients on HIV PrEP (screen every 3-4 months) or living with HIV, if patient or sex partners has multiple partners, sex in conjunction with drug use
Syphilis	Any age: annually, every 3-6 months if at increased risk	Screen every 3-4 months if on HIV PrEP
HIV	Annually if patient/partner(s) have had >1 sex partner since last HIV test; every 3-6 months if at increased risk	Screen every 2 months (if on injectable HIV PrEP) or 3 months (if on oral HIV PrEP)
Hepatitis B⁷	At least once	Test for HBsAg, HBV core antibody, and HBV surface antibody
Hepatitis C⁷	≥18 years: at least once, repeat if at risk	Except in settings where the prevalence of HCV infection is <0.1%

Transgender and Gender Diverse Persons²

Infection	Screening Recommendation	Comments
Chlamydia & Gonorrhea	Adapt screening recommendations based on anatomy	Consider screening for pharyngeal and rectal infections based on sexual behaviors and exposure, regardless of reproductive anatomy
Syphilis	Consider at least annually, repeat if at increased risk	None
HIV	<65 years: at least once (opt-out), annually if at risk	None
Hepatitis C⁷	≥18 years: at least once, repeat if at risk	Except in settings where the prevalence of HCV infection is <0.1%

Persons With HIV^10,11

Infection	Screening Recommendation	Comments
Chlamydia, Gonorrhea, & Syphilis	At first HIV evaluation, and at least annually thereafter; more frequently based on risk	Chlamydia & gonorrhea infection should include all sites of sexual exposure (pharynx, rectum, urethral [urine], and vagina) regardless of sex
Trichomonas	If receptive vaginal sex, at first HIV evaluation, then at least annually	Retest approximately 3 months after treatment
Hepatitis B⁷	At least once	Test for HBsAg, HBV core antibody, and HBV surface antibody
Hepatitis C⁷	Serologic testing at initial evaluation Annual HCV testing in MSM with HIV infection	None

¹Consider trichomonas screening in high-prevalence settings (e.g., STI clinics and correctional facilities) and for asymptomatic cisgender women at high risk for infection (e.g., those with multiple sex partners, transactional sex, drug misuse, or a history of STI or incarceration). The use of highly sensitive and specific tests (e.g., a nucleic acid amplification test (NAAT)) is recommended for detecting Trichomonas vaginalis.

²Human papillomavirus (HPV) testing is recommended as part of cervical cancer screening for persons with a cervix. See the American Society for Colposcopy and Cervical Pathology (www.asccp.org) for further guidance.

³Detailed STI/HIV Screening recommendation in pregnancy at https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/California-STI-HIV-Screening-Recommendations-in-Pregnancy.aspx

⁴A vaginal swab (self-collected) NAAT is the optimal urogenital specimen type for women. Consider rectal chlamydia (CT) and pharyngeal and rectal gonorrhea (GC) screening for women based on reported sexual history, through shared decision-making between the patient and the provider.

⁵CT or GC risk factors include prior CT or GC infection, particularly in past 24 months; more than one sex partner in the past year; suspicion that a recent partner may have had concurrent partners; new sex partner in past 3 months; illicit drug use; transactional sex in the past year, and local factors (e.g., community prevalence of infection). CDPH data has shown that CT and GC rates among Black/African American females are 1.5 and 3 times higher than statewide rates among all females, respectively, which are likely due to social determinants of health and living in communities with high STI prevalence. Providers should consider screening Black/African American women up to age 30.

⁶CDPH Expanded Syphilis Screening Recommendations for the Prevention of Congenital Syphilis. https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Expanded-Syphilis-Screening-Recommendations.pdf

⁷AB 789 requires primary care facilities in California to offer hepatitis B and hepatitis C testing based on the latest screening recommendations from the U.S. Preventive Services Task Force

⁸28 weeks gestation recommended by the Centers for Disease Control and Prevention 2021 STI Treatment Guidelines

⁹High risk (for HIV infection in pregnancy) include persons who use drugs, have STIs during pregnancy, have multiple sex partners during pregnancy, have a new sex partner during pregnancy, live in areas with high HIV prevalence, or have partners with HIV

¹⁰Primary Care Guidelines for Persons with Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Disease Society of America. Clinical Infectious Diseases. 6 November 2020; https://doi.org/10.1093/cid/ciaa1391.

¹¹Guidance on Anal HPV screening for persons with HIV at https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/human-0?view=full

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Sexually transmitted diseases control branch

​California Sexually Transmitted Infections (STI) Screening Recommendations

Non-Pregnant Cisgender Women1,2

​Pregnant Persons1,2,3

Persons With HIV10,11

California Sexually Transmitted Infections (STI) Screening Recommendations

Non-Pregnant Cisgender Women^1,2

Pregnant Persons^1,2,3

Persons With HIV^10,11