Michael L. LeFevre, MD, MSPH; on behalf of the U.S. Preventive Services Task Force *
Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Financial Support: The USPSTF is an independent, voluntary body. The U.S. Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF.
Disclosures: Dr. Gillman reports royalties from UpToDate and Cambridge University Press outside the submitted work. Authors not named here have disclosed no conflicts of interest. Authors followed the policy regarding conflicts of interest described at www.uspreventiveservicestaskforce.org/methods.htm. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1981.
Requests for Single Reprints: Reprints are available from the USPSTF Web site (www.uspreventiveservicestaskforce.org).
Update of previous U.S. Preventive Services Task Force (USPSTF) recommendations on screening for chlamydia (2007) and gonorrhea (2005).
The USPSTF reviewed the evidence on screening for chlamydial and gonococcal infections in asymptomatic patients from studies published since its last reviews. The USPSTF also considered evidence from its previous recommendations and reviews.
This recommendation applies to all sexually active adolescents and adults, including pregnant women.
The USPSTF recommends screening for chlamydia in sexually active females aged 24 years or younger and in older women who are at increased risk for infection. (B recommendation)
The USPSTF recommends screening for gonorrhea in sexually active females aged 24 years or younger and in older women who are at increased risk for infection. (B recommendation)
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men. (I statement)
Screening for chlamydia and gonorrhea: clinical summary of U.S. Preventive Services Task Force recommendation.
Appendix Table 1. What the USPSTF Grades Mean and Suggestions for Practice
Appendix Table 2. USPSTF Levels of Certainty Regarding Net Benefit
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Department of General Practice, University Hospital, 6K3, De Pintelaan 185, 9000 Gent, Belgium
January 14, 2015
To think about Chlamydia in low prevalent settings (and confirmation of a positive test?)
Dear editor,In your excellent article on screening for Chlamydia (1), the USPSTF concludes that screening can accurately detect chlamydia and is associated with benefit in different groups. We have one further question. In the Belgian guideline for general practitioners (2) it is stated that in case of low pre-test probability and/or absence of positive anamnesis, a positive result should be confirmed. This is not mentioned in the article.The need for confirmation in the Belgian guideline - especially when there are no anamnestic arguments for infection or in a mild or nonspecific complaint for example some intermenstrual bleeding, postcoïtal bleeding, persistent dysuria... - is because of the psychological impact of a positive result.The USPSTF (1) identified several published studies that describe some of the psychosocial harms of testing, such as anxiety and strain on relationships. As mentioned in the guideline, these studies did not meet inclusion criteria because they included symptomatic persons and focused on reactions to positive test results rather than screening. No studies addressing other harms for example, labeling or screening-related anxiety met inclusion criteria.NAAT‐based assays are sensitive for detecting chlamydia nucleic acid, but are unable to distinguish between viable and non‐viable organism thereby overestimating load? (3)Existing NAATtests are sensitive and specific but in low prevalence populations with lower positive predictive values, the need for confirmation remains because of the risk of false positives? (4)(5)email@example.com. LeFevre ML; U.S. Preventive Services Task Force. Screening for Chlamydia and gonorrhea: U.S. Preventive services task force recommendation statement. Ann Intern Med. 2014 Dec 16;161(12):902-10. doi: 10.7326/M14-1981.2. http://www.domusmedica.be/documentatie/richtlijnen/overzicht.html. Chlamydia trachomatis in general practice. Verhoeven V, Avonts D, Peremans L. 2004/02. In Dutch.3. Vodstrcil LA, McIver R, Huston WM, The epidemiology of organism load in genital Chlamydia trachomatis infection - a systematic review. J Infect Dis. 2014 Dec 9. pii: jiu670. [Epub ahead of print].4. Hocking JS, Guy R, Walker J, Tabrizi SN. Advances in sampling and screening for chlamydia. Future Microbiol. 2013 Mar;8(3):367-86. doi: 10.2217/fmb.13.3. Review. 5. Hadgu A, Dendukuri N, Wang L. Evaluation of screening tests for detecting Chlamydia trachomatis. Epidemiology. 2012;23:72–82.
LeFevre ML, on behalf of the U.S. Preventive Services Task Force. Screening for Chlamydia and Gonorrhea: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2014;161:902–910. doi: 10.7326/M14-1981
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Published: Ann Intern Med. 2014;161(12):902-910.
Guidelines, Infectious Disease, Prevention/Screening, Sexually Transmitted Infections.
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