STI Testing for Transgender and Nonbinary People: Which Sites to Test

Short answer: Test the body sites that were involved in sex, based on your current anatomy. CDC's STI Treatment Guidelines tell clinicians to assess risk and screen based on a person's current anatomy and sexual practices, and to screen at the body sites that were exposed (CDC).

Testing can feel more complicated than it should when you're transgender or nonbinary. Forms assume one set of organs. Clinicians may guess wrong about what sex you have. And some people avoid care altogether after a bad experience. The good news: the medical logic is simple. Tests follow anatomy and exposure. Once you know that, you can ask for exactly what you need.

Anatomy and behavior, not gender markers

CDC's guidelines for transgender and gender-diverse people say providers need to know a patient's current anatomy and sexual behaviors before counseling on STI and HIV prevention, and that screening should be based on anatomy and sexual practices (CDC). The same guidance notes that most transgender women haven't had genital surgery, and that anatomy among transgender men varies. That matters because a chart that lists "F" or "M" doesn't tell a lab whether you have a cervix, a prostate, a neovagina, or a phalloplasty.

In practice, this means:

• CDC says the yearly chlamydia and gonorrhea screening recommended for sexually active people under 25 with a cervix extends to trans men and nonbinary people with a cervix.
• Recommendations tied to receptive anal sex apply to anyone who has it.
• Throat testing applies to anyone who gives oral sex, when chlamydia or gonorrhea testing is indicated.

You don't need to share more than is useful. "Here's what I have, and here's what I do" is enough.

Site-by-site testing for chlamydia and gonorrhea

Chlamydia and gonorrhea can infect the throat, rectum and genitals separately. A urine test only checks the urethra or genital area. CDC's screening recommendations describe testing at each site of exposure for some groups.

For more on how each sample works, see our guide to chlamydia and gonorrhea sample types and our rectal STI testing guide.

After gender-affirming surgery

Surgery changes anatomy, so it can change which samples make sense. CDC's guidance is limited in places because research is still catching up. Here's what it says:

• Vaginoplasty: CDC says trans women who've had vaginoplasty should be screened at all exposed sites. It notes that no data show whether urine or a neovaginal swab works better, so ask how your clinician plans to sample and why. The type of tissue used in surgery can also affect screening, so share what kind of procedure you had. Without a cervix, CDC says there's no reason for cervical cancer screening.
• Metoidioplasty: If you've had metoidioplasty with urethral lengthening and still have a vagina and cervix, CDC says a cervical swab is needed, because urine isn't adequate for detecting cervical infections.
• Still have a cervix: Cervical cancer screening follows current guidelines (USPSTF). CDC notes that testosterone can thin vaginal tissue, which can make it harder to collect a good sample, and that self-collected HPV swabs are reported to be acceptable. Tell the clinician if you take testosterone.

HIV screening, PrEP, and blood tests

CDC's guidelines say HIV screening should be offered to all transgender people, with repeat testing based on your level of risk (CDC). More broadly, CDC recommends that everyone 13 to 64 get tested for HIV at least once, and that people with ongoing risk get tested at least once a year (CDC). Syphilis is also a blood test, so it can be drawn at the same time. These blood tests don't depend on anatomy, which makes them the simplest part of the plan.

If you could be exposed to HIV, PrEP is a highly effective prevention option. PrEP care includes regular HIV and STI testing, which our PrEP STI testing schedule explains. Our sister site FreePrEP.org covers free and low-cost ways to get PrEP.

How to ask for affirming care

You deserve care that uses your name and pronouns and doesn't make assumptions. If you're not sure how a clinic will respond, you can call ahead or open the visit with a clear request:

If you need to correct an assumption:

Places to look for affirming testing:

• Local and state health departments, which often run sexual health clinics.
• LGBTQ community health centers in many cities.
• CDC's GetTested finder, which lists HIV and STI testing sites by ZIP code.

Using online and at-home tests

Ordering tests online can feel easier than explaining yourself in person. A few things to know first:

• Check the sample types. Many online panels are urine plus blood. They won't test your throat or rectum, and they may not be set up for a neovagina.
• Sex fields on forms. Some services ask for sex assigned at birth or a legal sex on the order. CDC actually recommends that clinics record both gender identity and sex assigned at birth. If a form isn't clear about why it asks or how it's used, read the provider's FAQ or contact them before you order.
• Blood tests travel well. HIV and syphilis blood tests don't depend on anatomy, so they're a good fit for online ordering.

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A simple testing plan

1. List your current anatomy and any surgeries.
2. List the body sites involved in sex since your last test: throat, rectum, genitals.
3. Ask for blood tests for HIV and syphilis, and hepatitis if you haven't been screened.
4. Ask for swabs or urine for each exposed site.
5. Keep up with cervical screening if you have a cervix.
6. Repeat on a schedule that fits your partners, or every few months if you're on PrEP.

Disclaimer: This article is for informational purposes only and does not diagnose, prescribe, or replace individualized medical care. Testing and treatment decisions should be made with a qualified healthcare provider. Some links on this page are affiliate links; we may earn a commission at no extra cost to you.