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Meyers DS, Halvorson H, Luckhaupt S. Screening for Chlamydial Infection: A Focused Evidence Update for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007 Jun. (Evidence Syntheses, No. 48.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.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 Screening for Chlamydial Infection: A Focused Evidence Update for the U.S. Preventive Services Task Force

Screening for Chlamydial Infection: A Focused Evidence Update for the U.S. Preventive Services Task Force [Internet].

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3Methodology

In preparing this review, the USPSTF began by considering what type of evidence would be necessary to require revision of the 2001 recommendation statement. For example, since the USPSTF in 2001 found insufficient evidence to conclude that screening men could lead to a decreased incidence of infection in women, new evidence concerning this question might lead to a revision of the USPSTF recommendation for screening men. Additionally, changes in the epidemiology of chlamydial infection might lead to a revision of the categorization of increased risk. After its preliminary evaluation, the USPSTF selected the targeted critical key questions, subsidiary questions, and search strategies listed below.

Critical key questions

1.

Does screening for chlamydial infection in non-pregnant women reduce adverse health outcomes?

2.

Does screening for chlamydial infection in pregnant women reduce adverse health outcomes?

3.

Does screening for chlamydial infection in men reduce adverse health outcomes in men, reduce adverse health outcomes in women, or reduce the incidence of infection in women?

Health outcomes of interest were defined as follows: pelvic inflammatory disease, ectopic pregnancy, infertility, and chronic pelvic pain in non-pregnant women; chorioamnionitis, premature rupture of membranes, pre-term labor, pre-term delivery, spontaneous abortion, endometritis, and low birth weight in pregnant women; and epididymitis, urethritis, prostatitis, chronic prostatitis, reactive arthritis, and urethral strictures in men.

Search strategy for critical key questions

AHRQ staff conducted a systematic evidence review for each of the critical key questions. The search strategy included a review of English language articles identified from PubMed between July 2000 and July 2005. Additional articles were found through bibliography reviews and discussion with experts. These searches identified 452 articles.

For key question 1, the review was limited to randomized controlled trials of non-pregnant women at increased risk for infection. For non-pregnant women not at increased risk, the search was expanded to include both randomized controlled trials and non-randomized, prospective, controlled studies. For key questions 2 and 3, the reviews were limited to randomized controlled trials and non-randomized, prospective, controlled studies. Abstracts were reviewed by two staff members. All abstracts that were clearly within the scope of this review and those with potential or ambiguous relevance were retained. Twenty-three articles were identified as potentially meeting these broad inclusion and exclusion criteria. (Figure)

Figure 1. Stages of Article Review.

Figure

Figure 1. Stages of Article Review.

Two reviewers independently reviewed the full articles of all identified studies to determine whether they met pre-determined inclusion criteria. Additional reviewers were consulted for consensus-building around 2 articles that were ultimately not included in this review. The 2 principal reviewers independently abstracted data from included articles to determine study quality.

Subsidiary key questions

Members of the USPSTF determined several other questions for non-systematic review to assist them with updating their recommendations and supporting materials. These questions were as follows:

1.

Has the epidemiology of chlamydial infection in the U.S. changed in significant ways since 2001, including within populations at increased risk?

2.

What are the harms of screening for chlamydial infection?

3.

Are screening tests for chlamydial infection accurate?

4.

What is the optimal screening frequency?

5.

Does chlamydial infection increase the risk for infection with HIV?

6.

What is the cost-effectiveness of screening for chlamydial infection?

Search strategy for subsidiary questions

Limited non-systematic reviews were conducted for the subsidiary questions. Literature reviews for subsidiary questions included review articles and topic-specific searches. Articles reviewed during the critical key question reviews were tagged if they addressed a subsidiary key question. Recommendations for sentinel articles were also sought from content experts. The purpose of these searches was to provide updated context for recommendations rather than to serve as evidence for changes in the recommendations.

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