Screening for Gonorrhea: Update of the Evidence (continued)

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U.S. Preventive Services Task Force (USPSTF)

Discussion

Summary of Evidence

A summary of the evidence relating to each key question is presented in Table 3. Gonorrhea is the second most common sexually transmitted bacterial pathogen in the U.S. and is capable of causing serious infections, such as PID, as well as long-term complications. Adolescents and young adults, African Americans, and men who have sex with men have the highest prevalence rates. Gonorrhea is readily transmitted between sexual partners and to newborns. Many individuals with gonorrhea, including the majority of infected women, do not have symptoms prompting them to seek medical treatment. Many infections, therefore, are undetected in the absence of screening.

The update of the evidence found no new evidence of the effectiveness of population screening in asymptomatic men and women, adolescents, pregnant women, and MSM to reduce transmission and improve health outcomes. Evidence is also lacking to answer important and clinically relevant issues about the added value of including gonorrhea testing with routine chlamydia testing, and the cost-effectiveness of various screening strategies. No new evidence was identified to address key questions for pregnant women and newborns.

Studies identified several individual-level risk factors for gonorrhea infection including young age (<25 years), African American race, multiple sex partners or an infected sex partner, inconsistent use of barrier contraceptives, previous or coexistent STDs, douching, use of drugs, and history of incarceration. No risk assessment criteria have been developed and tested in a screening population.

Social capital and geographic region of residence within a community may be important determinants of STD transmission dynamics at the population level and important risk factors for infection at the individual level. Studies demonstrated that the greatest differences in risk were along parameters that constitute the organizing features of society (e.g., race/ethnicity, age, and gender), rather than those that differentiate individual behaviors (e.g., numbers of partners). Studies using geographic analysis of STD incidence show different incidence rates in different subpopulations, with the highest rates occurring in poor, inner city, and densely populated contiguous census tracts. Simply cataloging risk behaviors and demographic and socioeconomic characteristics has not provided adequate description of STD transmission. For example, in high STD prevalence populations, individual sexual risk behaviors may have less of an influence on risk for infection than the characteristics of sexual partners. Rather than an indicator of high-risk behavior, low socioeconomic status may be a marker for involvement in high-risk sexual networks and a consequent greater likelihood of exposure to an infected partner.

Gonorrhea can be diagnosed by a number of new testing technologies, such as nucleic acid amplification tests and nucleic acid hybridization tests. These tests demonstrate high sensitivity and specificity, although studies are methodologically limited. Sensitivity is lower using urine specimens for some tests, and may vary by symptom status. Urine tests and self-administered vaginal swabs provide a quick, non-invasive method of screening that can be implemented in non-traditional settings such as school-based clinics, substance abuse treatment programs, and job training programs.

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Outcomes Table

Table 4 summarizes the effects of screening 10,000 women in low, moderate, and high-risk groups. In a low-risk population (prevalence=0.001) using a 95-percent sensitive test, if 10,000 women were screened, nearly 10 would be diagnosed and treated, preventing slightly more than 1 case of PID. The number needed to screen (NNS) to detect one case of gonorrhea would be 1,085, and the NNS to prevent one case of PID would be 7,751. As the prevalence of gonorrhea increases, the NNS to prevent cases of gonorrhea and PID decrease accordingly. In a population with a prevalence of 0.01, the NNS to detect one case of gonorrhea would be 109, and the NNS to prevent one case of PID would be 840.

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Limitations of the Evidence

The evidence is limited by the descriptive, cross-sectional nature of the majority of the studies and the focus of research in high prevalence communities and settings, such as inner city STD clinics. Very few studies present data applicable to a general, asymptomatic population. Studies of tests are limited in many ways including use of inappropriate and dissimilar reference standards and populations. This heterogeneity prohibits meta-analysis or comparisons between tests.

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Future Research

Studies are needed that provide evidence that screening is associated with decreased transmission and complications. These include studies to evaluate screening criteria for men, women, adolescents, pregnant women, and MSM in primary care and community-based settings to determine the effectiveness of various screening strategies. These strategies would include comparisons of universal, age-based, and risk factor-based criteria among populations with various prevalence rates. Also, studies should be coordinated to define representative populations that can be studied over time rather than continuing to report from isolated cross-sectional convenience samples. A prospective approach would allow correct assessment of the performance of screening criteria, important in a disease such gonorrhea whose epidemiology is dynamic. Research that examines population-level factors and association to STD transmission rather than focusing primarily on individual-level factors is warranted given the recent studies that highlight the importance of social capital and residence in high prevalence communities. Further, studies that integrate individual-level and population-level theories of sexual health and risk behavior and the development and implementation of methods of investigating risk within a multi-level, multi-causal framework are needed.

Additional research on the effectiveness of screening in community-based settings, including screening strategies using mailed specimens would be useful. This also includes further testing of the effectiveness of urine gonorrhea tests, as well as research on the role of asymptomatic infections in treatment and prevention strategies. Studies on the value of adding gonorrhea testing to routine chlamydia testing are needed. Cost-effectiveness studies of current clinical options such as screening criteria, types of diagnostic tests, and partner notification would be useful. Importantly, measurement of harms of screening and intervention should also be included.

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Acknowledgments

This update of the evidence was funded by the Agency for Healthcare Research and Quality (AHRQ) for the U.S. Preventive Services Task Force (USPSTF), and the investigators acknowledge the contributions of Gurvaneet Randhawa M.D., M.P.H. and David Lanier, M.D., M.P.H., Task Order Officers, AHRQ and David Meyers, M.D., Medical Officer, AHRQ. Members of the USPSTF who served as leads for this project include Kimberly D. Gregory, M.D., M.P.H., Diana B. Petitti, M.D., M.P.H., Jonathan D. Klein, M.D., M.P.H., and Steven M. Teutsch, M.D., M.P.H. Investigators thank the expert reviewers commenting on draft versions, Andrew Hamilton, M.L.S., M.S., for conducting the literature searches and Peggy Nygren, M.A.

This study was conducted by the Oregon Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (AHRQ), Contract #290-02-0024, Rockville, MD.

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References

1. U.S. Preventive Services Task Force. Guide to Clinical Preventive Service, 2nd ed. Office of Disease Prevention and Health Promotion; 1996.

2. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2003 Supplement: Gonococcal Isolate Surveillance Project (GISP) Annual Report—2003. Atlanta, GA: U.S. Department of Health and Human Services; November 2004.

3. Miller WC, Ford CA, Morris M, Handcock MS, Schmitz JL, Hobbs MM, et al. Prevalence of chlamydial and gonococcal infections among young adults in the United States. JAMA 2004;291(18):2229-36.

4. Kahn RH, Moseley KE, Thilges JN, Johnson G, Farley TA. Community-based screening and treatment for STDs: results from a mobile clinic initiative. Sex Transm Dis 2003;30(8):654-8.

5. Bachmann LH, Pigott D, Desmond R, Jones M, Lumpkins J, Gala P, et al. Prevalence and factors associated with gonorrhea and chlamydial infection in at-risk females presenting to an urban emergency department. Sex Transm Dis 2003;30(4):335-9.

6. Centers for Disease Control and Prevention. High prevalence of chlamydial and gonococcal infection in women entering jails and juvenile detention centers—Chicago, Birmingham, and San Francisco, 1998. JAMA 1999;282(15):1417-8.

7. Poulin C, Alary M, Bernier F, Ringuet J, Joly JR. Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, and HIV infection among drug users attending an STD/HIV prevention and needle-exchange program in Quebec City, Canada. Sex Transm Dis 1999;26(7):410-20.

8. Liebschutz JM, Finley EP, Braslins PG, Christiansen D, Horton NJ, Samet JH. Screening for sexually transmitted infections in substance abuse treatment programs. Drug Alcohol Depend 2003;70(1):93-9.

9. Farley TA, Cohen DA, Elkins W. Asymptomatic sexually transmitted diseases: the case for screening. Prev Med 2003;36(4):502-9.

10. Cohen DA, Nsuami M, Brooks B, Martin DH. School-based screening for sexually transmitted diseases. J of LA STATE MED SOC 1999;151(12):617-21.

11. Orr DP, Johnston K, Brizendine E, Katz B, Fortenberry JD. Subsequent sexually transmitted infection in urban adolescents and young adults. Arch Pediatr Adolesc Med 2001;155(8):947-53.

12. Pack RP, Diclemente RJ, Hook EW, 3rd, Oh MK. High prevalence of asymptomatic STDs in incarcerated minority male youth: a case for screening. Sex Transm Dis 2000;27(3):175-7.

13. Wiesenfeld HC, Lowry DL, Heine RP, Krohn MA, Bittner H, Kellinger K, et al. Self-collection of vaginal swabs for the detection of chlamydia, gonorrhea, and trichomoniasis: opportunity to encourage sexually transmitted disease testing among adolescents. Sex Transm Dis 2001;28(6):321-5.

14. Mertz KJ, Finelli L, Levine WC, Mognoni RC, Berman SM, Fishbein M, et al. Gonorrhea in male adolescents and young adults in Newark, New Jersey: implications of risk factors and patient preferences for prevention strategies. Sex Transm Dis 2000;27(4):201-7.

15. Mertz KJ, Schwebke JR, Gaydos CA, Beidinger HA, Tulloch SD, Levine WC. Screening women in jails for chlamydial and gonococcal infection using urine tests: feasibility, acceptability, prevalence, and treatment rates. Sex Transm Dis 2002;29(5):271-6.

16. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines 2002. MMWR—Morbidity & Mortality Weekly Report 2002;51(RR-6).

17. Johnson RE, Newhall WJ, Papp JR, Knapp JS, Black CM, Gift TL, et al. Screening tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae infections—2002. Morbidity & Mortality Weekly Report. Recommendations & Reports. 2002;51(RR-15):1-38; quiz CE1-4.

18. Cecil JA, Howell MR, Tawes JJ, Gaydos JC, McKee KT, Jr., Quinn TC, et al. Features of Chlamydia trachomatis and Neisseria gonorrhoeae infection in male Army recruits. J Infect Dis 2001;184(9):1216-9.

19. Farley TA, Cohen DA, Wu SY, Besch CL. The value of screening for sexually transmitted diseases in an HIV clinic. JAIDS 2003;33(5):642-8.

20. Centers for Disease Control and Prevention. Screening Tests To Detect Chlamydia trachomatis and Neisseria gonorrhoeae Infections—2002. MMWR (No. RR-15). U.S. Department of Health and Human Services; 2002.

21. Sloan NL, Winikoff B, Haberland N, Coggins C, Elias C. Screening and syndromic approaches to identify gonorrhea and chlamydial infection among women. Stud Fam Plann 2000;31(1):55-68.

22. Koumans EH, Johnson RE, Knapp JS, St Louis ME. Laboratory testing for Neisseria gonorrhoeae by recently introduced nonculture tests: a performance review with clinical and public health considerations. Clin Infect Dis 1998;27(5):1171-80.

23. Katz AR, Effler PV, Ohye RG, Brouillet B, Lee MV, Whiticar PM. False-positive gonorrhea test results with a nucleic acid amplification test: the impact of low prevalence on positive predictive value. Clin Infect Dis 2004;38(6):814-9.

24. Klausner J. The NAAT is out of the bag. Clin Infect Dis 2004;38(6):820-1.

25. St Lawrence JS, Montano DE, Kasprzyk D, Phillips WR, Armstrong K, Leichliter JS. STD screening, testing, case reporting, and clinical and partner notification practices: a national survey of US physicians. Am J Public Health 2002;92(11):1784-8.

26. Banikarim C, Chacko MR, Wiemann CM, Smith PB. Gonorrhea and chlamydia screening among young women: stage of change, decisional balance, and self-efficacy. J. Adolesc Health 2003;32(4):288-95.

27. Gershman KA, Barrow JC. A tale of two sexually transmitted diseases. Prevalences and predictors of chlamydia and gonorrhea in women attending Colorado family planning clinics. Sex Transm Dis 1996;23(6):481-8.

28. Liau A, Diclemente RJ, Wingood GM, Crosby RA, Williams KM, Harrington K, et al. Associations between biologically confirmed marijuana use and laboratory-confirmed sexually transmitted diseases among African American adolescent females. Sex Transm Dis 2002;29(7):387-90.

29. Peters SE, Beck-Sague CM, Farshy CE, Gibson I, Kubota KA, Solomon F, et al. Behaviors associated with Neisseria gonorrhoeae and Chlamydia trachomatis: cervical infection among young women attending adolescent clinics. Clin Pediatr 2000;39(3):173-7.

30. Marrazzo JM, Handsfield HH, Whittington WL. Predicting chlamydial and gonococcal cervical infection: implications for management of cervicitis. Obstet Gynecol 2002;100(3):579-84.

31. Shain RN, Perdue ST, Piper JM, Holden AE, Champion JD, Newton ER, et al. Behaviors changed by intervention are associated with reduced STD recurrence: the importance of context in measurement. Sex Transm Dis 2002;29(9):520-9.

32. Katz AR, Effler PV, Ohye RG, Lee MV. Assessing age-related risk for gonococcal and chlamydial infections among females in Hawaii, 2001: a comparison of morbidity rates with screening test positivity. Ambul Pediatr 2004;4(2):188-91.

33. Katz BP, Fortenberry JD, Tu W, Harezlak J, Orr DP. Sexual behavior among adolescent women at high risk for sexually transmitted infections. Sex Transm Dis 2001;28(5):247-51.

34. Lifson AR, Halcon LL, Hannan P, St Louis ME, Hayman CR. Screening for sexually transmitted infections among economically disadvantaged youth in a national job-training program. J Adolesc Health 2001;28(3):190-6.

35. Mehta SD, Rothman RE, Kelen GD, Quinn TC, Zenilman JM. Unsuspected gonorrhea and chlamydia in patients of an urban adult emergency department: a critical population for STD control intervention. Sex Transm Dis 2001;28(1):33-9.

36. Boyer CB, Shafer MA, Teitle E, Wibbelsman CJ, Seeberg D, Schachter J. Sexually transmitted diseases in a health maintenance organization teen clinic: associations of race, partner's age, and marijuana use.[erratum appears in Arch Pediatr Adolesc Med 2000 May;154(5):433]. Arch Pediatr Adolesc Med. 1999;153(8):838-44.

37. Ellen JM, Langer LM, Zimmerman RS, Cabral RJ, Fichtner R. The link between the use of crack cocaine and the sexually transmitted diseases of a clinic population. A comparison of adolescents with adults. Sex Transm Dis 1996;23(6):511-6.

38. Schwebke JR, Desmond RA, Oh MK. Predictors of bacterial vaginosis in adolescent women who douche. Sex Transm Dis 2004;31(7):433-6.

39. Bloomfield PJ, Kent C, Campbell D, Hanbrook L, Klausner JD. Community-based chlamydia and gonorrhea screening through the United States mail, San Francisco. Sex Transm Dis 2002;29(5):294-7.

40. Sparks R, Helmers JR, Handsfield HH, Totten PA, Holmes KK, Wroblewski JK, et al. Rescreening for gonorrhea and chlamydial infection through the mail: a randomized trial. Sex Transm Dis 2004;31(2):113-6.

41. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2002 Supplement: Gonococcal Isolate Surveillance Project (GISP) Annual Report—2002. Atlanta, GA: U.S. Department of Health and Human Services; October 2003.

42. Centers for Disease Control and Prevention. Increases in fluoroquinolone-resistant Neisseria gonorrhoeae among men who have sex with men—United States, 2003, and revised recommendations for gonorrhea treatment, 2004. MMWR—Morbidity & Mortality Weekly Report 2004;53(16):335-8.

43. Acar J, Goldstein F. Trends in bacterial resistance to fluoroquinolones. Clin Infect Dis 1997;24(1):S67-73.

44. Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, et al. Current methods of the U.S. Preventive Services Task Force: a review of the process. Am J Prev Med 2001;20(3 (suppl 1):21-35.

45. Gunn RA, Fitzgerald S, Aral SO. Sexually transmitted disease clinic clients at risk for subsequent gonorrhea and chlamydia infections: possible 'core' transmitters. Sex Transm Dis 2000;27(6):343-9.

46. Klausner JD, Barrett DC, Dithmer D, Boyer CB, Brooks GF, Bolan G. Risk factors for repeated gonococcal infections: San Francisco, 1990-1992. J Infect Dis 1998;177(6):1766-9.

47. Todd CS, Haase C, Stoner BP. Emergency department screening for asymptomatic sexually transmitted infections. Am J Public Health 2001;91(3):461-4.

48. McKee KT, Jr., Jenkins PR, Garner R, Jenkins RA, Nannis ED, Hoffman IF, et al. Features of urethritis in a cohort of male soldiers. Clin Infect Dis 2000;30(4):736-41.

49. Oh MK, Cloud GA, Fleenor M, Sturdevant MS, Nesmith JD, Feinstein RA. Risk for gonococcal and chlamydial cervicitis in adolescent females: incidence and recurrence in a prospective cohort study. J Adolesc Health 1996;18(4):270-5.

50. Ellen JM, Hessol NA, Kohn RP, Bolan GA. An investigation of geographic clustering of repeat cases of gonorrhea and chlamydial infection in San Francisco, 1989-1993: evidence for core groups. J Infect Dis 1997;175(6):1519-22.

51. Holtgrave DR, Crosby RA. Social capital, poverty, and income inequality as predictors of gonorrhoea, syphilis, chlamydia and AIDS case rates in the United States. Sex Transm Infect 2003;79(1):62-4.

52. Cohen D, Spear S, Scribner R, Kissinger P, Mason K, Wildgen J. "Broken windows" and the risk of gonorrhea. Am J Public Health 2000;90(2):230-236.

53. Becker K, Glass G, Brathwaite W, Zenilman J. Geographic epidemiology of gonorrhea in Baltimore, Maryland, using a geographic information system. Am J Epidemiol 1998;147:709-16.

54. Tabrizi SN, Chen S, Cohenford MA, Lentrichia BB, Coffman E, Shultz T, et al. Evaluation of real time polymerase chain reaction assays for confirmation of Neisseria gonorrhoeae in clinical samples tested positive in the Roche Cobas Amplicor assay. Sex Transm Infect 2004;80(1):68-71.

55. Leslie DE, Azzato F, Ryan N, Fyfe J. An assessment of the Roche Amplicor Chlamydia trachomatis/Neisseria gonorrhoeae multiplex PCR assay in routine diagnostic use on a variety of specimen types. Commun Dis Intell 2003;27(3):373-9.

56. Van Der Pol B, Ferrero DV, Buck-Barrington L, Hook E, 3rd, Lenderman C, Quinn T, et al. Multicenter evaluation of the BDProbeTec ET System for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in urine specimens, female endocervical swabs, and male urethral swabs. J Clin Microbiol 2001;39(3):1008-16.

57. Livengood CH, 3rd, Wrenn JW. Evaluation of COBAS AMPLICOR (Roche): accuracy in detection of Chlamydia trachomatis and Neisseria gonorrhoeae by coamplification of endocervical specimens. J Clin Microbiol 2001;39(8):2928-32.

58. Darwin LH, Cullen AP, Crowe SR, Modarress KJ, Willis DE, Payne WJ. Evaluation of the Hybrid Capture 2 CT/GC DNA tests and the GenProbe PACE 2 tests from the same male urethral swab specimens. Sex Transm Dis 2002;29(10):576-80.

59. Diemert DJ, Libman MD, Lebel P. Confirmation by 16S rRNA PCR of the COBAS AMPLICOR CT/NG test for diagnosis of Neisseria gonorrhoeae infection in a low-prevalence population. J Clin Microbiol 2002;40(11):4056-9.

60. van Doornum GJ, Schouls LM, Pijl A, Cairo I, Buimer M, Bruisten S. Comparison between the LCx Probe system and the COBAS AMPLICOR system for detection of Chlamydia trachomatis and Neisseria gonorrhoeae infections in patients attending a clinic for treatment of sexually transmitted diseases in Amsterdam, The Netherlands. J Clin Microbiol 2001;39(3):829-35.

61. Farrell DJ, Sheedy TJ. Urinary screening for Neisseria gonorrhoeae in asymptomatic individuals from Queensland, Australia: an evaluation using three nucleic acid amplification methods. Pathology 2001;33(2):204-5.

62. Palladino S, Pearman JW, Kay ID, Smith DW, Harnett GB, Woods M, et al. Diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae. Genitourinary infections in males by the Amplicor PCR assay of urine. Diagn Microbiol Infect Dis 1999;33(3):141-6.

63. Modarress KJ, Cullen AP, Jaffurs WJ, Sr., Troutman GL, Mousavi N, Hubbard RA, et al. Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in swab specimens by the Hybrid Capture II and PACE 2 nucleic acid probe tests. Sex Transm Dis 1999;26(5):303-8.

64. Schachter J, Hook EW, 3rd, McCormack WM, Quinn TC, Chernesky M, Chong S, et al. Ability of the digene hybrid capture II test to identify Chlamydia trachomatis and Neisseria gonorrhoeae in cervical specimens. J Clin Microbiol 1999;37(11):3668-71.

65. Cosentino LA, Landers DV, Hillier SL. Detection of Chlamydia trachomatis and Neisseria gonorrhoeae by strand displacement amplification and relevance of the amplification control for use with vaginal swab specimens. J Clin Microbiol 2003;41(8):3592-6.

66. Uhrin M. Molecular diagnostics. The polymerase chain reaction and its use in the diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae. Gac Med Mex 1997;133(Suppl 1):133-7.

67. Young H, Anderson J, Moyes A, McMillan A. Non-cultural detection of rectal and pharyngeal gonorrhoea by the Gen-Probe PACE 2 assay. Genitourin Med 1997;73(1):59-62.

68. Roymans R, Onland G, Jansz A, Quint W, Boel E. Evaluation of an in-house polymerase chain reaction for detection of Neisseria gonorrhoeae in urogenital samples. J Clin Pathol 1999;52(6):411-4.

69. Bassiri M, Mardh PA, Domeika M. Multiplex AMPLICOR PCR screening for Chlamydia trachomatis and Neisseria gonorrhoeae in women attending non-sexually transmitted disease clinics. The European Chlamydia Epidemiology Group. J Clin Microbiol 1997;35(10):2556-60.

70. Crotchfelt KA, Welsh LE, DeBonville D, Rosenstraus M, Quinn TC. Detection of Neisseria gonorrhoeae and Chlamydia trachomatis in genitourinary specimens from men and women by a coamplification PCR assay. J Clin Microbiol 1997;35(6):1536-40.

71. Beltrami JF, Farley TA, Hamrick JT, Cohen DA, Martin DH. Evaluation of the Gen-Probe PACE 2 assay for the detection of asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae infections in male arrestees. Sex Transm Dis 1998;25(10):501-4.

72. Chan EL, Brandt K, Olienus K, Antonishyn N, Horsman GB. Performance characteristics of the Becton Dickinson ProbeTec System for direct detection of Chlamydia trachomatis and Neisseria gonorrhoeae in male and female urine specimens in comparison with the Roche Cobas System. Arch Pathol Lab Med 2000;124(11):1649-52.

73. Schwebke JR, Zajackowski ME. Comparison of DNA probe (Gen-Probe) with culture for the detection of Neisseria gonorrhoeae in an urban STD programme. Genitourin Med 1996;72(2):108-10.

74. Whiley DM, LeCornec GM, Mackay IM, Siebert DJ, Sloots TP. A real-time PCR assay for the detection of Neisseria gonorrhoeae by LightCycler. Diagn Microbiol Infect Dis 2002;42(2):85-9.

75. Darwin LH, Cullen AP, Arthur PM, Long CD, Smith KR, Girdner JL, et al. Comparison of Digene hybrid capture 2 and conventional culture for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in cervical specimens. J Clin Microbiol 2002;40(2):641-4.

76. Martin DH, Cammarata C, Van Der Pol B, Jones RB, Quinn TC, Gaydos CA, et al. Multicenter evaluation of AMPLICOR and automated COBAS AMPLICOR CT/NG tests for Neisseria gonorrhoeae. J Clin Microbiol 2000;38(10):3544-9.

77. Moncada J, Schachter J, Hook EW, 3rd, Ferrero D, Gaydos C, Quinn TC, et al. The effect of urine testing in evaluations of the sensitivity of the Gen-Probe Aptima Combo 2 assay on endocervical swabs for Chlamydia trachomatis and Neisseria gonorrhoeae: the infected patient standard reduces sensitivity of single site evaluation. Sex Transm Dis 2004;31(5):273-7.

78. Gaydos CA, Quinn TC, Willis D, Weissfeld A, Hook EW, Martin DH, et al. Performance of the APTIMA Combo 2 assay for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in female urine and endocervical swab specimens. J Clin Microbiol 2003;41(1):304-309.

79. Page-Shafer K, Graves A, Kent C, Balls JE, Zapitz VM, Klausner JD. Increased sensitivity of DNA amplification testing for the detection of pharyngeal gonorrhea in men who have sex with men. Clin Infect Dis 2002;34(2):173-6.

80. Rietmeijer CA, Patnaik JL, Judson FN, Douglas JM, Jr. Increases in gonorrhea and sexual risk behaviors among men who have sex with men: a 12-year trend analysis at the Denver Metro Health Clinic. Sex Transm Dis 2003;30(7):562-7.

81. Centers for Disease Control and Prevention. Increases in unsafe sex and rectal gonorrhea among men who have sex with men—San Francisco, California, 1994-1997. JAMA 1999;281(8):696-7.

82. Cook RL, St George K, Silvestre AJ, Riddler SA, Lassak M, Rinaldo CR, Jr. Prevalence of chlamydia and gonorrhoea among a population of men who have sex with men. Sex Transm Infect 2002;78(3):190-3.

83. Lafferty WE, Hughes JP, Handsfield HH. Sexually transmitted diseases in men who have sex with men. Acquisition of gonorrhea and nongonococcal urethritis by fellatio and implications for STD/HIV prevention. Sex Transm Dis 1997;24(5):272-8.

84. Kim AA, Kent CK, Klausner JD. Risk factors for rectal gonococcal infection amidst resurgence in HIV transmission. Sex Transm Dis 2003;30(11):813-7.

85. Mehta SD, Bishai D, Howell MR, Rothman RE, Quinn TC, Zenilman JM. Cost-effectiveness of five strategies for gonorrhea and chlamydia control among female and male emergency department patients. Sex Transm Dis 2002;29(2):83-91.

86. Gift T, Walsh C, Haddix A, Irwin KL. A cost-effectiveness evaluation of testing and treatment of Chlamydia trachomatis infection among asymptomatic women infected with Neisseria gonorrhoeae. Sex Transm Dis 2002;29(9):542-51.

87. Centers for Disease Control and Prevention. 1998 Guidelines for treatment of sexually transmitted diseases. MMWR—Morbidity & Mortality Weekly Report 1998;47(RR-1):1-116.

88. American College of Obstetricians and Gynecologists. Gonorrhea and chlamydial infections. ACOG Technical Bulletin Number 190-March 1994 (replaces No. 89, November 1985). Int J Gynaecol Obstet 1994;45(2):169-74.

89. Miller JM, Jr., Maupin RT, Mestad RE, Nsuami M. Initial and repeated screening for gonorrhea during pregnancy. Sex Transm Dis 2003;30(9):728-30.

90. Magriples U, Copel JA. Can risk factor assessment replace universal screening for gonorrhea and Chlamydia in the third trimester? Am J of Perinat 2001;18(8):465-8.

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Notes

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AHRQ Publication No. 05-0579-B
Current as of May 2005

Internet Citation:

Glass N, Nelson HD, Villemyer K.. Screening for Gonorrhea: Update of the Evidence for the U.S. Preventive Services Task Force. AHRQ Publication No. 05-0579-B, May 2005. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/uspstf05/gonorrhea/gonup.htm