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

BACKGROUND: Previous research has supported screening for gonorrhea and chlamydia in asymptomatic, sexually active women (including pregnant women) who are younger than 25 years or at increased risk but not in 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 (1 January 2004 to 13 June 2014), Cochrane databases (May 2014), ClinicalTrials.gov, and reference lists. STUDY SELECTION: English-language trials and observational studies about screening effectiveness, test accuracy, and screening harms. DATA EXTRACTION: Extracted study data were confirmed by a second investigator, and study quality and applicability were dual-rated using prespecified criteria. DATA SYNTHESIS: Screening a subset of asymptomatic young women for chlamydia in a good-quality trial did not significantly reduce the incidence of pelvic inflammatory disease over the following year (relative risk, 0.39 95% CI, 0.14 to 1.08); however, 1 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 patients, 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: There were few relevant studies of screening benefits and harms. Only screening tests and methods cleared by the U.S. Food and Drug Administration for current clinical practice were included to determine diagnostic accuracy. CONCLUSION: Chlamydia screening in young women may reduce the incidence of pelvic inflammatory disease. Nucleic acid amplification tests are accurate for diagnosing gonorrhea and chlamydia in asymptomatic persons. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.