Why Screening for Chlamydia and Gonorrhea is Being Recommended for Women but Not Men

Curated by Claudia Shannon / Research Scientist / ishonest

The U.S. Preventive Services Task Force (USPSTF) is recommending chlamydia and gonorrhea screening for sexually active women age 24 years old and younger and women 25 years old and older who are at increased risk of sexually transmitted infections (STIs).

Among factors that increase the risk of STIs are having a new sex partner or more than one sex partner.

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The task force concluded that current evidence is insufficient to assess the benefits and harms of screening for chlamydia and gonorrhea in men.

This is consistent with their 2014 recommendations.

The USPSTF does not recommend specific screening intervals, writing that “a reasonable approach would be to screen patients whose sexual history reveals new or persistent risk factors since the last negative test result.”

The task force noted that their recommendations for “men” and “women” have to do with biological sex, not gender identity. People should consider sex at birth and current anatomy.

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Those who are unsure which recommendations apply should speak with their doctor.

The U.S. Centers for Disease Control and Prevention (CDC) estimates that 1 in 5 people in the United States have a sexually transmitted infection. Almost half of all new STIs occur in people between the ages of 15 and 24.

Chlamydia and gonorrhea are among the most common. Both are curable.

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Dr. G. Thomas Ruiz is OB-GYN lead at MemorialCare Orange Coast Medical Center in Fountain Valley, California.

Ruiz told ishonest that the guidelines seem appropriate.

“As a clinician, I think screening of young men would be reasonable,” he added.

Ruiz also suggested another group that should be considered.

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“There has been a problem with nursing home residents getting chlamydia and gonorrhea. We need to keep an eye out for this population, but it doesn’t have as tragic consequences as it does for young women,” said Ruiz.

Complications from chlamydia and gonorrhea

Ruiz explained that for young women with asymptomatic infection, the effects of chlamydia and gonorrhea could be devastating.

“They can cause a lot of damage to fallopian tubes. Years later, women who were asymptomatic and not treated show up with pelvic pain, and you find lots of scar tissue in the pelvis,” said Ruiz.

Complications can also include:

  • pelvic inflammatory disease
  • chronic pelvic pain
  • permanent damage to the reproductive system
  • infertility
  • ectopic pregnancy
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Having these infections while pregnant can also harm the child.

“A baby coming through the birth canal of an untreated mother will affect the baby’s eyes and can cause blindness,” said Ruiz.

Exposure to chlamydia at birth can also affect the baby’s lungs and lead to pneumonia.

Men don’t usually have serious problems due to chlamydia or gonorrhea. But untreated, these infections can lead to:

  • inflammation of the urethra (urethritis)
  • inflammation of the tube that carries sperm from the testicles (epididymitis)
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Having chlamydia, gonorrhea, or other STIs can also increase the risk of contracting HIV.

Who should get tested

Dr. Leena Nathan is an OB-GYN at UCLA Health Westlake Village in California.

Nathan told ishonest that we need more data on the benefits of screening men.

“Nearly all women are contracting chlamydia and gonorrhea from male partners,” she said.

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“By eliminating asymptomatic infections in men, we can better protect women from infection. Screening for high-risk behavior is important in all age groups as well in order to offer [STI] testing as needed,” she added.

Nathan said that home testing kits could be helpful for those who are uncomfortable visiting a doctor’s office, have transportation limitations, or are fearful of a pelvic exam.

“However, when possible, I recommend that people visit a doctor to address concerns and perform testing. The benefit of seeing a doctor is that the patient can be tested for other STDs, counseled regarding prevention, and also treated as needed,” Nathan advised.

Ruiz recommends that women go for an annual check, even if you’re not due for a Pap test. Anyone with a new sexual partner should also be tested, he said.

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