STI Testing in Philadelphia

STI testing in Philadelphia should be easy: confidential, quick, no judgment, and integrated into ongoing care. Most clinics make it harder than it needs to be.

Standard STI panel

For sexually active adults, the standard panel includes:

• HIV (fourth-generation antibody/antigen test, detectable in most patients within 2-4 weeks).
• Syphilis (treponemal and non-treponemal serology, detectable around 3-6 weeks).
• Gonorrhea and chlamydia (NAAT urine for men, NAAT cervical or self-collected vaginal swab for women, throat and rectal swabs for relevant exposures).
• Hepatitis B surface antigen and surface antibody.
• Hepatitis C antibody (one-time screening recommended for all adults).

Additional testing by indication

• Trichomoniasis for women with symptoms or partner notification.
• HSV-2 IgG generally not recommended for asymptomatic screening; tested when symptoms suggest.
• HPV testing as part of cervical cancer screening per current guidelines.
• Pharyngeal and rectal gonorrhea/chlamydia for relevant exposure patterns.
• Mpox when clinical features suggest.

Window periods

The interval between exposure and reliable detection:

• HIV (4th-gen test): Usually detectable 2-4 weeks. Confirmation extends to 3 months for some assays.
• Syphilis: Detectable 3-6 weeks; re-test if exposure within 90 days and initial negative.
• Gonorrhea and chlamydia: Detectable 1-2 weeks.
• Hepatitis C: Antibody detectable 4-10 weeks; PCR if recent exposure suspected.
• Hepatitis B: Detectable 4-10 weeks.

Pre-exposure prophylaxis (PrEP)

For patients at meaningful risk of HIV, PrEP (daily tenofovir-emtricitabine, or 2-month injectable cabotegravir) substantially reduces risk. Prescribing PrEP requires baseline HIV testing, kidney function, hepatitis B status, and ongoing every-3-month follow-up.

We discuss PrEP with patients for whom it makes sense.

Treatment of positive results

• Chlamydia: Doxycycline 100 mg twice daily for 7 days (preferred), or single-dose azithromycin in some cases.
• Gonorrhea: Ceftriaxone 500 mg IM single dose, plus doxycycline if chlamydia not ruled out.
• Syphilis: Penicillin G IM (single dose for primary/secondary; weekly for 3 weeks for late latent).
• Trichomoniasis: Metronidazole.
• HIV: Refer to HIV specialty for ART initiation.

Partner notification is part of treatment. Expedited partner therapy (EPT) for gonorrhea and chlamydia is allowed in Pennsylvania for sexual partners who cannot be evaluated.

How STI testing works at Fishtown Medicine

For members, message to schedule. We do testing same day if needed. Results in 1-3 days. We discuss results by message or video. Treatment for positive results is same day.

Confidentiality is maintained throughout. Testing through your insurance may show up on an explanation of benefits; we discuss this openly and offer cash-pay options when confidentiality matters.

For non-members, the Philadelphia Department of Public Health offers free STI testing at multiple sites. We support that option for patients for whom it is the right fit.

What it costs

For members, STI testing visits are included in the membership. Lab fees are billed separately - typically modest with insurance, $50-150 self-pay for a basic panel.

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