Symptoms and signs of genital infection are not specific and may be absent. Therefore women should be tested on request, if at risk (Table Testing for sexually transmitted infections (): indications), or if they have clinical features of sexually transmitted infections (Table Clinical features of genital infections including sexually transmitted infections*). Recommendations on screening await the outcome of pilot studies conducted by the Department of Health in the UK.

Table Testing for sexually transmitted infections (): indications

On demand
Identified risk
Clinical features of sexually transmitted infection
Under 25 years of age
New partner in previous 6 months
More than one partner in previous 12 months
High-risk partner (e.g., symptomatic or has an sexually transmitted infection or multiple partners)
Recent history of an sexually transmitted infection (consider re-infection)
Before clinical procedures
termination of pregnancy
Intrauterine device insertion
other intrauterine procedures
(laparoscopy and dye injection, hysteroscopy, hysterosalpingogram, endometrial biopsy, dilation and curertage)

Table Clinical features of genital infections including sexually transmitted infections*

Vaginal or urethral discharge
Vulval or pubic pruritis
Genital malodor
Vulval or peri-anal pain
Lesions (ulcers or lumps)
Dysuria
internal (urethral or bladder pain)
external (urine in contact with inflamed vulva)
Dyspareunia (superficial or deep)
Abdominal or pelvic pain and tenderness
Abnormal bleeding
intermenstrual
postcoital
contact bleeding from cervix
Inflammation of vulva, vagina, cervix, peri-anal area and anal canal
Signs of pelvic inflammatory disease
Cardinal
cervical excitation
uterine or adnexal tenderness (usually bilateral)
Additional signs (may be present but are not essential for diagnosis)
pyrexia (oral temperature > 38.3°C/> 101°F)
adnexal mass
lower abdominal tenderness
peritonism
cervical or vaginal mucopurulent discharge

*Note: the absence of symptoms or signs does not exclude a sexually transmitted infection

A woman may request sexually transmitted infection testing for many reasons. She may be concerned about being infected by a specific partner, planning a pregnancy or seeking a check-up before starting a new relationship or discontinuing condoms. Awareness of the incubation periods of diseases is important in timing tests for sexually transmitted infections and in interpreting results. If a patient presents for testing during the likely incubation period, infection cannot be excluded. In these circumstances, it may be advisable to defer or repeat testing according to the risk of infection and the likelihood of her returning for follow-up. For example, if a woman presents a week after having unprotected intercourse with a new partner it may be possible to detect gonorrhea but too soon for a chlamydia test to be reliable. However, it may still be useful to test for chlamydia as she may have a preexisting infection, and, if negative, to repeat the test after the incubation period.

It is important to explain to the patient which diseases are (and which are not) being tested for. Although a clinical diagnosis can be made from the lesions of warts or herpes, it is impossible to say, with routine tests, that a patient is not carrying herpes simplex or wart virus. The patient should also be informed of the limitations of testing, as both false-positive and false-negative results can occur. An awareness of the positive and negative predictive values of tests, such as chlamydia antigen detection, can be useful in interpreting the results as the predictive values depend on the population prevalence. The local laboratory can provide information on the accuracy of their diagnostic tests.

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