MAJOR RECOMMENDATIONS
The US Preventive Services Task Force grades its recommendations (A, B, C, D, or I) and identifies the Levels of Certainty regarding Net Benefit (High, Moderate, and Low). The definitions of these grades can be found at the end of the "Major Recommendations" field.
Summary of the Recommendations
· The US Preventive Services Task Force (USPSTF) recommends screening for chlamydial infection for all sexually active non-pregnant young women aged 24 and younger, and for older non-pregnant women who are at increased risk. A recommendation
· The USPSTF recommends screening for chlamydial infection for all pregnant women aged 24 and younger, and for older pregnant women who are at increased risk. B recommendation
· The USPSTF recommends against routinely providing screening for chlamydial infection for women aged 25 and older, whether or not they are pregnant, if they are not at increased risk. C recommendation
· The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydial infection for men. I statement.
See "Assessment of Risk" and "Suggestions for Practice Regarding an I Statement" below for discussions of assessing risk for chlamydial infection in women and suggestions for practice regarding screening for men.
Clinical Considerations
Patient Population Under Consideration
These recommendations target all sexually active individuals, including adolescents and pregnant women.
Assessment of Risk
All sexually active women 24 years and younger—including adolescents—are at increased risk for chlamydial infection. In addition to sexual activity and age, other risk factors for chlamydial infection include a history of previous chlamydial or other sexually transmitted infection, new or multiple sexual partners, inconsistent condom use, and exchanging sex for money or drugs. Risk factors for pregnant women are the same as for non-pregnant women. Prevalence of chlamydial infection varies widely among patient populations. African American and Hispanic women have a higher prevalence of infection than the general population in many communities and settings. Among men and women, increased prevalence rates are also found in incarcerated populations, military recruits, and patients at public sexually transmitted infection clinics.
Screening Tests
Nucleic acid amplification tests (NAATs) have high specificity and sensitivity when used as screening tests for chlamydial infection. NAATs can be used with urine and vaginal swabs, enabling screening when a pelvic examination is not performed.
Treatment
Appropriate treatment of chlamydia infection has been outlined by the Centers for Disease Control and Prevention (CDC) see the National Guideline Clearinghouse (NGC) summary of the CDC guideline Clinical prevention guidance. Sexually transmitted diseases treatment guidelines 2006.
In its 2006 sexually transmitted disease (STD) treatment guidelines, the CDC recommends that chlamydia infection be treated with a single oral dose of 1 g of azithromycin or seven days of twice daily oral doxycline (100 mg). Pregnant women with chlamydial infection may be treated with a single dose of one gram of Azithromycin or Amoxicillin 500 mg orally three times daily for 7 days. Since the CDC updates these recommendations regularly, clinicians are encouraged to access the CDC website to obtain the most up-to-date information. (http://www.cdc.gov/STD/treatment).
To prevent recurrent transmission, clinicians should ensure that all sexual partners of infected individuals are tested and treated if infected, or treated presumptively.
Screening Intervals
Screening for pregnant women who are at increased risk for chlamydial infection is recommended at the first prenatal visit. For pregnant women who remain at increased risk, and for those who acquire a new risk factor such as a new sexual partner, a screening should be conducted during the third trimester. The optimal interval for screening for non-pregnant women is unknown. The CDC recommends at least annual screening for women at increased risk.
Suggestions for Practice in the Face of Insufficient Evidence Regarding Screening in Men
The USPSTF concluded that the evidence is insufficient to determine the balance of benefits and harms related to screening men for chlamydial infection. Specifically, the USPSTF did not find evidence that screening programs that target men result in a decreased incidence of infection in women. The USPSTF notes that programs that screen men as a means of reducing transmission to women are not common practice, that primary care clinicians are capable of instituting screening in men, that the costs of additional screening tests per individual are relatively low, and that the potential harms of screening are small.
The USPSTF recognizes that asymptomatic, untreated infections in men provide a reservoir of infection that may make it difficult to improve health outcomes in women through screening programs that target only women. However, given the low national rates of screening in women at risk, the USPSTF believes that clinicians and health care systems should focus on improving the screening rates among women at increased risk, a group in which the benefits of screening are certain.
Other Approaches to Prevention
Primary care clinicians and the health care systems in which they work are responsible for ensuring that asymptomatic women at risk for chlamydial infection are screened. In some communities, this may involve home- or school-based screening programs.
BIBLIOGRAPHIC SOURCE(S)
· U.S. Preventive Services Task Force. Screening for chlamydial infection: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2007 Jul 17;147(2):128-34. [9 references] PubMed.
SOURCE: National Guidelines Clearinghouse
