NCHR’s Comments on USPSTF’s Recommendations for Chlamydia and Gonorrhea Screenings

March 29, 2021

National Center for Health Research’s Public Comments on the United States Preventive Services Task Force’s Draft Recommendation Statement Regarding Screenings for Chlamydia and Gonorrhea

We are writing to express our views on the U.S. Preventive Services Task Force’s (USPSTF) draft recommendation statement regarding the screenings for chlamydia and gonorrhea.

The National Center for Health Research (NCHR) is a nonprofit think tank that conducts, analyzes, and scrutinizes research on a range of health issues, with particular focus on which prevention strategies and treatments are most effective for which patients and consumers. We do not accept funding from companies that make products that are the subject of our work, so we have no conflicts of interest.

Although we support the reissued “B” grade recommendation for screening for chlamydia and gonorrhea in all sexually active ages 24 and younger, we disagree that women ages 25 and over should only be screened if at high risk, since that might be very difficult to accurately determine. Based on the prevalence of disease in women ages 25-29, we urge USPSTF to recommend screening in all sexually active women 29 and younger, and those 30 and over who are at increased risk. Given the high risks to newborns, we also urge that USPSTF recommend screening for all pregnant persons, rather than the current recommendation to limit screening to sexually active individuals aged 24 or younger and those 25 and over who are considered high-risk.

We strongly agree with USPSTF’s assessment that there continue to be several gaps in the current research that need to be addressed, such as the effectiveness of screening in pregnant persons, and the benefits of screening men as well as in racial and ethnic minorities.

Although we agree with the USPSTF’s assessment that additional research is needed regarding men who have sex with men and men under age 24 who are at an increased risk, we have concerns about the “I” recommendation regarding screening for chlamydia and gonorrhea in men. While there is not substantial evidence for the benefits of screening among men, the USPSTF evidence summary indicates that there is some evidence (albeit limited) of some benefit to screening men, and there is a low risk of harms. Given this, it is unclear why USPSTF concludes that there is not enough evidence to suggest a favorable benefit to risk ratio, especially for men who are particularly at-risk. For example, men who have sex with men have notable prevalence rates of both chlamydia and gonorrhea, at 6 and 8 percent, respectively. This prevalence of infection is particularly alarming given that these diseases increase the likelihood of acquiring or transmitting HIV. 

The importance of screening men is also supported by the USPSTF’s evidence summary stating that both chlamydia and gonorrhea are more prevalent among men ages 20-24 than they are among women of the same age, and the prevalence is increasing. In addition to benefiting men who are screened, screening men could help reduce cases overall, due to decreases in transmission to partners. We thus urge that USPSTF reconsider their recommendation for men, for example by aligning their recommendation with the Center for Disease Control’s, which proposes screening among men who have sex with men and men in high-risk populations or living in high-prevalence areas. We suggest that a “C” recommendation may capture that health care providers should assess patients’ risk factors and suggest screening accordingly.