The USPSTF recommends that women at increased risk of infection be screened for chlamydia, gonorrhea, human immunodeficiency virus, and syphilis. Men at increased risk should be screened for human immunodeficiency virus and syphilis. All pregnant women should be screened for hepatitis B, human immunodeficiency virus, and syphilis; pregnant women at increased risk also should be screened for chlamydia and gonorrhea.
Nonpregnant women and men not at Cdc sexually transmitted disease screening risk do not require routine screening for sexually transmitted infections.
Engaging in high-risk sexual behavior places persons at increased risk of sexually transmitted infections. The USPSTF recommends that all sexually active women younger than 25 years be considered at increased risk of chlamydia and gonorrhea.
Because not all communities present equal risk of sexually transmitted infections, the USPSTF encourages physicians to consider expanding or limiting the routine sexually transmitted infection screening they provide based on the community and populations they serve. Sexually transmitted infections STIs cause significant morbidity and mortality in the United States each year.
The Centers for Disease Control and Prevention CDC estimates that 19 million new infections occur annually in the United States, almost one half of which occur in persons 15 to 24 years of age. Screen sexually active, nonpregnant women at increased risk for chlamydia, gonorrhea, HIV, and syphilis infection. Screen all pregnant women for hepatitis B, HIV, and syphilis; additionally, screen all pregnant women at increased risk for chlamydia and gonorrhea infection.
Do not routinely screen women and men who are not at increased risk for transmitted infections. Preventive Services Task Force. For information about the SORT evidence rating system, see page or https: Rather than considering each recommendation separately, physicians can cluster STI screening at the time of a periodic health examination. For each of these groups, physicians need to consider what risk factors, both behavioral and demographic, place individual patients at increased risk of infection.
Information from references 2 through 9. For nonpregnant women, physicians should consider two main factors to determine if a patient has an increased risk of STIs: The USPSTF recommends the service; there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.
The USPSTF recommends against routinely providing the service; there may be considerations that support providing the service in an individual patient; there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. The USPSTF recommends Cdc sexually transmitted disease screening the service; there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service; evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. If offered, patients should understand the uncertainty about the balance of benefits and harms. Adapted with permission from Screening for chlamydial infection: Preventive Services Task Force recommendation statement.
In general, physicians should determine a
Cdc sexually transmitted disease screening woman's risk status using the same factors that determine a nonpregnant woman's risk status i.
In men, as in women, it is important that physicians take a thorough sexual history to assess if the patient engages in high-risk sexual behavior. In men who have sex with men, it is important to focus on high-risk sexual behavior and not on sexual orientation. Physicians should consider the demographics of the populations they serve in determining which STI screening tests to offer.
In addition to evaluating a patient's modifiable behaviors, physicians should consider the patient's nonmodifiable demographics and social situation. All communities do not present the same infection risk.
In the United States, syphilis and gonorrhea have widely varying prevalence rates. Southern states and many urban centers have higher rates of STIs. This is partially caused by social network and socioeconomic influences e.
The USPSTF recommends that physicians be aware that in some communities black and Hispanic men and women including pregnant women may be at increased risk of chlamydia, gonorrhea, and syphilis, irrespective of age or sexual behaviors, and may need to be screened. Research has documented that social-contextual factors contribute to varying STI prevalence rates within communities.
Through a variety of direct and indirect mechanisms, factors in a community e. The concepts of social capital e. When considering screening for STIs, physicians should consult with local public health officials, if possible; and should use national, regional, state, and local epidemiologic data to tailor screening Cdc sexually transmitted disease screening based on the community and populations served.
Age at first sexual encounter varies among populations and communities. The USPSTF uses epidemiologic data and data on the prevalence of risk behaviors to provide clinical guidance about what age to begin screening.
Persons as young as 12 years may be having sexual intercourse, and the possibility of STIs and high-risk behavior should be considered in all adolescents when making screening decisions. There is no evidence to support stopping screening at a specific age. Persons continue to be at risk of acquiring an STI if exposed to a pathogen, regardless of age; however, the clinical implications of untreated asymptomatic infections e.
For sexually active women who are at increased risk only because of demographic reasons e. In the absence of direct evidence, it seems reasonable for physicians to consider stopping routine screening at menopause or at 55 years of age.
Similar to many other screening categories, little evidence is available to guide decision making about the periodicity of STI screening.
Yearly screening for chlamydia in young women has been adopted as a pragmatic approach in the face of insufficient evidence. Occasionally, recommendations from the two groups differ, primarily Cdc sexually transmitted disease screening of differences in mission and target audience. Other factors that may lead to differences between USPSTF and CDC recommendations include different methods used for evidence review and different emphases on the harms of screening.
Using this methodology, the USPSTF recommends that all adolescents and adults at increased risk of HIV infection and all pregnant women be screened for HIV, but it does not recommend for or against screening adults not at increased risk.
However, the CDC went further by recommending that all persons 13 to 64 years of age be screened, regardless of risk status.
The CDC largely based its HIV screening recommendations on the potential benefit of preventing secondary HIV transmission if knowledge of seropositive status leads to a reduction of risky behavior. Although the USPSTF has not found evidence to support specific screening recommendations for men who have sex with men, based on the overall high STI prevalence rates in this population, the CDC currently recommends routine screening for HIV, syphilis, chlamydia, and gonorrhea.
This may be because of different methodology for evidence reviews; the use of experts with Cdc sexually transmitted disease screening interests "Cdc sexually transmitted disease screening" or economic in the content area; and, most importantly, a desire to meet members' needs for clinical guidance in the face of limited evidence or resources. Do not screen general population; insufficient evidence to recommend for or against screening women at increased risk.
Information from references 2 through 9 and 15 through Already a member or subscriber? Wolff received her medical degree from the Medical University of South Carolina, Charleston, and she completed a family medicine residency at the University of Maryland School of Medicine and a preventive medicine residency at the Johns Hopkins University Bloomberg School of Public Health.
Reprints are not available from the authors. The authors thank John S.
Sexually transmitted diseases among American youth: Perspect Sex Reprod Health. Screening for chlamydial infection: Calonge N, for the U.
Screening for syphilis infection: Screening for hepatitis B virus infection: Accessed June 21, Screening for hepatitis C virus infection in adults: Screening for genital herpes: Screening for cervical cancer: How to read the new recommendation statement: Hwang L, Shafer MA.
Chlamydia trachomatis infection in adolescents.
Centers for Disease Control and Prevention. Sexually transmitted disease surveillance supplement. Accessed June 11, Social capital, poverty, and income inequality as predictors of gonorrhoea, syphilis, chlamydia and AIDS case rates in the United States. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings.
Screening tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae infections— A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: American Academy of Family Physicians. Summary of recommendations for clinical preventive services. American College of Obstetricians and Gynecologists. Primary and preventive care: Int J Gynaecol Obstet.
Gynecologic herpes simplex virus infections. Clinical management guidelines for obstetrician-gynecologists. Guidelines for Perinatal Care. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing the AAFP.
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