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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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