Screening Adolescents for STI

Is it time to test? 

“Though teen birth rates have declined in recent years, STIs are increasing among Texas youth.”

Healthy Futures of Texas, 2026

Check your knowledge

Taylor

16 years

Taylor, accompanied by his mother, is in your office for his 16-year Texas Health Steps preventive medical checkup. Before you begin the examination, you talk with Taylor and his mother for a few minutes to assess their areas of concern. The mother shares that Taylor maintains a busy schedule with school, athletics and his new girlfriend. Taylor remains silent and looks uncomfortable as his mother talks about his girlfriend. You make a note to follow up with Taylor when you speak privately with him as you check the required screenings to be conducted during the checkup.

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What is the recommended approach during this visit to assess Taylor for the presence of a sexually transmitted infection (STI)?

Sexual health screening is not recommended at preventive health visits unless a complaint is noted.

This answer is incorrect.

Sexual health screening and risk assessment are part of Texas Health Steps preventive medical checkups for adolescents. Best practice and Texas Health Steps guidance support private adolescent-provider conversations during preventive medical checkups. Speaking privately with an adolescent may improve disclosure of sexual activity and risk behaviors and promote appropriate STI screening, counseling and preventive care.

Conduct sexual health screening with the parent present.

This answer is incorrect.

Conduct sexual health screening with the patient privately, without the parent present.

This answer is correct.

Sexual health screening and risk assessment are part of Texas Health Steps preventive medical checkups for adolescents. Best practice and Texas Health Steps guidance support private adolescent-provider conversations during preventive medical checkups. Speaking privately with an adolescent may improve disclosure of sexual activity and risk behaviors and promote appropriate STI screening, counseling and preventive care.

Screening is not recommended, but you should ask whether the patient is experiencing symptoms of STIs.

This answer is incorrect.

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During your private discussion, Taylor reports being sexually active with his girlfriend and says they have used condoms inconsistently. Taylor denies STI symptoms and states, “I feel fine.”

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Based on Taylor’s responses, should you order STI screening/testing?

No. Taylor has no symptoms, so STI testing is unnecessary.

This answer is incorrect.

Sexually active adolescents may have STIs even in the absence of symptoms. Risk-based STI screening is an important component of adolescent preventive care and supports early identification and treatment. Many STIs, including chlamydia, are frequently asymptomatic in adolescents. Appropriate screening should be considered based on the patient’s age, sexual history, gender, risk factors, and current clinical guidelines.

An HIV test should be conducted at this visit as required by the Texas Health Steps periodicity schedule.

Yes. Risk-based STI screening should be performed even if the patient is asymptomatic.

This answer is correct.

Sexually active adolescents may have STIs even in the absence of symptoms. Risk-based STI screening is an important component of adolescent preventive care and supports early identification and treatment. Many STIs, including chlamydia, are frequently asymptomatic in adolescents. Appropriate screening should be considered based on the patient’s age, sexual history, gender, risk factors, and current clinical guidelines.

An HIV test should be conducted at this visit as required by the Texas Health Steps periodicity schedule.

Yes. However, only HIV testing is required at this visit.

This answer is partially correct.

HIV testing should also be conducted at this visit as required by the Texas Health Steps Periodicity Schedule. 

However, sexually active adolescents may have STIs even in the absence of symptoms. Risk-based STI screening is an important component of adolescent preventive care and supports early identification and treatment. Many STIs, including chlamydia, are frequently asymptomatic in adolescents. Appropriate screening should be considered based on the patient’s age, sexual history, gender, risk factors, and current clinical guidelines.

No. STI testing should be delayed until Taylor reaches age 18 years.

This answer is incorrect.

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The Texas Health Steps Periodicity Schedule requires risk-based screening and testing at every preventive medical checkup for adolescents ages 11 through 20 years. An HIV test is required at the 16-year preventive medical checkup or at a subsequent checkup if it has not yet been performed. Risk-based HIV testing can be performed when one of the following risk factors is identified:

• Exposure or potential exposure as a result of abuse, sexual activity or intravenous drug use
• History of an STI
• Transmission from mother to child 

Keep up with adolescent health risks and Texas Health Steps Periodicity Schedule requirements and screening tools by consulting the Texas Health Steps Online Provider Education course catalog and Tools & Resources page.

References

Centers for Disease Control and Prevention. (2025). Sexually Transmitted Infections Surveillance, 2024 (Provisional). 

Healthy Futures of Texas. (2026). STI Data Explorer.

Texas Health and Human Services. (2021). Texas Health Steps Periodicity Schedule.