Under 30 and sexually active? It’s a good idea to get tested for chlamydia and gonorrhea

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Anyone who is sexually active under the age of 30 should be offered tests for chlamydia and gonorrhea, according to a new guideline from the Canadian Task Force on Preventive Health Care published in CMAJ (Journal of the Canadian Medical Association).

Chlamydia and gonorrhea are the most commonly reported sexually transmitted bacterial infections (STIs) in Canada and can be treated with antibiotics. Left untreated, these infections can lead to pelvic inflammatory disease, pain, and possibly infertility.

“If people are under 30 and are sexually active, it’s a good idea to get tested,” says Dr. Ainsley Moore, family physician and associate clinical professor in the Department of Family Medicine at McMaster University and chair of the chlamydia and gonorrhea working group. work group. “Many people are asymptomatic and may not seek treatment, so we recommend opportunistic testing – that is, during any medical visit.”

The guideline recommends that health care providers in Canada offer routine testing for chlamydia and gonorrhea annually to all sexually active patients under the age of 30 who are not known to be in a high risk group. . Sexual activity is defined as anyone who has had oral, vaginal or anal sex.

Why does the task force recommend screening?

  • 1 in 20 sexually active people aged 15 to 29 will get chlamydia.
  • The reported rates for this age group are 1.0% to 1.9% (chlamydia) and 0.2% to 0.3% (gonorrhea).
  • Many people are asymptomatic or not seeking care and are not included in the reported cases.
  • Actual rates of chlamydia in 15-29 year olds can be as high as 5-7%.
  • Increased levels of chlamydia and gonorrhea in people aged 25 to 29 since 2000.
  • Screening can reduce pelvic inflammatory disease in women.

This recommendation does not apply to pregnant women, to people recognized by the clinician to be at increased risk due to sexual behavior, or to patients seeking care for a possible STI. Clinicians should consult with national, provincial or local councils when providing care to these individuals.

Current practice in Canada recommends screening sexually active people who are not at high risk until the age of 25.

“This recommendation to expand screening to age 30 reflects the increasing rates of infection among Canadians aged 25 to 29,” says Dr. Donna Reynolds, working group member, family physician and assistant professor at the University of Toronto. “Because this is an easy test, usually a urine test or a vaginal swab, it can be done during any visit to a doctor, nurse practitioner, or sexual health clinic.”

The recommendations also take into account the potential for anxiety and embarrassment associated with STI screening.

“While we recommend this as a routine, clinicians know they should expect feelings of fear, anxiety or embarrassment from some patients and be prepared to discuss them,” says Dr. Brenda. Wilson, Task Force Member, Public Health Physician and Professor at Memorial University, St. John’s, Newfoundland.

The guideline also recommends screening men as the main source of infection in women, for whom the health consequences may be more serious.

“Screening in men, who often have no symptoms, can reduce transmission and complications in women and can improve health equity for women,” says Dr. Moore.

Target audiences

  • Clinicians – The guideline is intended for clinicians in primary care, sexual health, student clinics and others.
  • Audience – With the guide aimed at people under the age of 30, an infographic, Instagram campaign, and frequently asked questions will help explain why it makes sense to get tested.

The working group invited Canadians to understand their screening values ​​and preferences in order to inform recommendations. They expressed a strong preference for screening.

The College of Family Physicians of Canada, the Canadian Nurse Practitioner Association and the Canadian Association of Perinatal and Women’s Health Nurses have endorsed the guideline.

In a related comment http: // www.cmaj.California/search/do I/ten.1503 /cmaj.210604, Drs. Troy Grennan, BC Center for Disease Control, Vancouver, British Columbia, and Darrell Tan, University of Toronto, write that a “potential benefit of the authors’ recommendations is its potential to normalize conversations about sexual health and STIs between women and men. clinicians and patients, who have long been marred by stigma and shame. Providing screening can help patients feel “empowered” to discuss health issues that may seem difficult to address. ”

The commenters note that the lack of high-quality evidence on the subject should prompt researchers to engage in future studies to inform guidelines and clinical practice.

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For guidelines, public infographics, clinician and patient FAQs, visit the Chlamydia and Gonorrhea Guidelines page at http: // www.canadiantaskforce.California. Listen to a podcast with author Dr Ainsley Moore: https: //soundcloud.com /cmajpodcasts /201967-guide /s-9efVPEXmdA3

About the Canadian Task Force on Preventive Health Care

The Canadian Task Force on Preventive Health Care is an independent group of health professionals who are experts in clinical preventive health care and guideline methodology. The mandate of the working group is to develop and disseminate evidence-based clinical practice guidelines for primary and preventive care.

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