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CLINICAL SUMMARY OF U.S. PREVENTIVE SERVICES TASK FORCE RECOMMENDATION

PopulationSexually active women, including those who are pregnant, who are at increased risk for infectionMen who are at increased risk for infectionMen and women who are at low risk for infectionPregnant women who are not at increased risk for infection
RecommendationScreen for gonorrhea.
Grade: B
No recommendation.
Grade: I (Insufficient Evidence)
Do not screen for gonorrhea.
Grade: D
No recommendation.
Grade: I (Insufficient Evidence)
Risk AssessmentWomen and men younger than age 25 years—including sexually active adolescents—are at highest risk for gonorrhea infection. Risk factors for gonorrhea include a history of previous gonorrhea infection, other sexually transmitted infections, new or multiple sexual partners, inconsistent condom use, sex work, and drug use. Risk factors for pregnant women are the same as for non-pregnant women.
Screening TestsVaginal culture is an accurate screening test when transport conditions are suitable. Newer screening tests, including nucleic acid amplification and hybridization tests, have demonstrated improved sensitivity and comparable specificity when compared with cervical culture. Some newer tests can be used with urine and vaginal swabs, which enables screening when a pelvic examination is not performed.
Timing of ScreeningScreening is recommended at the first prenatal visit for pregnant women who are in a high-risk group for gonorrhea infection. For pregnant women who are at continued risk, and for those who acquire a new risk factor, a second screening should be conducted during the third trimester. The optimal interval for screening in the non-pregnant population is not known.
InterventionsGenital gonorrhea infection in men and women, including pregnant women, may be treated with a third-generation cephalosporin. Because of increased prevalence of resistant organisms, fluoroquinolones should not be used to treat gonorrhea. Current guidelines for treating gonorrhea infection are available from the Centers for Disease Control and Prevention (http://www​.cdc.gov/std/treatment).
Balance of Benefits and HarmsThe USPSTF concluded that the benefits of screening women at increased risk for gonorrhea infection outweigh the potential harms.The USPSTF could not determine the balance of benefits and harms of screening for gonorrhea in men at increased risk for infection.Given the low prevalence of gonorrhea infection in the general population, the USPSTF concluded that the potential harms of screening in low-prevalence populations outweigh the benefits.The USPSTF could not determine the balance between the benefits and harms of screening for gonorrhea in pregnant women who are not at increased risk for infection.
Other Relevant USPSTF RecommendationsThe USPSTF has also made a recommendation on ocular prophylaxis in newborns for gonococcal ophthalmia neonatorum.
This recommendation is available at http://www​.uspreventiveservicestaskforce.org/.

From: Recommendations for Adults

Cover of The Guide to Clinical Preventive Services 2012
The Guide to Clinical Preventive Services 2012: Recommendations of the U.S. Preventive Services Task Force.

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