Chlamydia and gonorrhea: new recommendation to screen sexually active patients under 30
A new guideline recommends offering screening for chlamydia and gonorrhea to all sexually active patients under 30 years of age. Aimed at primary care providers, the guideline from the Canadian Task Force on Preventive Health Care extends screening from age 25 to 30.
“If patients are under 30 and sexually active, we recommend offering screening for chlamydia and gonorrhea annually at any health visit,” says Dr. Ainsley Moore, a family physician and associate clinical professor, Department of Family Medicine, McMaster University, and chair of the task force chlamydia and gonorrhea working group. “Also, since females carry most of the health burden associated with infection, screening of males, a source of infection, may improve health equity.”
The guideline, published in CMAJ, is based on the latest evidence as well as patient values and preferences.
Who is exempt from this recommendation?
- The guideline does not apply to pregnant patients, people known to the clinician to be at increased risk based on sexual behaviours and people seeking treatment for a possible sexually transmitted infection (STI).
- Clinicians should consult national, provincial or local resources for guidance on caring for these individuals.
Putting into Practice
- Offer screening routinely, every year as feasible to all sexually active patients under 30 years of age at any primary care visit (i.e. not only during a pap smear or sexual health visit).
- Offering screening requires sensitivity to stigmatization and fear of social disapproval, especially regarding gender, culture, behaviour and other vulnerabilities.
- Urine or self-collected vaginal swabs are likely more acceptable to patients and may improve uptake of screening.
- Undertake informed consent and inform patients that positive results are automatically reported to local public health units for potential partner notification.
Why screen patients up to age 30?
- Chlamydia and gonorrhea are the most commonly reported bacterial STIs in Canada, with cases increasing in the 25-29 age group since 2000
- Chlamydia prevalence in 15-29 year-olds may be as high as 5-7%
- Chlamydia and Gonorrhea can cause complications including pelvic inflammatory disease (PID), chronic pelvic pain, ectopic pregnancy, and possibly infertility.
The College of Family Physicians of Canada, Nurse Practitioner Association of Canada and The Canadian Association of Perinatal and Women's Health Nurses have endorsed the guideline.