🗂 Key Takeaways
- The CDC 2021 STI Treatment Guidelines are the operative US clinical document; USPSTF recommendations set the screening frequency for asymptomatic adults.[1][2]
- Core routine panel: HIV, syphilis, chlamydia, gonorrhea. Trichomoniasis, HPV, and hepatitis are added based on exposure and history.[1]
- Nucleic acid amplification testing (NAAT) is the gold standard for chlamydia and gonorrhea and should be site-specific: urogenital, rectal, and pharyngeal swabs where exposure occurred.[1]
- USPSTF recommends universal HIV screening at least once for adults 15 to 65 (grade A), and chlamydia and gonorrhea annually for sexually active women under 25 (grade B).[3][4]
- Syphilis screening is USPSTF grade A in pregnancy and grade A for asymptomatic nonpregnant adolescents and adults at increased risk. US congenital syphilis cases have risen sharply since 2018.[5][6][7]
- Home-collection STI kits (mail-in or point-of-care) can be a reasonable option for asymptomatic screening. Symptoms, pregnancy, sexual assault, and prior positive tests still warrant in-person evaluation.[8]
- Doxycycline post-exposure prophylaxis (doxy-PEP) is a CDC-recommended option for men who have sex with men and transgender women with a bacterial STI in the past 12 months. See the doxy-PEP guide.[9]
What Is a Standard STI Panel?
The core CDC-endorsed panel for asymptomatic screening in a sexually active adult includes four tests: HIV, syphilis (RPR or treponemal), chlamydia, and gonorrhea. The chlamydia and gonorrhea tests use nucleic acid amplification testing (NAAT), typically on a first-catch urine sample for people with urogenital exposure or self-collected/clinician-collected swabs of the vagina, rectum, or pharynx depending on the exposure sites.[1]
What is not on the routine panel matters as much as what is. Trichomoniasis testing is recommended for women with symptoms or risk factors, not universally. HPV testing is a cervical cancer screening tool (via Pap co-test), not a routine STI screen. Herpes serology is not recommended for asymptomatic adults because false positives outnumber true positives in low-prevalence populations. Hepatitis B and C are added based on exposure history and USPSTF risk categories.[1]
Ask specifically for a "4-panel" or "5-panel" STI screen when you book a visit, and make sure the requisition covers the anatomic sites where exposure actually occurred. A urogenital-only NAAT will miss rectal and pharyngeal chlamydia and gonorrhea, which is common in men who have sex with men and in receptive oral or anal exposure regardless of gender.
Who Should Test, and When
Routine screening (asymptomatic)
Every adult aged 15 to 65 should be screened for HIV at least once. That is a USPSTF grade A recommendation.[3] For sexually active women under 25, USPSTF recommends annual chlamydia and gonorrhea screening (grade B), and CDC extends the same guidance to women 25 and older with new or multiple partners or a partner with an STI.[4][1] For sexually active men who have sex with men and transgender women, CDC recommends chlamydia, gonorrhea, syphilis, and HIV testing at least annually, and every 3 to 6 months if they have multiple partners or use recreational drugs during sex.[1]
If you have symptoms
Symptoms change the algorithm. Unusual discharge, dysuria, pelvic or testicular pain, painful bowel movements, a genital or oral sore, or a new rash all warrant in-person clinical evaluation rather than a home test kit. NAAT of the symptomatic site is standard, and empiric treatment before results is common when the clinical picture is clear (for example, presumptive treatment for gonorrhea and chlamydia in a symptomatic patient during their visit).[1]
After a known or possible exposure
Testing timing matters because different pathogens have different window periods (see the window-period section below). If you were exposed within the last 72 hours, HIV post-exposure prophylaxis (PEP) is time-sensitive; call a clinician or an ER immediately, do not wait for a screening test result. If the exposure was more than 72 hours ago, follow CDC guidance for testing timing by pathogen.[1]
Pregnancy
All pregnant women should be screened for HIV, syphilis, and hepatitis B at the first prenatal visit. Syphilis screening in pregnancy is a USPSTF grade A reaffirmed recommendation, and CDC now recommends universal chlamydia and gonorrhea screening in pregnancy under age 25 and repeat syphilis testing in the third trimester and at delivery in areas with high syphilis burden.[5][1] The 2023 CDC MMWR Vital Signs report documented that 88% of congenital syphilis cases in 2022 involved missed testing or missed treatment opportunities, most of them preventable.[7]
Test Types: What Each One Actually Detects
| Pathogen | Standard test | Sample | Turnaround | Window period |
|---|---|---|---|---|
| Chlamydia | NAAT | First-catch urine or site swab (vaginal, rectal, pharyngeal) | 1–3 days | 2 weeks after exposure |
| Gonorrhea | NAAT | First-catch urine or site swab (rectal and pharyngeal in MSM) | 1–3 days | 2 weeks after exposure |
| HIV | 4th-gen antigen/antibody combo (lab) or rapid antibody (point-of-care) | Venous blood or fingerstick | Minutes to 1 day (lab) | 2–6 weeks (Ag/Ab); up to 90 days (antibody-only) |
| Syphilis | RPR or treponemal (reverse-sequence) | Blood | 1–3 days | 3–6 weeks after exposure |
| Trichomoniasis | NAAT (women); NAAT or wet mount if symptomatic (men) | Vaginal swab or urine | 1–3 days | 1 week after exposure |
| Herpes (symptomatic) | NAAT or viral culture of the lesion | Swab of active lesion | 1–3 days | Test during outbreak |
| Hepatitis B | HBsAg + anti-HBc + anti-HBs | Blood | 1–3 days | 3–6 weeks after exposure |
| Hepatitis C | Anti-HCV screen, reflex to HCV RNA | Blood | 1–3 days | 2–6 weeks (RNA); 8–12 weeks (antibody) |
Two nuances worth calling out. First, HIV window periods depend on the test generation: fourth-generation combo tests detect infection at 2 to 6 weeks after exposure, while older antibody-only rapid tests can miss infection for up to 90 days. Second, syphilis serology can stay positive for life after successful treatment, so a positive treponemal test in someone with a prior confirmed treated infection needs interpretation, not automatic retreatment.[1]
Home vs Clinic Testing
Home-collection STI kits fall into two categories. Mail-in kits (Everlywell, LetsGetChecked, myLAB Box) ship a collection kit, you self-collect at home, mail the specimen to a certified lab, and get results in a few days. Point-of-care home tests (Visby Medical's at-home PCR device for chlamydia, gonorrhea, and trichomoniasis) deliver results in about 30 minutes without a lab step.[8]
When home testing is appropriate
Home testing works well for asymptomatic routine screening in low-risk adults who want privacy and convenience, for people who cannot easily reach a clinic, and for repeat testing after a known negative baseline. See the Everlywell STI test panel review and the Visby at-home STI PCR test review for detailed head-to-head coverage of the two dominant options in this space.
When you need a clinic instead
Symptoms, pregnancy, a positive home result, sexual assault, an exposure within the past 72 hours (for PEP), a partner with a diagnosed STI, or a history of recurrent infections all warrant in-person clinical care. Home kits do not include a physical exam, cannot obtain rectal or pharyngeal swabs in all cases (though some are now available), cannot start treatment same-day, and cannot deliver expedited partner therapy where legal.[1]
| Situation | Home kit OK? | Clinic visit needed? |
|---|---|---|
| Asymptomatic annual screening | ✓ Reasonable | ✓ Also fine |
| New partner, no symptoms | ✓ Reasonable | ✓ Also fine |
| Unusual discharge, sore, or pain | ✗ Skip, needs exam | ✓ Required |
| Positive home test | ✗ Confirm in clinic | ✓ Required for treatment |
| Pregnancy | ✗ Prenatal panel is standard of care | ✓ Required |
| Exposure within 72 hours | ✗ HIV PEP is time-critical | ✓ Required (or ER) |
| Sexual assault | ✗ Forensic + medical + prophylaxis | ✓ Required (ER or SANE) |
| Rectal or pharyngeal swabs | Depends on kit | ✓ Reliable |
What Has Changed Since the Last CDC Guideline Cycle
Three shifts are worth knowing about. First, US congenital syphilis cases rose more than tenfold from 2013 to 2022. The 2023 CDC MMWR Vital Signs report found that 88% of cases involved missed testing or treatment opportunities, prompting CDC and state health departments to expand third-trimester and delivery-time syphilis screening in high-prevalence areas.[7]
Second, doxycycline post-exposure prophylaxis (doxy-PEP) is now a CDC-recommended option. In the 2024 CDC clinical guidelines, a single 200 mg dose of doxycycline within 72 hours of condomless sex reduces incident chlamydia and syphilis by roughly two-thirds and gonorrhea by about half in men who have sex with men and transgender women with a bacterial STI in the past 12 months. Doxy-PEP is not currently recommended for cisgender women because the one trial in that population did not show benefit. Full analysis in the doxy-PEP guide.[9]
Third, at-home NAAT testing platforms have matured. The Visby home device received FDA authorization for point-of-care testing that detects chlamydia, gonorrhea, and trichomoniasis in about 30 minutes, moving accurate STI testing outside the clinic for the first time. Mail-in options from Everlywell, LetsGetChecked, and myLAB Box have widened access to routine screening without a visit.[8]
After a Positive Test
A positive STI result is a starting point for four actions: confirm if needed, treat per CDC 2021, notify partners, and rescreen at the correct interval.
Confirmation
Home NAAT results for chlamydia and gonorrhea are generally reliable and do not require repeat testing before treatment in a symptomatic patient. Syphilis testing uses a two-step algorithm (reverse-sequence or traditional) and requires confirmation before diagnosis. HIV screening positives require confirmatory testing per the CDC HIV testing algorithm. Home HIV rapid tests should be confirmed with a lab-based fourth-generation test before diagnosis.[1]
Treatment (what CDC recommends, and where to get it)
Treatment is pathogen-specific and only chlamydia fits cleanly into an oral-only, no-exam telehealth workflow. The other pathogens require an intramuscular injection, an exam, or specialty follow-up that a general telehealth visit cannot substitute for. What CDC recommends, per pathogen:
- Chlamydia: doxycycline 100 mg twice daily for 7 days (or single-dose azithromycin 1 g in pregnancy and where adherence is a concern). Oral, no exam required, telehealth-appropriate. See the chlamydia treatment guide.[1]
- Gonorrhea: a single 500 mg intramuscular ceftriaxone injection (1 g for people weighing 150 kg or more). IM injection required, so an in-person visit at a health department STI clinic, primary care office, or urgent care is needed.[1]
- Trichomoniasis: metronidazole. Best paired with a clinical exam to rule out concurrent BV or PID and confirm cure of a partner, so handled at a health department or primary care visit rather than general telehealth. See the trichomoniasis guide.[1]
- Syphilis: staging drives treatment. Benzathine penicillin G 2.4 million units IM once for primary, secondary, or early latent; longer courses for late latent or unknown duration. IM injection required, and staging usually requires clinical evaluation.[1]
- Genital herpes: oral acyclovir, valacyclovir, or famciclovir. Initial episodes typically warrant an exam; suppressive therapy is usually managed by primary care. See the genital herpes guide.[1]
- HIV: antiretroviral therapy, started as soon as possible after confirmation, and typically coordinated with a Ryan White clinic, ID specialist, or PrEP/PEP clinic.[1]
Partner notification and expedited partner therapy
All partners in the 60 days before diagnosis should be notified and tested. For chlamydia and gonorrhea, expedited partner therapy (EPT) is legal or permissible in most US states and allows the treating clinician to prescribe treatment for a patient's partner without a separate clinical evaluation. Because gonorrhea EPT is typically an oral cefixime prescription that carries its own drug-interaction and allergy considerations, and because state EPT laws vary, EPT is usually coordinated through the treating clinic or the state health department rather than a general telehealth visit. Many state health departments also offer anonymous partner notification services.[1]
Retest
Rescreen at 3 months after treatment for chlamydia, gonorrhea, and trichomoniasis. High reinfection rates make this one of the most important steps for reducing repeat infection and downstream complications like pelvic inflammatory disease. HIV and syphilis follow-up follow the CDC HIV testing algorithm and syphilis staging respectively.[1]
Cost, Insurance, and Confidentiality
Under the Affordable Care Act, USPSTF grade A and B preventive services (including HIV screening at least once, chlamydia and gonorrhea screening for women per USPSTF criteria, syphilis screening in pregnancy and for adults at increased risk, and hepatitis B and C screening per USPSTF criteria) are covered without cost-sharing on most private health plans.[2] Public options include state and local health departments (free or low-cost STI clinics, findable via the CDC clinic locator), Planned Parenthood (sliding-fee testing), and federally qualified health centers.
Cash-pay ranges as of 2026: home mail-in 4-panel or 5-panel kits typically $150 to $250; Visby home PCR kit for chlamydia, gonorrhea, and trichomoniasis around $150 to $200; retail lab draw self-order for the standard 4-panel roughly $75 to $200; a cash-pay telehealth visit with lab requisition typically $35 to $75 plus lab fees. Confidentiality: adolescents in most US states can consent to STI testing and treatment without parental notification, but insurance explanation-of-benefits documents may still surface to the policyholder; ask about confidential billing options if that matters.
Cost Comparison: Where to Get Tested
| Option | Cash cost (adult, 4-panel) | Turnaround | Best for |
|---|---|---|---|
| Public health department STI clinic | $0 to $30 (sliding scale) | 1 to 5 days | Anyone; uninsured; positives that need treatment on-site |
| Planned Parenthood | $0 to $150 (sliding scale) | 1 to 5 days | Uninsured; young adults; contraception plus screening |
| Primary care visit + lab draw | Covered without cost-sharing (USPSTF A/B) on most plans; ~$75 to $200 cash | 1 to 3 days | Established patients; full history and exam |
| Telehealth visit + lab requisition | $35 to $75 visit + $75 to $200 lab | 1 to 3 days | Asymptomatic screening; discreet; positive-result follow-up |
| Mail-in home kit (Everlywell, LetsGetChecked) | $150 to $250 | 3 to 7 days | Asymptomatic screening; privacy; low urgency |
| Home point-of-care PCR (Visby) | $150 to $200 | ~30 minutes on device | Rapid CT/NG/TV result; travel or new-partner check |
| Emergency department | $500+ facility fee | Same visit | Symptomatic urgency; sexual assault; PID; after-hours |
ACA-covered preventive services (USPSTF grade A or B) generally have no out-of-pocket cost on private plans, Medicaid expansion, and Medicare. If your insurance flags a copay, ask the billing office to code the visit under the preventive screening code rather than a diagnostic code.[2]
Red Flags: When to Skip the Home Kit
- Fever, pelvic pain, or lower abdominal pain (possible pelvic inflammatory disease, needs in-person evaluation)
- Testicular pain or swelling (possible epididymitis or torsion, needs same-day evaluation)
- Painful or bloody bowel movements after receptive anal exposure (possible proctitis)
- New genital or oral sore, ulcer, or rash
- Exposure within the last 72 hours (HIV PEP is time-critical)
- Pregnancy or possible pregnancy
- Sexual assault (needs forensic and medical care in the ER or a SANE program)
- A previously known positive test that has never been treated
Getting STI Testing Through Telehealth
Telehealth fits STI testing at two points in the workflow. First, a virtual visit can order a lab requisition for asymptomatic routine screening at a nearby Quest or LabCorp draw site, which is often cheaper than a home kit and uses the same NAAT platform. Second, for a confirmed chlamydia positive, telehealth can review the result, prescribe first-line doxycycline (or azithromycin where indicated), and set up a 3-month retest.
Scope note: TeleDirectMD offers testing workup and chlamydia treatment via telehealth. Gonorrhea (requires intramuscular ceftriaxone), syphilis (requires intramuscular benzathine penicillin), trichomoniasis, genital herpes, HIV, and HPV are outside the scope of what we treat and require in-person care or a specialty referral. Positive results for any of those are best handled by a local health department STI clinic, a primary care office that can administer IM injections, an infectious disease clinic, or (for HIV) a ryan-white or PrEP clinic.
Telehealth of any kind, ours included, cannot substitute for in-person care when an IM injection is needed (gonorrhea ceftriaxone, benzathine penicillin for syphilis), when a pelvic or scrotal exam is essential, when the presentation could plausibly be non-STI (endometritis, ovarian pathology, prostatitis), or when acute complications like PID or epididymitis are on the differential.
Frequently Asked Questions
USPSTF recommends HIV screening at least once for every adult aged 15 to 65, chlamydia and gonorrhea annually for sexually active women under 25 (and older women at increased risk), and syphilis for anyone at increased risk. CDC recommends men who have sex with men and transgender women screen every 3 to 6 months, and anyone with new or multiple partners screen at least annually. See a clinician sooner if you develop symptoms.[3][4][1]
The core panel is HIV, syphilis, chlamydia, and gonorrhea. Trichomoniasis, hepatitis B, and hepatitis C are added based on exposure history and USPSTF risk categories. HPV testing is done via cervical cancer screening (Pap co-test), not routine STI screening. Herpes serology is not recommended for asymptomatic adults.[1]
Window periods vary by pathogen. Chlamydia and gonorrhea NAAT is reliable at 2 weeks. Fourth-generation HIV Ag/Ab combo tests are reliable at 2 to 6 weeks (older antibody-only tests can miss infection for up to 90 days). Syphilis serology is reliable at 3 to 6 weeks. Hepatitis C RNA is reliable at 2 to 6 weeks; the antibody screen may take 8 to 12 weeks. If you have an acute exposure within the past 72 hours, do not wait, call a clinician about HIV PEP immediately.[1]
For asymptomatic screening, home mail-in NAAT and the Visby home PCR device use lab-comparable technology and give reliable results. The limitations are practical: home kits cannot always obtain rectal or pharyngeal swabs, cannot include a physical exam, cannot initiate same-day treatment for gonorrhea or syphilis (which need IM injections), and cannot substitute for in-person care in pregnancy, symptomatic infection, or after sexual assault. See the Everlywell review and Visby review for details.[8]
Cervical cancer screening for women aged 21 to 65 uses Pap testing alone every 3 years, or HPV testing alone every 5 years starting at age 30 (grade A). Co-testing (Pap plus HPV) every 5 years is also acceptable in women 30 to 65. This is separate from the STI screening panel discussed here, and it is not routinely part of an STI-only visit.
Routine herpes serology in asymptomatic adults is not recommended by CDC. In low-prevalence populations, false-positive results outnumber true positives and can cause more anxiety and stigma than clinical benefit. Testing is appropriate when there is an active lesion (using NAAT or culture of the lesion, not blood), when a partner has genital herpes, or in certain HIV or pregnancy scenarios where the result would change management.[1]
Not routinely. HPV testing is a cervical cancer screening tool for women aged 30 to 65 (via Pap co-test or primary HPV test). There is no routine HPV screen for men. The HPV vaccine is recommended for all adolescents at age 11 to 12 and available through age 45. If your last exposure was to a partner with a new HPV diagnosis, no immediate test changes management for either of you.
Chlamydia usually can. First-line treatment is oral doxycycline 100 mg twice daily for 7 days, which fits a telehealth visit without an exam. Gonorrhea requires an intramuscular ceftriaxone injection and syphilis requires benzathine penicillin G, so both need an in-person visit. Trichomoniasis (oral metronidazole) is typically handled at a health department or primary care visit alongside an exam and partner treatment rather than through general telehealth. Herpes, HIV, and HPV each need specialty or in-person follow-up. TeleDirectMD provides testing workup and treats chlamydia; the other pathogens are outside our scope and require in-person care or a specialty referral.[1]
Free or low-cost options include your state or local health department STI clinic, Planned Parenthood, and federally qualified health centers. Home mail-in kits run $150 to $250 for a 4-panel or 5-panel. Retail lab self-order for the standard 4-panel is roughly $75 to $200. A cash-pay telehealth visit with a lab requisition typically runs $35 to $75 on top of lab fees. Most USPSTF-recommended screenings are covered without cost-sharing under private insurance and Medicaid expansion plans.[2]
CDC recommends doxy-PEP (200 mg doxycycline within 72 hours of condomless sex) for men who have sex with men and transgender women who have had a bacterial STI in the past 12 months. It is not currently recommended for cisgender women (the one trial in that population did not show benefit) or for people not in the CDC-defined risk categories. The doxy-PEP guide covers eligibility, dosing, and resistance concerns.[9]
References
- Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recommendations and Reports. 2021 Jul 23;70(4):1-187. PMID: 34292926. https://pubmed.ncbi.nlm.nih.gov/34292926/
- US Preventive Services Task Force. A and B Recommendations covered without cost-sharing under the Affordable Care Act. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations
- US Preventive Services Task Force. Screening for HIV Infection: US Preventive Services Task Force Recommendation Statement. JAMA. 2019 Jun 18;321(23):2326-2336. PMID: 31184701. https://pubmed.ncbi.nlm.nih.gov/31184701/
- US Preventive Services Task Force. Screening for Chlamydia and Gonorrhea: US Preventive Services Task Force Recommendation Statement. JAMA. 2021 Sep 14;326(10):949-956. PMID: 34519796. https://pubmed.ncbi.nlm.nih.gov/34519796/
- US Preventive Services Task Force. Screening for Syphilis Infection in Pregnant Women: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA. 2018 Sep 4;320(9):911-917. PMID: 30193283. https://pubmed.ncbi.nlm.nih.gov/30193283/
- US Preventive Services Task Force. Screening for Syphilis Infection in Nonpregnant Adolescents and Adults: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA. 2022 Sep 27;328(12):1243-1249. PMID: 36166020. https://pubmed.ncbi.nlm.nih.gov/36166020/
- McDonald R, O'Callaghan K, Torrone E, et al. Vital Signs: Missed Opportunities for Preventing Congenital Syphilis - United States, 2022. MMWR Morbidity and Mortality Weekly Report. 2023 Nov 17;72(46):1269-1274. PMID: 37971936. https://pubmed.ncbi.nlm.nih.gov/37971936/
- US Food and Drug Administration. Visby Medical Sexual Health Test (over-the-counter authorization for chlamydia, gonorrhea, and trichomoniasis PCR). https://www.fda.gov/
- Bachmann LH, Barbee LA, Chan P, et al. CDC Clinical Guidelines on the Use of Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention, United States, 2024. MMWR Recommendations and Reports. 2024 Jun 6;73(2):1-8. PMID: 38833414. https://pubmed.ncbi.nlm.nih.gov/38833414/
About the Author
Parth Bhavsar, MD is a board-certified family medicine physician and the founder of TeleDirectMD, a physician-only virtual urgent care platform. He reviews every guide in this library. NPI 1104323203.