Screening for Chlamydial Infection
Screening for chlamydial infection is recommended in women over the age of 25 years engaged in high-risk sexual behavior as well as in women below the age of 25 years who are sexually active.
Why is screening for chlamydial infection important?
Screening for chlamydial infection is important for the following reasons:
- Chlamydial infection does not cause any symptoms in the initial stages. Thus, it can be detected only through screening.
- Chlamydial infection once diagnosed is very easy to treat with antibiotics.
- Untreated chlamydial infection can cause a serious complication called pelvic inflammatory disease, which could lead to chronic pelvic pain, infertility and ectopic pregnancy (pregnancy outside the uterus).
Thus, screening is important to detect and treat the infection in its early stages before the onset of any complications. In addition, screening also helps to reduce sexual transmission of the infection.
Who should undergo screening for chlamydial infection?
Current guidelines indicate that screening for chlamydial infection should be carried out in the following nonpregnant as well as pregnant women:
- Women who engage in high-risk sexual behavior. These behaviors include:
- Having multiple current partners
- Having a new partner
- Using condoms inconsistently
- Having sex while under the influence of alcohol or drugs
- Having sex in exchange for money or drugs
- Sexually active women less than 25 years of age even if they do not indulge in high-risk sexual behaviors. This is necessary since younger women are more at risk for developing the infection due to their lower immunity status, immaturity of the cervical epithelium and likelihood of having more new sex partners.
Routine screening is not necessary in women over the age of 25 years not involved in high-risk sexual behavior.
How often should tests for Chlamydia infection be repeated?
Screening for chlamydial infection in women at high risk for developing the infection should preferably be repeated every year.
Which are the preferred tests for detecting chlamydial infections?
Tests referred to as Nucleic Acid Amplification Tests (NAATs) are used to diagnose chlamydial infection. These tests use various techniques like polymerase chain reaction (PCR), transcription mediated amplification (TMA), and the DNA strand displacement amplification (SDA). These tests are accurate and convenient to carry out. They have thus replaced the traditional culture tests in the screening for chlamydial infection.
Tests for chlamydial infection may be carried out on cervical swabs or urine samples in woman, or on urine samples or urethral swabs from men.
Some of these tests may be less sensitive when conducted on urine as compared to cervical swab.
- Meyers D, Wolff T, Gregory K, Marion L, Moyer V, Nelson H, et al. USPSTF Recommendations for STI Screening. American Family Physician 2008; 77(6): 819-824.
- Miller KE. Diagnosis and Treatment of Chlamydia trachomatis Infection. Am Fam Physician 2006;73:1411-6.
- Screening Tests To Detect Chlamydia trachomatis and Neisseria gonorrhoeae Infections - (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5115a1.htm)
- Land J.A., Van Bergen J.E.A.M., Morre´ S.A., and Postma M.J.. Epidemiology of Chlamydia trachomatis infection in women and the costeffectiveness of screening. Human Reproduction Update 2010; 16 (2): 189–204