Bernadette Zakher, MBBS; Amy G. Cantor, MD, MHS; Miranda Pappas, MA; Monica Daeges, BA; Heidi D. Nelson, MD, MPH
Disclaimer: The findings and conclusions in this article are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this article should be construed as an official position of AHRQ or the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank Andrew Hamilton, MLS, MS, Oregon Health & Science University, who conducted literature searches for this systematic review. They also thank AHRQ Medical Officer Karen Lee, MD, MPH, and the USPSTF Leads Linda Baumann, PhD, RN; Kirsten Bibbins-Domingo, PhD, MD, MAS; Francisco Garcia, MD, MPH; and Michael LeFevre, MD, MSPH.
Grant Support: By AHRQ (contract HSSA 290-2007-10057-I).
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1022.
Corresponding Author: Heidi D. Nelson, MD, MPH, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Mailcode BICC, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Zakher, Cantor, and Nelson; Ms. Pappas; and Ms. Daeges: Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Mailcode BICC, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098.
Author Contributions: Conception and design: B. Zakher, A.G. Cantor, M. Pappas, H.D. Nelson.
Analysis and interpretation of the data: B. Zakher, A.G. Cantor, M. Pappas, H.D. Nelson.
Drafting of the article: B. Zakher, A.G. Cantor, M. Pappas, H.D. Nelson.
Critical revision of the article for important intellectual content: B. Zakher, A.G. Cantor, M. Pappas, H.D. Nelson.
Final approval of the article: B. Zakher, A.G. Cantor, M. Pappas, H.D. Nelson.
Provision of study materials or patients: H.D. Nelson.
Statistical expertise: H.D. Nelson.
Obtaining of funding: H.D. Nelson.
Administrative, technical, or logistic support: M. Pappas, M. Daeges, H.D. Nelson.
Collection and assembly of data: B. Zakher, A.G. Cantor, M. Pappas, M. Daeges, H.D. Nelson.
Zakher B, Cantor AG, Pappas M, Daeges M, Nelson HD. Screening for Gonorrhea and Chlamydia: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2014;161:884-893. doi: 10.7326/M14-1022
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Published: Ann Intern Med. 2014;161(12):884-893.
Previous research has supported screening for gonorrhea and chlamydia in asymptomatic, sexually active women (including pregnant women) who are younger than 25 years or at increased risk but not in other patient populations.
To update the 2005 and 2007 systematic reviews for the U.S. Preventive Services Task Force on screening for gonorrhea and chlamydia in men and women, including pregnant women and adolescents.
MEDLINE (1 January 2004 to 13 June 2014), Cochrane databases (May 2014), ClinicalTrials.gov, and reference lists.
English-language trials and observational studies about screening effectiveness, test accuracy, and screening harms.
Extracted study data were confirmed by a second investigator, and study quality and applicability were dual-rated using prespecified criteria.
Screening a subset of asymptomatic young women for chlamydia in a good-quality trial did not significantly reduce the incidence of pelvic inflammatory disease over the following year (relative risk, 0.39 [95% CI, 0.14 to 1.08]); however, 1 previous trial reported a reduction. An observational study evaluating a risk prediction tool to identify persons with chlamydia in high-risk populations had low predictive ability and applicability. In 10 new studies of asymptomatic patients, nucleic acid amplification tests demonstrated sensitivity of 86% or greater and specificity of 97% or greater for diagnosing gonorrhea and chlamydia, regardless of specimen type or test.
There were few relevant studies of screening benefits and harms. Only screening tests and methods cleared by the U.S. Food and Drug Administration for current clinical practice were included to determine diagnostic accuracy.
Chlamydia screening in young women may reduce the incidence of pelvic inflammatory disease. Nucleic acid amplification tests are accurate for diagnosing gonorrhea and chlamydia in asymptomatic persons.
Agency for Healthcare Research and Quality.
Table 1. Summary of Evidence
Table 2. Diagnostic Accuracy Studies (2004–2013) of Nucleic Acid Amplification Tests for Gonorrhea and Chlamydia Screening
Diagnostic accuracy of nucleic acid amplification tests for gonorrhea screening in men and women.
* The study reporting lower sensitivities for urine specimens in women (78.6% and 82.1%) used urine volumes that were larger than recommended (25), differing from the other studies.
† Two studies produced identical data points for tests of the endocervix.
‡ Three data points for urethral specimens and 3 data points for urine specimens.
§ Two data points for urethral specimens.
Diagnostic accuracy of nucleic acid amplification tests for chlamydia screening in men and women.
* The study reporting lower sensitivities for urine specimens in women (72.0% and 84.0%) experienced technical and specimen-processing errors (27), differing from the other studies.
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