Screening for sexual infections is essential as cases increase

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In response, the United States Task Force on Preventive Services (USPSTF) recently reviewed the latest evidence on screening for chlamydia and gonorrhea, “so we can post an update to our final recommendation from 2014.” said Michael Barry, MD, vice president of the USPSTF, and director of the Informed Medial Decisions program at the Health Decisions Sciences Center at Massachusetts General Hospital in Boston.

The new recommendation statement in JAMA notes that screening for chlamydia and gonorrhea “is essential because these STIs often do not cause symptoms, which makes them more difficult to detect,” said Barry Contemporary OB / GYN®. “Screening can prevent serious health problems, including infertility, pregnancy problems and chronic pain.

Newborns of pregnant women with untreated infection can develop neonatal chlamydial pneumonia or gonococcal or chlamydial ophthalmia, while infection in men can cause urethritis and epididymitis. Both types of infection can also increase the risk of getting or transmitting HIV.

Age is one of the biggest risk factors for chlamydia and gonorrhea, “with the highest infection rates in adolescents and young adults,” Barry said. “Therefore, the working group recommends screening sexually active women and pregnant people 24 years of age and under, as well as those 25 years or older and at increased risk.”

Women and people who are 25 years of age or older are at increased risk if they have a previous or coexisting STI; one or more new sexual partners; a sexual partner having sex with other partners at the same time; a sexual partner with an STI; inconsistent condom use outside of a mutually monogamous relationship; a story of exchanging sex for money or drugs; and / or a history of incarceration.

According to the task force’s recommendation, “clinicians may also want to consult with their local public health authorities about local epidemiology and advice to determine who is at increased risk.”

The working group also concluded that in women, the rates of false positives, false negatives, false alarms, and false assurances varied by anatomical site, but were generally low for all nucleic acid amplification tests ( NAAT) and sample types.

Primary care clinicians who wish to implement the recommender statement are encouraged to ask their patients in a confidential, respectful and culturally appropriate manner if they are sexually active, so the clinician can determine who should be screened, according to Barry.

“Although the prevalences of chlamydia and gonorrhea differ, the risk factors for infection overlap, so the working group suggests screening for both simultaneously,” he said.

However, as there is not enough evidence available for the task force to make a recommendation for or against screening for men, “we call for more research,” said Barry, professor of medicine at Harvard Medical. School. “We also advocate for further research on the pros and cons of screening other high-risk groups, including men who have sex with men, members of the LGBTQ + community, and people with non-gender identities. binary.”

Meanwhile, any patient who is concerned about STIs or their overall sexual health “should speak with their clinician so they can get the care they need,” Barry said.

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Disclosure

Barry does not report any relevant financial disclosure.

Reference

United States Task Force on Preventive Services. Chlamydia and Gonorrhea Screening: US Prevention Services Task Force Recommendation Statement. JAMA. 2021; 326 (10): 949-956. doi: 10.1001 / jama.2021.14081


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