All sexually active females ages 24 years or younger should be screened for chlamydia and gonorrhea, as should older women who are at an increased risk of sexually transmitted infections, according to an evidence-based update of the 2007 screening recommendations for chlamydia and the 2005 recommendations for gonorrhea. There is no recommendation for screening men.

Chlamydia and gonorrhea are the most common sexually transmitted infections (STIs) in the United States, with a reported 1.4 million and 330,000 cases, respectively, in 2012.

Age is a strong predictor of risk, with the highest infection rates occurring in women ages 20 to 24. Other risk factors include new or multiple sex partners, inconsistent condom use among people who are not mutually monogamous, previous or concurrent STI, and exchanging sex for money or drugs. Screening should be implemented in women whose sexual history reveals new or persistent risk factors since their last negative test result.

Nucleic acid amplification tests accurately detect both diseases, which are often asymptomatic and can lead to pelvic inflammatory disease in women. In men, STIs are more likely to cause symptoms that lead to diagnosis and treatment, and serious complications are less common. A systematic review of published studies on the effectiveness of screenings in men revealed little direct evidence of chlamydial screening and no evidence for gonorrheal screening.

Citation: LeFevre ML. Screening for chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014. doi: 10.7326/M14-1981. [Epub ahead of print]

Commentary: There were more than 1.4 million cases of chlamydia and more than 330,000 cases of gonorrhea reported to the Centers for Disease Control and Prevention (CDC) in 2012. It is certain that those reported cases do not represent all individuals infected with chlamydia, since screening is done in less than half the individuals in whom it is recommended, men are not generally screened, and most infections are asymptomatic. Undetected infections can lead to pelvic inflammatory disease with concomitant infertility, ectopic pregnancy, and chronic pelvic pain, and when it occurs in pregnant women it can lead to adverse neonatal outcomes including conjunctivitis and pneumonia in newborns. These recommendations by the USPSTF echo those of the CDC STD Guidelines (2010). It remains disappointing and surprising that the evidence remains inadequate to recommend routine screening for sexually active men as one would think that such screening would also decrease transmission to women, but such a recommendation awaits further studies. Of note, the CDC guidelines do recommend annual screening of MSM based upon exposure history. In addition, the CDC STD Guidelines also recommend retesting women who were treated for chlamydia or gonorrhea 3 months after treatment, not as a test of cure, but because there is a high rate of reinfection.¹—Neil Skolnik, MD

1. Workowski KA, Berman S; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):1-110. Erratum in: MMWR Recomm Rep. 2011;60(1):18. Dosage error in article text.