An epidemic of the bacterial sexually transmitted infections (STIs) syphilis, chlamydia and gonorrhea is taking hold worldwide, with the World Health Organization estimating that nearly 1 million people are infected daily with a curable STI. (1) Canada has seen increases of more than 160% over the last decade. (2) A critical component of STI control is testing, but a paucity of evidence on how best to do this, particularly with respect to screening frequency, means recommendations on the topic are scarce.
In a related guideline issued by the Canadian Task Force on Preventive Health Care, Moore and colleagues provide a recommendation for screening for chlamydia and gonorrhea in primary care. (3) This publication updates national guidance on screening from the Public Health Agency of Canada, (4,5) as well as guidelines by the Canadian Task Force on the Periodic Health Examination, (6) which were last updated in 1996. The authors outline their rigorous use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) (7) system, a widely accepted methodology for the development of clinical practice guidelines, including a systematic review of the literature, a 2-phase patient engagement process, and a transparent discussion of the benefits, harms and implementation considerations.
Given the paucity of available data, the guideline provides only 1 conditional recommendation, based on very low-certainty evidence: primary care providers should, once yearly, opportunistically screen sexually active individuals younger than 30 years who are not known to be part of a high-risk group for chlamydia and gonorrhea. Its authors argue this screening may confer an "uncertain but potentially important" benefit, such as the prevention of pelvic inflammatory disease in females.
One strength of the recommendation is that the authors intentionally extend their screening recommendation to individuals up to age 29 years (compared with the previous cut-off of 25 yr), to ensure that those with the highest STI rates are captured. This increase is justified by data showing recent increases in rates of STIs among people aged 25-29 years. For example, since 2012, the rate of gonorrhea in Canada in this age range has consistently been higher than among people aged 15-19 years, with data from 2017 showing 264 cases per 100 000 population versus 151 per 100000, respectively. (2)
Another strength is the authors' emphasis on an opportunistic approach to screening. Although the randomized controlled trials available did not explicitly examine this approach, such a...