![](media/image1.png){width="5.96875in" height="0.41944444444444445in"}

Top of Form

## Complete Summary

#### GUIDELINE TITLE

Screening for chlamydial infection: recommendation statement.

#### BIBLIOGRAPHIC SOURCE(S)

U.S. Preventive Services Task Force. Screening for chlamydial infection:
U.S. Preventive Services Task Force recommendation statement. Ann Intern
Med 2007 Jul 17;147(2):128-34. \[9 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17576996)

#### GUIDELINE STATUS

This is the current release of the guideline.

This release updates a previously published guideline: Berg AO.
Screening for chlamydial infection. Recommendations and rationale. Am J
Prev Med 2001 Apr;20(3 Suppl):90-4. \[7 references\]

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

*Chlamydia trachomatis* infection

#### GUIDELINE CATEGORY

Prevention\
Screening

#### CLINICAL SPECIALTY

Family Practice\
Internal Medicine\
Obstetrics and Gynecology\
Pediatrics\
Preventive Medicine

#### INTENDED USERS

Advanced Practice Nurses\
Allied Health Personnel\
Health Care Providers\
Nurses\
Physician Assistants\
Physicians

#### GUIDELINE OBJECTIVE(S)

-   To summarize the U.S. Preventive Services Task Force (USPSTF)
    recommendations and supporting scientific evidence on routine
    screening for chlamydial infection

-   To update the 2001 USPSTF recommendations on routine screening for
    chlamydial infection

#### TARGET POPULATION

All sexually active individuals, including adolescents and pregnant
women

#### INTERVENTIONS AND PRACTICES CONSIDERED

Routine screening for chlamydial infection

#### MAJOR OUTCOMES CONSIDERED

**Key Question 1**: Does screening for chlamydial infection in
non-pregnant women reduce adverse health outcomes?

**Key Question 2**: Does screening for chlamydial infection in pregnant
women reduce adverse health outcomes?

**Key Question 3**: Does screening for chlamydial infection in men
reduce adverse health outcomes in men, reduce adverse health outcomes in
women, or reduce the incidence of infection in women?

Health outcomes of interest were defined as follows:  pelvic
inflammatory disease, ectopic pregnancy, infertility, and chronic pelvic
pain in non-pregnant women; chorioamnionitis, premature rupture of
membranes, pre-term labor, pre-term delivery, spontaneous abortion,
endometritis, and low birth weight in pregnant women; and epididymitis,
urethritis, prostatitis, chronic prostatitis, reactive arthritis, and
urethral strictures in men.

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Hand-searches of Published Literature (Secondary Sources)\
Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

**Note from the National Guideline Clearinghouse (NGC)**: A focused
systematic review of the literature was prepared by the Agency for
Healthcare Research and Quality (AHRQ) for use by the U.S. Preventive
Services Task Force (USPSTF) (see the \"Availability of Companion
Documents\" field).

AHRQ staff conducted a systematic evidence review for each of the
critical key questions.

**Data Sources**

The search strategy included a review of English language articles
identified from PubMed between July 2000 and July 2005. Additional
articles were found through bibliography reviews and discussion with
experts. These searches identified 452 articles.

**Study Selection**

For key question 1, the review was limited to randomized controlled
trials of non-pregnant women at increased risk for infection. For
non-pregnant women not at increased risk, the search was expanded to
include both randomized controlled trials and non-randomized prospective
controlled studies. For key questions 2 and 3 (related to screening in
pregnant women and men), the reviews were limited to randomized
controlled trials and non-randomized prospective controlled studies.

Abstracts were reviewed by two staff members. All abstracts that were
clearly within the scope of this review and those with potential or
ambiguous relevance were retained. Eighteen articles were identified as
potentially meeting these broad inclusion and exclusion criteria. (see
Figure 1 in the evidence update \[see \"Availability of Companion
Documents\" field\])

**Data Extraction and Quality Assessment**

Two reviewers independently reviewed the full articles of all identified
studies to determine whether they met pre-determined inclusion criteria.
Additional reviewers were consulted for consensus-building around 2
articles that were ultimately not included in this review. The 2
principal reviewers independently abstracted data using standardized
forms from included articles to determine study quality.

Only one new poor quality study met inclusion criteria. This study
addressing the effectiveness of screening for chlamydial infection among
non-pregnant women at increased risk found that screening was associated
with a lower prevalence of chlamydial infection and fewer reported cases
of pelvic inflammatory disease at 1-year follow-up.

See the focused evidence update (see \"Availability of Companion
Documents\" field) for information about the search strategies for 6
subsidiary questions.

#### NUMBER OF SOURCE DOCUMENTS

**Key Question 1**: Only 1 study in the current systematic review met
the inclusion criteria and addressed the effectiveness of screening for
chlamydial infection among non-pregnant women at increased risk. The
current systematic review found no new direct trials of screening for
chlamydial infection among women not at increased risk.

**Key Question 2**: Evidence reviewed for this report found no new
randomized controlled studies or non-randomized studies addressing this
topic.

**Key Question 3**: The current systematic review identified no
randomized controlled studies or non-randomized cohort studies
addressing the screening of men for chlamydial infection including the
ability of screening programs to reduce the incidence of infection among
women.

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Expert Consensus

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review with Evidence Tables

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

**Note from the National Guideline Clearinghouse (NGC)**: A systematic
evidence review was prepared by the Agency for Healthcare Research and
Quality (AHRQ) for use by the U.S. Preventive Services Task Force
(USPSTF) (see the \"Companion Documents\" field).

The USPSTF considered each link in the evidence chain for a screening
service to make its recommendations (for further discussion of USPSTF
methods, please see <http://www.ahrq.gov/clinic/ajpmsuppl/harris1.htm>).
These included the accuracy of screening tests, the effectiveness of
treatment, estimating the potential magnitude of benefit from screening,
and bounding the potential for harms of screening and treatment.

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Balance Sheets\
Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

When the overall quality of the evidence is judged to be good or fair,
the U.S. Preventive Services Task Force (USPSTF) proceeds to consider
the magnitude of net benefit to be expected from implementation of the
preventive service. Determining net benefit requires assessing both the
magnitude of benefits and the magnitude of harms and weighing the two.

The USPSTF classifies benefits, harms, and net benefits on a 4-point
scale: \"substantial,\" \"moderate,\" \"small,\" and \"zero/negative.\"

\"Outcomes tables\" (similar to \'balance sheets\') are the USPSTF\'s
standard resource for estimating the magnitude of benefit. These tables,
prepared by the topic teams for use at USPSTF meetings, compare the
condition specific outcomes expected for a hypothetical primary care
population with and without use of the preventive service. These
comparisons may be extended to consider only people of specified age or
risk groups or other aspects of implementation. Thus, outcomes tables
allow the USPSTF to examine directly how the preventive services affects
benefits for various groups.

When evidence on harms is available, the topic teams assess its quality
in a manner like that for benefits and include adverse events in the
outcomes tables. When few harms data are available, the USPSTF does not
assume that harms are small or nonexistent. It recognizes a
responsibility to consider which harms are likely and judge their
potential frequency and the severity that might ensue from implementing
the service. It uses whatever evidence exists to construct a general
confidence interval on the 4-point scale (e.g., substantial, moderate,
small, and zero/negative).

Value judgments are involved in using the information in an outcomes
table to rate either benefits or harms on the USPSTF\'s 4-point scale.
Value judgments are also needed to weigh benefits against harms to
arrive a rating of net benefit.

In making its determinations of net benefit, the USPSTF strives to
consider what it believes are the general values of most people. It does
this with greater confidence for certain outcomes (e.g., death) about
which there is little disagreement about undesirability, but it
recognizes that the degree of risk people are willing to accept to avert
other outcomes (e.g., cataracts) can vary considerably. When the USPSTF
perceives that preferences among individuals vary greatly, and that
these variations are sufficient to make trade-off of benefits and harms
a \'close-call\', then it will often assign a C recommendation (see the
\"Recommendation Rating Scheme\" field). This recommendation indicates
the decision is likely to be sensitive to individual patient
preferences.

The USPSTF uses its assessment of the evidence and magnitude of net
benefit to make recommendations. The general principles the USPSTF
follows in making recommendations are outlined in Table 5 of the
companion document cited below. The USPSTF liaisons on the topic team
compose the first drafts of the recommendations and rationale
statements, which the full panel then reviews and edits. Recommendations
are based on formal voting procedures that include explicit rules for
determining the views of the majority.

From: Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow, CD, Teutsch SM,
Atkins D. Current methods of the U.S. Preventive Services Task Force: a
review of the process. Methods Work Group, Third U.S. Preventive
Services Task Force. *Am J Prev Med* 2001 Apr;20(3S):21-35.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

**What the United States Preventive Services Task Force (USPSTF) Grades
Mean and Suggestions for Practice**

  --------------------------------------------------------------------------
  **Grade**   **Grade Definitions**          **Suggestions for Practice**
  ----------- ------------------------------ -------------------------------
  A           The USPSTF recommends the      Offer/provide this service.
              service. There is high         
              certainty that the net benefit 
              is substantial.                

  B           The USPSTF recommends the      Offer/provide this service.
              service. There is high         
              certainty that the net benefit 
              is moderate or there is        
              moderate certainty that the    
              net benefit is moderate to     
              substantial.                   

  C           The USPSTF recommends against  Offer/provide this service only
              routinely providing the        if there are other
              service. There may be          considerations in support of
              considerations that support    the offering/providing the
              providing the service in an    service in an individual
              individual patient. There is   patient.
              moderate or high certainty     
              that the net benefit is small. 

  D           The USPSTF recommends against  Discourage the use of this
              the service. There is moderate service.
              or high certainty that the     
              service has no net benefit or  
              that the harms outweigh the    
              benefits.                      

  I Statement The USPSTF concludes that the  Read \"Clinical
              current evidence is            Considerations\" section of
              insufficient to assess the     USPSTF Recommendation Statement
              balance of benefits and harms  (see \"Major Recommendations\"
              of the service.  Evidence is   field). If offered, patients
              lacking, of poor quality or    should understand the
              conflicting, and the balance   uncertainty about the balance
              of benefits and harms cannot   of benefits and harms.
              be determined.                 
  --------------------------------------------------------------------------

**USPSTF Levels of Certainty Regarding Net Benefit**

**Definition**: The U.S. Preventive Services Task Force defines
certainty as \"likelihood that the USPSTF assessment of the net benefit
of a preventive service is correct.\" The net benefit is defined as
benefit minus harm of the preventive service as implemented in a
general, primary care population. The USPSTF assigns a certainty level
based on the nature of the overall evidence available to assess the net
benefit of a preventive service.

+---------+------------------------------------------------------------+
| **Level | **Description**                                            |
| of      |                                                            |
| Cert    |                                                            |
| ainty** |                                                            |
+=========+============================================================+
| High    | The available evidence usually includes consistent results |
|         | from well-designed, well-conducted studies in              |
|         | representative primary care populations. These studies     |
|         | assess the effects of the preventive service on health     |
|         | outcomes. This conclusion is therefore unlikely to be      |
|         | strongly affected by the results of future studies.        |
+---------+------------------------------------------------------------+
| M       | The available evidence is sufficient to determine the      |
| oderate | effects of the preventive service on health outcomes, but  |
|         | confidence in the estimate is constrained by factors such  |
|         | as:                                                        |
|         |                                                            |
|         | -   The number, size, or quality of individual studies     |
|         |                                                            |
|         | -   Inconsistency of findings across individual studies    |
|         |                                                            |
|         | -   Limited generalizability of findings to routine        |
|         |     primary care practice; or                              |
|         |                                                            |
|         | -   Lack of coherence in the chain of evidence             |
|         |                                                            |
|         | As more information becomes available, the magnitude or    |
|         | direction of the observed effect could change, and this    |
|         | change may be large enough to alter the conclusion.        |
+---------+------------------------------------------------------------+
| Low     | The available evidence is insufficient to assess effects   |
|         | on health outcomes. Evidence is insufficient because of:   |
|         |                                                            |
|         | -   The limited number or size of studies                  |
|         |                                                            |
|         | -   Important flaws in study design or methods             |
|         |                                                            |
|         | -   Inconsistency of findings across individual studies    |
|         |                                                            |
|         | -   Gaps in the chain of evidence                          |
|         |                                                            |
|         | -   Findings not generalizable to routine primary care     |
|         |     practice; or                                           |
|         |                                                            |
|         | -   A lack of information on important health outcomes     |
|         |                                                            |
|         | More information may allow an estimation of effects on     |
|         | health outcomes.                                           |
+---------+------------------------------------------------------------+

#### COST ANALYSIS

The guideline developers reviewed published cost analyses.

#### METHOD OF GUIDELINE VALIDATION

Comparison with Guidelines from Other Groups\
External Peer Review\
Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

[Peer Review]{.underline}. Before the U.S. Preventive Services Task
Force makes its final determinations about recommendations on a given
preventive service, the Evidence-based Practice Center and the Agency
for Healthcare Research and Quality send a draft systematic evidence
review to 4 to 6 external experts and to federal agencies and
professional and disease-based health organizations with interests in
the topic. They ask the experts to examine the review critically for
accuracy and completeness and to respond to a series of specific
questions about the document. After assembling these external review
comments and documenting the proposed response to key comments, the
topic team presents this information to the Task Force in memo form. In
this way, the Task Force can consider these external comments and a
final version of the systematic review before it votes on its
recommendations about the service. Draft recommendation statements are
then circulated for comment from reviewers representing professional
societies, voluntary organizations and Federal agencies. These comments
are discussed before the final recommendations are confirmed.

[Comparison with Guidelines from Other Groups]{.underline}.
Recommendations for screening from the following groups were discussed:
the American Academy of Pediatrics (AAP), American Academy of Family
Physicians (AAFP), the American College of Obstetricians and
Gynecologists (ACOG), the American College of Preventive Medicine
(ACPM), the Canadian Task Force on Preventive Health Care, and the
Centers for Disease Control and Prevention (CDC).

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

The US Preventive Services Task Force grades its recommendations (A, B,
C, D, or I) and identifies the Levels of Certainty regarding Net Benefit
(High, Moderate, and Low). The definitions of these grades can be found
at the end of the \"Major Recommendations\" field.

**[Summary of the Recommendations]{.underline}**

-   The US Preventive Services Task Force (USPSTF) recommends screening
    for chlamydial infection for all sexually active non-pregnant young
    women aged 24 and younger, and for older non-pregnant women who are
    at increased risk. **A recommendation**

-   The USPSTF recommends screening for chlamydial infection for all
    pregnant women aged 24 and younger, and for older pregnant women who
    are at increased risk. **B recommendation**

-   The USPSTF recommends against routinely providing screening for
    chlamydial infection for women aged 25 and older, whether or not
    they are pregnant, if they are not at increased risk. **C
    recommendation**

-   The USPSTF concludes that the current evidence is insufficient to
    assess the balance of benefits and harms of screening for chlamydial
    infection for men. **I statement**.

See \"Assessment of Risk\" and \"Suggestions for Practice Regarding an I
Statement\" below for discussions of assessing risk for chlamydial
infection in women and suggestions for practice regarding screening for
men.

**[Clinical Considerations]{.underline}**

**Patient Population Under Consideration**

These recommendations target all sexually active individuals, including
adolescents and pregnant women.

**Assessment of Risk**

All sexually active women 24 years and younger---including
adolescents---are at increased risk for chlamydial infection. In
addition to sexual activity and age, other risk factors for chlamydial
infection include a history of previous chlamydial or other sexually
transmitted infection, new or multiple sexual partners, inconsistent
condom use, and exchanging sex for money or drugs. Risk factors for
pregnant women are the same as for non-pregnant women. 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.

**Screening Tests**

Nucleic acid amplification tests (NAATs) have high specificity and
sensitivity when used as screening tests for chlamydial infection. NAATs
can be used with urine and vaginal swabs, enabling screening when a
pelvic examination is not performed.

**Treatment**

Appropriate treatment of chlamydia infection has been outlined by the
Centers for Disease Control and Prevention (CDC) see the National
Guideline Clearinghouse (NGC) summary of the CDC guideline [Clinical
prevention guidance. Sexually transmitted diseases treatment guidelines
2006](http://www.guideline.gov/summary/summary.aspx?doc_id=9672&nbr=005181).
In its 2006 sexually transmitted disease (STD) treatment guidelines, the
CDC recommends that chlamydia infection be treated with a single oral
dose of one gram of Azithromycin or seven days of twice daily oral
Doxycline (100 mg). Pregnant women with chlamydial infection may be
treated with a single dose of one gram of Azithromycin or Amoxicillin
500 mg orally three times daily for 7 days. Since the CDC updates these
recommendations regularly, clinicians are encouraged to access the CDC
website to obtain the most up-to-date information.
(<http://www.cdc.gov/STD/treatment>).

To prevent recurrent transmission, clinicians should ensure that all
sexual partners of infected individuals are tested and treated if
infected, or treated presumptively.

**Screening Intervals**

Screening for pregnant women who are at increased risk for chlamydial
infection is recommended at the first prenatal visit. For pregnant women
who remain at increased risk, and for those who acquire a new risk
factor such as a new sexual partner, a screening should be conducted
during the third trimester. The optimal interval for screening for
non-pregnant women is unknown. The CDC recommends at least annual
screening for women at increased risk.

**Suggestions for Practice in the Face of Insufficient Evidence
Regarding Screening in Men**

The USPSTF concluded that the evidence is insufficient to determine the
balance of benefits and harms related to screening men for chlamydial
infection. Specifically, the USPSTF did not find evidence that screening
programs that target men result in a decreased incidence of infection in
women. The USPSTF notes that programs that screen men as a means of
reducing transmission to women are not common practice, that primary
care clinicians are capable of instituting screening in men, that the
costs of additional screening tests per individual are relatively low,
and that the potential harms of screening are small. The USPSTF
recognizes that asymptomatic, untreated infections in men provide a
reservoir of infection that may make it difficult to improve health
outcomes in women through screening programs that target only women.
However, given the low national rates of screening in women at risk, the
USPSTF believes that clinicians and health care systems should focus on
improving the screening rates among women at increased risk, a group in
which the benefits of screening are certain.

**Other Approaches to Prevention**

Primary care clinicians and the health care systems in which they work
are responsible for ensuring that asymptomatic women at risk for
chlamydial infection are screened. In some communities, this may involve
home- or school-based screening programs.

**Useful Resources**

See the NGC summaries for other USPSTF recommendations on screening for
sexually transmitted infections ([hepatitis
B](http://www.guideline.gov/summary/summary.aspx?doc_id=4774&nbr=003453)
and [hepatits C virus
infection](http://www.guideline.gov/summary/summary.aspx?doc_id=4581&nbr=003371),
[HIV](http://www.guideline.gov/summary/summary.aspx?doc_id=7178&nbr=004292),
[genital herpes
simplex](http://www.guideline.gov/summary/summary.aspx?doc_id=6494&nbr=004067),
[gonorrhea](http://www.guideline.gov/summary/summary.aspx?doc_id=7176&nbr=004290),
and
[syphilis](http://www.guideline.gov/summary/summary.aspx?doc_id=5265&nbr=003592)).

**[Definitions]{.underline}:**

**What the United States Preventive Services Task Force (USPSTF) Grades
Mean and Suggestions for Practice**

  --------------------------------------------------------------------------
  **Grade**   **Grade Definitions**          **Suggestions for Practice**
  ----------- ------------------------------ -------------------------------
  A           The USPSTF recommends the      Offer/provide this service.
              service. There is high         
              certainty that the net benefit 
              is substantial.                

  B           The USPSTF recommends the      Offer/provide this service.
              service. There is high         
              certainty that the net benefit 
              is moderate or there is        
              moderate certainty that the    
              net benefit is moderate to     
              substantial.                   

  C           The USPSTF recommends against  Offer/provide this service only
              routinely providing the        if there are other
              service. There may be          considerations in support of
              considerations that support    the offering/providing the
              providing the service in an    service in an individual
              individual patient. There is   patient.
              moderate or high certainty     
              that the net benefit is small. 

  D           The USPSTF recommends against  Discourage the use of this
              the service. There is moderate service.
              or high certainty that the     
              service has no net benefit or  
              that the harms outweigh the    
              benefits.                      

  I Statement The USPSTF concludes that the  Read \"Clinical
              current evidence is            Considerations\" section of
              insufficient to assess the     USPSTF Recommendation Statement
              balance of benefits and harms  (see \"Major Recommendations\"
              of the service.  Evidence is   field). If offered, patients
              lacking, of poor quality or    should understand the
              conflicting, and the balance   uncertainty about the balance
              of benefits and harms cannot   of benefits and harms.
              be determined.                 
  --------------------------------------------------------------------------

**USPSTF Levels of Certainty Regarding Net Benefit**

**Definition**: The U.S. Preventive Services Task Force defines
certainty as \"likelihood that the USPSTF assessment of the net benefit
of a preventive service is correct.\" The net benefit is defined as
benefit minus harm of the preventive service as implemented in a
general, primary care population. The USPSTF assigns a certainty level
based on the nature of the overall evidence available to assess the net
benefit of a preventive service.

+---------+------------------------------------------------------------+
| **Level | **Description**                                            |
| of      |                                                            |
| Cert    |                                                            |
| ainty** |                                                            |
+=========+============================================================+
| High    | The available evidence usually includes consistent results |
|         | from well-designed, well-conducted studies in              |
|         | representative primary care populations. These studies     |
|         | assess the effects of the preventive service on health     |
|         | outcomes. This conclusion is therefore unlikely to be      |
|         | strongly affected by the results of future studies.        |
+---------+------------------------------------------------------------+
| M       | The available evidence is sufficient to determine the      |
| oderate | effects of the preventive service on health outcomes, but  |
|         | confidence in the estimate is constrained by factors such  |
|         | as:                                                        |
|         |                                                            |
|         | -   The number, size, or quality of individual studies     |
|         |                                                            |
|         | -   Inconsistency of findings across individual studies    |
|         |                                                            |
|         | -   Limited generalizability of findings to routine        |
|         |     primary care practice; or                              |
|         |                                                            |
|         | -   Lack of coherence in the chain of evidence             |
|         |                                                            |
|         | As more information becomes available, the magnitude or    |
|         | direction of the observed effect could change, and this    |
|         | change may be large enough to alter the conclusion.        |
+---------+------------------------------------------------------------+
| Low     | The available evidence is insufficient to assess effects   |
|         | on health outcomes. Evidence is insufficient because of:   |
|         |                                                            |
|         | -   The limited number or size of studies                  |
|         |                                                            |
|         | -   Important flaws in study design or methods             |
|         |                                                            |
|         | -   Inconsistency of findings across individual studies    |
|         |                                                            |
|         | -   Gaps in the chain of evidence                          |
|         |                                                            |
|         | -   Findings not generalizable to routine primary care     |
|         |     practice; or                                           |
|         |                                                            |
|         | -   A lack of information on important health outcomes     |
|         |                                                            |
|         | More information may allow an estimation of effects on     |
|         | health outcomes.                                           |
+---------+------------------------------------------------------------+

#### CLINICAL ALGORITHM(S)

None available

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is not specifically stated for each
recommendation.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

**Benefits of Detection and Early Intervention**

-   **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 pelvic inflammatory
    disease (PID). The US Preventive Services Task Force (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: 1) screening identifies infection in
    asymptomatic pregnant women; 2) there is a relatively high
    prevalence of infection among pregnant women who are at increased
    risk; and 3) 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.

#### POTENTIAL HARMS

**Harms of Detection and Early Treatment**

The U.S. Preventive Services Task Force (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.

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

-   The U.S. Preventive Services Task Force (USPSTF) makes
    recommendations about preventive care services for patients without
    recognized signs or symptoms of the target condition.

-   It bases its recommendations on a systematic review of the evidence
    of the benefits and harms and an assessment of the net benefit of
    the service.

-   The USPSTF recognizes that clinical or policy decisions involved
    more considerations than this body of evidence alone. Clinicians and
    policy-makers should understand the evidence but individualize
    decision making to the specific patient or situation.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

The experiences of the U.S. Preventive Services Task Force (USPSTF), as
well as that of other evidence-based guideline efforts, have highlighted
the importance of identifying effective ways to implement clinical
recommendations. Practice guidelines are relatively weak tools for
changing clinical practice when used in isolation. To effect change,
guidelines must be coupled with strategies to improve their acceptance
and feasibility. Such strategies include enlisting the support of local
opinion leaders, using reminder systems for clinicians and patients,
adopting standing orders, and audit and feedback of information to
clinicians about their compliance with recommended practice.

In the case of preventive services guidelines, implementation needs to
go beyond traditional dissemination and promotion efforts to recognize
the added patient and clinician barriers that affect preventive care.
These include clinicians\' ambivalence about whether preventive medicine
is part of their job, the psychological and practical challenges that
patients face in changing behaviors, lack of access to health care or of
insurance coverage for preventive services for some patients, competing
pressures within the context of shorter office visits, and the lack of
organized systems in most practices to ensure the delivery of
recommended preventive care.

Dissemination strategies have changed dramatically in this age of
electronic information. While recognizing the continuing value of
journals and other print formats for dissemination, the Agency for
Healthcare Research and Quality makes all U.S. Preventive Services Task
Force (USPSTF) products available through its [Web
site](http://www.preventiveservices.ahrq.gov/). The combination of
electronic access and extensive material in the public domain should
make it easier for a broad audience of users to access U.S. Preventive
Services Task Force materials and adapt them for their local needs.
Online access to U.S. Preventive Services Task Force products also opens
up new possibilities for the appearance of the annual, pocket-size
*Guide to Clinical Preventive Services*. USPSTF recommendations also are
available in an electronic selector tool. The ePSS can be accessed on
the Internet or downloaded to to a PDA.

To be successful, approaches for implementing prevention have to be
tailored to the local level and deal with the specific barriers at a
given site, typically requiring the redesign of systems of care. Such a
systems approach to prevention has had notable success in established
staff-model health maintenance organizations, by addressing organization
of care, emphasizing a philosophy of prevention, and altering the
training and incentives for clinicians. Staff-model plans also benefit
from integrated information systems that can track the use of needed
services and generate automatic reminders aimed at patients and
clinicians, some of the most consistently successful interventions.
Information systems remain a major challenge for individual clinicians\'
offices, however, as well as for looser affiliations of practices in
network-model managed care and independent practice associations, where
data on patient visits, referrals, and test results are not always
centralized.

#### IMPLEMENTATION TOOLS

Foreign Language Translations\
Patient Resources\
Personal Digital Assistant (PDA) Downloads\
Pocket Guide/Reference Cards\
Tool Kits

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Staying Healthy

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

U.S. Preventive Services Task Force. Screening for chlamydial infection:
U.S. Preventive Services Task Force recommendation statement. Ann Intern
Med 2007 Jul 17;147(2):128-34. \[9 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17576996)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

1996 (revised 2007)

#### GUIDELINE DEVELOPER(S)

United States Preventive Services Task Force - Independent Expert Panel

#### GUIDELINE DEVELOPER COMMENT

The U.S. Preventive Services Task Force (USPSTF) is a
Federally-appointed panel of independent experts. Conclusions of the
USPSTF do not necessarily reflect policy of the U.S. Department of
Health and Human Services (DHHS) or DHHS agencies.

#### SOURCE(S) OF FUNDING

United States Government

#### GUIDELINE COMMITTEE

U.S. Preventive Services Task Force (USPSTF)

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Corresponding Author*: Ned Calonge, MD, MPH, Chair, U.S. Preventive
Services Task Force, c/o Program Director, USPSTF, Agency for Healthcare
Research and Quality

*Task Force Members\**: Ned Calonge, MD, MPH, Chair, USPSTF (Chief
Medical Officer and State Epidemiologist, Colorado Department of Public
Health and Environment, Denver, CO); Diana B. Petitti, MD, MPH ,
Vice-chair, USPSTF (Senior Scientific Advisor for Health Policy and
Medicine, Regional Administration, Kaiser Permanente Southern
California, Pasadena, CA); Thomas G. DeWitt, MD (Carl Weihl Professor of
Pediatrics and Director of the Division of General and Community
Pediatrics, Department of Pediatrics, Children\'s Hospital Medical
Center, Cincinnati, OH); Leon Gordis, MD, MPH, DrPH (Professor,
Epidemiology Department, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD); Kimberly D. Gregory, MD, MPH (Director, Women\'s
Health Services Research and Maternal-Fetal Medicine, Department of
Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles,
CA); Russell Harris, MD, MPH (Professor of Medicine, Sheps Center for
Health Services Research, University of North Carolina School of
Medicine, Chapel Hill, NC); Kenneth W. Kizer, MD, MPH (President and
CEO, National Quality Forum, Washington, DC); Michael L. LeFevre, MD,
MSPH (Professor, Department of Family and Community Medicine, University
of Missouri School of Medicine, Columbia, MO); Carol Loveland-Cherry,
PhD, RN (Executive Associate Dean, Office of Academic Affairs,
University of Michigan School of Nursing, Ann Arbor, MI); Lucy N.
Marion, PhD, RN (Dean and Professor, School of Nursing, Medical College
of Georgia, Augusta, GA); Virginia A. Moyer, MD, MPH (Professor,
Department of Pediatrics, University of Texas Health Science Center,
Houston, TX); Judith K. Ockene, PhD (Professor of Medicine and Chief of
Division of Preventive and Behavioral Medicine, University of
Massachusetts Medical School, Worcester, MA); George F. Sawaya, MD
(Associate Professor, Department of Obstetrics, Gynecology, and
Reproductive Sciences and Department of Epidemiology and Biostatistics,
University of California, San Francisco, CA); Albert L. Siu, MD, MSPH
(Professor and Chairman, Brookdale Department of Geriatrics and Adult
Development, Mount Sinai Medical Center, New York, NY); Steven M.
Teutsch, MD, MPH (Executive Director, Outcomes Research and Management,
Merck & Company, Inc., West Point, PA); and Barbara P. Yawn, MD, MSc
(Director of Research, Olmstead Research Center, Rochester, MN)

*\*Members of the Task Force at the time this recommendation was
finalized. For a list of current Task Force members, go to*
[www.ahrq.gov/clinic/uspstfab.htm](http://www.ahrq.gov/clinic/uspstfab.htm).

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

This release updates a previously published guideline: Berg AO.
Screening for chlamydial infection. Recommendations and rationale. Am J
Prev Med 2001 Apr;20(3 Suppl):90-4. \[7 references\]

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [U.S. Preventive Services Task
Force (USPSTF) Web
site](http://www.ahrq.gov/clinic/uspstf/uspschlm.htm). Also available
from the [Annals of Internal Medicine Web
site](http://www.annals.org/cgi/content/full/147/2/128?maxtoshow=&HITS=25&hits=25&RESULTFORMAT=1&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT).

Print copies: Available from the Agency for Healthcare Research and
Quality Publications Clearinghouse. For more information, go to
<http://www.ahrq.gov/news/pubsix.htm>.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

Evidence Reviews:

-   Meyers, D.S., Halvorson, H., Luckhaupt, S. Screening for chlamydial
    infection: an evidence update for the United States Preventive
    Services Task Force. Rockville (MD): Agency for Healthcare Research
    and Quality, 2007. \[24 references\] Electronic copies: Available
    from the [USPSTF Web
    site](http://www.ahrq.gov/clinic/uspstf07/chlamydia/chlamydiaup.htm).
    Also available from the [Annals of Internal Medicine Web
    site](http://www.annals.org/cgi/content/full/147/2/135?maxtoshow=&HITS=25&hits=25&RESULTFORMAT=1&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT).

-   Meyers, D.S., Halvorson, H., Luckhaupt, S. Screening for chlamydial
    infection: a focused evidence update for the United States
    Preventive Services Task Force. Rockville (MD): Agency for
    Healthcare Research and Quality, 2007. Evidence synthesis number 48.
    \[53 references\] Electronic copies: Available from the [USPSTF Web
    site](http://www.ahrq.gov/clinic/uspstf07/chlamydia/chlamydiasyn.pdf).

-   Screening for chlamydial infection. Clinical summary of
    recommendations by the U.S. Preventive Services Task Force (USPSTF).
    Ann Intern Med 2007;147(2):131. Electronic copies: Available from
    the [USPSTF Web
    site](http://www.ahrq.gov/clinic/uspstf07/chlamydia/chalcsum.htm).

Background Articles:

-   Barton M et al. How to Read the new Recommendation Statement:
    Methods Update from the U.S. Preventive Services Task Force. Ann
    Intern Med. 2007;147:123-127.

-   Guirguis-Blake J et al. Current Processes of the U.S. Preventive
    Preventive Services Task Force: Refining Evidence-Based
    Recommendation Development. Ann Intern Med. 2007;147:117-122. \[2
    references\]

-   Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow, CD, Teutsch SM,
    Atkins D. Current methods of the U.S. Preventive Services Task
    Force: a review of the process. Methods Work Group, Third U.S.
    Preventive Services Task Force. Am J Prev Med 2001 Apr;20(3S):21-35.

Electronic copies: Available from the [USPSTF Web
site](http://www.ahrq.gov/clinic/uspstmeth.htm).

The following is also available:

-   The guide to clinical preventive services, 2006. Recommendations of
    the U.S. Preventive Services Task Force. Rockville (MD): Agency for
    Healthcare Research and Quality (AHRQ), 2006. 228 p. Electronic
    copies available from the [AHRQ Web
    site](http://www.ahrq.gov/clinic/pocketgd.htm).

-   A step-by-step guide to delivering clinical preventive services: a
    systems approach. Rockville (MD): Agency for Healthcare Research and
    Quality (AHRQ), 2002 May. 189 p. Electronic copies available from
    the [AHRQ Web site](http://www.ahrq.gov/ppip/manual/). See the
    related QualityTool summary on the [Health Care Innovations Exchange
    Web site](http://innovations.ahrq.gov/content.aspx?id=542).

Print copies: Available from the Agency for Healthcare Research and
Quality Publications Clearinghouse. For more information, go to
<http://www.ahrq.gov/news/pubsix.htm> or call 1-800-358-9295 (U.S.
only).

The [Electronic Preventive Services Selector
(ePSS)](http://epss.ahrq.gov/PDA/index.jsp), available as a PDA
application and a web-based tool, is a quick hands-on tool designed to
help primary care clinicians identify the screening, counseling, and
preventive medication services that are appropriate for their patients.
It is based on current recommendations of the USPSTF and can be searched
by specific patient characteristics, such as age, sex, and selected
behavioral risk factors.

#### PATIENT RESOURCES

The following is available:

-   The Pocket Guide to Good Health for Adults. Rockville (MD): Agency
    for Healthcare Research and Quality (AHRQ); 2003.

Electronic copies: Available from the [U.S. Preventive Services Task
Force (USPSTF) Web site](http://www.ahrq.gov/ppip/adguide/). Copies also
available in Spanish from the [USPSTF Web
site](http://www.ahrq.gov/ppip/spadguide/).

Print copies: Available from the Agency for Healthcare Research and
Quality (AHRQ) Publications Clearinghouse. For more information, go to
<http://www.ahrq.gov/news/pubsix.htm> or call 1-800-358-9295 (U.S.
only).

Please note: This patient information is intended to provide health
professionals with information to share with their patients to help them
better understand their health and their diagnosed disorders. By
providing access to this patient information, it is not the intention of
NGC to provide specific medical advice for particular patients. Rather
we urge patients and their representatives to review this material and
then to consult with a licensed health professional for evaluation of
treatment options suitable for them as well as for diagnosis and answers
to their personal medical questions. This patient information has been
derived and prepared from a guideline for health care professionals
included on NGC by the authors or publishers of that original guideline.
The patient information is not reviewed by NGC to establish whether or
not it accurately reflects the original guideline\'s content.

#### NGC STATUS

This summary was completed by ECRI on April 6, 2001. The information was
verified by the guideline developer as of April 10, 2001. This NGC
summary was updated by ECRI Institute on June 11, 2007. The updated
information was verified by the guideline developer on August 3, 2007.

#### COPYRIGHT STATEMENT

Requests regarding copyright should be sent to: Randie A. Siegel,
Electronic Dissemination Advisor, Division of Print and Electronic
Publishing, Agency for Healthcare Research and Quality (formerly the
Agency for Health Care Policy and Research), 540 Gaither Road,
Rockville, MD 20852; Facsimile: 301-427-1873; E-mail:
<Randie.siegel@ahrq.hhs.gov>.

### DISCLAIMER

#### NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce,
approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced
under the auspices of medical specialty societies, relevant professional
associations, public or private organizations, other government
agencies, health care organizations or plans, and similar entities.

Guidelines represented on the NGC Web site are submitted by guideline
developers, and are screened solely to determine that they meet the NGC
Inclusion Criteria which may be found at
<http://www.guideline.gov/about/inclusion.aspx> .

NGC, AHRQ, and its contractor ECRI Institute make no warranties
concerning the content or clinical efficacy or effectiveness of the
clinical practice guidelines and related materials represented on this
site. Moreover, the views and opinions of developers or authors of
guidelines represented on this site do not necessarily state or reflect
those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or
hosting of guidelines in NGC may not be used for advertising or
commercial endorsement purposes.

Readers with questions regarding guideline content are directed to
contact the guideline developer.

Bottom of Form

© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008