USPSTF affirms recommendations for chlamydia, gonorrhea screening amid record STI cases

The U.S. Preventive Services Task Force said today it recommends chlamydia and gonorrhea screening in all sexually active women aged younger than 24 years and women aged 25 years or older with an increased risk for infection.

The evidence was insufficient to make similar screening recommendations for men, according to the task force.

The B-level recommendations for screening in women and I-level recommendation for men mirror the USPSTF’s 2014 recommendations in this area, the task force said, and come amid an increase in cases. CDC data released in April showed 2019 was the sixth straight year that a record number of STIs were reported in the United States.

The recommendations are based on 27 studies with 179,515 participants, researchers wrote in JAMA. The review included four randomized trials evaluating the effectiveness of chlamydia screening, Marti Kubik, PhD, RN, a task force member and professor in the School of Nursing in the College of Health and Human Services at George Mason University, told Healio Primary Care.

“Three of those had been reviewed in the task force’s prior recommendation. The new data from a large study with over 63,000 participants was generally consistent with the results of the prior trials, and overall, the research showed that screening reduces the risk of serious health complications, such as pelvic inflammatory disease,” Kubik continued.

In a related editorial, Jeanne Marrazzo, MD, MPH, and Jodie Dionne-Odom, MD, MSPH, both of the division of infectious diseases in the department of medicine at the University of Alabama at Birmingham, wrote that although the USPSTF recommendations are “timely,” they also “leave several questions unanswered.”

“It may be time to consider the inclusion of a more diverse menu of biologically based assessments of upper reproductive tract infection that incorporate comprehensive measures of infection and pathogenesis into considerations of screening efficacy,” they wrote.

In addition, they added that “the absence of new information about gonorrhea screening” and the single, “high-quality” randomized clinical trial on chlamydia screening “highlight the need for investment in STI clinical trials designed to measure screening efficacy and effectiveness using clinically relevant and well-defined outcomes for key populations at risk of infection.”

“Current guidelines that address men (as the USPSTF does) should consider STI risk conferred while having sex as a man, whether with men, women or both,” Marrazzo and Dionne-Odom continued.

Kubik acknowledged that there is an abundance of more research that can be done on STIs.

“We are specifically calling for more research on the benefits and harms of screening men for chlamydia and gonorrhea,” she said. “We hope to see more research on the benefits and harms of screening men who have sex with men, members of the LGBTQ+ community and people whose gender is nonbinary.”

The USPSTF will update the new recommendation “as appropriate,” according to Kubik.

“We aim to keep all recommendations current and generally revisit topics every 5 years, depending on the available evidence,” she said. “In the meantime, we encourage clinicians to ask their patients in confidential, respectful and culturally appropriate ways about their sexual health and any concerns they might have about sexually transmitted infections.”

References:

Cantor A, et al. JAMA. 2021;doi:10.1001/2021.10577.

Marrazzo J, Dionne-Odom J. JAMA. 2021;326(10):913-915.

USPSTF. JAMA. 2021;doi:10.1001/jama.2021.14081.