Screening for chlamydial infection in men: An evidence update
Creators: name: Lee, Jennifer
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2011

description: Background: Chlamydial infection is the most common bacterial genital infection in the US with 1,244,180 cases documented in 2009. There are likely additional unreported cases because of presumptive treatment of disease, asymptomatic nature of genital infection, and lack of access to medical care. In 2007, the USPSTF published a recommendation statement to screen all sexually active nonpregnant women age 24 years or younger and older nonpregnant women at increased risk. Because of a lack of direct evidence on the effect of screening in men to reduce transmission to women, in reducing reinfection rates in men, or in preventing adverse health outcomes for men, they refrain from recommended for or against screening, leaving primary care clinicians and STD prevention programs with little guidance in practice. Objectives: This systematic review was conducted to update the evidence for screening the sexually transmitted bacterial disease (STD), Chlamydia trachomatis in men, the screening effect on improving health outcomes, the evidence on the harms of screening and adverse events from treatment in men. This review will not assess existing recommendations that the USPSTF have already deemed "good" or "fair". Qualitative Methods: An analytic framework was developed by adapting the previously published work by the USPSTF on screening for Chlamydia infections in young women. From the framework, four key questions were developed to guide the literature search of articles published in PubMed-MEDLINE from 2000 through September 2010 and in the Cochrane Database of Systematic Review. Results were abstracted into tables, reviewed and assessed for methodological quality using criteria adapted from the STROBE statement. Results: A total of 497 titles and abstracts were found from the initial search of databases plus 4 hand-selected articles from references of relevant articles. The final 8 articles that met all criteria were abstracted for data and rated for quality. The search produced one "fair" but inconclusive study examining the effect of screening on disease frequency and no studies on changes in disease morbidity and mortality with screening. Two studies pertaining to positivity rates found significantly higher rates in men aged 19-24 and black Caribbean and unspecified black background. One fair and one good study found only mild to moderate harms from screening to conclude that benefits to screening were greater than the mild psychological harms. Lastly, one good meta-analysis concluded that doxycycline and azithromycin are equally efficacious in the treatment for Chlamydia in men and women with mild side effects including diarrhea, abdominal pain, and nausea. Conclusions: There continues to be a lack of evidence on the effectiveness of lowering disease frequency, mortality and morbidity in women by screening asymptomatic men. Even while non-harmful screening tests and effective treatment of chlamydial infection are available, there is insufficient data to recommend any screening strategies of asymptomatic men at this time.