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).

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.

The new recommendation statement in JAMA 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 Contemporary OB/GYN®. “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.

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Disclosure

Barry reports no relevant financial disclosures.

Reference

U.S. Preventive Services Task Force. Screening for chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. JAMA.2021;326(10):949-956. doi:10.1001/jama.2021.14081