This month’s cover story provides an in-depth approach for getting started with office hysteroscopy, an underutilized procedure with many advantages. 

Vol 66 No 9: September 2021

Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.

Early exposure to peanuts has been shown to reduce the risk of peanut allergy. Is the same true with cow's milk?

Roughly 20% of all babies born in the United States are supplemented with formula in their first few days of life.1 Although they may be exclusively breastfed later on, a new study raises questions about how early exposure to cow’s milk proteins might help shape future allergies.

the Journal of Allergy and Clinical Immunology

 was done using a multilocation randomized control trial across 4 hospitals in Japan. During the trial, early formula feeding practices were investigated to determine if there were safe and practical ways to prevent the development of cow’s milk allergy.

Researchers examined when infants were exposed to cow’s milk proteins, for how long, and whether they later developed cow’s milk allergies. They concluded that early cow’s milk formula introduction—along with consistent exposure—may help prevent the development of cow’s milk allergy. When formula is used for the first few days, even as a supplement, and then discontinued, this could have the opposite effect and increase the chances of cow’s milk allergy development later on, the study notes.2

The significance of the study results, according to Tetsuhiro Sakihara, MD, lead author and a pediatrician at Heartlife Hospital in Okinawa, Japan, is that the strategy doesn’t compete with breastfeeding. Instead, research suggests that small-dose supplementation of cow’s milk formula—not enough to replace breast milk nutritionally—may have a protective effect against cow’s milk allergy development.

Cow’s milk allergies affect between 0.5% and 3% of infants globally by age 1 year. Genetics play a role in the development of some of these allergies, and cow’s milk allergies often appear alongside other food allergies. However, a number of environmental factors during the prenatal and postnatal periods can also have an impact.3

In this study, none of the 31 participants who avoided cow’s milk formula for the first 3 days of life later developed a cow’s milk allergy, suggesting that avoiding this type of formula in the days after birth could help prevent future allergies. However, when cow’s milk formula was used, continued exposure until at least 3 months of age—even in small doses—appeared to help prevent a later reaction, Sakihara said.

“We guess that early discontinuation of cow’s milk formula ingestion might be associated with the development of cow’s milk allergy,” said Sakihara.

A subgroup was investigated during the study involving infants who developed a cow’s milk allergy at 6 months of age. The research team broke these infants into categories, comparing those who stopped using cow’s milk formula before 1 month of age, at 1 to 2 months of age, and between 3 and 5 months of age. The group that stopped using cow’s milk formula the earliest had the highest rates of allergy development, according to the study.

“Early discontinuation of cow’s milk formula ingestion, particularly in the first month of life, increased the risk of cow’s milk allergy in infants who received cow’s milk formula in the first 3 days of life,” Sakihara says.

The research team used its study to come up with the suggestion that ingesting 10 milliliters or less of cow’s milk formula daily between 1 and 2 months of age could help prevent the development of cow’s milk allergies later on. The small volume means that this strategy doesn’t have to compete with breastfeeding as a nutrition source, Sakihara adds.

In fact, Sakihara says this strategy might be particularly helpful at helping infants who may have had supplemental formula feedings in the first few days of life avoid cow’s milk allergies once they become more exclusively breastfed.

1. Centers for Disease Control and Prevention. Breastfeeding Report Card. Updated September 17,2020.


https://www.cdc.gov/breastfeeding/data/reportcard.htm

2. Sakihara T, et al. Randomized trial of early infant formula introduction to prevent cow’s milk allergy. 

Food Allergy and Gastrointestinal Disease

. 2021;147(1):224-232. doi: 10.1016/j.jaci.2020.08.021

3. Flom JD, Sicherer SH. Epidemiology of Cow's Milk Allergy. 

. 2019;11(5):1051. doi: 10.3390/nu11051051

This article was originally posted on Contemporary Pediatrics®. 

Articles

Ingesting cow's milk formula prevents cow's milk allergies

About a third of 1,500 women surveyed from Alberta, Canada, reported using cannabis to alleviate some of the commonly-reported symptoms associated with menopause, according to a study presented in a poster at the annual meeting of the North American Menopause Society, being held this week in Washington, D.C.

Katherine Babyn, a master of science student from the University of Alberta, and colleagues conducted a quantitative phase 1 and qualitative phase 2 study, which included one-on-one interviews of 1,500 women between October and December of 2020, recruiting women aged 35 and over from popular social media platforms. Eighteen percent of the women were in premenopause, 33% reported they were in perimenopause, and about 35% were in postmenopause. One-third reported using cannabis within the last month, and slightly more than half of the women, about 52%, reported having used cannabis for more than 3 years.Many of the women reported getting information about cannabis use through Internet searches (about 46%), but said their most desired information about this use comes from their physician, with about half noting it as their preferred method to obtain health information.

Of 499 women who reported using cannabis, three-quarters noted it was for medical use, citing sleep issues, anxiety, muscle aches, irritability, and depression as some of the symptoms that were alleviated due to its use.

The researchers reported that edibles and oils were the most commonly used types of cannabis, at 52% and 47% respectively. Forty-one percent of the women reported smoking cannabis, 25% reported vaping, and 16% reported using capsules.

Researchers noted that the women who reported using cannabis were less likely to report problems sleeping, mood issues, achiness, or painful intercourse, all commonly associated with menopausal transition.

“Our study confirmed that a large percentage of midlife women are using cannabis for symptoms that overlap with menopause, especially those women who reported more symptoms,” Babyn said in a press release about the study.

Researchers said that more study is needed in this area, noting that the study sampling was limited by social media, and that the results do not assess cannabis efficacy for these symptoms.

The study was funded by a grant from the Canadian Institutes of Health Research.

Babyn K, Ross S, Yuksei N. Cannabis use in menopause: capturing the experiences and perspectives of women. Poster presented at: North American Menopause (NAMS) Annual Meeting. Washington, DC. Sept. 22-25, 2021.

One in three women in an Alberta, Canada, survey reported using cannabis to alleviate their symptoms associated with menopause.

Common problems associated with menopause alleviated with cannabis use, patients report

“There’s going to be human gene editing therapies, discovery of new drugs, and new drug targets, CRISPR systems are being used in diagnostics including for SARS-COV-2, vector control, increased crop and food output,” said Neville Sanjana, a New York University professor who spoke virtually at the meeting on his team’s research.

Sanjana cited recently-published research relating to CRISPR with SARS-COV2, as an example of the promise that this technology holds. While the research into vaccines for COVID-19, has provided “great cause for optimism” in drastically reducing the impact that this pandemic has had on the population, vaccines do have their limitations, including not being broadly available across the world and the potential introduction of new viral variants. Using gene-editing technology, researchers may be able hone in on new therapeutic targets if they are needed, he said.

As an example, Sanjana said that his lab at the New York Genome Center and NYU in collaboration with Ben tenOever, PhD,  at Mt. Sinai's School of Medicine used “top-ranked hits from the genome-scale CRISPR screen,” to identify key human genes requires for viral infection.1 Using human lung cells expressing the ACE2 receptor, they found that many of these genes were involved in the endosomal entry pathway, such as RAB7A. More importantly, inhibition of several top-ranked genes from the CRISPR screen led to a robust reduction (>100-fold) in SARS-CoV-2 infection of those human lung cells, demonstrating how CRISPR-identified genes can be used to discover new therapeutics.

Research like this is key to honing in on how the virus functions, and potential therapeutic targets, he noted.

Sanjana was part of the NYU and New York Genome Center research team that also recently developed chemically modified guide RNAs for a CRISPR system that targets RNA, intead of DNA, enhancing their ability to target, trace, edit, and or “knockdown,” RNA in human cells.

Questioned by an audience member on the cost involved in this type of research, Sanjana discussed NPR’s series on Victoria Gray, a woman who became the first patient in the United States to have her sickle cell disease treated using CRISPR technology. The series noted that the treatment was close to a million dollars. While he acknowledged the field is still very much in its infancy, and much more needs to be done to address the costs involved in manufacturing these types of health care answers, he feels as the technology continues to evolve, more research will enable more streamlined, and cost-effective ways to deliver these solutions.

“There is so much potential for this technology to help the world and we have to stay focused on that,” Sanjana said.

1. Daniloski Z, Jordan JK, Wessels HH, et al. Identification of required host factors for SARS-COV-2 infection in human cells. Cell.2021; 184: 92-105.

2. Sanjana N. Promises and challenges of gene editing in the age of CRISPR. Presented at The North American Menopause Society Annual Meeting. September 24, 2021.

CRISPR gene-editing technology holds the potential to usher in a new age in medicine, according to a featured speaker at the North American Menopause Society Annual Meeting, being held this week in Washington, D.C.

Gene-editing technology: potential to usher in a new age in medicine

Roughly 40% of women over 60 will experience female pattern hair loss, or androgenetic alopecia. However, new research from the University of California, Los Angeles, suggests nutraceuticals may be the key to hair growth in menopausal women. 

Although there are several Food and Drug Administration (FDA)-approved drugs for male and female pattern hair loss, many women prefer more natural medications. The new study suggests that a nutraceutical supplement with nutrient-derived bioactive compounds may promote hair growth in perimenopausal, menopausal, and postmenopausal women. 

Hear the perspective of lead author Glynis Ablon of the Ablon Skin Institute and Research Center in California, in the video above. 

. 2021;39(3):417-427. doi:10.1016/j.det.2021.03.006

Nutraceuticals May Be the Secret to a Full Head of Hair for Women at Midlife

. Accessed September 24, 2021. https://www.menopause.org/docs/default-source/press-release/nutraceutical-supplement-for-promoting-hair-growth.pdf

Videos

We sat down with Glynis Ablon, MD, FAAD to learn about her research on nutraceuticals for hair growth in midlife. 

Nutraceuticals show promising results for hair growth in women

The recently-released and long-awaited guidelines on screening for sexually transmitted infections (STIs) from the Centers for Disease Control and Prevention (CDC) introduce some new ways of approaching some common questions you’re probably used to asking your patients.

Michael S. Policar, MD, MPH, who is professor emeritus, obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco, School of Medicine, addressed attendees of the North American Menopause Society (NAMS) meeting being held this week in Washington, DC, and said that some of the old questions about sexual partners, such as, “do you have sex with men, women or both,” have now been replaced with “are you currently have sex of any kind, oral, vaginal, or anal, with anyone?”

 Also, asking patients if they are having sex with another person, and if so, what kinds of sexual contact do they have, and how they met their partners are important questions to discuss.

Policar also addressed the importance of discussing the “5 P’s of sexual history,” including partners, protection, past history of STIs, and intention to become pregnant, but he added what he called a 6th P – “pleasure, you want to ask, are you satisfied with your sexual relationship with your partner.” This is a particularly important question for patients at midlife, as studies have shown up to 43% of women report sexual problems during this period of their lives.

Discussing sexual history is key during an examination, Policar said, especially as CDC data have shown continual spikes in STIs year after year up until 2020, when rates went down, he said but that was likely due to less people being screened during the pandemic and less access to testing for those infections.

Prior to 2020, however, CDC data showed a nearly 30% increase in chlamydia, gonorrhea, and syphilis between 2015 and 2019. In the most recent CDC update, health officials prioritized prevention and control, noting the importance of risk assessment and education; pre-exposure vaccination for vaccine-preventable STIs, like human papillomavirus; screening for people with an STI; and effective diagnosis and treatment.

Policar said that when screening patients for gonorrhea and chlamydia focus on those patients with a previous or concurrent STI; patients with new or multiple sex partners, a sex partner with an STI; patients who demonstrate inconsistent condom use; people who are not in monogamous relationships; and those patients who report exchanging sex for money, housing or other needs.

He noted that treatment recommendations were updated in the new guidelines as well, with treatment shifting for chlamydia from a single dose of doxycycline to 100 mg orally twice daily for 7 days.

A new alternative gonorrhea treatment of cefixime 800 mg Po x 1 was also offered in the guidelines for people with uncomplicated infections of the cervix, or rectum, if ceftriaxone is not available.

Policar completed his discussion by reviewing the “checklist” of chlamydia and gonorrhea management, including, ensuring timely and appropriate treatment within 14 days of specimen collection, testing for other STIs, patient education and counseling, reporting of the case to the local health department, scheduling a follow up test in 3 months, and finally, ensuring that all sex partners are treated.

1. Policar MS. Sexually transmitted infections in midlife women: what clinicains need to know. Presented at The North American Menopause Society Annual Meeting. September 24, 2021.

New guidelines from the Centers for Disease Control and Prevention (CDC) for the screening of sexually transmitted infections (STIs) offer new ways to ask common questions.

CDC guidelines on STIs update some 'old questions' 

Nonetheless, many of these patients do believe that dietary adjustments have a beneficial effect on their symptoms.

“Little scientific evidence exists on the effect of nutrition on endometriosis,” wrote the authors. “In addition, most of the current studies are case-control studies investigating dietary intake and the risk of developing endometriosis instead of endometriosis treatment.”

The study used the Dutch Healthy Diet 2015 index (DHD-15) and quality of life (QoL) with the Endometriosis Health Profile-30 questionnaire (EHP-30) to assess diet quality.

The questionnaires were completed by 157 women with endometriosis, 56% of whom were recruited through the Dutch Endometriosis Society and 44% from Rijnstate Hospital in Arnhem, the Netherlands.

The general health score of the participants was 58.5 and their physical pain score was 57.3, both on a 100-point scale. The 3 most commonly reported endometriosis symptoms were lack of energy, pelvic pain, and menstrual pain; however, gastrointestinal problems were also frequently cited.

The EHP-30 core score was 193.6 on a 500-point scale. In the additional EHP-30 modules, endometriosis-related quality of life was least affected by work and most affected by infertility.

Overall, 55.5% of respondents indicated that nutrition impacted their endometriosis symptoms. Within this subgroup, 70.0% reported that nutrition decreased their symptoms, while 30.0% reported an increase in symptoms.

Nutrition also affected other symptoms, not related to endometriosis. For instance, 32.5% of participants reported having 1 or several food allergies or intolerances or both, with lactose intolerance and gluten intolerance or allergy most frequently mentioned.

The majority of participants made at least 1 dietary adaptation for their endometriosis: a specific diet (46.5%), dietary supplements (56.1%) or other dietary adjustments (64.3%).

In total, 314 specific food adjustments were mentioned, of which 71.3% were reported to reduce pain symptoms. Of the food products that were mentioned at least 4 times, the removal of gluten showed the greatest reduction of symptoms. The removal of dairy or soy, plus the addition of vegetables, were also often cited as causing the greatest perceived reductions of symptoms.

Participants reported they made these dietary adjustments for less than a week to a maximum of 10 years, with a median duration of 1 year.

Endometriosis patients had a significantly lower DHD-15 score, indicating a lower diet quality than a healthy reference group (

Similarly, diet users had a significantly higher total DHD-15 score than non-diet users (

“This was mainly due to the higher intakes of vegetables, fruits, nuts and fish in diet users,” wrote the authors.

But diet quality did not correlate with quality of life (

Research has shown that women with negative encounters with providers and treatments are more likely to follow a diet.

The authors noted, however, that more research is required to glean evidence about the specific effects of nutrients on endometriosis symptoms.

“This could be investigated through an intervention study in which attention should be paid to providing information concerning healthy dietary choices,” they wrote.

Krabbenborg I, de Roos N, van der Grinten P, et al. Diet quality and perceived effects of dietary changes in Dutch endometriosis patients: an observational study. 

. Published online July 24, 2021. doi:10.1016/j.rbmo.2021.07.011

An online explorative observational study in the journal Reproductive BioMedicine Online has found that there are no specific dietary adjustments to increase quality of life among Dutch endometriosis patients.

No specific dietary adjustments increase quality of life in endometriosis patients

The difference in uptake was smallest for the youngest maternal age group (less than or equal to 25 years) versus other age groups.

“In 2017, NIPT was introduced as a first-tier test for all pregnant women within our governmentally supported prenatal screening program, as part of the TRIDENT-2 study initiated by the Dutch NIPT Consortium, for which women pay 175 euros ($205 U.S. dollars),” said first author Karuna R. M. van der Meij, a PhD student in human genetics at Amsterdam University Medical Center (UMC) and Vrije Universiteit Amsterdam.

The inspiration for the study came from second author Caroline Kooij, who is a midwife in a socioeconomically disadvantaged neighborhood in Amsterdam. “She noticed in her neighborhood that new guidelines or innovations in maternity care often either do not meet the needs of pregnant women or women are unable to afford them,” van der Meij told 

NIPT uptake, postal code, and the age of 156,562 pregnant women who received pretest counselling for prenatal screening in 2018 were retrieved from the national prenatal screening database. Postal codes were used to categorize neighborhoods as being either socioeconomically disadvantaged or other.

Roughly 10% of the women lived in socioeconomically disadvantaged areas.

NIPT uptake in socioeconomically disadvantaged neighborhoods was 20.3% compared to 47.6% in all other neighborhoods (

“The uptake in socioeconomically disadvantaged neighborhoods is over 2 times lower in the Netherlands,” van der Meij said. “We were surprised by this large difference because the Netherlands is a country with a nationwide prenatal screening program.”

Because the Dutch Population Screening Act prohibits screening for untreatable disorders without a governmental license, there is no commercial screening in the Netherlands.

The study confirms findings from other high-income countries like Australia, the United Kingdom, and the United States where there are socioeconomic disparities in fetal aneuploidy screening uptake.

The study also found that women who chose NIPT had a significantly higher mean age than women who did not have NIPT: 31.5 vs. 29.4 years, respectively (

Disparities in NIPT uptake undermine the goals of a national fetal aneuploidy screening program of providing reproductive autonomy and equitable access, according to van der Meij, along with ethical and policy implications for ensuring fair and responsible implementation of fetal aneuploidy screening.

The use of specialized tools, such as low-literacy decision aids, culturally competent audio/visual tools, value clarification exercises and additional group counselling could be used to support the counselling process and decrease inequalities in NIPT uptake, according to van der Meij. “Another option would be to offer NIPT free of charge or at a much lower price for women who cannot afford the procedure,” she said.

It has been proposed, however, that a modest financial barrier may encourage informed decision-making among pregnant women by promoting deliberation.

Meanwhile, the reasons for discrepancies in NIPT uptake rates remain unclear. “Research is needed to determine whether the out-of-pocket payment is a barrier for prenatal screening uptake, especially for women living in socioeconomically disadvantaged areas,” van der Meij said. “Other factors such as literacy, religion and culture might also play a role.”

Van der Meij reports no relevant financial disclosures.

Van der Meij KRM, Kooij C, Bekker MN, et al. Non-invasive prenatal test uptake in socioeconomically disadvantaged neighborhoods. 

. Published online September 9, 2021. doi:

Noninvasive prenatal testing (NIPT) uptake is significantly lower in socioeconomically disadvantaged neighborhoods compared to all other neighborhoods in the Netherlands, according to a study in the journal Prenatal Diagnosis.

Uptake of NIPT lower in disadvantaged neighborhoods

Cow’s milk allergies are a common food allergy in infants and young children. Although anaphylaxis is rare with milk allergies, parents may still struggle to find alternative formulas that can help their child avoid the uncomfortable gastrointestinal symptoms that often come with this allergy.

Nearly 3% of children around the world have immune-mediated allergies to the proteins in cow’s milk, but as many as 17% of parents report symptoms that indicate some level of allergy or intolerance to cow’s milk.1 Many cases of cow’s milk allergies resolve on their own with age, but this makes the infant feeding stage no less stressful.

Breastfeeding can be a challenge when it comes to cow’s milk allergies, too. Many people who breastfeed encounter situations where they have to supplement with formula at least sometimes, and these infants are particularly at risk of developing cow’s milk allergies. Even those who exclusively breastfeed can encounter problems, as the nursing mother can pass these proteins on through her own milk.

, outlines options for parents in this situation.

“With not many options for formula for babies, especially those found to have cow’s milk allergy, it was important for us to provide an up-to-date and evidence-based summary of options,” said Ran Goldman, MD, a professor of pediatrics at the University of British Columbia in Vancouver, and co-author of the report. “We recognize that a lot of factors need to be considered when choosing an alternative such as symptom severity, patient preference, cost, and efficacy.”

The study isn’t meant to deter families from considering breastfeeding, Goldman said. Rather, an effort to present safe, effective options.

“I truly believe “breast is best” because breastfeeding has so many benefits. I always recommend to mothers in my practice to continue to breastfeed if they can and want to do that,” Goldman said.

Elimination diets are a big part of diagnosing and managing milk allergies in infants, he notes, adding that the same method can work for mothers.

“Elimination of all milk products from the mother’s diet results in significant remission rate of the symptoms in babies,” he said.

A proper diagnosis is also an important first step, as many parents assume their infant’s symptoms are from a milk allergy. However, only a fraction of infants whose parents believe they have a cow’s milk allergy are actually clinically diagnosed.

“I highly recommend consulting the pediatrician in regard to diagnosing cow's milk allergy. Some parents read symptoms like increased gas or fussiness as milk allergy and may be switching formula prematurely,” Goldman said. “Parents who see blood in the stool should see their doctor immediately. Follow up by the primary provider is also important, to ensure that switching the formula actually helped and that they can rule out other conditions that may have been initially thought to be cow’s milk allergy.”

Understanding the benefits of early exposure is important, too, as this has been shown to be effective in a number of food allergies like peanut allergies for years. Decades of research on early exposure2 have shown some benefit, but avoidance is still a favorite method when it comes to managing these allergies, Goldman said.

“In general, we know that early exposure results in reduced sensitivity and allergy in children. The best example is the exposure of Israeli babies to a snack called Bamba in early childhood, likely protecting them from any peanut allergy,” he added.

For infants who have true milk allergies or for whom early exposure is not desired or possible, the study offers solutions. Goldman and lead author Sharon Kipfer suggest the following formula options as alternatives to formulas with cow’s milk proteins:

Partially hydrolyzed cow’s milk formula.

 Although this type of formula isn’t used to treat cow’s milk allergy because of a 50% chance of cross reactivity, the report notes that extensively hydrolyzed formula that contains no peptides with a molecular weight greater than 5000 Da can be considered hypoallergenic. Only 2% of infants aged younger than 2 years with confirmed cow’s milk allergies had reactions to this type of formula compared to 10% who were given soy-based formula. Bitter taste, high costs, and risks of anaphylaxis are drawbacks to this option, according to the study.

 These types of formulas have been a favorite for decades in Europe, but are not readily available everywhere. Rice formula offers infants good growth while somehow modifying its allergenic properties and preventing immune responses. Bitter taste can be a drawback along with limited availability in some areas, according to researchers.

 Soy formulas have been debated for use in children with cow’s milk allergies. Although these formulas provide enough nutrition to keep infants on appropriate growth schedule, they tend to have lower weight gain than infants fed with cow’s milk formulas. Even though soy formulas have a 10% risk of allergic reaction, they are favored in many cases for taste, texture, and affordability.

. These formulas are considered to be hypoallergenic by the American Academy of Pediatrics, and are often used in infants who can’t tolerate other types of formulas. However, these can cost 6 to 8 times more than other high-end formulas, and some infants refuse it because of its taste.

Although hydrolyzed rice formulas appear to have the most wide-ranging applications, Goldman said the decision should ultimately be one made between parents and their infants’ primary care doctor or allergist.

“It is important not to decide in a hurry to switch formula in young children and to avoid changing a new formula after just a few days of trying,” Goldman added. “Pediatricians should work with families around decision-making and support them when symptoms of cow’s milk allergy arise.”

1.Kipfer S, Goldman RD. Formula choices in infants with cow's milk allergy. 

. 2021;67(3):180-182. doi: 10.46747/cfp.6703180


2. Stintzing G, Zetterström R. Cow's milk allergy, incidence and pathogenetic role of early exposure to cow's milk formula. 

 May 1979;68(3):383-7. doi: 10.1111/j.1651-2227.1979.tb05024.x.

For infants with milk allergies, finding a formula that won't cause a reaction is key to happy feeding times. Parents face a dizzying array of options. Here's a look at them.

Best formulas for infants with cow's milk allergy

We're covering a variety of topics this week.

Screening for sexual infections critical as cases rise

Not only are chlamydia and gonorrhea 2 of the most common sexually transmitted infections (STIs) in the United States, but people are being diagnosed with them at a higher rate than ever before, according to the Centers for Disease Control and Prevention (CDC).

Here's what's coming up this week on Contemporary OB/GYN®

This week on Contemporary OB/GYN®: Sept. 27 to Oct. 1

In response, the U.S. Preventive Services Task Force (USPSTF) recently reviewed the latest evidence on screening for chlamydia and gonorrhea, “so that we could issue an update to our 2014 final recommendation,” said Michael Barry, MD, vice chair of USPSTF, and director of the Informed Medial Decisions Program in the Health Decisions Sciences Center at Massachusetts General Hospital in Boston.

 notes that screening for chlamydia and gonorrhea “is critical because these STIs often do not cause symptoms, which makes them harder to detect,” Barry told 

. “Screening can prevent serious health problems, including infertility, pregnancy disorders and chronic pain.”

Newborns of pregnant women with untreated infection may develop neonatal chlamydial pneumonia or gonococcal or chlamydial ophthalmia, whereas infection in men may cause urethritis and epididymitis. Both types of infection can also increase the risk of acquiring or transmitting HIV.

Age is one of the most important risk factors for chlamydia and gonorrhea, “with the highest rates of infection among teens and young adults,” Barry said. “Therefore, the Task Force recommends screening sexually active women and pregnant people who are 24 years old and younger, as well as those who are 25 or older and at increased risk.”

Women and pregnant people who are 25 years or older are at increased risk if they have a previous or coexisting STI; a new or more than one sex partner; a sex partner having sex with other partners at the same time; a sex partner with an STI; inconsistent condom usage when not in a mutually monogamous relationship; a history of exchanging sex for money or drugs; and/or a history of incarceration.

According to the Task Force’s recommendation, “clinicians may also want to consult their local public health authorities about local epidemiology and guidance on determining who is at increased risk.”

The Task Force also concluded that among women, the false-positive, false-negative, false alarm and false reassurance rates varied by anatomical site, but were overall generally low across all nucleic acid amplification testing (NAATs) and specimen types.

Primary care clinicians who wish to implement the recommendation statement are encouraged to ask their patients in confidential, respectful and culturally appropriate ways whether they are sexually active, so that the clinician can determine who should be screened, according to Barry.

“While the prevalences of chlamydia and gonorrhea differ, the risk factors for infection overlap, so the Task Force suggests screening for both simultaneously,” he said.

However, because there is insufficient evidence available for the Task Force to make a recommendation for or against screening men, “we are calling for more research,” said Barry, a professor of medicine at Harvard Medical School. “We are also advocating additional research on the benefits and harms of screening other groups at high risk, including men who have sex with men, members of the LGBTQ+ community and people with a nonbinary gender identity.”

Meanwhile, any patient who is concerned about STIs or their overall sexual health “should talk with their clinician so they can receive the care they need,” Barry said.

Barry reports no relevant financial disclosures.

U.S. Preventive Services Task Force. Screening for chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. 

.2021;326(10):949-956. doi:10.1001/jama.2021.14081