Men Who Have Sex With Men (MSM) or With Transgender Women²

Transgender and Gender Diverse Persons^2,4

Persons With HIV ^5,20

^1​See d​etailed California STI/HIV Screening Recommendations in Pregnancy

²The experience and needs of transgender and gender diverse persons is not well reflected in gender-based screening recommendations. CDC recommends that gender-based STI screening recommendations be adapted on the basis of anatomy. For example, recommendations to screen cisgender females ≤35 years of age for chlamydia/gonorrhea should be extended to transgender men and nonbinary persons with a cervix in the age group. See CDC's Transgender and Gender Diverse Persons

Trichomonas

³Consider trichomonas screening in high-prevalence settings (e.g., STI clinics and correctional facilities) and for asymptomatic cisgender women at high risk for infection (e.g., those with multiple sex partners, transactional sex, drug misuse, or a history of STI or incarceration). The use of highly sensitive and specific tests (e.g., a nucleic acid amplification test [NAAT]) is recommended for detecting Trichomonas vaginalis.

Human papillomavirus (HPV)

⁴HPV testing is recommended as part of cervical cancer screening for persons with a cervix. See Screening Guidelines - American Society for Colposcopy and Cervical Pathology (ASCCP)

⁵Guidance on Anal HPV screeningfor persons with HIV, see Human Papillomavirus Disease | NIH (hiv.gov)

Chlamydia (CT) or Gonorrhea (GC)

⁶A vaginal swab (self-collected) nucleic acid amplification test (NAAT) is the optimal urogenital specimen type for persons with a vagina/cervix. Consider rectal CT and pharyngeal and rectal GC screening for persons assigned female at birth based on reported sexual history via shared clinical decision-making.

⁷CT or GC risk factors include prior CT or GC infection, particularly in past 24 months; more than one sex partner in the past year; suspicion that a recent partner may have had concurrent partners; new sex partner in past 3 months; illicit drug use; transactional sex in the past year, local factors (e.g., community prevalence of infection).

CDPH data (2024) has shown that GC rates among Black/African American females are 2.1 times higher than statewide rates among all females, which are likely due to social determinants of health and living in communities with high STI prevalence. Providers should consider screening Black/African American women up to age 30.

⁸For persons on doxycycline post-exposure prophylaxis (doxy PEP), CDPH recommends screening for GC and CT at all anatomic sites of exposure (urogenital, pharyngeal, and/or rectal), as well as test for syphilis and HIV (if not known to be persons with HIV) at initiation and every three months. See CDPH Doxycycline Post-Exposure Prophylaxis (doxy PEP) for the Prevention of Bacterial Sexually Transmitted Infections (STIs), CDC Clinical Guidelines on the Use of Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention, United States, 2024 | MMWR

Syphilis

⁹California Department of Public Health (CDPH) Updates Syphilis Screening Recommendations
 
¹⁰ Screening for syphilis is based on serologic tests for the detection of treponemal and nontreponemal antibodies. See California Department of Public Health (CDPH) Updates Syphilis Screening Recommendations (10/2024), American College of Obstetricians and Gynecologists (ACOG) Syphilis Screening Algorithm, and the California Prevention Training Center (CAPTC) Clinical Interpretation of Syphilis Screening Algorithms.

¹¹Risk factors for syphilis include history of incarceration (within the last year) or transactional/commercial sex work, geography, race/ethnicity, methamphetamine use, people experiencing homelessness or unstable housing, persons with HIV, on HIV pre-exposure prophylaxis, on doxycycline postexposure prophylaxis (doxy PEP), or with a new/recent STI diagnosis, and being a male younger than 29 years. Other risk factors include multiple partners, a new partner, or partner(s) with STIs. STI Screening Recommendations | CDC.

¹²Confirm HIV and syphilis status of all pregnant persons receiving care or services at emergency departments; urgent care clinics; jails; mental health, drug treatment, and syringe services programs; and street medicine or homeless outreach programs with documented lab results or by providing opt-out HIV and syphilis testing. See Dear Colleague Letter: Call to Expand HIV and Syphilis Testing for Pregnant Women (11/2021, updated 03/2025) and also California Department of Public Health (CDPH) Updates Syphilis Screening Recommendations (10/2024).

Human Immunodeficiency Virus (HIV)

¹³See Recommendation: Human Immunodeficiency Virus (HIV) Infection: Screening | USPSTF

¹⁴HIV Screening Tests: CDC guidelines recommended HIV testing with HIV-1,2 antigen/antibody combination immunoassay, with supplemental testing following a reactive test to differentiate between HIV-1 and HIV-2 antibodies. If supplemental testing for HIV-1/HIV-2 antibodies is nonreactive or indeterminate (or if acute HIV infection or recent exposure is suspected or reported), an HIV-1 nucleic acid test (e.g., HIV RNA assay) is recommended to differentiate acute HIV-1 infection from a false-positive test result. 2018 Quick reference guide: Recommended laboratory HIV testing algorithm for serum or plasma specimens (cdc.gov).
 
Point-of-care HIV tests are often utilized in non-clinical settings. See Implementing HIV Testing in Nonclinical Settings: A Guide for HIV Testing Providers.
 
HIV self-testing options are a method to provide HIV testing to people not accessing HIV testing in healthcare settings (e.g., TakeMeHome)

¹⁵Risk factors for HIV infection include: men who have sex with men; people who have condomless anal or condomless vaginal sex with a person with HIV or whose HIV status is unknown; people with more than one sex partner since their last HIV test; people who have shared needles, syringes, or other drug injection equipment (e.g., cookers); transactional sex; people who have been diagnosed with or treated for a bacterial STI (e.g. syphilis); people diagnosed with or treated for hepatitis or tuberculosis (TB); people with a sex partner who has one of the risk factors listed above or whose sexual history is unknown. Getting Tested for HIV | CDC.

¹⁶Risk factors for acquiring HIV in pregnancy: injection drug use; sex partner of a person who injects drugs; transactional sex; sex partner of a person with HIV; new sex partner or more than one sex partner during the current pregnancy; suspected or diagnosed STI during pregnancy (e.g., syphilis);  signs and/or symptoms of acute HIV infection or exposure to HIV; or those receiving care in facilities with an HIV incidence rate of >1 case per 1000 pregnant persons per year or residing in a local health jurisdiction with high HIV incidence rates.
See Maternal HIV Testing and Identification of Perinatal HIV Exposure | NIH. See Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings.
 
¹⁷All pregnant people should be tested with an HIV-1,2 antigen/antibody (Ag/Ab) combination immunoassay as early as possible in each pregnancy. Additionally, partners of pregnant people should be referred for HIV testing if their HIV status is unknown.
 
¹⁸ Expedited HIV testing is defined as testing with a very short turnaround time for results (e.g., one hour). Although HIV-1,2 Ag/Ab combination immunoassays are the recommended test for HIV screening in clinical settings, expedited testing is dependent on the available HIV tests in a particular facility and may include antigen/antibody combination immunoassays, antibody-only assays, or HIV nucleic acid tests (e.g., HIV RNA).

If the pregnant person has a positive HIV test result during labor and delivery, or postpartum, or when a newborn's expedited antibody test is positive, supplemental HIV testing should be performed on the mother (e.g., an HIV-1/HIV-2 antibody differentiation assay and in most cases an HIV RNA assay) and the infant (HIV RNA assay).
 
¹⁹For people receiving HIV pre-exposure prophylaxis (PrEP), an HIV-1,2 antigen/antibody combination immunoassay and an HIV-1 nucleic acid test (e.g., HIV RNA) are both recommended for HIV testing. Including an HIV-1 nucleic acid test improves the sensitivity of HIV testing in people on PrEP who have acquired HIV infection.
Preexposure Prophylaxis for the Prevention of HIV Infection in the United States – 2021 Update: A Clinical Practice Guideline.
 
²⁰Primary Care Guidelines for Persons with Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Disease Society of America. Clinical Infectious Diseases. 6 November 2020; Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America | Clinical Infectious Diseases | Oxford Academic.​

Hepatitis B virus (HBV) & Hepatitis C virus (HCV)

²¹California law (AB 789) requires primary care facilities in California to offer hepatitis B and hepatitis C testing based on the latest screening recommendations from USPSTF.

²² CDC guidance (2023) recommends universal adult hepatitis B screening with a triple panel test of HBsAg, anti-HBs, and anti-HBc, which is reflected on this guidance page. However, the U.S. Preventive Services Task Force (USPSTF) still recommends risk-based screening.
 
²³ Hepatitis B risk factors include persons who use drugs, people who share needles or are sexual contacts with people with known HBV infection, people with current or past sexually transmitted infections or multiple sex partners, men who have sex with men, people with HIV infection, people with hepatitis C virus infection, and people currently or formerly incarcerated in a jail, prison, or other detention setting.

²⁴ Hepatitis C virus (HCV) testing should be initiated with an HCV antibody (anti-HCV) test. For specimens testing anti-HCV positive/reactive, CDC and CDPH encourage automatic reflex HCV RNA testing. For persons who might have been exposed to HCV within the past 6 months, testing for HCV RNA two weeks after exposure or testing for anti-HCV six months after exposure is recommended. For persons who are immunocompromised, testing for HCV RNA can be considered. For men who have sex with men (MSM) on HIV pre-exposure prophylaxis (PrEP), HCV testing at initiation and at least annually thereafter (while on HIV PrEP) is recommended (depending on sexual or drug use risk practices, more frequent testing may be warranted). CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020 | MMWR, 
Management of Unique & Key Populations With HCV Infection | HCV Guidance 
For all pregnant persons, HCV screening is recommended during each pregnancy. Call to Action: Routine Hepatitis C Screening in Pregnancy | ACOG; HCV in Pregnancy – HCV Guidance | AASLD

²⁵ Risk factors for HCV include people who currently inject drugs and share needles, syringes, or other drug preparation equipment, people with selected medical conditions including people who ever received maintenance hemodialysis. CDC recommends routine, periodic Hepatitis C testing for people with ongoing risk factors, while risk factors persist. Clinical Screening and Diagnosis for Hepatitis C | Hepatitis C | CDC

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