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Screening for Gonorrhea and Chlamydia: Systematic Review to Update the U.S. Preventive Services Task Force Recommendations

Evidence Syntheses, No. 115

Investigators: , MD, MPH, , MBBS, , MD, MPH, , BA, and , MA.

Author Information
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 13-05184-EF-1

Structured Abstract

Background:

Previous research has supported screening for gonorrhea and chlamydia in asymptomatic sexually active women, including pregnant women, who are younger than age 25 years or at increased risk, but not other patient populations.

Purpose:

To update the 2005 and 2007 systematic reviews for the U.S. Preventive Services Task Force on screening for gonorrhea and chlamydia in men and women, including pregnant women and adolescents.

Data Sources:

MEDLINE (2004 to June 13, 2014), Cochrane Central Register of Controlled Trials (through May 2014), Cochrane Database of Systematic Reviews (through May 2014), Health Technology Assessment Database (through May 2014), Database of Abstracts of Reviews of Effects (through May 2014), and reference lists.

Study Selection:

English-language trials and observational studies about screening effectiveness, test accuracy, and screening harms.

Data Extraction:

One investigator extracted data on participants, study design, analysis, followup, and results and a second investigator confirmed key data. Investigators independently dual-rated study quality and applicability using established criteria.

Data Synthesis:

Screening a subset of asymptomatic young women for chlamydia in a good-quality trial did not statistically significantly reduce pelvic inflammatory disease over the following year (relative risk, 0.39 [95% CI, 0.14 to 1.08]), while one previous trial reported a reduction. An observational study evaluating a risk prediction tool to identify persons with chlamydia in high-risk populations had low predictive ability and applicability. In 10 new studies of asymptomatic participants, nucleic acid amplification tests demonstrated sensitivity of 86% or greater and specificity of 97% or greater for diagnosing gonorrhea and chlamydia, regardless of specimen type or test.

Limitations:

Studies of screening benefits and harms were lacking for men, pregnant women, adolescents, and subgroups. Only screening tests and methods cleared by the U.S. Food and Drug Administration for current clinical practice were included to determine diagnostic accuracy, excluding rectal, pharyngeal, and self-administered specimens obtained outside a clinical setting.

Conclusions:

Chlamydia screening in young women may reduce pelvic inflammatory disease. Nucleic acid amplification tests are accurate for diagnosing gonorrhea and chlamydia in asymptomatic persons using various types of specimens. Research is needed on the effectiveness of screening to reduce adverse health outcomes in specific population groups, effectiveness of different screening strategies, and adverse effects of screening to further inform practice guidelines.

Contents

Acknowledgments: The authors acknowledge Andrew Hamilton, MLS, MS, at the Oregon Health & Science University; Karen Lee, MD, MPH, at AHRQ; and current and former members of the U.S. Preventive Services Task Force who contributed to topic deliberations.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. HHS-290-2007-10057-I, Task Order No. 13. Prepared by: Pacific Northwest Evidence-Based Practice Center2

Suggested citation:

Nelson HD, Zakher B, Cantor A, Deagas M, Pappas M. Screening for Gonorrhea and Chlamydia: Systematic Review to Update the U.S. Preventive Services Task Force Recommendations. Evidence Synthesis No. 115. AHRQ Publication No. 13-05184-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2014.

This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHS-290-2007-10057-I, Task Order No. 13). The findings and conclusions in this document are those of the authors, who are responsible for its contents, and do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.

1

540 Gaither Road, Rockville, MD 20850; www​.ahrq.gov

2

Oregon Health & Science University, 3181 SW Sam Jackson Park Road; Portland, OR 97239

www​.ohsu.edu/epc

Bookshelf ID: NBK248299PMID: 25356451

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