1. Screening for chlamydia and gonorrhea should be done in asymptomatic, sexually active women 24 years and under, as well as older women with increased risk of infection, in order to prevent pelvic inflammatory disease and its complications.
2. There was inadequate evidence to evaluate the benefit of screening for chlamydia and gonorrhea in men.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Chlamydia and gonorrhea are commonly encountered sexually transmitted infections (STIs), with more than 1.7 million cases being reported to the Centers for Disease Control and Prevention (CDC) in 2012. Most cases of chlamydia and gonorrhea are asymptomatic and therefore not diagnosed. If left untreated these infections can lead to pelvic inflammatory disease (PID) and its complications, such as ectopic pregnancy, chronic pelvic pain, and infertility. The majority of these STIs occur in females between 15 and 24 years of age. This systematic review conducted by the U.S. Preventative Services Task Force (USPSTF) found moderately strong evidence that screening for chlamydia and gonorrhea in asymptomatic females who are 24 years or younger and sexually active provides moderate net benefit. Older women at high-risk (i.e., those with multiple sex partners, the incarcerated, recent military recruits, and those obtaining care at free STI clinics) would also benefit from screening. There was inadequate evidence to assess the value of screening for these STIs in men. It was noted that screening of pregnant women to avoid ophthalmia neonatorum provided no net benefit because universal ocular prophylaxis of newborns is very effective and the prevalence of infection is low in this group. Screening for both chlamydia and gonorrhea should be done simultaneously using the highly sensitive nucleic acid amplification tests (NAATs).
In-Depth [systematic review]: In this study, the USPSTF found 2 RCTs of good- and fair-quality demonstrating that screening and treating chlamydia in high-risk, non-pregnant women significantly reduced the risk of PID (RR 0.44; 95%CI 0.20-0.90 & RR 0.39; 95%CI 0.14-1.08). Fair-quality cohort studies of pregnant women at high-risk of infection showed that screening or treating chlamydia during pregnancy improved maternal and fetal outcomes.
No studies were found that directly evaluated the effectiveness of gonorrhea screening. However, indirect evidence supported screening by demonstrating that most gonorrheal infections are asymptomatic and go untreated, with 10-20% of those leading to PID. There was insufficient evidence to evaluate the effectiveness of screening for chlamydia or gonorrhea in men, or women at low-risk of infection. Fair-quality evidence from ten studies showed that NAATs accurately diagnosed infections using specimens collected from various sources (e.g., urogenital, endocervical, vaginal, rectal specimens) with sensitivities between 86-100%. There were no studies on the comparative effectiveness of different screening methods.
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