| Table 5: Summary of manoeuvres, effectiveness, levels of evidence and recommendations for screening for chlamydial infection | |||
|---|---|---|---|
| Manoeuvre | Effectiveness | Level of evidence | Recommendation |
| Screening for chlamydial infection with the following methods: culture or polymerase chain reaction (PCR) for all sites, direct fluorescent antibody (DFA) testing for genitourinary, conjunctival, rectal and nasopharyngeal sites, enzyme-linked immunoassay (ELISA) for genitourinary or conjunctival sites, or DNA probes for genitourinary sites; and subsequent treatment with the following drugs: erythromycin or amoxicillin, for pregnant women, or tetracyclines, azithromycin or ofloxacin for nonpregnant women and for men | Pregnant women
Erythromycin treatment of women with an infection leads to improved perinatal and postnatal outcomes for their infants |
Cohort studies163, 190 192,194 (II-2) |
Fair evidence to support screening of pregnant women during their first prenatal visit and subsequent treatment (B) |
| High-risk groups* Available screening tests are accurate and reliable | Cohort studies of DFA,76,79,100 ELISA197 and PCR112,123,198 (II-2) | Fair evidence to support annual screening of high-risk groups (B) | |
| Treatment is effective in eliminating chlamydial infection. One study190 shows that screening leads to reduction of complications | Randomized controlled trials129,131,136,138,145 (I) | Fair evidence to support annual screening of high-risk groups (B) | |
| General population Available screening tests are accurate and reliable but have poor positive predictive value and cost-effectiveness when prevalence is low. No study shows that screening and early detection lead to reduction of complications | Modelling studies13,186,195,196 | Fair evidence to exclude routine screening of the general population (D) | |
| *High-risk groups are sexually active women less than 25 years of age, women with new sexual partners, women or men with multiple sexual partners during the previous year, women who use nonbarrier contraceptive methods and women who have symptoms of chlamydial infection (cervical friability, mucopurulent cervical discharge or intermenstrual bleeding). | |||