What medical and laboratory screening should be done?
Symptoms or signs of an STD or known exposure to STDs should prompt immediate physical and laboratory examinations. However, because STDs are often present without symptoms, every patient should be screened for laboratory evidence of syphilis, trichomonads (women only), gonorrhea, and chlyamdia at the initial visit and at least annually (see Table 4-2). Some experts also recommend type-specific testing for herpes simplex virus type 2 because of its association with a higher risk of HIV transmission and possible need for enhanced counseling. More frequent screening for STDs is appropriate with evidence or suspicion of high-risk sexual behavior (eg, sex with a new partner, sexual activity without consistent and correct condom use); however, there are no data to guide the precise frequency. More frequent screening might also be appropriate in asymptomatic men who have sex with men (MSM) and younger women because of a higher STD prevalence among these demographic groups. The local prevalen
