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Appendix E

Chlamydia trachomatis Screening Recommendations

The U.S. Preventive Services Task Force (USPSTF) has published recommendations for screening certain groups of women for C. trachomatis infection (E-1). The following summarizes those recommendations:

  • Routinely screen all sexually active women aged <25 years for C. trachomatis infection, whether or not they are pregnant. Women and adolescents aged <20 years are at highest risk for chlamydial infection, but the majority of reported data indicate that infection is prevalent among women aged 20--25 years. More targeted screening might be indicated by local prevalence data.
  • Screening of women aged >25 years for C. trachomatis should also be considered if they are at increased risk.
  • Prevalence of C. trachomatis infection varies widely among communities and patient populations. Knowledge of the patient population is the best guide to developing a screening strategy. Certain risk factors should be considered, including
    --- having new or multiple sex partners,*
    --- having a prior history of a sexually transmitted disease, and
    --- not using condoms consistently and correctly.
  • Personal risk depends on the number of risk markers and local disease prevalence. Specific risk-based protocols need to be tested locally.
  • The optimal timing of screening in pregnancy is uncertain. --- Screening early in pregnancy provides increased opportunities to improve pregnancy outcomes, including low birth weight and premature delivery.
    --- Screening and treatment in the third trimester might be more effective at preventing transmission of chlamydial infection to the infant during birth by reducing the risk for reinfection.
    --- The incremental benefit of repeated screening is unknown.
  • The optimal interval for screening women with a previous negative screening test is uncertain. The interval for rescreening should be based on changes in sexual partners, young age, and other C. trachomatis risk factors. If evidence exists that a woman is at low risk for infection (e.g., in a mutually monogamous relationship with a previous history of negative screening tests for chlamydial infection), screening frequently might be unnecessary.

USPSTF did not address screening of women with a C. trachomatis infection. CDC recommends that women with C. trachomatis infection be screened 3--4 months after treatment is completed (E-2).

References

E-1. US Preventive Services Task Force. Screening for chlamydial infection: recommendations and rationale. Am J Prev Med 2001;20(3Suppl):90--4.
E-2. CDC. Sexually transmitted diseases treatment guidelines. MMWR 2002;51(No. RR-6):1--80.

* USPSTF does not include a time interval for this risk factor. Having new or multiple sex partners within the past 90 days was the criterion recommended previously by CDC (Source: CDC. Recommendations for the prevention and management of Chlamydia trachomatis infections, 1993. MMWR 1993;42[No. RR-12]:1--39). A history of new or multiple sex partners since the woman's last screening would also provide a time interval for previously screened women.

USPSTF did not include a time limitation for the risk factor of having a prior history of sexually transmitted disease. Obtaining a history of a sexually transmitted disease within the past year includes an arbitrary choice of time interval. Obtaining a history of a sexually transmitted disease since the woman's last screening would also restrict the time interval for a sexually transmitted disease in the past.



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