Under 30 and sexually active? It鈥檚 a good idea to get tested for chlamydia and gonorrhea
Canadian Task Force on Preventive Health Care recommends routine screening
Source: CMAJ
Anyone sexually active under age 30聽should be offered testing for chlamydia and gonorrhea, according to a new聽聽from the Canadian Task Force on Preventive Health Care published in聽CMAJ听(Canadian Medical Association Journal).
Chlamydia and gonorrhea are the most commonly reported sexually transmitted bacterial infections (STIs) in Canada and are treatable with antibiotics. Without treatment, these infections can lead to pelvic inflammatory disease, pain and possibly infertility.
鈥淚f people are under 30聽and sexually active, it鈥檚 a good idea to get tested,鈥� says Dr.聽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. 鈥淢any people are asymptomatic and may not seek treatment so we鈥檙e recommending opportunistic testing 鈥斅爐hat is, at any health care visit.鈥�
The guideline recommends that health care providers in Canada offer routine testing for chlamydia and gonorrhea annually to all sexually active patients younger than 30聽who are not known to belong to a high-risk group. Sexual activity is defined as anyone who has had oral, vaginal or anal intercourse.
Why is the task force recommending screening?
- 1聽in 20聽sexually active individuals 15鈥�29聽years old will get chlamydia.
- Reported rates for this age group are 1.0%鈥�1.9% (chlamydia) and 0.2%鈥�0.3% (gonorrhea).
- Many people are asymptomatic or do not seek care and are not included in reported cases.
- True rates of chlamydia in 15- to 29-year-olds may be as high as 5%鈥�7%.
- Rising rates of chlamydia and gonorrhea in people aged 25鈥�29 years since 2000.
- Screening may reduce pelvic inflammatory disease in females.
This recommendation does聽not聽apply to pregnant people, people known to the clinician to be at increased risk based on sexual behaviours, or patients seeking care for a possible STI. Clinicians should consult national, provincial, or local guidance when providing care for these individuals.
Current practice in Canada recommends screening sexually active people who are not at high risk up to age 25.
鈥淭his recommendation to extend screening to age 30 reflects increasing rates of infection among Canadians aged 25聽to 29聽years,鈥� says Dr.聽Donna Reynolds, a member of the working group, family physician and an assistant professor at the University of Toronto. 鈥淎s it鈥檚 an easy test, usually a urine test or vaginal swab, it can be done at any visit to a physician, nurse practitioner or sexual health clinic.鈥�
The recommendations also consider the potential for anxiety and embarrassment around screening for STIs.
鈥淎lthough we recommend this as routine, clinicians know to expect feelings of fear, anxiety or embarrassment on the part of some patients and be ready to discuss these,鈥� says task force member Dr.聽Brenda Wilson, a public health physician and professor at Memorial University, St.聽John鈥檚, Newfoundland.
The guideline recommends also screening males as the primary source of infection for females, for whom the health consequences can be greater.
鈥淪creening males, who are often without symptoms, may reduce transmission and complications in females and may improve health equity for females,鈥� says Dr.聽Moore.
Target Audiences
- Clinicians聽鈥撀燭he guideline is aimed at clinicians in primary care, sexual health and student clinics and other settings.
- Public聽鈥撀燗s the guideline is aimed at people younger than 30, an infographic, Instagram campaign and frequently asked questions will help explain why it鈥檚 a good idea to get tested.
The task force engaged Canadians to understand their values and preferences around screening to inform recommendations. They expressed a strong preference for screening.
The College of Family Physicians of Canada, the Nurse Practitioner Association of Canada and the Canadian Association of Perinatal and Women鈥檚 Health Nurses have endorsed the guideline.
For the guideline, public infographic, clinician and patient FAQs, visit the聽听补迟听. Listen to a聽聽with author Dr.聽Ainsley Moore.
In a related聽, Drs. Troy Grennan, BC Centre for Disease Control, Vancouver, British Columbia, and Darrell Tan, University of Toronto, write a 鈥減otential benefit of the authors鈥� recommendations is its potential to normalize conversations about sexual health and STIs between clinicians and patients, which have long been marred by stigma and shame. Offering screening may help patients feel that they 鈥榟ave permission鈥� to discuss health issues that may seem difficult to talk about.鈥�
The commentary authors note that the lack of high-quality evidence on the topic should spur researchers to engage in future studies to inform guidelines and clinical practice.
About the Canadian Task Force on Preventive Health Care
The Canadian Task Force on Preventive Health Care is an independent panel of health professionals who are experts in clinical preventive health care and guideline methodology. The task force鈥檚 mandate is to develop and disseminate evidence-based clinical practice guidelines for primary and preventive care.
General media contact:聽Kim Barnhardt,听CMAJ,听kim.barnhardt [at] cmaj.ca