Screening for Chlamydial and Gonococcal Infections

Importance The 2014 US Preventive Services Task Force (USPSTF) recommendation statement supported the effectiveness of screening for chlamydia and gonorrhea in asymptomatic, sexually active women 24 years or younger older at increased risk infection, although evidence men was insufficient. Objective To update USPSTF review on chlamydial gonococcal infection adults adolescents, including those who are pregnant. Data Sources Cochrane Central Register Controlled Trials, Database Systematic Reviews, Ovid MEDLINE (January 1, 2014, through May 28, 2020) with surveillance 21, 2021. Study Selection Randomized clinical trials observational studies effectiveness, accuracy stratification alternative methods, tests, harms. Extraction Synthesis One investigator abstracted data; a second checked accuracy. Two investigators independently assessed study quality. Main Outcomes Measures Complications infection; transmission acquisition; diagnostic anatomical site–specific testing collection methods; Results Twenty-seven were included (N = 179 515). Chlamydia compared no significantly associated reduced pelvic inflammatory disease (PID) 2 4 hospital-diagnosed PID (0.24% vs 0.38%); relative risk, 0.6 [95% CI, 0.4-1.0]), but not clinic-diagnosed epididymitis, largest trial. In prediction instruments asymptomatic women, age than 22 demonstrated comparable to extensive criteria. Sensitivity similar endocervical (89%-100%) self- clinician-collected vaginal (90%-100%) sites meatal (100%), urethral (99%), rectal (92%) lower pharyngeal (69.2%) have sex men. 89% greater all samples. False-positive false-negative rates low across methods. Conclusions Relevance Screening young women. Risk criteria limited beyond age. Testing infections highly accurate most sites, urine self-collected specimens. Effectiveness during pregnancy, optimal intervals, adverse effects require further evaluation.