In the Journals

USPSTF: Screen sexually active young women for chlamydia, gonorrhea

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September 22, 2014

The US Preventive Services Task Force has recommended screening for chlamydia and gonorrhea in sexually active, asymptomatic females aged 24 years and younger and in older women who are at risk for infection.

However, it concluded that there is insufficient evidence to assess the benefits of similar screening recommendations for men.

“Chlamydia and gonorrhea are the most commonly reported STIs in the United States,” Michael L. LeFevre, MD, MSPH, of the College of Medicine, University of Missouri, wrote in Annals of Internal Medicine on behalf of the USPSTF. “Although the prevalence of chlamydia and gonorrhea differs, the risk factors for infection overlap and the USPSTF recommends screening for both simultaneously.”

The USPSTF recommended that the infections be diagnosed using nucleic acid amplification tests. Although there are no studies on screening intervals, it suggests screening patients whose sexual history has changed and includes new or persistent risk factors since the last negative test result.

In addition, the USPSTF also recommends that all sexually active adolescents and adults at increased risk for STIs undergo intensive behavioral counseling for sexual risk reduction in primary care.

“The USPSTF found adequate evidence that intensive behavioral counseling interventions reduce the likelihood of STIs in sexually active adolescents and in adults who are at increased risk,” LeFevre wrote. “Primary care clinicians can identify adolescents and adults who are at increased risk for STIs.”

The 2008 USPSTF guideline recommended high-intensity behavioral counseling. The updated recommendation reaffirms the evidence for this and suggests that lower-intensity behavioral interventions also are effective, although the evidence suggests that higher-intensity interventions (2 hours of contact time or more) have the highest benefit.

The systematic review included many different successful interventions that were targeted to age, sex and ethnicity, including face-to-face counseling, videos, written materials and telephone support. All approaches provided basic information about STIs and transmission and included training in important skills such as condom use and communication about safe sex.

For more information:

LeFevre M. Ann Intern Med. 2014;doi:10.7326/P14-9042.

LeFevre M. Ann Intern Med. 2014;doi:10.7326/M14-1965.

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