Currentblue cross blue shield - tennesseePolicy N/A

Diagnostic Testing of Common Sexually Transmitted Infections

Defines coverage criteria, limitations, and clinical indications for laboratory testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (syphilis), herpes simplex virus (HSV-1/HSV-2), and human papillomavirus (HPV). Also addresses PrEP-related screening and notes tests/panels that are not covered.

Policy Summary

Payerblue cross blue shield - tennessee

PolicyDiagnostic Testing of Common Sexually Transmitted Infections

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionDocument indications (symptoms, risk status, pregnancy, assault, newborn) and use two-tiered treponemal/nontreponemal algorithms to support coverage when screening/diagnosing syphilis.

SourceLink

POLICY UPDATE CHANGES

No material clinical/coverage changes in this update.

5Pathogens covered (CT, NG, T. pallidum, HSV, HPV)

MultipleNAAT vs serology distinctions

PrEPPrEP monitoring recommended tests

>40Procedure codes listed

NAATPreferred method for CT/NG/HSV (lesions)

Coverage Summary

This policy defines coverage for diagnostic laboratory testing of common sexually transmitted infections — specifically Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (syphilis), herpes simplex virus (HSV‑1/HSV‑2), and human papillomavirus (HPV) — and addresses PrEP‑related monitoring. The policy status is CURRENT and the coverage stance is mixed: it prefers NAAT methods for CT/NG and lesion‑based NAAT/culture/PCR for HSV, supports guideline‑based serologic two‑tiered testing for syphilis, and restricts HPV testing to cancer‑related or age‑based cervical screening indications. PrEP monitoring (baseline and interval testing) is explicitly included in covered indications.

Key testing intervals/thresholds

Syphilis screening frequency (high-risk asymptomatic)Once a year

Syphilis screening frequency (HIV-positive men/MSM)Once every three months

Chlamydia/gonorrhea NAAT frequency on PrEP (MSM & individuals with child-bearing potential)Once every three months

HPV cervical screening interval (ages 30-65)

Policy Summary

Payerblue cross blue shield - tennessee

PolicyDiagnostic Testing of Common Sexually Transmitted Infections

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionDocument indications (symptoms, risk status, pregnancy, assault, newborn) and use two-tiered treponemal/nontreponemal algorithms to support coverage when screening/diagnosing syphilis.

SourceLink

On This Page

Once every five years

Medical-Necessity Criteria

Syphilis antibody testing - Medically Necessary

Antibody testing for syphilis infection MEETS COVERAGE CRITERIA in the following situations:

ALL of the following

ANY of the following (asymptomatic high-risk individuals, once a year): Asymptomatic person in a high-risk category: once a year assessment using either a 'standard' or 'reverse' algorithm that includes initial and confirmatory tests for any initial positive test (e.g., treponemal Ig test and nontreponemal Ig test).
Diagnosis of any person presenting with signs and/or symptoms of a syphilis infection.
Once every three months for HIV-positive men or men who have sex with men (MSM).
When a nontreponemal test is used as a test of cure (TOC) for a positive syphilis infection.

Syphilis antibody testing - Asymptomatic not high-risk

For asymptomatic individuals NOT belonging to a high-risk category, antibody screening for syphilis MEETS COVERAGE CRITERIA only in the following situations:

ANY of the following

As part of newborn screening.
As part of follow-up in a victim of sexual assault.

Syphilis PCR/NAAT

Tests that do not meet coverage criteria:

ANY of the following

Polymerase chain reaction (PCR) testing for syphilis DOES NOT MEET COVERAGE CRITERIA.
Nucleic acid amplification testing (NAAT) for syphilis DOES NOT MEET COVERAGE CRITERIA.

Chlamydia NAAT - Medically Necessary

NAAT for chlamydia MEETS COVERAGE CRITERIA in the following situations:

ANY of the following

Once a year assessment for any asymptomatic person in a high-risk category.once a year
See Note 3 for high-risk definitions.
Diagnosis of any person presenting with signs and/or symptoms of a chlamydial infection.
See clinical signs/symptoms definitions.
Diagnosis of any person with suspected lymphogranuloma venereum (LGV).
Refer positives to LGV-discriminatory NAAT as indicated.
At least three months after initial chlamydial diagnosis as a test of cure (TOC).

Chlamydia testing - Asymptomatic not high-risk

For asymptomatic individuals NOT belonging to a high-risk category, screening for chlamydia MEETS COVERAGE CRITERIA only in the following situations:

ANY of the following

As part of newborn screening.
As part of follow-up in a victim of sexual assault.

Chlamydia serology

Serologic testing not covered:

ANY of the following

Serology testing for chlamydia or LGV DOES NOT MEET COVERAGE CRITERIA.

Gonorrhea NAAT and culture

NAAT for gonorrhea MEETS COVERAGE CRITERIA in the following situations:

ANY of the following

Once a year assessment for any asymptomatic person in a high-risk category.once a year
See Note 3 for high-risk definitions.
Diagnosis of any person presenting with signs and/or symptoms of a gonorrheal infection.
See clinical signs/symptoms definitions.
As a test of cure (TOC) for treatment.
Follow guideline-specified timing per organism/site.
For individuals not responding to initial treatment, culture testing for N. gonorrhoeae to determine antimicrobial susceptibility MEETS COVERAGE CRITERIA.

Gonorrhea screening - Asymptomatic not high-risk

For asymptomatic individuals NOT belonging to a high-risk category, screening for gonorrhea MEETS COVERAGE CRITERIA only in the following situations:

ANY of the following

As part of newborn screening.
As part of follow-up in a victim of sexual assault.

Multitarget PCR for CT/NG

When both chlamydia and gonorrhea conditions are met:

ALL of the following

Multitarget PCR testing that targets only C. trachomatis and N. gonorrhoeae MEETS COVERAGE CRITERIA when individual meets conditions for both chlamydia and gonorrhea testing.
Targets must be limited to CT and NG.

HSV testing - lesion-based NAAT/culture

HSV testing coverage:

ANY of the following

For individuals with active genital ulcers or mucocutaneous lesions, NAAT for HSV-1 or HSV-2 MEETS COVERAGE CRITERIA.
Viral culture and PCR-based testing are preferred for patients presenting with active lesions; PCR has greatest sensitivity and specificity.
PCR is preferred as most sensitive.

HSV serology

Type-specific and general serologic testing coverage:

ANY of the following

Immunoassay testing for HSV-1 and/or nonspecific herpes simplex DOES NOT MEET COVERAGE CRITERIA.
Type-specific serologic testing for HSV-2 using glycoprotein G2 (gG2) test MEETS COVERAGE CRITERIA in the following situations: recurrent or atypical genital symptoms/lesions with negative HSV PCR or culture; clinical diagnosis of genital herpes with negative PCR/culture or without lab confirmation; when an individual's partner has genital herpes.
In asymptomatic individuals, screening for HSV-1 or HSV-2 DOES NOT MEET COVERAGE CRITERIA.

HPV testing - covered indications

Testing for HPV MEETS COVERAGE CRITERIA in the following situations:

ANY of the following

In diagnosis and/or assessment of cancer or cancer therapy (e.g., immunohistochemistry testing for p16 or NAAT testing for HPV).
Once every five years for women aged 30 to 65 years as part of cervical screening, per Avalon policy AHS-G2002.every 5 years
Ages 30-65 only.

HPV testing - not covered situations

Testing for HPV DOES NOT MEET COVERAGE CRITERIA in the following situations:

ANY of the following

To screen for oncogenic high-risk types (e.g., HPV-16 and HPV-18) as part of a general STD/STI screening process or panel for asymptomatic individuals.
As part of the diagnosis of anogenital warts.
To screen for low-risk types of HPV.
In the general population, either as part of a panel of tests or as an individual NAAT to determine HPV status.

PrEP-related testing (pre-initiation and during PrEP)

Prior to and during PrEP regimens, the following tests meet coverage criteria:

ALL of the following

Prior to beginning PrEP
- Serum creatinine and estimated creatinine clearance to determine baseline renal function.
- Antibody screening to confirm a baseline negative antibody result for HIV.
- Hepatitis B and/or Hepatitis C screening.
- Pregnancy testing.
During PrEP

Quantitative NAAT for microorganisms

Not covered due to lack of evidence:

ANY of the following

Using nucleic acid testing to quantify Chlamydia trachomatis DOES NOT MEET COVERAGE CRITERIA.
Using nucleic acid testing to quantify Neisseria gonorrhoeae DOES NOT MEET COVERAGE CRITERIA.
Using nucleic acid testing to quantify HSV-1 DOES NOT MEET COVERAGE CRITERIA.
Using nucleic acid testing to quantify HSV-2 DOES NOT MEET COVERAGE CRITERIA.
Using nucleic acid testing to quantify HPV DOES NOT MEET COVERAGE CRITERIA.

Testing modality and indication principles

Covered/appropriate testing approaches when clinical indications or screening criteria are met according to cited guideline sources:

ANY of the following

Use NAATs for screening and diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae; NAAT testing of first-catch urine or swab specimens is recommended. Test anatomic exposure sites for extragenital infections (rectal, pharyngeal).
Near-patient NAATs preferred over POCT antigen tests due to higher sensitivity.
Annual screening for chlamydia and gonorrhea in sexually active females aged <25 years and in older women at increased risk; screen men only in high-prevalence/high-risk settings per USPSTF and CDC.annual for females <25
Use NAAT-based point-of-care tests (e.g., GeneXpert) to enable rapid treatment and reduce over/under treatment in ED or POC settings.

Guideline-based testing indications and frequency (summarized)

Testing recommended per referenced organizations when criteria are met:

ANY of the following

Chlamydia screening: annual for sexually active females <=25 years; consider annual screening for sexually active males in high-prevalence settings; MSM: annual urethral and rectal screening, more frequent (every 3-6 months) for higher risk.annual or q3-6 months for higher risk
Gonorrhea screening: annual for sexually active females <=25 years; similar approach to chlamydia for MSM with urethral, rectal, pharyngeal testing as indicated; high-risk individuals tested more frequently (3-6 months).annual or q3-6 months for higher risk
Syphilis screening: recommended for sexually active adolescent and young adult MSM annually or every 3-6 months if high risk; pregnant women screened at first prenatal visit and rescreen at 28-32 weeks and at delivery if high risk.annual or q3 months for MSM

Not Covered / Experimental Tests

Tests that DO NOT MEET COVERAGE CRITERIA

Consolidated list of tests that DO NOT MEET COVERAGE CRITERIA and their stated rationales:

ref

Coding

Applicable/Referenced FDA-approved assays mentionedmixed

BD Onclarity HPV Assay	FDA-approved qualitative NAAT for cervical swabs identifying HPV 16, 18, 45 and other high-risk HPV types; indicated for specified age/cytology contexts per FDA labeling.
Cepheid Xpert CT/NG	FDA-approved NAAT for Chlamydia trachomatis and Neisseria gonorrhoeae for urogenital and extragenital specimens (urine, patient-collected vaginal swabs, endocervical, pharyngeal, rectal) performed on GeneXpert systems; rapid ~90-minute turnaround.

Referenced CPT/HCPCS procedure codes (general reference list)CPT/HCPCS

82565	Creatinine; blood.
82575	Creatinine; clearance.
84702	Gonadotropin, chorionic (hCG); quantitative.
84703	Gonadotropin, chorionic (hCG); qualitative.
86592	Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART).
86593	Syphilis test, non-treponemal antibody; quantitative.
86631	Antibody; Chlamydia.
86632	Antibody; Chlamydia, IgM.
86694	Antibody; herpes simplex, non-specific type test.
86695	Antibody; herpes simplex, type 1.

1–10 of 50

1/5

Proprietary/lab-specific codes referencedCPT/HCPCS

0064U	BioPlex 2200 Syphilis Total & RPR Assay (Bio-Rad Laboratories) - treponemal total and RPR immunoassay proprietary test.
0065U	BioPlex 2200 RPR Assay (Bio-Rad Laboratories) - syphilis non-treponemal immunoassay (RPR).
0096U	HPV High-Risk, Male Urine proprietary test (Molecular Testing Labs/Roche Cobas) for high-risk HPV types in male urine.
0167U	ADEXUSDx hCG Test (NOWDiagnostics) - hCG immunoassay with direct optical observation (proprietary).
0210U	BioPlex 2200 RPR Assay - Quantitative (Bio-Rad Laboratories) proprietary quantitative non-treponemal RPR immunoassay.

Provider Actions and Billing Guidance

Documentation Required

Use of two-tiered serologic algorithm for syphilis

When screening or diagnosing syphilis, use a two-tiered serologic algorithm (standard or reverse) that includes both treponemal and nontreponemal testing. Document the clinical indication for testing (symptoms, high‑risk status, pregnancy, sexual assault, newborn) to support coverage.

Prior Authorization

Coverage dependent on member benefits

Coverage of requested tests depends on the member's specific benefits. Verify the member's plan benefits and applicable Medicare/Medicaid specifications (LCD/NCD or state Medicaid rules) prior to ordering or billing.

Billing Rule

Use appropriate FDA-approved assay per indication

Order and bill assays consistent with FDA indications and the clinical scenarios described in this policy. Use FDA‑approved assays for their indicated specimen types and indications (for example, BD Onclarity per its cervical/cytology indications and Cepheid Xpert CT/NG for FDA‑cleared specimen types). Follow manufacturer instructions and applicable indications when selecting assays to bill.

Documentation Required

PrEP monitoring schedule

For persons on PrEP document baseline and interval monitoring as specified: baseline HIV antigen/antibody testing, serum creatinine/estimated creatinine clearance, hepatitis B/C screening, and pregnancy testing. During PrEP document HIV testing every 3 months, serum creatinine at 3 months then per schedule, pregnancy testing every 3 months as indicated, and NAAT screening for gonorrhea and chlamydia at anatomic exposure sites at the required intervals (eg, every 3 months for MSM and individuals with childbearing potential, then per guidance).

Baseline: HIV antigen/antibody, serum creatinine/estimated creatinine clearance, HBV/HCV screening, pregnancy test
During PrEP: HIV test every 3 months
Renal function: at 3 months, then per schedule (once every 6 months thereafter as indicated)
NAAT site-based screening for CT/NG per anatomic exposure and PrEP schedule (eg, every 3 months for MSM/childbearing potential)

Documentation Required

Reflex testing for syphilis algorithms

Follow reflex testing procedures for syphilis algorithms: if a treponemal test is positive, perform reflex quantitative nontreponemal testing on the same serum; if a nontreponemal test is positive, perform reflex treponemal testing on the same serum; when both TT and NTT are used, ensure the NTT is quantitative when positive or discrepant.

Documentation Required

Use of NAATs and specimen site selection

Collect NAAT specimens from the anatomic sites that correspond to reported exposures and per manufacturer/CLIA/FDA guidance: first‑catch urine, clinician‑ or patient‑collected vaginal/endocervical swabs, urethral swabs, rectal swabs, and pharyngeal swabs. Document the exposure sites and ensure specimen type is consistent with the assay's validated/FDA‑cleared or locally validated uses.

Billing Rule

POCT/near-patient NAAT use

Point‑of‑care or near‑patient NAATs (eg, GeneXpert/Cepheid) may be used to enable same‑day treatment and improved management. Ensure tests are used for manufacturer‑cleared specimen types; for extragenital uses that are not FDA‑cleared, laboratories must perform local CLIA validation and follow manufacturer instructions before billing.

POCT/near‑patient NAATs can facilitate same‑day treatment and reduce overtreatment
Local CLIA validation required for non‑FDA‑cleared extragenital specimen use

Documentation Required

HSV serology limited use

Do not perform routine HSV serologic screening in asymptomatic patients. Reserve type‑specific serology for indicated scenarios (pregnancy evaluation, partner evaluation, recurrent or atypical disease, or when PCR/culture is negative but clinical suspicion persists).

Documentation Required

Specimen and test selection documentation

Document sexual exposure history (eg, receptive oral/anal intercourse, urethral exposure) and the chosen specimen source (urine, vaginal/cervical swab, pharyngeal swab, rectal swab, lesion fluid) to justify NAAT, culture, PCR, or serologic testing per guidelines and assay indications.

Documentation Required

Follow-up testing documentation

Document clinical reasons for follow‑up culture or repeat testing when indicated: test‑of‑cure, suspected antimicrobial resistance, pregnancy, uncertain compliance, persistent symptoms, pharyngeal/rectal infection, or disseminated disease. Follow guideline‑specific timing for TOC and susceptibility testing (eg, gonorrhea culture for susceptibility; NAAT or culture timing per guidance).

Gonorrhea: culture for susceptibility when treatment failure suspected; TOC timing per guidance
Chlamydia/Gonorrhea: retest at ~3 months after treatment when indicated
Pharyngeal gonorrhea: follow-up NAAT ~14 days or culture 3–7 days as indicated

Billing Rule

Procedure code use for proprietary tests

Report the following proprietary CPT codes when using the referenced manufacturer/lab assays as listed in this policy.

0064U
0065U
0096U
0167U
0210U

Documentation Required

Medico-legal confirmation

For medico‑legal cases (such as sexual assault), obtain cultures of cervical or urethral specimens and/or confirm NAAT positives with an alternate method (different primer set, DNA sequencing, or culture) per guideline recommendations. Document the confirmatory method and chain‑of‑custody/medico‑legal justification.

Prior Authorization

Check government/local coverage conflicts

If a government or local coverage determination (LCD/NCD or state Medicaid) conflicts with this policy for a given member, follow the applicable government policy. Verify Medicare and state Medicaid coverage prior to ordering or billing.

Background and Evidence

Chlamydia and gonorrhea are common bacterial STIs in the U.S.; untreated infections can cause pelvic inflammatory disease (PID), infertility, pregnancy complications, neonatal infection, urethritis, proctitis, and other sequelae. NAAT is the gold standard for CT and NG due to high sensitivity and specificity and is recommended on first‑catch urine or appropriate swab specimens including extragenital sites; culture remains important for NG when antimicrobial susceptibility testing is needed. (CDC/IUSTI/BASHH guidance and studies support near‑patient NAATs and the Cepheid Xpert CT/NG platform for rapid diagnosis and same‑day treatment.)

Syphilis, caused by Treponema pallidum, can be asymptomatic or progress to serious cardiac and neurologic disease and can be transmitted congenitally; maternal screening and repeat testing in pregnancy are public‑health priorities. The standard diagnostic approach is a two‑tiered serologic algorithm using treponemal and nontreponemal tests (TT and quantitative NTT such as RPR/VDRL) with reflex testing rules (eg, reflex quantitative NTT for positive TT). Direct detection (darkfield, PCR) can confirm early lesion‑based disease but NAAT/PCR for T. pallidum is not a routine covered replacement for serology.

HSV infections are common and often asymptomatic; vertical transmission risk exists with primary infection near delivery. For patients with active genital or mucocutaneous lesions, viral culture or NAAT/PCR of lesion material is preferred (PCR has greatest sensitivity/specificity). Routine HSV serologic screening in asymptomatic individuals is not recommended; type‑specific serology (gG2) has limited, defined indications (eg, recurrent atypical lesions with negative PCR/culture, partner with genital herpes, or clinical counseling).

HPV is the most common anogenital viral infection and is linked to multiple cancers. HPV NAAT and p16 IHC are supported only for diagnostic/cancer assessment or per cervical cancer screening guidelines (eg, women aged 30–65: HPV testing alone every 5 years or cotesting per guidelines). The BD Onclarity HPV Assay is an FDA‑approved PCR‑based NAAT example for cervical specimens; FDA‑cleared NAATs (eg, Cepheid Xpert CT/NG) are cited for CT/NG detection across specimen types.

Evidence/Measure	Value
Trep-Sure EIA performance
Sensitivity 98.0%, Specificity 98.6% (Wong et al., 2011)
TPPA assay
Sensitivity 87.1%, Specificity 100% (Juarez-Figueroa et al., 2007)
USPSTF HSV-2 serology pooled estimates
Sensitivity 99%, Specificity 81% at manufacturer's cutpoint; high false-positive rate in general population (Feltner et al., 2016)
POCT sensitivity for chlamydia (pooled)
Sensitivity: 53% cervical, 37% vaginal, 63% male urine; Specificity 97-99% (Kelly et al., 2017)
Near-patient NAAT sensitivity
>98% sensitivity and 99.4% specificity across sample types (Kelly et al., 2017)
Xpert CT/NG agreement vs APTIMA (extragenital)
Rectal CT pooled positive agreement 89.72% and negative agreement 99.23%; similar performance with faster turnaround (Bristow et al., 2019)
Syphilis PCR sensitivity/specificity
PCR sensitivity 68% and specificity 99% vs serology sensitivity 97% (Brischetto et al., 2018)
HerpeSelect pooled serology
Sensitivity 99%, Specificity 81% (Feltner et al., 2016)
Guideline concordance
Multiple national/international guidelines cited (CDC, USPSTF, NCCN, BASHH, CPS, IUSTI, NICE, etc.)
NAAT performance (general)
NAATs approach high sensitivity and specificity and are preferred for genital and extragenital CT/NG testing
Reference count (approx)
40+ citations referenced in policy

Definitions

High‑risk for Syphilis: includes MSM, sexually active HIV‑positive persons, partners recently diagnosed with an STI, exchange of sex for money or drugs, incarceration, and specific pregnancy risk factors (eg, multiple partners, late/no prenatal care, substance use).

High‑risk for Chlamydia/Gonorrhea: includes MSM, sexually active HIV‑positive persons, sexually active women <25 years, women ≥25 with multiple partners, partners recently diagnosed with an STI, prior or concurrent STI, and exchange of sex for money or drugs.

TOC (Test of Cure): a follow‑up diagnostic test performed after treatment to confirm eradication of infection (for example, chlamydia/gonorrhea retest at ~3 months; gonorrhea test‑of‑cure timing per guidelines).

NAAT (Nucleic Acid Amplification Test): a molecular assay that detects pathogen DNA or RNA; preferred method for diagnosing CT and NG and for lesion‑based HSV testing due to superior sensitivity and specificity.

TT (Treponemal Test): treponemal assays for syphilis such as TPHA, TPPA, EIA/ELISA/CLIA, used in two‑tiered serologic algorithms.

NTT (Nontreponemal Test): assays like RPR or VDRL that detect non‑treponemal antibodies and are often quantitative to assess disease activity and response to therapy.

MSM: men who have sex with men.

LGV (Lymphogranuloma venereum): an invasive C. trachomatis infection; diagnosis requires initial NAAT detection of C. trachomatis followed by LGV‑discriminatory NAAT on the same specimen.

Culture required for susceptibility testing/resistance concerns.

Blood test once every three months to confirm a negative antibody result for HIV.every 3 months

Serum creatinine and estimated creatinine clearance three months after beginning PrEP and up to one time every six months thereafter.3 months then q6 months

i) Once every three months for MSM and for individuals with child-bearing potential; ii) Nine months after PrEP is initiated and once every six months thereafter for sexually active individuals.

NAAT screening for gonorrhea and chlamydia based on anatomic site of exposure:

Once every three months for MSM and for individuals with child-bearing potential; nine months after initiation then every six months for sexually active individuals.

Blood test to screen for syphilis once every three months in MSM and individuals with childbearing potential.every 3 months for MSM and those with childbearing potential

Pregnancy testing once every three months.every 3 months

Using nucleic acid testing to quantify Treponema pallidum DOES NOT MEET COVERAGE CRITERIA.

For suspected syphilis, a presumptive diagnosis requires two serologic tests: a nontreponemal test (RPR or VDRL) and a treponemal test (TP-PA, EIA/ELISA/CLIA).

If TT used alone and positive, perform reflex quantitative NTT; if NTT used alone and positive, perform reflex TT; ensure NTT is quantitative when both used.

Direct detection methods (darkfield exam, PCR) provide definitive diagnosis of syphilis; PCR preferred for oral and contaminated sites; darkfield largely not recommended for routine diagnosis.

HSV diagnosis: HSV DNA detection (NAAT/PCR) is gold standard for diagnosis; serologic testing not routinely recommended in asymptomatic patients but useful in specific scenarios (pregnancy, partner with HSV, recurrent/atypical disease).

HPV testing: for cervical cancer screening, use cytology and/or HPV testing per age-based guidelines (30-65 years: cytology every 3 years, HPV test alone every 5 years, or cotest every 5 years); do not use HPV testing as general STI test or for men.

For LGV: use a two-step approach — commercial NAAT to detect C. trachomatis DNA/RNA, then LGV-discriminatory NAAT on the same specimen when positive.

HSV: Do not test asymptomatic patients routinely; for genital lesions, use NAAT or culture on lesion fluid; type-specific serology may be used for counseling/management.

HPV: HPV testing recommended as part of cervical cancer screening for women >=30 years (co-testing every 5 years or cytology every 3 years per CDC/NCCN); HPV testing not recommended for asymptomatic men or for anogenital wart diagnosis.every 5 years for ages 30-65

LGV: Test symptomatic individuals using NAAT for C. trachomatis and refer positives to LGV-discriminatory NAAT; HIV-positive men with chlamydia should be tested for LGV even if asymptomatic.

Use NAATs for genital and extragenital chlamydia/gonorrhea when available; culture preferred for gonorrhea pharyngeal/rectal specimens and when antimicrobial susceptibility testing is required.

Test-of-cure timing: Chlamydia/gonorrhea retest at 3 months after treatment for those who tested positive; gonorrhea test-of-cure via culture 3-7 days or NAAT 2-3 weeks post-treatment in specified situations (resistance concern, second-line therapy, uncertain compliance, pregnancy, persistent symptoms, pharyngeal/rectal infection, disseminated disease).3 months or 3-7 days/2-3 weeks as specified

Syphilis diagnostic approach: use treponemal-specific screening assay followed by a second treponemal test for confirmation; perform quantitative RPR or VDRL when screening tests are positive; repeat serology per stage-specific intervals.

For suspected chancres, perform dark-field microscopy or PCR where expertise available; PCR appropriate on lesions where organism expected.

OpenPayer

Diagnostic Testing of Common Sexually Transmitted Infections

Coverage Summary

Medical-Necessity Criteria

Not Covered / Experimental Tests

Coding

Provider Actions and Billing Guidance

Background and Evidence

Definitions

Revision History