Can STD testing be performed at anytime?

Helpful question?

+3
I had a 22 yo pt who came in for STD testing. He is sexually active with multiple sexual partners (Females and males) and he wanted to get STD testing. He states that he stopped using condoms about a month ago. From my understanding, STD includes testing for multiple viruses and they all have different incubation periods. How can we take the incubation period into consideration if the test is negative. What if the patient is positive but he is still in the incubation period and the test result is falsely negative. He could go spread the infection to others thinking he is not infected.

Review these 2 answers or add your answer below.

Helpful answer?

+2

Fourth generation HIV testing shortens the window period down to two weeks so if your patient has had a potential exposure within the last two weeks from when they saw you, offer retesting for HIV in a month after your initial testing.

This patient must consider PrEP with Truvada. Please review our PrEP guidelines and feel free to contact me directly if you need help with addressing PrEP and managing his care.

GC/CT PCR looks for DNA so there is no window period. Additionally, GC/CT can be asymptomatic so testing should be performed in this high risk patient routinely. Remember that untreated GC/CT can cause sterility and in women PID. So more reasons to test him as needed. Moreover, he needs to be tested for GC/CT from ALL sources of exposure (pharyngeal, urethral and or anal).

He should also be considered for HCV testing especially if he believes any of his partners may be a IVDU or has a substance use disorder. MSM are high risk for HCV exposure.

He should also be counseled about prevention. HPV, Meningococcal and possibly HAV, HBV vaccination are recommended for this patient. And again, PrEP!

Behavioral health must be involved. They can help with risk reduction, prevention and CBT.

I would be interested in their social history as well. Check for substance use, homelessness, support system and income sources.

Great case! Great answers! 

Helpful answer?

+1

I would approach this patient as what type of STI screening should be done for someone with his age and risk factors:
If you refer to USPSTF guidelines and AAFP recommendation: (Sexually Transmitted Infections: Recommendations from the U.S. Preventive Services Task Force.)
A 22 y.o male with high risk sexual behavior should be tested for:
1. HIV infection
2. HBV (if not previously vaccinated or if vaccination status is unknown)
3. Syphilis

Routine screening for gonorrhea/chlamydia and Herpes is not recommended in this patient unless he is symptomatic for any of these conditions.

As for incubation period for the above infections:
1. HIV: depending on the type of screening test ordered, it would be safe to say that he should be tested again in at least 90 days if initial HIV screen is negative. (see CDC guidelines: https://www.cdc.gov/actagainstaids/basics/testing.html)
2. HBV: can be detected in an infected person's blood from anywhere on average 4 weeks up to 12 weeks after exposure (see CDC: https://www.cdc.gov/hepatitis/hbv/hbvfaq.htm)
3. Syphilis: RPR becomes positive in an infected person within approximately 4-6 weeks after infection or 1-3 weeks after the appearance of primary lesion. (see AAFP recommendations: Resolving the common clinical dilemmas of syphilis.)

Final thoughts: I would test the patient at the initial visit and then repeat these tests in 3 months if he continues to engage in high risk sexual behavior without using protection consistently.
May also consider offering Truvada (PReP) for primary prevention of HIV.

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