Announcements

U.S. Preventive Services Task Force calls for chlamydia and lipid screening and issues two other recommendations

In its first set of recommendations, the third U.S. Preventive Services Task Force (USPSTF) has recommended that primary care clinicians screen all sexually active women ages 25 and younger for chlamydia, as well as older women who are at risk for chlamydia, as part of regular health care visits.

Chlamydia is the most common bacterial sexually transmitted disease in the United States, with an estimated 3 million new cases each year. Most women have no symptoms when initially infected, but if they go untreated, they can develop pelvic inflammatory disease, infertility, and other serious health problems, including increased risk of HIV infection. Although chlamydia is most common in women 25 and younger, older women also can be at risk for chlamydia if they have a new or multiple sexual partners, have had a sexually transmitted disease in the past, or do not use condoms consistently and correctly. Treatment with antibiotics is easy and effective.

The USPSTF recommendation is particularly important because data indicate that many women are not being screened. According to a survey of 546 doctors reported in the March 2001 Journal of Adolescent Health, only 32 percent said they would screen an asymptomatic sexually active teenage girl for chlamydia as part of a routine gynecologic examination. A 1997 study of four major U.S. health plans indicated that only 2 percent to 42 percent of sexually active females aged 15 to 25 years had been screened for chlamydia.

The USPSTF, a panel of independent, private-sector experts in prevention and primary care, made its recommendation after concluding that there is good scientific evidence that routine screening and treatment could reduce serious consequences of chlamydia in women. The Agency for Healthcare Research and Quality sponsors the USPSTF, which is led by Alfred O. Berg, M.D., M.P.H., Chair of the Department of Family Medicine, University of Washington, Seattle.

In a broadening of its 1996 recommendations, the USPSTF has recommended that regular screening for high blood cholesterol and other lipid abnormalities, which can lead to coronary heart disease, should not have an upper age limit (previously set by the panel at age 65). The USPSTF also issued a new recommendation calling for the screening of younger adults for lipid abnormalities beginning at age 20 if they have risk factors for coronary heart disease such as diabetes, family history of heart disease, tobacco use, or high blood pressure. In addition, the panel revised its 1996 statement to recommend that for initial screening purposes, clinicians measure high density lipoprotein (HDL) cholesterol along with total cholesterol.

In addition, the USPSTF also released recommendations on skin cancer and bacterial vaginosis. They stated that:

• There is still insufficient scientific evidence to determine whether regular total body skin examination for skin cancer is effective in reducing illness and death, the same conclusion the Task Force reached in 1996.
• Despite research showing that pregnant women with bacterial vaginosis have a higher risk of preterm delivery, evidence does not merit regular screening to reduce the incidence of pre-term delivery. For women at high risk due to a previous pre-term delivery, however, the USPSTF found conflicting results regarding the benefit of screening and treatment, and concluded that these options be left to the discretion of clinicians. Bacterial vaginosis is a common condition among women of childbearing age that results in a vaginal discharge caused by an imbalance in vaginal bacteria.

The USPSTF conducts impartial assessments of scientific evidence for a broad range of clinical conditions to produce recommendations for the regular provision of clinical preventive services. The Task Force grades the strength of evidence from A (strongly recommends) to D (recommends against) and I (insufficient evidence to recommend for or against).

As the panel updates the 70 chapters in its 1996 report, it is issuing individual updates as they are completed. Releasing the recommendations as they are finished rather than all at once, as in the past, will get them into the hands of clinicians more quickly.

The recommendations on these four topics and summaries of the evidence on which they are based are published in a supplement to the April 2001 edition of the American Journal of Preventive Medicine. A limited number of free copies of the supplement (AHRQ Publication No. OM 01-0009) are available from the AHRQ Publications Clearinghouse.

Select USPSTF to access the recommendations, summaries of the evidence, easy-to-read fact sheets explaining the recommendations, and related materials or access them through the National Guideline Clearinghouse™. Print copies of these items are available from the AHRQ Publications Clearinghouse.

AHRQ is planning to compile all of the USPSTF chapters and summaries of evidence in a semiannual incremental release notebook that will include an annual cumulative index. For more information on how you can subscribe to this notebook, contact the AHRQ Publications Clearinghouse.

To help clinicians apply Task Force recommendations in practice and to help patients understand which clinical preventive services they should expect clinicians to provide, AHRQ sponsors the Put Prevention Into Practice (PPIP) program. Select for information about the PPIP program and products.

Contact the AHRQ Publications Clearinghouse to obtain a brochure (AHRQ Publication No. APPIP 01-0006) that lists all of the USPSTF and PPIP products available from AHRQ.

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