subject: Developments in STD Screening [print this page] Developments in STD Screening Developments in STD Screening
Chlamydia is the most commonly reported communicable disease in the U.S. , occurring most often among adolescent and young adult females. Acute chlamydia infections often have no symptoms, leaving many cases undetected and untreated. However, the infection may progress to serious health outcomes including pelvic inflammatory disease (P I D), which is a cause of infertility and pregnancy complications-preventable because chlamydia infections are easily treated with antibiotics.
The U.S. Preventive Services Task Force and major medical organizations recommend an annual chlamydia screening test for all sexually active adolescents and young adult females 24 years of age and younger, for pregnant females, and for females and males at high risk. Yet chlamydia screening remains an underutilized clinical preventive service with 49.9 percent of eligible females in commercial or Medicaid health plans screened during the prior two years 1. Improvements in screening test technology hold promise for increasing screening rates and preventing consequences of untreated infections.
Molecular tests called Nucleic Acid Amplified Tests (NAAT ' s) 2 are currently recommended by the Centers for Disease Control and Prevention (C D C) as the chlamydia and gonorrhea diagnostic assays of choice 3. These highly sensitive and specific tests are the primary tests used to screen for chlamydia infections.
Traditionally, chlamydia tests were conducted on cervical swabs for females and urethral swabs for males. Due to the greater sensitivity and specificity of N A A T assays, less invasive samples, such as urine for females and males, can be used. Urine specimens are a convenient option for settings, such as primary care offices, that do not perform gynecologic services and in outreach screening programs. Non-invasive specimens can eliminate the necessity for a clinician performed pelvic examination for asymptomatic females and may be cost-saving when a Pap test is not required 9. For males, a urine specimen is the sample of choice for chlamydia detection 10 - 11. However, when pelvic examinations are being performed due to the presence of symptoms or because a Pap test is required, the cervical swab is usually preferred as the sample type. Cervical swabs have been shown to have a slightly higher organism load than urine for chlamydia 12.
