| Key Question |
Levels of Evidence |
Conclusions |
Internal Validity |
External Validity |
| Asymptomatic Men and Women Including Adolescents |
| 1A. Does screening women reduce complications and transmission of disease? |
No studies |
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| 1B. Does screening men reduce complications and transmission of disease? |
No studies |
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| 2A. What individual-level risk factors identify groups at higher risk for gonococcal infection? |
15 descriptive studies |
Age is the strongest predictor of gonococcal infection (<25 years). Additional risk factors include African American race, having 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. |
Not rated | Studies focus on high-risk, urban STD clinic populations |
| 2B. What population-level characteristics identify groups at higher risk for gonococcal infection? |
4 descriptive studies |
Contextual risk factors include sexual networks, sexual mixing within a community or neighborhood with high prevalence of STDs, and residence in a community with limited social capital or markers of physical deterioration. |
Not rated | Limited to specific urban populations |
| 2C. What individual-level risk factors identify groups at higher risk for gonococcal infection when used in conjunction with population-level or provider-level characteristics? |
No studies |
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| 2D. What are the screening tests and their performance characteristics? |
25 studies |
NAATs: PCR sensitivity 42%-100%/specificity 96%-100%; SDA 84%-100%/95%-100%; TMA 88%-100%/98%-99.6%.
DNA probes: 92%-93%/99%-99.8%. |
Fair | Studies focus on high-risk, urban STD clinic populations |
| 2E and 2F. What is the yield of screening in different risk populations? Does performance of screening tests vary by specimen type? |
25 studies |
NAATs: Women—high sensitivity/specificity with endocervical swab, decreased sensitivity with urine (PCR, TMA, SDA).
Men—high sensitivity/specificity with urethral swab, decreased sensitivity with urine (PCR but not SDA).
For both men and women—sensitivity may vary depending on symptom status.
DNA probes: Using PACE® 2, sensitivity higher than culture for rectal and pharyngeal specimens. |
Fair | Studies focus on high-risk, urban STD clinic populations |
| 2G. What is the role of screening for gonococcal infection among men who have sex with men (MSM)? |
No studies |
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| |
| 3A. What is the evidence on cost-effectiveness for universal vs. targeted strategies? |
1 decision analysis |
Screening all women aged 18-31 years is more cost-effective than selective screening even when the combined prevalence of gonorrhea and chlamydia is 7%-17.5%. For men, standard practice (e.g., history and examination) is more cost-saving than enhanced screening strategies. |
Not rated | Not rated |
| 3B. Are dual chlamydia-gonorrhea screening tests cost-effective? | No studies |
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| Pregnant Women |
| 1A. Does screening reduce adverse maternal/pregnancy outcomes (septic abortion, stillbirth, preterm delivery/low birth weight)? |
No studies |
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| 1B. Does screening reduce adverse neonatal outcomes (gonococcal conjunctivitis, blindness)? |
No studies |
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| 2A. Does screening reduce maternal complications (chorioamnionitis, premature rupture of membranes, preterm labor)? |
No studies |
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| 2B. Does screening reduce transmission to the newborn? |
No studies |
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| 3. What is the evidence on cost-effectiveness for universal vs. targeted strategies? |
No studies |
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| Newborn Chemoprophylaxis |
| 1. What are the adverse effects of treatment? |
No studies |
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