Screening for Chlamydia and Gonorrhea | Adolescent Medicine | JAMA | JAMA Network
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September 14, 2021

Screening for Chlamydia and Gonorrhea

Author Affiliations
  • 1Associate Editor, JAMA
JAMA. 2021;326(10):984. doi:10.1001/jama.2021.14770

The US Preventive Services Task Force (USPSTF) has recently published recommendations on screening for chlamydia and gonorrhea in adolescents and adults.

What Are Chlamydia and Gonorrhea?

Chlamydia and gonorrhea are 2 common sexually transmitted infections. For both, rates of infection are especially high in women aged 15 to 24 years. Other risk factors include a new sex partner, multiple sex partners, a sex partner with multiple partners, a sex partner who has another sexually transmitted infection, and inconsistent condom use when not in a mutually monogamous relationship.

Symptoms of chlamydia and gonorrhea in women may include vaginal discharge or abnormal vaginal bleeding; however, most women have no symptoms initially. Symptoms in men include abnormal discharge from the penis or pain when urinating, but many men also have no symptoms. Because of the lack of symptoms, many people do not know when they are transmitting the infection to others.

Both infections are easily cured with antibiotics. In women, if untreated over time, both chlamydia and gonorrhea can lead to pelvic inflammatory disease (an infection of the female reproductive organs), which can then lead to future pregnancy complications. Serious complications are less common in men.

What Screening Tests Are Used for Chlamydia and Gonorrhea?

Screening for chlamydia and gonorrhea is done by taking a swab sample (cervical, vaginal, or urethral swab for women; urethral or rectal swab for men) and looking for bacterial DNA specific to each of the 2 bacteria. For both men and women, a urine sample can also be used.

What Is the Population Under Consideration for Screening for Chlamydia and Gonorrhea?

This recommendation applies to sexually active adolescents and adults, including pregnant persons, who do not have symptoms of chlamydia or gonorrhea.

What Are the Potential Benefits and Harms of Screening for Chlamydia and Gonorrhea?

The goal of screening for chlamydia and gonorrhea is to catch and treat infections that may present without symptoms so they are not passed on to others and so they do not cause complications from prolonged, untreated infection. For women, there is some direct evidence that screening for chlamydia reduces the rate of pelvic inflammatory disease. There is indirect evidence linking screening for gonorrhea and health outcomes (including pregnancy outcomes) in women. For men, there is not enough evidence linking screening and health outcomes, including transmission of disease, for both chlamydia and gonorrhea.

Potential harms of screening for chlamydia and gonorrhea include false-positive or false-negative results, as well as stigma and anxiety from having positive results.

How Strong Is the Recommendation to Screen for Chlamydia and Gonorrhea?

Given the current evidence, the USPSTF concludes with moderate certainty that screening for chlamydia and gonorrhea in all sexually active women aged 24 years or younger and in women aged 25 years or older who are at increased risk of 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.

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Conflict of Interest Disclosures: None reported.

Source: US Preventive Services Task Force. Screening for chlamydia and gonorrhea: US Preventive Services Task Force recommendation statement. JAMA. Published September 14, 2021. doi:10.1001/jama.2021.14081