Clinical Context

Adolescents have the highest prevalence rates for many sexually transmitted infections (STIs). Early detection of nonviral STIs facilitates treatment, prevents transmission, and avoids complications.

Chlamydia, gonorrhea, and syphilis screening guidelines from the US Preventive Services Task Force and the Centers for Disease Control and Prevention recommend screening those at risk based on epidemiologic and clinical outcomes data. This American Academy of Pediatrics (AAP) policy statement regarding these curable, nonviral STIs summarizes the evidence for nonviral STI screening in adolescents, discusses the value of screening, and offers recommendations for routine screening of adolescents for nonviral STIs.

Study Synopsis and Perspective

The AAP has recommended routine laboratory screening for nonviral STIs in some adolescents and young adults in a policy statement published online June 30 in Pediatrics.

The AAP's Committee on Adolescence and Society for Adolescent Health and Medicine developed the policy statement and recommendations "to identify and treat individuals with treatable infections, reduce transmission to others, avoid or minimize long-term consequences, identify other exposed and potentially infected individuals, and decrease the prevalence of infection in a community."

Although prevalence rates of some STIs are highest among adolescents, nonviral STIs can be treated and transmission to others eliminated if they are caught early, the authors write. The US Preventive Services Task Force and the Centers for Disease Control and Prevention have published similar guidelines.

The AAP recommendations cover chlamydia, gonorrhea, trichomoniasis, and syphilis.

Specifically, the academy recommends routine laboratory screening for chlamydia:

• in all sexually active female adolescents and young adults (<25 years) annually;
• in sexually active adolescent and young adult men who have sex with other men (MSM) at least annually, and every 3 to 6 months if at high risk;
• in adolescents and young adults exposed to chlamydia in the past 60 days; and
• possibly in sexually active young men annually who are in high-prevalence environments, such as jails or detention centers; national job training programs; and STI clinics, high school clinics, or adolescent clinics for patients with a history of multiple sex partners.

The academy recommends routine laboratory screening for gonorrhea:

• in sexually active female adolescents and young adults annually;
• in sexually active adolescent and young adult MSM annually, and every 3 to 6 months if high risk (those who have multiple or anonymous sex partners, sex combined with illicit drug use, or partners who engage in these activities);
• in adolescents and young adults exposed to gonorrhea from an infected partner in the past 60 days; and
• possibly in sexually active adolescent and young adult men with individual or population-based risk factors.

The academy recommends against routine screening of asymptomatic adolescents for trichomoniasis but suggests that this screening may be necessary for female adolescents and young adults who have new or multiple partners, have a history of STIs, exchange sex for money, or inject drugs.

The academy recommends against routine screening for syphilis in nonpregnant, heterosexual adolescents but recommends screening for all sexually active adolescent and young adult MSM annually or every 3 to 6 months if at high risk. It also recommends the following:

• Rescreen all adolescents infected with chlamydia or gonorrhea, and consider rescreening all female adolescents and young adults diagnosed with trichomoniasis, 3 months after treatment.
• Develop clinical procedures to incorporate risk assessments, screening, treatment, and prevention counseling into routine healthcare.
• Work to minimize barriers to screening and other barriers such as access and stigma.

"Pediatricians can take an active role in reducing disease prevalence and adverse sequelae by identifying and treating undiagnosed infections," the authors write.

Pediatrics. Published online June 30, 2014. Abstract

Guideline Highlights

• All sexually active female adolescents and adults 25 years or younger should be routinely screened annually for Chlamydia trachomatis and Neisseria gonorrheae.
• Sexually active adolescent and young adult MSM should be routinely screened annually for rectal and urethral chlamydia and gonorrhea if they participate in receptive anal or insertive intercourse, respectively.
• MSM participating in receptive oral sex should also be routinely screened annually for pharyngeal gonorrhea.
• High-risk patients (multiple or anonymous partners, sex combined with illicit drug use, or partners who participate in these activities) should be screened every 3 to 6 months for chlamydia and gonorrhea.
• Adolescents and young adults exposed in the past 60 days to chlamydia or gonorrhea from an infected partner should be screened for these respective infections.
• Annual screening for chlamydia or gonorrhea should be considered for sexually active young men in high-prevalence settings, such as jails or juvenile corrections facilities, national job training programs, STI clinics, high school clinics, and adolescent clinics for patients who have a history of multiple partners.
• Regardless of whether they believe that their sex partners were treated, all adolescents infected with chlamydia or gonorrhea should be rescreened 3 months after treatment.
• Routine screening of asymptomatic adolescents for Trichomonas vaginalis is not recommended, but such screening may be indicated in patients with risk factors such as new or multiple partners, a history of STIs, exchange of sex for payment, or use of injecting drugs.
• Clinicians should consider rescreening female adolescents and young adults for trichomoniasis 3 months after treatment, or whenever they next present for healthcare in the 12 months after initial treatment.
• Routine screening of nonpregnant, heterosexual adolescents for syphilis is not recommended.
• Screening for syphilis is recommended for all sexually active adolescent and young adult MSM annually, or every 3 to 6 months if high risk, based on individual behaviors and local syphilis prevalence.
• Clinicians should develop clinical procedures using prepared resources to include STI risk evaluation, screening, treatment, and prevention counseling in routine healthcare.
• Staff should be trained in procedures and related issues, including consent, confidentiality, and billing.
• Staff should become competent with screening using the noninvasive nucleic acid amplification test (NAAT).
• Clinicians should advocate for reducing barriers to STI screening, such as access and stigma, without breaching confidentiality.

Clinical Implications

• An AAP policy statement recommends that sexually active female adolescents and young adults and MSM 25 years or younger be routinely screened annually for chlamydia and gonorrhea. Routine screening for trichomoniasis or syphilis is not recommended.
• Clinicians should develop clinical procedures using prepared resources to include STI risk evaluation, screening, treatment, and prevention counseling in routine healthcare, according to the AAP.

CME Test