Sexually Transmitted Infections (STI) in Adolescents — Diagnostic Testing: Screening and Symptom Evaluation — Clinical Pathway: Emergency and Primary Care

Sexually Transmitted Infections (STI) in Adolescents Clinical Pathway — Emergency Department and Primary Care

Diagnostic Testing: Screening and Symptom Evaluation

  • Review STI testing that will be completed during the encounter with the patient
  • Refer to HIV consent and counseling if HIV testing indicated
  • Primary care sites have differences in availability of testing
  • Consider screen with urine POC and urine HCG testing

Tests for STI Screening

Gonorrhea Trichomonas Chlamydia

  • ED and Primary Care
    • Molecular Amplification Test for GC & Chlamydia, Trichomonas
    • For urine molecular amplification test
      • Non-clean catch or ‘dirty’ urine sample is preferred
    • Vaginal or cervical swab may be used in place of urine, and have slightly higher sensitivity.
    • For history of rectal and/or oral sex:
      • Rectal (clinician or patient-collected) and/or throat swab
  • Primary Care
    • Consider vaginal self-swab if also doing wet prep or point-of-care STI testing

Syphilis

  • ED and Primary Care
    • Serum RPR

HIV

  • ED and Primary Care

 

Symptom-Based Testing

Bacterial Vaginosis

  • ED
    • Gram Stain w/o culture not routinely done
  • Primary Care
    • Microscopy for
      • Clue cells
      • Whiff test
      • pH
    • Consider send-out Sureswab® if in-office microscopy is not available

Herpes Simplex Virus

  • ED and Primary Care
    • PCR
      • Use green-top culture swab, unroof lesion, scrape base
      • Place in Viral Transport Media

PID

Pelvic Inflammatory Disease

  • ED and Primary Care
    • Molecular Amplification Test
      • GC, Chlamydia, Trichomonas
    • CBC, ESR, CRP, BMP as clinically indicated
    • Indications for Pelvic Ultrasound:
      • Severe pain or significant focality to pain
      • Palpable mass on PE
      • Uncertain diagnosis
      • Elevated inflammatory markers

Epididymitis

  • ED and Primary Care
    • Urine POC to assess for leukocytes

Hepatitis B, C

  • ED and Primary Care
    • Clinical indications by history, risk factors, PE
    • Hepatitis C antibody test
    • Hepatitis B surface antigen test