Synopsis
Select pathogen-, site- and timing-appropriate STI tests, explain self- versus clinician sampling, preserve gonococcal resistance information, recognise pregnancy and urgent syndromes, and close every result pathway.
- Use a private exposure history to choose genital, rectal, pharyngeal, lesion and blood tests; one negative anatomical site does not clear another.
- For chlamydia and gonorrhoea, a self-taken vulvovaginal swab is generally more sensitive than urine in people with a vagina; first-catch urine is commonly used in people with a penis.
- Sample rectal and pharyngeal sites according to exposure and pathogen guidance. Current gonorrhoea guidance adds pharyngeal testing for every urogenital case and contact.
Key red flags
Pelvic pain with cervical, uterine or adnexal tenderness may require empirical PID treatment even when lower-tract NAAT is pending or negative.
Acute testicular pain or swelling needs torsion exclusion before it is attributed to epididymo-orchitis.
Pharyngeal gonorrhoea, persistent symptoms or suspected treatment failure requires culture and susceptibility planning rather than NAAT alone.
Pregnancy changes treatment and follow-up for several infections and requires prompt linkage to maternity or specialist sexual-health care.
Ocular, neurological, otological or systemic features with possible syphilis or gonorrhoea require urgent specialist assessment.
Suspected or confirmed gonorrhoea requires culture where feasible before treatment, especially at a positive site or when failure is possible.
Pregnancy changes antimicrobial choices, urgency, neonatal implications and test-of-cure requirements for several infections.
Pelvic pain, testicular pain, ulceration, systemic illness or neuro-ocular symptoms needs clinical assessment in addition to specimens.
Investigation priorities
Detect common bacterial STIs sensitively at every exposed anatomical site.
Management branches
A patient requests screening after genital, oral and anal exposure and has no acute symptoms.
- Record exposure dates, anatomical sites, barrier use, pregnancy possibility, previous antibiotics and partner diagnoses.
- Offer the preferred genital specimen plus rectal and pharyngeal sampling as indicated, with HIV, syphilis and hepatitis tests according to risk.