Based on the available evidence, the task force recommends screening for gonorrhea and chlamydia in all sexually active women age 24 years and younger, and in women age 25 years and older who are at increased risk of infection. These are “B” recommendations.
The USPSTF also concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men — an “I” statement.
The recommendations apply to all asymptomatic, sexually active adolescents and adults, including those who are pregnant.
“Chlamydia and gonorrhea are among the most common sexually transmitted infections in the U.S.,” said task force member Martha Kubik, Ph.D., R.N., in a press release. “People with these infections often don’t have symptoms, so screening is important to help prevent serious health complications.”
The press release also advised anyone who is concerned about STIs or their overall sexual health to speak with a health care professional.
Almost 1.8 million chlamydial infections were reported to the CDC in 2018, the last year for which data are available, and infection rates for chlamydia have more than doubled since 2000. More than 580,000 cases of gonorrhea, meanwhile, were reported in 2018, with more than half of those infections occurring in adolescents and young adults aged 15-24.
While both types of infection can be cured with the right treatment, they rarely present with symptoms. If left untreated, chlamydial and gonococcal infections can cause a range of health complications, including pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy, infertility, urethritis and epididymitis. Both types of infection may also increase the risk of acquiring or transmitting HIV.
With slight changes in wording to account for age ranges, the current draft recommendation statement is in accordance with the task force’s previous recommendation statement on the topic, which was issued in 2014.
While the 2014 statement recommended screening for chlamydia and gonorrhea in sexually active women age 24 and younger, it also recommended screening for these infections “in older women who are at increased risk for infection.” The current draft recommendation clarifies the age at which screening for women at increased risk for infection should begin.
The AAFP supported the 2014 recommendation.
To update the existing recommendation, the task force commissioned a systematic review to evaluate the benefits and harms of screening for chlamydia and gonorrhea in all sexually active adolescents and adults. The review included a search of studies published between January 2014 and May 2020, with additional surveillance conducted through Nov. 20, 2020. Twenty studies met the researchers’ inclusion criteria, including seven that were carried forward from the prior evidence review.
The task force found convincing evidence that clinicians could identify sexually active women at increased risk for chlamydial and gonococcal infections, and adequate evidence that clinicians could identify sexually active men at increased risk.
The task force also found convincing evidence that available screening tests, such as the nucleic acid amplification test, can accurately diagnose chlamydial and gonococcal infections in both men and women.
With regard to early detection and treatment, the researchers found that compared with no screening, screening for chlamydia was associated with a reduced risk of pelvic inflammatory disease and may reduce the incidence of PID in young women.
A review of several cohort studies of screening at the first prenatal visit in pregnant women who are at increased risk for infection also found that treatment of chlamydial infection was associated with significantly lower rates of preterm delivery, early rupture of membranes and infants with low birth weight compared with no treatment or treatment failure.
While several studies in the evidence review focused on women at increased risk of chlamydial or gonococcal infections, the task force found no studies that directly evaluated the effectiveness of screening for gonorrhea in any population group in its current or previous evidence reviews. The task force also found little direct evidence on the effectiveness of screening for chlamydia in men or low-risk women in reducing infection complications, disease transmission or disease acquisition, and little evidence on the effectiveness of screening for gonorrhea in men or low-risk women.
Based on these evidence gaps, the task force stated that more research is needed to determine the effectiveness of screening in men, optimal screening intervals, and adverse effects of screening.
The USPSTF has published several recommendations on screening for other STIs, including
The task force has also published related recommendations on preexposure prophylaxis to prevent HIV infection and behavioral counseling for all sexually active adolescents and for adults at increased risk for STIs.
The AAFP will review the USPSTF's draft recommendation statement and supporting evidence and will provide comments to the task force.