Consequences Of Screening Diagnosis And Treatment
Screening, with the associated follow up including treatment, aims to reduce the consequences discussed above related to the natural course of infection. However, testing procedures themselves, inaccurate diagnostic tests, being diagnosed with an infection, and being treated with antibiotics may lead to other consequences that may be considered during decisions about screening.
Screening and diagnosis
Even though the diagnostic tests used for screening have good sensitivity and high specificity , some people will experience a false negative testwhereby treatment would not be provided and transmission to others may occur, or a false positive test informing them of an infection which does not exist. A false positive result may lead to adverse effects from treatment , and/or a risk for negative psychosocial effects about being infected with an STI , without any possible benefit to the individual tested. The availability of non-invasive diagnostic tests , including self-sampling, reduces the likelihood of people experiencing discomfort or embarrassment during the procedure.
Frequently Asked Questionsexpand All
- What is a sexually transmitted infection ?
A sexually transmitted infection is an infection spread by sexual contact. There are many STIs. This FAQ focuses on chlamydia, gonorrhea, and syphilis. These STIs can cause long-term health problems and problems during pregnancy. Having an STI also increases the risk of getting human immunodeficiency virus if you are exposed to it.
- What is chlamydia?
Chlamydia is the most commonly reported STI in the United States. Chlamydia is caused by a type of bacteria, which can be passed from person to person during vaginal sex, oral sex, or anal sex. Infections can occur in the mouth, reproductive organs, urethra, and rectum. In women, the most common place for infection is the cervix .
- What are the risk factors for chlamydia?
The following factors increase the risk of getting chlamydia:
Having a new sex partner
Having more than one sex partner
Having a sex partner who has more than one sex partner
Having sex with someone who has an STI
Having an STI now or in the past
Not using condoms consistently when not in a mutually monogamous relationship
Exchanging sex for money or drugs
Chlamydia usually does not cause symptoms. When symptoms do occur, they may show up between a few days and several weeks after infection. They may be very mild and can be mistaken for a urinary tract or vaginal infection. The most common symptoms in women include
yellow discharge from the vagina or urethra
yellow vaginal discharge
How Do You Get Tested For Gonorrhea
You can be tested for gonorrhea in several different ways. Both men and women will typically need a gonorrhea urine test, which analyzes your urine sample for the presence of gonorrhea bacteria. An oral gonorrhea test uses swab samples from your mouth as a screening test that helps determine if any detectable gonorrhea bacteria are present.
You may also need to have swab samples taken from the anus, vagina, or from the opening of the urethra to ensure a bacterial infection doesnÃ¢t go undetected elsewhere in your body.
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How To Collect A Rectal Swab
Gonorrhea and chlamydia often occur simultaneously because the risk factors are very similar. Patients who are suspected of having one of these sexually transmitted bacterial infections are usually tested for the other as well.
Insert a sterile swab approximately 2.5 cm into the anal canal
Move swab from side to side in the anal canal
Allow swab to remain 10-30 seconds for absorption of organisms onto the swab
Remove swab and insert into a vial containing 1-3 ml of viral transport media
Label the vial with appropriate patient information
Chlamydia Gonorrhea & Trichomoniasis
This panel provides an assessment of sexual health by screening for three common sexually transmitted infections :
For your urine test, it’s best not to urinate for two hours before your sample collection urinating within this period could affect the accuracy of your results.
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How To Get Tested
Chlamydia testing is usually ordered by a doctor. In people without symptoms, a doctor can evaluate their risk and suggest an appropriate screening schedule. If a patient has symptoms of this infection, a doctor will order testing to diagnose or rule out chlamydia.
Testing for chlamydia can be conducted at a hospital, doctors office, health clinic, or community health program.
Rationale For Screening Programs
Screening is a program, not only a test. Screening therefore includes a series of events initiated by offering of the test to diagnose an infection in those asymptomatic or not purposively seeking care for symptoms, detection of infection, with follow up for treatment and possibly partner notification and treatment, and retesting of cases to detect and treat reinfection .
While CT and NG may present with symptoms based on the location of infection, it is common that these STIs are detected asymptomatically. This increases both the risk of transmission to others and chances for complications when left undetected and untreated. The target groups for screening are usually defined by age and sex, considering prevalence and consequences of untreated infection. Further, although knowledge of behavioral and other risk factors will help identify those at a higher risk of becoming infected, there are challenges to accurate identification. People at high-risk may access services infrequently, they may not accurately self-report higher risk behaviors which may lead to inaccurate reporting, results, and missing cases .
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Each Year There Are Approximately 15 Million Cases Of Chlamydia And 350000 Cases Of Gonorrhea Reported To The Centers For Disease Control And Prevention
However this may not accurately reflect the total number of infected individuals, as most people with these infections have no symptoms and go untested. These bacterial infections are spread through sexual intercourse . This test will not be able to tell you the specific site of the infection, but will detect the infection if present.
Pregnant women with an active gonorrhea or chlamydia infection at the time of vaginal delivery can spread the infection directly to their children during birth. All sexually active women under age 25 and women over age 25 with risk factors for contracting chlamydia or gonorrhea should get tested every year: risk factors include unprotected sex, new sexual partners, or multiple sexual partners. Men at risk for chlamydia or gonorrhea should get tested each year, and more often as needed: risk factors include having sex with a partner who has chlamydia or gonorrhea, men who have sex with men, unprotected sexual intercourse, and multiple sex partners.
What Are Chlamydia And Gonorrhea
Gonorrhea and chlamydia are common sexually transmitted diseases . Both are typically asymptomatic , caused by bacteria, and have high prevalence across the United States. Chlamydia is one of the most widespread STDs in the United States, with the CDC estimating that 3 million cases occur annually. Rates of gonorrhea have been increasing sharply over the past 5 years, and certain strains are becoming antibiotic resistant.
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What Are The Signs Of Chlamydia Or Gonorrhea
Many people who have chlamydia or gonorrhea dont have any signs or symptoms. When there are symptoms, chlamydia and gonorrhea cause very similar things.
Women with symptoms may have:
- Abnormal discharge from the vagina
- Burning when they urinate
- Bleeding between periods
Men with symptoms may have:
- Abnormal discharge from the penis
- Burning when they urinate
- Painful or swollen testicles
Diagnostic Tests For Chlamydia In Male Patients
The process of diagnosing chlamydia in men works slightly different from how the procedure works in female patients. There are certain laboratory tests that a doctor will need to perform on a male patient to determine if they have been infected with chlamydia. Additionally, the doctor will also need to rule out the presence of other sexually transmitted infections. This is critical due to the fact that some of the other STIs that can affect a man may have similar symptoms as chlamydia.
The first test performed on men who are suspected of having been infected with the chlamydia bacterial infection is a urine sample test. The doctor will ask the male patient to provide them with a urine sample. The sample will then be sent toward a laboratory.
A scientist at the laboratory facility will analyze the urine sample that was sent to them. This will help them determine if the organism that causes chlamydia is present in the urine of the patient. This may provide an indication of chlamydia urethritis, which means the urethra of the patient has been infected with the bacterial infection.
If the patient experiences discharge from the tip of their penis, then a swab might also be conducted. This test is called a urethral discharge culture. A technician or a doctor will be able to perform the swab itself.
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When To Speak With A Doctor
Those receiving a positive test for an STI should seek medical advice. A doctor may suggest a treatment plan that may help alleviate symptoms and reduce the chances of spreading the infection.
People should also consider speaking with a healthcare professional if they wish to discuss their sexual health concerns, such as their risk of STIs.
Which Std Tests Should I Get
If you are sexually active, getting tested for STDs is one of the most important things you can do to protect your health. Make sure you have an open and honest conversation about your sexual history and STD testing with your doctor and ask whether you should be tested for STDs. If you are not comfortable talking with your regular health care provider about STDs, there are many clinics that provide confidential and free or low-cost testing.
Below is a brief overview of STD testing recommendations. STD screening information for healthcare providers can be found here.
You can quickly find a place to be tested for STDs by entering your zip code in the form below.
Find an STD testing site near you.
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How Does This At
This gonorrhea and chlamydia at-home test is a urine test â so a vaginal swab or blood sample is not required. To take the test, simply urinate in a collection cup and place your sample in the mail. Weâll send your sample to one of the labs we use for testing .
The lab will then use molecular testing technology that can identify the DNA of gonorrhea and chlamydia in your sample. This type of testing, known as nucleic acid amplification, is usually more accurate than other methods of gonorrhea and chlamydia testing .
During And After The Test
When you have a urine STI test, it is usually during a regular appointment. You will be asked to pee into a sample collection cup or tube. That tube or cup will be given to one of the medical staff.
Your urine sample will then be sent out to a lab or tested at the clinic. You can leave as soon as you are done giving the sample or when your appointment is finished.
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What If Symptoms Persist
Unfortunately, some types of gonorrhea bacteria dont respond to the usual antibiotic treatment. Doctors call this antibiotic resistance. Theyve been seeing a rise in these stronger bacteria for several years. If you continue to have symptoms a few days after treatment, see your doctor again. They may prescribe a longer course of different antibiotics
Suggestions For Practice Regarding The I Statement
Potential Preventable Burden. Chlamydial and gonococcal infections are often asymptomatic in men but may result in urethritis, epididymitis, and proctitis. Uncommon complications include reactive arthritis and disseminated gonococcal infection. Infections at extragenital sites are typically asymptomatic. Chlamydial and gonococcal infections may facilitate HIV transmission in men and women.1,4,5 Median prevalence rates among men who have sex with men who were tested in STD Surveillance Network clinics in 2012 were 16% for gonorrhea and 12% for chlamydia.1
Potential Harms. Potential harms of screening for chlamydia and gonorrhea include false-positive or false-negative results as well as labeling and anxiety associated with positive results.
Costs. According to the CDC, STIs in the United States are associated with an annual cost of almost $16 billion.8 Among nonviral STIs, chlamydia is the most costly, with total associated costs of $516.7 million . Gonococcal infections are associated with total costs of $162.1 million .9
In 2008, estimated direct lifetime costs per case of chlamydial infection were $30 in men and $364 in women. Similarly, gonococcal infections were associated with direct costs of $79 in men and $354 in women.9
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Chlamydia And Gonorrhea Testing Best Practices
Chlamydia and gonorrhea are the most common and second most common notifiable diseases in the United States, respectively.1 Rates of both sexually transmitted infections have been increasing in recent years.1 Emergency physicians are on the front lines of diagnosis and treatment of these infections. The ACEP Public Health and Injury Prevention Committee recently issued an information paper on best practices for diagnosing chlamydia and gonorrhea in adult and adolescent patients. Here are highlights from the most current and evidence-based recommendations.
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Testing for chlamydia and gonorrhea may be warranted in a range of circumstances, and clinicians should take into consideration patient, provider, and test characteristics when determining how to proceed. Patients with symptoms of infection , sexual contact with infected individuals, and high-risk demographics may all require testing. Empiric treatment based on clinical suspicion is reasonable when test results are not readily available and/or when follow-up is unlikely. In addition, patients diagnosed with chlamydia or gonorrhea should be offered testing for other STIs, such as syphilis and HIV. Of note, test of cure is generally not necessary.
Development of improved point-of-care testing for chlamydia and gonorrhea is underway and has the potential to improve the diagnostic and therapeutic capabilities of emergency physicians in this area.
Data Extraction And Reporting
We will use piloted, standardized data extraction forms. One reviewer will independently extract data from each included study into DistillerSR a second reviewer will verify all data for accuracy and completeness. Disagreements will be resolved through discussion or a third reviewer.
For each key question, we will extract data on the following:
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Sti Are Often Asymptomatic Screen For One Sti Screen For All
Screening: Early STI detection in asymptomatic individualsFootnote
Chlamydia trachomatis AND Neisseria gonorrhoeae
Image 1 depicts a flow chart of the different specimens and laboratory tests that may be used for Chlamydia trachomatis and Neisseria gonorrhoeae screening. First void urine samples can be tested for CT and NG using Nucleic Acid Amplification Testing . Urethral, vaginal or cervical swabs can be tested for CT and NG using NAAT and/or culture for NG. Rectal or pharyngeal swabs can be tested for CT and NG using NAAT, if available, and/or culture.
- Nucleic Acid Amplification Test is highly sensitive and the test of choice when screening asymptomatic individuals for CT and NG
- Preferred specimens for NAAT are first void urine or self-collected vaginal swab
- Collect pharyngeal and rectal specimens from individuals with a history of performing oral sex or having receptive anal intercourse, respectively
- Check with your laboratory for the availability of NAAT for rectal and pharyngeal specimens
- Testing algorithms may vary by province and territory
Offer HIV testing when screening for other STIFootnote
Questions For Your Doctor After At
After taking an at-home gonorrhea test, it may be helpful to bring questions about test results to a doctor for additional support and guidance. The following questions may be useful when talking to a doctor about at-home gonorrhea test results:
- What does my test result mean about my health?
- Is additional testing needed to confirm my test result?
- How often should I be tested for gonorrhea?
- Should I be tested for other STDs? How often?
- Should I tell my sexual partners about my test results?
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Benefits And Downsides Of At
Before ordering an at-home gonorrhea test, it may be helpful to consider the benefits and drawbacks of collecting samples at home.
Benefits of at-home gonorrhea testing include:
- Availability: At-home gonorrhea testing is an accessible and convenient approach to screen for this common STD. Ordering an at-home test kit may be a good option when in-person testing isnt available.
- User-friendly: Test kits provide detailed instructions for collecting, packaging, and preparing samples for testing. Many test kits include free return shipping labels, simplifying the process of sending samples to a lab for analysis.
- Upfront pricing: The total cost of an at-home gonorrhea test is typically straightforward and clear. In contrast, the cost of physician-ordered testing may include a variety of charges, from lab fees to health insurance copays.
- Combining STD tests: Many at-home testing companies offer panels or packages of STD tests, allowing people to screen for a variety of STDs using the same test samples. This approach may save time and money and offer more comprehensive STD screening.
Potential drawbacks of at-home gonorrhea testing include: