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US Preventive Services Task Force. Guide to Clinical Preventive Services: Periodic Updates [Internet]. 3rd edition. Rockville (MD): Agency for Healthcare Research and Quality (US); 2002-.

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Guide to Clinical Preventive Services

Guide to Clinical Preventive Services: Periodic Updates [Internet]. 3rd edition.

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Clinical Considerations

  • Women and adolescents through age 20 years are at highest risk for chlamydial infection, but most reported data indicate that infection is prevalent among women aged 20-25.
    Age is the most important risk marker. Other patient characteristics associated with a higher prevalence of infection include being unmarried, African-American race, having a prior history of sexually transmitted disease (STD), having new or multiple sexual partners, having cervical ectopy, and using barrier contraceptives inconsistently. Individual risk depends on the number of risk markers and local prevalence of the disease. Specific risk-based screening protocols need to be tested at the local level.
  • Clinicians should consider the characteristics of the communities they serve in determining appropriate screening strategies for their patient population.
    More targeted screening may be indicated in specific settings as better prevalence data become available. Prevalence of chlamydial infection varies widely among communities and patient populations. Knowledge of the patient population is the best guide to developing a screening strategy. Local public health authorities can be a source of valuable information.
  • The optimal interval for screening is uncertain.
    For women with a previous negative screening test, the interval for re-screening should take into account changes in sexual partners. If there is evidence that a woman is at low risk for infection (e.g., in a mutually monogamous relationship with a previous history of negative screening tests for chlamydial infection), it may not be necessary to screen frequently. Re-screening at 6 to 12 months may be appropriate for previously infected women because of high rates of reinfection.
  • The optimal timing of screening in pregnancy is also uncertain.
    Screening early in pregnancy provides greater opportunities to improve pregnancy outcomes, including low birth weight and premature delivery; however, screening in the third trimester may be more effective at preventing transmission of chlamydial infection to the infant during birth. The incremental benefit of repeated screening is unknown.
  • Screening high-risk young men is a clinical option.
    Until the advent of urine-based screening tests, routine screening of men was rarely performed. As a result, very little evidence regarding the efficacy of screening in men in reducing infection among women exists. Trials are underway to assess the effectiveness of screening asymptomatic men. The choice of specific screening technique is left to clinical judgment.
    Choice of test will depend on issues of cost, convenience, and feasibility, which may vary in different settings. Although specificity is high with most approved tests, false-positive results can occur with all non-culture tests and rarely with culture tests. The Centers for Disease Control and Prevention (CDC) is developing laboratory guidelines that outline the advantages and disadvantages of available tests. These guidelines will be available at www.cdc.gov in 2001.
  • Partners of infected individuals should be tested and treated if infected or treated presumptively.
  • Clinicians should remain alert for findings suggestive of chlamydial infection during pelvic examination of asymptomatic women (e.g., discharge, cervical erythema, and cervical friability).
  • Clinicians should be sensitive to the potential effect of diagnosing a sexually transmitted disease on a couple.
    To prevent false-positive results, confirmatory testing may be appropriate in settings with low population prevalence.
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