Screening for gonorrhea and Chlamydia: a systematic review for the U.S. Preventive Services Task Force

Area of Science:

• Public Health
• Infectious Disease Prevention
• Diagnostic Accuracy

Background:

• Previous guidelines recommended gonorrhea and chlamydia screening for sexually active women under 25 and high-risk individuals.
• Limited evidence existed for screening in other populations.

Purpose of the Study:

• To provide an updated systematic review on gonorrhea and chlamydia screening for the U.S. Preventive Services Task Force.
• To evaluate screening effectiveness, test accuracy, and harms in men and women, including pregnant women and adolescents.

Main Methods:

• Systematic review of English-language trials and observational studies from MEDLINE, Cochrane, and ClinicalTrials.gov (2004-2014).
• Data extraction and quality assessment were performed by two independent investigators.
• Included studies focused on screening effectiveness, test accuracy, and harms.

Main Results:

• One trial showed a non-significant reduction in pelvic inflammatory disease incidence with chlamydia screening in young women (RR, 0.39).
• Nucleic acid amplification tests demonstrated high sensitivity (≥86%) and specificity (≥97%) for gonorrhea and chlamydia in asymptomatic patients.
• A risk prediction tool for chlamydia in high-risk populations showed low predictive ability.

Conclusions:

• Few studies adequately addressed the benefits and harms of gonorrhea and chlamydia screening.
• Nucleic acid amplification tests are accurate for diagnosing gonorrhea and chlamydia in asymptomatic individuals.
• Chlamydia screening in young women may potentially reduce pelvic inflammatory disease incidence.