Screening for Chlamydial and Gonococcal Infections

Cantor, Amy; Dana, Tracy; Griffin, Jessica; Nelson, Heidi D; Weeks, Chandler; Winthrop, Kevin; Chou, Roger

doi:10.1001/jama.2021.10577

Cited by 24 publications

(29 citation statements)

References 41 publications

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“…NAATs are the tests of choice at all potentially infected sites, and the approach to testing is similar to the one described for gonorrhea (Table 1). Chlamydia NAAT tests results are typically positive for LGV but cannot distinguish the L1 through L3 from the D through K serovars . Molecular tests to confirm LGV infection exist but none are FDA cleared or widely available in the US.…”

Section: Methodsmentioning

confidence: 99%

“…12 Testing and Screening for Gonorrhea Nucleic acid amplification tests (NAATs), which differ in their amplification methods and their target nucleic acid sequences, have sensitivities of more than 90% and specificities of 98% or more for detecting gonorrhea at genital and extragenital sites, respectively. 13,14 In women, the preferred specimen is a vaginal swab (including self-collected swabs) given its high sensitivity and ease of collection, but endocervical swabs and first-catch urine (ie, 20-30 mL of the initial urinary stream collected after abstinence from urination for at least 1 hour) are acceptable (Table 1). 15 In men, the preferred specimen is a first-catch urine, but urethral swabs are acceptable.…”

Section: Clinical Presentationsmentioning

confidence: 99%

“…18 At least annual screening for gonorrhea is recommended for sexually active women younger than 25 years and for other groups based on selected characteristics or risk factors (Table 2). 13,15…”

Section: Clinical Presentationsmentioning

confidence: 99%

“…Rates for women are approximately twice that of men, in part because screening recommendations focus on women (see Table 2). 13,15 Rates are highest among young women aged 20 through 24 years (4109.5 cases per 100 000 per year) and are 5.6 times higher in people who are Black (1233.2 cases per 100 000 per year) compared with people who are White (209.7 cases per 100 000 per year). Incidence is highest in the southern US (573.9 cases per 100 000 per year).…”

Section: Epidemiologymentioning

confidence: 99%

“…NAATs are the tests of choice at all potentially infected sites, and the approach to testing is similar to the one described for gonorrhea (Table 1). 13,15 Chlamydia NAAT tests results are typically positive for…”

Section: Testing and Screeningmentioning

confidence: 99%

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Diagnosis and Treatment of Sexually Transmitted Infections

Tuddenham

Hamill

Ghanem

2022

JAMA

131

136

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In 2019, an estimated 2.55 million new sexually transmitted infections (STIs) were reported in the US, 1 with a projected direct medical cost of approximately $1.1 billion for gonorrhea, chlamydia, and syphilis in 2018. 2 In 2018, there were approximately 67.6 million prevalent infections in the US, suggesting that an estimated 1 in 5 adults had an STI. 3 People with STIs are at greater risk of transmitting HIV to others. Among people without HIV, STIs increase rates of HIV acquistion. 4,5 STIs also increase rates of infertility, chronic pelvic pain, ectopic pregnancy, miscarriage, fetal death, and congenital and neonatal infections. [6][7][8][9] This review summarizes current evidence regarding the epidemiology, diagnosis, treatment, and prevention of gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, trichomoniasis, and genital herpes. For the purposes of clarity, in this article, the terms male and female refer to those assigned male or female at birth, respectively (see eTable 1 in the Supplement for additional clinician resources). MethodsWe searched PubMed and Cochrane databases using Medical Subject Headings for English-language studies of the epidemiology, diagnosis, and treatment of gonorrhea, chlamydia (including lymphogranuloma venereum), syphilis, Mycoplasma genitalium, trichomoniasis, and herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) between October 1, 2010, and October 31, 2021. We manually searched the references of selected articles for additional relevant studies (including older studies). Randomized clinical trials, meta-analyses, systematic reviews, and national and international clinical practice guidelines were prioritized for inclusion. Of 1896 reports identified, 81 were included, consisting of 8 randomized trials, 7 meta-analyses, 27 systematic reviews, 5 clinical practice guidelines, 28 observational studies, 3 modeling studies, and 3 retrospective case series. IMPORTANCE Approximately 1 in 5 adults in the US had a sexually transmitted infection (STI) in 2018. This review provides an update on the epidemiology, diagnosis, and treatment of gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, trichomoniasis, and genital herpes.OBSERVATIONS From 2015 to 2019, the rates of gonorrhea, chlamydia, and syphilis increased in the US; from 1999 to 2016, while the rates of herpes simplex virus type 1 (HSV-1) and HSV-2 declined. Populations with higher rates of STIs include people younger than 25 years, sexual and gender minorities such as men and transgender women who have sex with men, and racial and ethnic minorities such as Black and Latinx people. Approximately 70% of infections with HSV and trichomoniasis and 53% to 100% of extragenital gonorrhea and chlamydia infections are asymptomatic or associated with few symptoms. STIs are associated with HIV acquisition and transmission and are the leading cause of tubal factor infertility in women. Nucleic acid amplification tests have high sensitivities (86.1%-100%) and specificities (97.1%-100%) for the diagnosis of gonorrhea, chlamydia,...

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Section: Methodsmentioning

confidence: 99%

Section: Clinical Presentationsmentioning

confidence: 99%

Section: Clinical Presentationsmentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Section: Testing and Screeningmentioning

confidence: 99%

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Diagnosis and Treatment of Sexually Transmitted Infections

Tuddenham

Hamill

Ghanem

2022

JAMA

131

136

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Screening for Chlamydial and Gonococcal Infections

Cantor

Dana

Griffin

et al. 2021

JAMA

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The 2014 US Preventive Services Task Force (USPSTF) recommendation statement supported the effectiveness of screening for chlamydia and gonorrhea in asymptomatic, sexually active women 24 years or younger and in older women at increased risk for infection, although evidence for screening in men was insufficient.OBJECTIVE To update the 2014 USPSTF review on screening for chlamydial and gonococcal infection in adults and adolescents, including those who are pregnant.

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Screening for Chlamydia and Gonorrhea

Force

Davidson

Barry

et al. 2021

JAMA

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IMPORTANCE Chlamydia and gonorrhea are among the most common sexually transmitted infections in the US. Infection rates are highest among adolescents and young adults of both sexes. Chlamydial and gonococcal infections in women are usually asymptomatic and may lead to pelvic inflammatory disease and its associated complications. Newborns of pregnant persons with untreated infection may develop neonatal chlamydial pneumonia or gonococcal or chlamydial ophthalmia. Infection in men may lead to urethritis and epididymitis. Both types of infection can increase risk of acquiring or transmitting HIV.OBJECTIVE To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for chlamydia and gonorrhea in sexually active adolescents and adults, including pregnant persons.POPULATION Asymptomatic, sexually active adolescents and adults, including pregnant persons. EVIDENCE ASSESSMENTThe USPSTF concludes with moderate certainty that screening for chlamydia in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection has moderate net benefit. The USPSTF concludes with moderate certainty that screening for gonorrhea in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection has moderate net benefit. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men.RECOMMENDATION The USPSTF recommends screening for chlamydia in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection. (B recommendation) The USPSTF recommends screening for gonorrhea in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men. (I statement)

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Screening for Chlamydial and Gonococcal Infections

Cited by 24 publications

References 41 publications

Diagnosis and Treatment of Sexually Transmitted Infections

Diagnosis and Treatment of Sexually Transmitted Infections

Screening for Chlamydial and Gonococcal Infections

Screening for Chlamydia and Gonorrhea

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