Sexually Transmitted Infections
Routine screening recommendations
It is recommended for annual chlamydia and gonorrhea testing in all sexually active women under 24 years.
It is also recommended to test males who have sex with males at least annually.
Screening recommendations should be adapted based on anatomy. Transgender men and gender diverse people with a cervix should follow the same guidelines as written for females. Transgender females follow the guidelines written for males. Information below regarding gender is based on anatomy, not identity.
Our testing policies
Our office policy is to collect urine for testing on all females over the age of 15 years at least once a year for chlamydia.
We do not routinely test all males because there is insufficient evidence of benefit unless there are risk factors.
Risk of all sexually transmitted infections includes sexual activity, past history of a sexually transmitted infection, or symptoms that could be consistent with infection. In cases of increased risk, additional screening is recommended.
Why do non-sexually active adolescents get tested?
There is a significant percentage of sexually active adolescents who fail to disclose sexual activity to their healthcare providers and if we only test those who share their status, we may miss infections that need to be treated.
Many people have no symptoms with infection, but they can go on to have significant long term complications.
How do we notify patients of results?
Negative tests are reported through the portal.
If there is a positive test, we will call the patient to discuss the results and treatment plan.
By law we are not allowed to discuss results with parents.
The recommendations are for more than just chlamydia testing, why do we only test for that?
Only chlamydia testing is routinely performed because it is much more common than gonorrhea.
Testing for only chlamydia saves healthcare costs while identifying the majority of infections.
If there is a positive test for chlamydia, a repeat test along with gonorrhea is recommended 3 months after treatment.
What are the risks of not testing?
These infections often have no symptoms and untreated chlamydia and gonorrhea in females can lead to pelvic inflammatory disease (PID), which can lead to ectopic pregnancy (pregnancy outside the uterus), and infertility.
What are symptoms of infection?
It is possible to have an infection without any symptoms, which is why routine testing is needed, but symptoms vary based on anatomy.
Some of the most common STDs symptoms in females may include:
- Itchiness
- Lumps and bumps
- Changes in vaginal discharge
- Pain in the affected area
Some of the most common STD symptoms in males may include:
- Unusual discharge from the penis
- Lumps or bumps on the genital area
- Sores or ulcers on the genital area
- Burning or pain during urination
- Pain in the abdomen
- Pain during sex
- Pain in the testicles
What if the chlamydia test is positive?
Treatment
Persons with chlamydia should abstain from sexual activity until both partners have been treated. People may be contagious for 7 days after a single dose antibiotic or until the completion of a 7-day course of antibiotics. Wait to have sex until at least these 7 days of treatment of both partners to prevent spreading the infection back to each other.
Antibiotic will be prescribed and it is important that you complete the full course. Treatment options will be discussed to find the best for you. It is also important that your partner(s) get treated.
- Doxycycline 100mg by mouth with a full glass of water twice a day for 7 days (preferred)
- Azithromycin 1 g by mouth once
- Levofloxacin 500 mg once a day for 7 days
If insurance will not be used to purchase medication, online coupons, such as those from GoodRx, make them more affordable. You can also use the health department or Planned Parenthood for affordable options.
Although medication will stop the infection, it will not repair any permanent damage done by the disease.
If symptoms continue for more than a few days after receiving treatment, return to a health care provider to be reevaluated.
Retesting
Anyone with chlamydia should be retested about three months after treatment of an initial infection, regardless of whether they believe that their sex partners were successfully treated.
This retest can be at our office, the health department, student health centers (for college students), and Planned Parenthood.
Costs vary depending on where you go. Insurance will usually cover testing if done through our office, but if you do not want parents seeing the bill, the health department or Planned Parenthood are options.
You must remember to do this testing, so put a reminder in your calendar for 3 months from treatment to get retested.
Repeat infection with chlamydia is common. Women whose sex partners have not been appropriately treated are at high risk for re-infection. It is important to tell your partner(s) and make sure they complete treatment.
Confidentiality issues
Parents often want to know everything about their adolescents, but per standard of care and by law youth are provided confidentiality around certain issues. This is important to allow them to make safe healthcare decisions for themselves and not be afraid to talk with their healthcare providers about healthcare issues.
In Kansas, minors can consent to testing and treatments related to the following without parental consent:
- Pregnancy testing and all other healthcare issues related to pregnancy
- Sexually transmitted diseases
- Emergency care
- Drug and Alcohol abuse, misuse or addiction
Parents should recognize that we will make every attempt to convince your teen or young adult child that it is important that a parent is aware of the issues discussed in our office, but we need to maintain confidentiality if the patient desires. If we fail to maintain this confidentiality, not only are we going against standard of care and legal precedent, we risk that adolescents will not tell their doctors important information, which leaves them at risk of unidentified healthcare issues.
Exceptions to confidentiality include:
- Suspected abuse
- Risk of self harm or harm to others
- Billing claims will reflect testing and treatments performed
For more information
Check out this helpful summary of information from the CDC.
