9
Screening for Syphilis
Î All patients should be screened for syphilis upon initiation of care and
periodically thereafter, depending on risk (SR-H).
Î A lumbar puncture should always be performed for patients with a
reactive syphilis serology who have neurologic or ocular symptoms or
signs, irrespective of past syphilis treatment history (SR-H).
Î A lumbar puncture should be performed in patients who experience
serologic treatment failure (ie, whose nontreponemal titers fail
to decline 4-fold after stage-appropriate therapy, or whose titers
increase 4-fold if reinfection is ruled out) (WR-L).
Screening for Other Sexually Transmitted Diseases
Î All women should be screened for trichomoniasis, and all women ≤25
years of age should be screened for Chlamydia trachomatis infection
(SR-H).
Î Men and women should be screened for gonorrhea and chlamydia
infection at initial presentation and then annually if at risk for
infection (SR-H).
Î Retesting in 3 months is indicated in men and women found to be
positive for gonorrheal and chlamydial infections and women found
to be positive for trichomoniasis on initial screening, because of high
reinfection rates (SR-M).
Î Patients should be screened for all of these conditions periodically
thereafter, depending on the population, reported behaviors, the
presence of other sexually transmitted diseases (STDs) in the patient
or his/her partner(s), and the prevalence of STDs in the community
(SR-L).
Cervical Cancer Screening and Prevention
Î HIV-infected women should have a cervical Pap smear performed upon
initiation of care, and this test should be repeated at 6 months and
annually thereafter if results are normal (SR-M).
Î Women with atypical squamous cells (both ASC-US [atypical
squamous cells of unknown significance] and ASCH [ASC, cannot rule
out high-grade squamous intraepithelial lesion]), atypical glandular
cells, low-grade or high-grade squamous intraepithelial lesion, or
squamous carcinoma noted by Pap testing should undergo colposcopy
and directed biopsy, with further treatment as indicated by results of
the evaluation (SR-H).
