Who this is for
If you are a woman aged 25 or older, the question both bodies ask is whether you have a risk factor. USPSTF (2021) lists them: a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STI; inconsistent condom use when not in a mutually monogamous relationship; a previous or coexisting STI; a history of exchanging sex for money or drugs; or a history of incarceration. CDC's screening table (reviewed March 22, 2024) uses the same list and credits USPSTF for it. Any one of these puts you inside both bodies' screening population. None of them, and neither body recommends routine screening for you.
Sexually active women under 25 are screened by both bodies without a risk assessment, and CDC (2021) specifies that this is annual. USPSTF's Grade B statements include pregnant persons; CDC specifies the timing: the first prenatal visit, with a third-trimester retest for those under 25 or at increased risk.
If you are a man, the answer depends on which body you read and on whom you have sex with. USPSTF (2021) issues no recommendation for or against screening any man. CDC (2021) recommends screening all sexually active men who have sex with men at least annually at each site of sexual contact, and every 3 to 6 months where risk is higher, including men taking PrEP. CDC also recommends screening every sexually active person with HIV at the first HIV care visit and at least annually after that. For heterosexual men at low risk the two bodies land in the same place: CDC states the evidence is insufficient (chlamydia) and that screening is not recommended for those over 25 at low risk (gonorrhea).
USPSTF stratifies by sex at birth and current anatomy rather than gender identity, and says so on its page. CDC's table extends the under-25 rule for women to all transgender men and gender diverse people with a cervix.
Where the recommendations diverge
- USPSTF Up to 24
- USPSTF 25 and older
- USPSTF Not age-bounded Not age-bounded
- CDC Up to 24
- CDC 25 and older
- CDC Not age-bounded Not age-bounded
- CDC Not age-bounded Not age-bounded
- CDC Not age-bounded Not age-bounded
The USPSTF recommends screening for chlamydia in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection.
Our note: Recommendation Summary table, Grade B. The gonorrhea statement on the same page is identical apart from the infection named and is also Grade B; USPSTF recommends screening for both simultaneously. No start age is stated: the recommendation applies to sexually active adolescents and adults. USPSTF grades no interval; its Screening Intervals section is one sentence about rescreening on new or persistent risk factors. This statement is consistent with the 2014 USPSTF recommendation.
The USPSTF recommends screening for gonorrhea in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection.
Our note: Recommendation Summary table, Grade B; the chlamydia statement is identical apart from the infection named. Increased risk, from the page's Assessment of Risk: a new sex partner, more than 1 sex partner, a sex partner with concurrent partners, or a sex partner who has an STI; inconsistent condom use when not in a mutually monogamous relationship; a previous or coexisting STI; exchanging sex for money or drugs; a history of incarceration. No upper age is stated.
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men.
Our note: An I statement is not a recommendation against screening; it means USPSTF declines to recommend for or against. It covers all sexually active men with no carve-out for men who have sex with men. USPSTF states it did not review evidence on persons living with HIV or taking PrEP and refers readers to CDC for those groups. Unchanged from the 2014 statement.
Annual screening of all sexually active women aged <25 years is recommended, as is screening of older women at increased risk for infection (e.g., women aged ≥25 years who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STI).
Our note: Chlamydial Infections chapter of the Sexually Transmitted Infections Treatment Guidelines, 2021 (page last reviewed July 22, 2021). CDC attaches no letter grade. The word annual comes from this chapter text; CDC's screening table (last reviewed March 22, 2024) states the population as Sexually active women under 25 years of age and cites USPSTF for it. The gonorrhea chapter (last reviewed September 21, 2022) carries the parallel sentence. Under 25 is the same band as USPSTF's 24 years or younger.
Annual screening for N. gonorrhoeae infection is recommended for all sexually active women aged <25 years and for older women at increased risk for infection (e.g., those aged ≥25 years who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STI).
Our note: Gonococcal Infections Among Adolescents and Adults chapter (page last reviewed September 21, 2022). The screening table (March 22, 2024) states this row as Sexually active women 25 years of age and older if at increased risk, and its footnote defines increased risk Per USPSTF with the same seven items USPSTF lists. The same chapter adds inconsistent condom use outside a mutually monogamous relationship, previous or coexisting STIs, and exchanging sex for money or drugs as gonorrhea risk factors. No upper age is stated.
Women aged <25 years and those at increased risk for chlamydia (i.e., those who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STI) should be screened at the first prenatal visit and rescreened during the third trimester to prevent maternal postnatal complications and chlamydial infection in the infant.
Our note: Chlamydial Infections chapter, pregnancy section (July 22, 2021). The screening table (March 22, 2024) states the gonorrhea row as All pregnant women under 25 years of age, and those 25 and older if at increased risk, with Retest during the 3rd trimester for women under 25 years of age or at risk. After treatment in pregnancy, CDC asks for a chlamydia test of cure about 4 weeks after therapy and a retest within 3 months; the pregnancy chlamydia regimen is azithromycin 1 g in a single dose, not doxycycline.
At least annually for sexually active MSM at sites of contact (urethra, rectum, pharynx) regardless of condom use
Our note: Gonorrhea row of CDC's screening table (last reviewed March 22, 2024); the chlamydia row reads the same with sites (urethra, rectum), because pharyngeal testing is for gonorrhea only. Second cell: Every 3 to 6 months if at increased risk (i.e., MSM on PrEP, with HIV infection, or if they or their sex partners have multiple partners). The MSM chapter (August 22, 2022) states the same two tiers and says most evidence for the interval comes from mathematical modeling. Not covered by USPSTF, whose I statement for men has no MSM carve-out.
At the initial HIV care visit, providers should screen all sexually active persons for syphilis, gonorrhea, and chlamydia, and perform screening for these infections at least annually during the course of HIV care.
Our note: HIV Infection chapter (page last reviewed July 22, 2021). Testing is NAAT at the anatomic site of exposure. The same chapter: More frequent screening for syphilis, gonorrhea, and chlamydia (e.g., every 3 or 6 months) should be tailored to individual risk and the local prevalence of specific STIs. The screening table (March 22, 2024) restates the row as screen at first HIV evaluation, and at least annually thereafter. USPSTF did not review this group and defers to CDC.
Why they differ
Read side by side, these two bodies agree on women and differ on men. Two things that look like disagreements are not, and the page should be read with that in mind.
The age line is the same line. USPSTF writes "24 years or younger" and "25 years or older". CDC writes "under 25 years of age" and "25 years of age and older". That is one partition of the population, not two: a woman aged 24 is in the younger band under both, and a woman on her 25th birthday is in the older band under both. There is no age at which the bodies disagree about which band a woman falls in. CDC's screening table (2024) footnotes its risk definition "Per USPSTF", and its 2021 chapter text cites the USPSTF statement for the women's rule. For a reader in her 40s the older band is the one that matters, and the two bodies define it identically.
"Annual" is CDC's word, not USPSTF's. CDC's chlamydia chapter (2021) opens its screening paragraph with "Annual screening of all sexually active women aged <25 years is recommended". USPSTF's graded statements name no interval, and its Screening Intervals section is a single sentence: "In the absence of studies on screening intervals, a reasonable approach would be to screen patients whose sexual history reveals new or persistent risk factors since the last negative test result." USPSTF reports CDC's annual interval only under Recommendations of Others. Both bodies allow risk-driven rescreening; only CDC names a calendar interval. A page that says USPSTF recommends annual screening is wrong.
Men are the genuine divergence, and specifically men who have sex with men. USPSTF (2021): "The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men." That is an I statement for all sexually active men, with no carve-out for MSM, and USPSTF says it did not review persons living with HIV or taking PrEP and defers to CDC for those groups. Its reasoning, in its own words: "The USPSTF found little evidence on the effectiveness of screening for gonorrhea in men or low-risk women. Prevalence in these groups is low. Moreover, the majority of genital gonococcal infections in men are symptomatic, which can result in more timely clinical presentation and lead to diagnosis and treatment that prevents serious complications."
CDC (2021) does recommend. Its gonorrhea chapter: "At least annual screening is recommended for all MSM." Its MSM chapter: "More frequent STI screening (i.e., for syphilis, gonorrhea, and chlamydia) at 3- to 6-month intervals is indicated for MSM, including those taking PrEP and those with HIV infection, if risk behaviors persist or if they or their sex partners have multiple partners." CDC states its own evidence basis in the same section: "Limited data exist regarding the optimal frequency of screening for gonorrhea, chlamydia, and syphilis among MSM, with the majority of evidence derived from mathematical modeling." So the two bodies are not disputing a fact. They read the same thin direct evidence and handle it differently: USPSTF will not grade without direct evidence, and CDC recommends on modeling and population burden. It is a difference in how each body handles indirect evidence, not a factual dispute.
The divergence is bounded. On heterosexual men at low risk the bodies agree. CDC's table, chlamydia row: "There is insufficient evidence for screening among heterosexual men who are at low risk for infection, however, screening young men can be considered in high prevalence clinical settings (adolescent clinics, correctional facilities, STI/sexual health clinic)". CDC's gonorrhea chapter: "Screening for gonorrhea among heterosexual men and women aged >25 years who are at low risk for infection is not recommended." Note the verbs. USPSTF's I statement is not a recommendation against; CDC's "not recommended" for low-risk heterosexual men is one.
What the test involves
One specimen, no blood draw. USPSTF (2021): "Nucleic acid amplification tests (NAATs) for Chlamydia trachomatis and Neisseria gonorrhoeae infections are usually used for screening because their sensitivity and specificity are high for detecting these infections." The FDA approves NAATs on urine, endocervical, vaginal, male urethral, rectal and pharyngeal specimens, and the same specimen can be used to test for both infections.
For women, CDC (2021) names vaginal swabs as the optimal specimen and states that patient-collected vaginal swabs are equivalent in sensitivity and specificity to clinician-collected ones. For men, first-catch urine. No pelvic exam is required for screening. USPSTF reports the sensitivity of urogenital NAAT specimens in women at 72% to 100% (excluding one outlier study), 89% to 100% for urethral, meatal and urine testing in men, and specificity of 90% to 100% at several sites for both infections in men and women.
For men who have sex with men, CDC tests site by site: a urine NAAT for men who have had insertive intercourse in the past year, a rectal NAAT for men who have had receptive anal intercourse, and a pharyngeal NAAT for gonorrhea in men who have had receptive oral intercourse. Rectal swabs can be self-collected. Pharyngeal chlamydia is not a screening target: CDC says its clinical significance is unclear and its prevalence low, although a throat test for gonorrhea may report a chlamydia result because some NAATs detect both bacteria from one specimen.
If the result is abnormal
A positive result is treated with antibiotics, and the regimens come from CDC's 2021 treatment guidelines. Chlamydia: doxycycline 100 mg orally twice a day for 7 days, with azithromycin 1 g in a single dose as the regimen in pregnancy and an alternative otherwise. Gonorrhea: ceftriaxone 500 mg by intramuscular injection in a single dose (1 g for people weighing 150 kg or more), plus the doxycycline course if chlamydia has not been excluded. CDC says only ceftriaxone is recommended for treating gonorrhea in the United States, and USPSTF points clinicians to CDC's current guidance because antibiotic resistance in gonorrhea is increasing.
After treatment, CDC asks for no sexual intercourse for 7 days after single-dose therapy or until a 7-day course is finished and symptoms have resolved, and none until all sex partners have been treated. Anyone diagnosed with chlamydia should also be tested for HIV, gonorrhea and syphilis. Sex partners from the previous 60 days should be referred for testing and presumptive treatment; where that is impractical, CDC allows expedited partner therapy, medication or a prescription delivered through the patient, "as permitted by law", and the law varies by state.
Then a retest at 3 months, for either infection, regardless of whether you believe your partners were treated. CDC's reasoning: most post-treatment infections are reinfections from an untreated partner or a new infected partner, not treatment failures, and repeat infections raise the risk of PID in women. A test of cure is a different thing. CDC says it is unnecessary for uncomplicated urogenital or rectal gonorrhea, needed 7 to 14 days after treatment for pharyngeal gonorrhea, and needed about 4 weeks after treatment for chlamydia in pregnancy.
More on this screening
Frequently asked questions
I am in my 40s and in a long-term relationship. Do I need this test?
For a woman 25 or older, both bodies screen only at increased risk, and both use the same list: a new sex partner, more than one sex partner, a sex partner with concurrent partners or an STI, inconsistent condom use outside a mutually monogamous relationship, a previous or coexisting STI, exchanging sex for money or drugs, or a history of incarceration. If none applies, you are outside both bodies' screening population. If one does, you are inside both. For a man in the same situation, USPSTF makes no recommendation either way and CDC's gonorrhea chapter says screening is not recommended for heterosexual men over 25 at low risk.
Does USPSTF recommend annual screening?
No. USPSTF's 2021 statement grades the population and not the interval. Its only sentence on timing: "In the absence of studies on screening intervals, a reasonable approach would be to screen patients whose sexual history reveals new or persistent risk factors since the last negative test result." Annual is CDC's interval, for sexually active women under 25 and, at least annually, for men who have sex with men and for people with HIV.
USPSTF has no recommendation for men. Does that mean I should not be screened?
An I statement means USPSTF found the evidence insufficient to weigh benefits against harms; it is not a recommendation against. USPSTF explicitly did not review men who have sex with men, people with HIV or people taking PrEP as separate groups and points to CDC for them. CDC (2021) recommends screening for all sexually active MSM at least annually at each site of contact, every 3 to 6 months at higher risk, and for every sexually active person with HIV at the first care visit and at least annually after. For heterosexual men at low risk, CDC agrees with USPSTF that the evidence is insufficient.
Is it a blood test or a pelvic exam?
Neither. Screening uses a NAAT on urine or a swab. CDC names first-catch urine for men and a vaginal swab for women, and states that a swab you collect yourself is equivalent in sensitivity and specificity to one a clinician collects. One specimen covers both infections.
I tested positive and was treated. When am I retested?
At 3 months, for either infection, whether or not you believe your partners were treated; CDC asks that the follow-up visit be scheduled at the time of treatment. Sex partners from the 60 days before your symptoms or diagnosis should be tested and presumptively treated. Pharyngeal gonorrhea is the exception that also needs a test of cure, 7 to 14 days after treatment, and chlamydia in pregnancy needs one about 4 weeks after therapy.