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Screening for Chlamydia and Gonorrhea: U.S. Preventive Services Task Force Recommendation Statement FREE

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This article was published online first at www.annals.org on 23 September 2014.


The full report is titled “Screening for Chlamydia and Gonorrhea: U.S. Preventive Services Task Force Recommendation Statement.” It is published in the 16 December 2014 issue of Annals of Internal Medicine (volume 161, pages 902-910). The author is M.L. LeFevre, on behalf of the U.S. Preventive Services Task Force.


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Ann Intern Med. 2014;161(12):I-30. doi:10.7326/P14-9042
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Who developed these guidelines?

The U.S. Preventive Services Task Force (USPSTF) developed these recommendations. The USPSTF is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Chlamydia and gonorrhea are the most commonly reported sexually transmitted infections (STIs) in the United States. Risk factors include young age, new or multiple sex partners, a sex partner with an STI, inconsistent condom use in a relationship that is not mutually monogamous, history of STI, and exchanging sex for money or drugs.

These infections can cause discharge from the vagina or penis, pain with urination, or abdominal pain. However, some people with chlamydia or gonorrhea have no symptoms. Treatment with antibiotics relieves symptoms, stops the spread of infection to others, and prevents complications. In women, these infections can cause difficulties in becoming pregnant (infertility), ectopic pregnancy, and chronic pelvic pain. Infections in pregnant women can also lead to premature birth and other problems in newborns. Both infections may make it easier to transmit HIV infection. Because some people with chlamydia or gonorrhea have no symptoms and do not know they are infected, screening otherwise healthy people for these STIs might identify some in whom treatment could prevent complications and spread of the infection.

In 2007, the USPSTF recommended screening for chlamydia in all sexually active women younger than 25 years and in older women at increased risk for infection. At that time, the USPSTF recommended against routine screening in older women who were not at increased risk. It also concluded that there was not enough information to make a recommendation on screening for chlamydia in men. In 2005, the USPSTF recommended screening for gonorrhea in all sexually active women, including pregnant women, if they were at increased risk for infection (that is, if they were young or had other risk factors). It recommended against screening for gonorrhea in men and in nonpregnant women who were at low risk for infection. At that time, the USPSTF did not find enough information to recommend for or against routine screening in high-risk men or low-risk pregnant women. The USPSTF has updated these recommendations.

How did the USPSTF develop these recommendations?

The USPSTF reviewed published research to evaluate the benefits and harms of screening for chlamydia and gonorrhea infection.

What did the authors find?

The USPSTF found good evidence that screening for chlamydia and gonorrhea reduces complications in women who are at increased risk for infection. Information about the benefits and harms of screening in men is still lacking.

What does the USPSTF recommend that patients and doctors do?

Sexually active women aged 24 years or younger and older women at increased risk for infection should be screened for chlamydia and gonorrhea. Women whose sexual history reveals new or continued risk factors since the last negative test result should be rescreened. There is not enough evidence to make a recommendation on screening for chlamydia and gonorrhea in men.

What are the cautions related to these recommendations?

These recommendations apply only to people with no symptoms of infection. People with symptoms that might be due to STIs should be tested for these infections.

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