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Level I – Chlamydial Screening

Level I Services: Preventive services for which clinicians and health systems must assess the need. These services must be recommended to each patient, as they have the highest value and are worthy of attention at every opportunity.

The USPSTF recommendations are fully endorsed by the ICSI Preventive Services work group.
Grade of Recommendation and Level of Certainty as Evaluated by USPSTF
  1. “Screening for chlamydial infection in all sexually active, non-pregnant young women age 24 years and younger and in older non-pregnant women who are at increased risk.”
  2. “Screening for chlamydial infection in all pregnant women age 24 and younger and in older pregnant women who are at increased risk.”
  3. “Against routinely providing screening for chlamydial infection in women age 25 and older, whether or not they are pregnant, if they are not at increased risk.”
  4. “The current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydial infection in men.”
(USPSTF Last Revised 2007 – Update in Progress)
Grade of Recommendation:
  1. A
  2. B
  3. C
  4. I Statement

Level of Certainty:

  1. High
  2. Moderate
  3. Moderate
  4. Uncertain
“Benefits:
Non-pregnant women at increased risk. There is good evidence that screening for chlamydial infection in women who are at increased risk can reduce the incidence of PID. The USPSTF concluded that the benefits of screening women at increased risk are substantial.
Pregnant women at increased risk. There are no studies evaluating the effectiveness of screening for chlamydial infection in pregnant women who are at increased risk. The USPSTF, however, found the following:
  • Screening identifies infection in asymptomatic pregnant women.
  • There is a relatively high prevalence of infection among pregnant women who are at increased risk.
  • There is fair evidence of improved pregnancy and birth outcomes for women who are treated for chlamydial infection.
The USPSTF concluded that the benefits of screening pregnant women who are at increased risk are substantial.
Women not at increased risk. The USPSTF identified no studies documenting the benefits of screening women, including pregnant women, who are not at increased risk for chlamydial infection. While recognizing the potential benefit to women identified through screening, the USPSTF concluded the overall benefit of screening would be small, given the low prevalence of infection among women not at increased risk.
Men. While concluding that the direct benefit to men of screening was likely to be small, the USPSTF noted that screening for chlamydial infection in men may be beneficial if it were to lead to a decreased incidence of chlamydial infection in women. The USPSTF did not, however, find evidence to support this outcome, and therefore concluded that the benefits of screening men are unknown. The USPSTF identified this as a critical gap in the evidence.
Harms:
The USPSTF concluded that the harms of screening for chlamydial infection are no greater than small, although few studies have been published on this subject. Potential harms include anxiety and relationship problems arising from false-positive results and over-treatment.
The USPSTF identified the lack of evidence related to potential harms of screening as a gap in the evidence.
Benefits-Harms Assessment:
For non-pregnant women at increased risk, the certainty is high that the benefits of screening for chlamydial infection substantially outweigh the harms.
For pregnant women at increased risk, the certainty is moderate that the benefits substantially outweigh the harms of screening for chlamydial infection.
For women not at increased risk (including pregnant women not at increased risk), the certainty is moderate that the benefits outweigh the harms of screening to only a small degree. There may be considerations that support screening an individual patient.
For men, the benefits of screening are not known; thus, the USPSTF could not determine the balance of benefits and harms of screening men for chlamydial infection.
Assessment of Risk:
Prevalence of chlamydial infection varies widely among patient populations. African-American and Hispanic women have a higher prevalence of infection than the general population in many communities and settings. Among men and women, increased prevalence rates are also found in incarcerated populations, military recruits, and patients at public sexually transmitted infection clinics.”
Relevant Resources:
Chlamydia and Gonorrhea Screening