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STD Quarterly: Group issues guidelines on chlamydia screening
The push for chlamydia screening has been intensified, with the Washington, DC-based American College of Preventive Medicine (ACPM) issuing a practice policy statement calling for the annual screening of all sexually active women 25 years of age or younger, as well as sexually active women with other risk factors.1
Why has the 2,000-physician member professional society issued the new guidelines? The move comes in light of the fact that Chlamydia trachomatis infection now is the most common bacterial sexually transmitted disease (STD) in the United States, explains Katerina Hollblad-Fadiman, MD, MPH, clinical instructor in the department of medicine at the University of California, San Francisco (UCSF) and lead author of the practice policy statement.
It is estimated that chlamydia affects more than 4 million people yearly at a cost exceeding $2.7 billion.2,3 Widespread screening is necessary because up to 70% of infected women and 75% of infected men are asymptomatic.4-6
With urine-based screening tests and one-dose therapy now available, diagnosis and treatment of the STD now is simplified, says Hollblad-Fadiman.
The society’s statement follows similar practice guidelines issued by the Chicago-based American Medical Association (AMA), the Elk Grove Village, IL-based American Academy of Pediatrics (AAP), the Atlanta-based Centers for Disease Control (CDC), and the U.S. Preven- tive Services Task Force.7-10 (Contraceptive Technology Update reported on the latest of these guidelines in the July 2001 article, "Task force calls for chlamydia screening," p. 81.)
"Chlamydia trachomatis, our most common sexually transmitted infection, is an important cause of pelvic inflammatory disease — and its late sequelae of tubal factory infertility and ectopic pregnancy — and pneumonia in infants who are exposed to the infection at birth," says Julius Schachter, PhD, professor in the department of laboratory medicine at UCSF and North America representative to the International Union against Sexually Transmitted Infections, a globally based organization seeking international cooperation in the control of STDs.
"The recommendation that sexually active young women be screened annually for genital infections is particularly welcome because young age has consistently been shown to be the most important risk factor for being infected, and programs of screening and treating those found to be infected have been shown to reduce the prevalence of infection and the incidence of PID and perinatal infections," he says.
Review the guidelines
The ACPM’s guidelines call for annual screening of all sexually active women 25 or younger, as well as sexually active women with other risk factors. These risk factors include having a new male sex partner or two or more partners during the preceding year, inconsistent use of barrier contraception, history of a prior sexually transmitted disease, African-American race, and cervical ectopy.
These guidelines fall in line with other professional directives: The AMA and the AAP both recommend that all sexually active adolescents be screened annually for the STD7-8, while the CDC recommends screening all sexually active women younger than 20 for chlamydial infection during routine annual examinations.9
The CDC also advocates annual screening of women older than 20 who use barrier contraceptive measures inconsistently and who have new or multiple sex partners during the previous three months.9 The U.S. Preventive Services Task Force recommends routine screening for all sexually active women age 25 and younger, all asymptomatic pregnant women 25 and younger and/or at high risk for infection, as well as other asymptomatic women at high risk for infection.10
High-risk characteristics include being unmarried or African American, having a prior history of STD, having new or multiple sexual partners, having cervical ectopy, and using barrier contraceptives inconsistently.10
Health care providers are reminded that while annual screening is an important first step, treatment of sex partners and regular follow-up of those found to be infected should be part of the program, states Schachter.
Because there are excellent diagnostic capabilities in nucleic acid amplification tests and highly effective single dose therapy in azithromycin (1 g orally), "the chlamydia problem is one we can make go away," he says.
1. Hollblad-Fadiman K, Goldman SM. American College of Preventive Medicine practice policy statement. Screening for Chlamydia trachomatis. Am J Prev Med 2003; 24:287-292.
2. Howell MR, Quinn TC, Brathwaite W, et al. Screening women for Chlamydia trachomatis in family planning clinics: The cost-effectiveness of DNA amplification assays. Sex Transm Dis 1998; 25:108-117.
3. Washington AE, Katz P. Cost of and payment source for pelvic inflammatory disease: Trends and projections, 1983 through 2000. JAMA 1991; 266:2,5652,569.
4. Andersen B, Olesen F, Moller JK, et al. Population-based strategies for outreach screening of urogenital Chlamydia trachomatis infections: A randomized, controlled trial. J Infect Dis 2002; 185:252-258.
5. Doing KM, Curtis K, Long JW, et al. Prospective comparison of the Gen-probe PACE 2 Assay and the Abbott Ligase Chain Reaction for the direct detection of Chlamydia trachomatis in a low prevalence population. J Med Microbiol 1999; 48:507-510.
6. Clinical Effectiveness Group (Association of Genitourinary Medicine and the Medical Society for the Study of Venereal Diseases). National guideline for the management of Chlamydia trachomatis genital tract infection. Sex Transm Infect 1999; 75(suppl 1):4-8. 1997; 176:103-107.
7. American Medical Association. Guidelines for Adolescent Preventive Services. Chicago: American Medical Association; 1997.
8. American Academy of Pediatrics. Recommendations for preventive pediatric health care (RE9939). Pediatrics 2000; 105:645-666.
9. Centers for Disease Control and Prevention. CDC recommendations for the prevention and management of Chlamydia trachomatis infections, 1993. MMWR Recomm Rep 1993; 42:1-39.
10. U.S. Preventive Services Task Force. Screening for chlamydial infection. Am J Prev Med 2001; 20:90-93.