Screening for chlamydia and/or gonorrhea in primary health care: protocol for systematic review

Pillay, Jennifer; Moore, Ainsley; Rahman, Prinon; Lewin, Gabriel; Reynolds, Donna; Riva, John J.; Thériault, Guylène; Thombs, Brett D.; Wilson, Brenda J.; Robinson, Joan; Ramdyal, Amanda; Cadieux, Geneviève; Featherstone, Robin; Burchell, Anne N.; Dillon, Jo-Anne R.; Singh, Ameeta E.; Wong, Tom; Doull, Marion; Traversy, Greg; Courage, Susan; MacGregor, Tara; Johnson, Cydney; Vandermeer, Ben; Hartling, Lisa

doi:10.1186/s13643-018-0904-5

Cited by 8 publications

(24 citation statements)

References 73 publications

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“…Chlamydia and gonorrhea screening guidelines have been released for sexually active women to promote the testing uptake in many countries which do not include China, such as United states [23], Australia [24] and England [25]. It has been proven that screening is an effective strategy for chlamydia and gonorrhea control [26]. There is an urgent need for the establishment of national guideline for chlamydia and gonorrhea screening in China.…”

Section: Discussionmentioning

confidence: 99%

Uptake and Correlates of Chlamydia and Gonorrhea Testing among Female Sex Workers in Southern China: A Cross-sectional Study

Zhao

Wang

Cheng

et al. 2020

Preprint

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Background: Female sex workers (FSW) are at high risk of chlamydia and gonorrhea infection. However, there is a limited literature examining their testing uptake to date. The aim of this study was to assess the uptake and determinants of chlamydia and gonorrhea testing among FSW in Southern China.Methods: A cross-sectional study with convenience sampling was conducted in five cities in Southern China. We collected data on socio-demographic characteristics, sex behaviors, chlamydia and gonorrhea testing in the past twelve months and the utilization of health care services from participants through face-to-face interviews. Multivariable logistic regression was performed to identify factors associated with chlamydia and gonorrhea testing, respectively.Results: Overall, 1207 FSWs were recruited, with the mean age of 30.7±6.8 years old, and an average number of clients per week of 7.0(4.0-10.0). 65.4% participants consistently used condoms with clients in the past month. Only 7.5% and 10.4% had been tested for chlamydia and gonorrhea in the past twelve months, respectively. Multivariable analysis indicated that FSW who worked at low titers (adjusted Odds Ratio (aOR)=2.36, 95%CI:1.23-10.14), had more clients in past month (aOR=1.03, 95%CI:1.01-1.05), used condoms consistently (aOR=1.79, 95%CI:1.12-2.86), had STD symptoms (aOR=4.09,95%CI:2.62-6.40), had HIV testing (aOR=5.16, 95%CI:3.21-8.30) or syphilis testing (aOR=6.90, 95%CI:4.21-11.22) in the past year were more likely to have received chlamydia testing. In addition, FSW who had more clients in the past month (aOR=1.02,95%CI:1.00-1.04), had STD symptoms (aOR=3.33, 95%CI:2.03-5.46), had HIV (aOR=3.94, 95%CI:2.34-6.65) and syphilis testing (aOR=3.27, 95%CI:1.96-5.46) in the past year were more likely to have gonorrhea testing.Conclusions: The chlamydia and gonorrhea testing uptake are low among Chinese FSW. Integrating chlamydia and gonorrhea testing promotion strategies into HIV testing promotion programs may help bridge the gap among FSW.

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Section: Discussionmentioning

confidence: 99%

Uptake and Correlates of Chlamydia and Gonorrhea Testing among Female Sex Workers in Southern China: A Cross-sectional Study

Zhao

Wang

Cheng

et al. 2020

Preprint

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“…The review was undertaken following a peer-reviewed protocol [ 66 ] and is reported following current standards for systematic reviews [ 67 ]. The methods are outlined briefly here, focusing on the eligibility criteria and any deviations or new methods developed after the protocol.…”

Section: Methodsmentioning

confidence: 99%

“…Our research librarian conducted comprehensive, peer-reviewed, searches in relevant bibliographic databases on June 5, 2018, with an update on January 24, 2020: Ovid Medline, Ovid Embase, Wiley Cochrane Library, CINAHL via EBSCOhost, and Ovid PsycINFO (searches in Additional File 7 in protocol [ 66 ]). The search was comprehensive for all KQs, with the exception of studies for KQ3 measuring health-state utility values for which we updated the search of an existing systematic review from 2013 to January 26, 2020 [ 32 ].…”

Section: Methodsmentioning

confidence: 99%

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Screening for chlamydia and/or gonorrhea in primary health care: systematic reviews on effectiveness and patient preferences

et al. 2021

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Background We conducted systematic reviews on the benefits and harms of screening compared with no screening or alternative screening approaches for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in non-pregnant sexually active individuals, and on the relative importance patients’ place on the relevant outcomes. Findings will inform recommendations by the Canadian Task Force on Preventive Health Care. Methods We searched five databases (to January 24, 2020), trial registries, conference proceedings, and reference lists for English and French literature published since 1996. Screening, study selection, and risk of bias assessments were independently undertaken by two reviewers, with consensus for final decisions. Data extraction was conducted by one reviewer and checked by another for accuracy and completeness. Meta-analysis was conducted where appropriate. We used the GRADE approach to rate the certainty of the evidence. The Task Force and content experts provided input on determining thresholds for important effect sizes and on interpretation of findings. Results Of 41 included studies, 17 and 11 reported on benefits and harms of screening, respectively, and 14 reported on patient preferences. Universal screening for CT in general populations 16 to 29 years of age, using population-based or opportunistic approaches achieving low screening rates, may make little-to-no difference for a female’s risk of pelvic inflammatory disease (PID) (2 RCTs, n=141,362; 0.3 more in 1000 [7.6 fewer to 11 more]) or ectopic pregnancy (1 RCT, n=15,459; 0.20 more per 1000 [2.2 fewer to 3.9 more]). It may also not make a difference for CT transmission (3 RCTs, n=41,709; 3 fewer per 1000 [11.5 fewer to 6.9 more]). However, benefits may be achieved for reducing PID if screening rates are increased (2 trials, n=30,652; 5.7 fewer per 1000 [10.8 fewer to 1.1 more]), and for reducing CT and NG transmission when intensely screening high-prevalence female populations (2 trials, n=6127; 34.3 fewer per 1000 [4 to 58 fewer]; NNS 29 [17 to 250]). Evidence on infertility in females from CT screening and on transmission of NG in males and both sexes from screening for CT and NG is very uncertain. No evidence was found for cervicitis, chronic pelvic pain, or infertility in males from CT screening, or on any clinical outcomes from NG screening. Undergoing screening, or having a diagnosis of CT, may cause a small-to-moderate number of people to experience some degree of harm, mainly due to feelings of stigmatization and anxiety about future infertility risk. The number of individuals affected in the entire screening-eligible population is likely smaller. Screening may make little-to-no difference for general anxiety, self-esteem, or relationship break-up. Evidence on transmission from studies comparing home versus clinic screening is very uncertain. Four studies on patient preferences found that although utility values for the different consequences of CT and NG infections are probably quite similar, when considering the duration of the health state experiences, infertility and chronic pelvic pain are probably valued much more than PID, ectopic pregnancy, and cervicitis. How patients weigh the potential benefits versus harms of screening is very uncertain (1 survey, 10 qualitative studies); risks to reproductive health and transmission appear to be more important than the (often transient) psychosocial harms. Discussion Most of the evidence on screening for CT and/or NG offers low or very low certainty about the benefits and harms. Indirectness from use of comparison groups receiving some screening, incomplete outcome ascertainment, and use of outreach settings was a major contributor to uncertainty. Patient preferences indicate that the potential benefits from screening appear to outweigh the possible harms. Direct evidence about which screening strategies and intervals to use, which age to start and stop screening, and whether screening males in addition to females is necessary to prevent clinical outcomes is scarce, and further research in these areas would be informative. Apart from the evidence in this review, information on factors related to equity, acceptability, implementation, cost/resources, and feasibility will support recommendations made by the Task Force. Systematic review registration International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42018100733.

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“…10 Consequences of untreated gonorrhea may include rates of pelvic inflammatory disease that exceed those for chlamydia. 12 In males, chlamydia may be associ ated with epididymitis in up to 7%, with or without orchitis, 6,13 and, very rarely, infertility. 14 Consequences of chlamydia affect ing both sexes include urethritis in 4% of females and up to 3% of males; 15 pharyngitis; proctitis; reactive arthritis lasting longer than 6 months in 1%-4% (when considering both chlamydia and gonorrhea); 16,17 and disseminated gonococcal infection in less than 1%, which can rarely lead to sepsis, meningitis, endocarditis or osteomyelitis.…”

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confidence: 99%

Recommendation on screening for chlamydia and gonorrhea in primary care for individuals not known to be at high risk

Moore

Traversy

Reynolds

et al. 2021

CMAJ

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In Canada, Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhea) are the most commonly reported sex ually transmitted bacterial infections (STIs), 1,2 with reported cases in the population increasing annually since 2000. 3 In 2018, reported cases were highest in people aged 15-29 years, with rates of 1.0%-1.9% for chlamydia and 0.2%-0.3% for gonorrhea in this population, 4 while rates among individuals older than 30 years were less than 0.5% for chlamydia and less than 0.2% for gonor rhea. 4 Many infected individuals, however, are asymptomatic or do not seek care, and are not included in reported cases. 3 Taking into account underreporting, the true prevalence of chlamydia in people aged 15 to 29 years may be as high as 5%-7%. [3][4][5][6] Consequences of untreated chlamydia in females can include cervicitis in 10%-20%, 7 pelvic inflammatory disease in 10%-16%, 8,9 infertility in up to 5%, 10 chronic pelvic pain in 3%-8%, 10,11 and ectopic pregnancy in up to 2%. 10 Consequences of untreated gonorrhea may include rates of pelvic inflammatory disease that exceed those for chlamydia. 12 In males, chlamydia may be associ ated with epididymitis in up to 7%, with or without orchitis, 6,13 and, very rarely, infertility. 14 Consequences of chlamydia affect ing both sexes include urethritis in 4% of females and up to 3% of males; 15 pharyngitis; proctitis; reactive arthritis lasting longer than 6 months in 1%-4% (when considering both chlamydia and gonorrhea); 16,17 and disseminated gonococcal infection in less than 1%, which can rarely lead to sepsis, meningitis, endocarditis or osteomyelitis. 18 Screening sexually active individuals for chlamydia and gon orrhea could reduce clinical complications and transmission, but should be done only if benefits from screening exceed harms 19,20 and resource use is justifiable.In Canada, STI screening is most commonly offered oppor tun istically by clinicians in a variety of primary care settings (e.g., family practice, sexual health clinics, school health centres) during visits that may or may not be for sexual health-related

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Screening for chlamydia and/or gonorrhea in primary health care: protocol for systematic review

Cited by 8 publications

References 73 publications

Uptake and Correlates of Chlamydia and Gonorrhea Testing among Female Sex Workers in Southern China: A Cross-sectional Study

Uptake and Correlates of Chlamydia and Gonorrhea Testing among Female Sex Workers in Southern China: A Cross-sectional Study

Screening for chlamydia and/or gonorrhea in primary health care: systematic reviews on effectiveness and patient preferences

Recommendation on screening for chlamydia and gonorrhea in primary care for individuals not known to be at high risk

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