Background:
Broad-based gonorrhea screening among women continues despite <1% prevalence in many communities in the U.S. Baseline analysis of gonorrhea prevalence monitoring data collected by the Region III Infertility Prevention Project revealed that overall gonorrhea positivity in Title X family planning clinics in Philadelphia is low. However, higher positivity occurs in some communities/age groups. Analysis of clinic-level gonorrhea prevalence data provides an opportunity to target screening resources to at-risk populations.

Objective:
To develop gonorrhea screening criteria for family planning providers that target screening resources to women at appreciable risk, utilizing clinic-level prevalence monitoring data.

Method:
Data were analyzed for nearly 40,000 gonorrhea tests performed in 2004-2005 on women seen in 67 family planning clinics in the metropolitan Philadelphia area. Gonorrhea positivity data were stratified by age group (10-14, 15-19, 20-24, 25-29, and 30+) and clinic. Gonorrhea positivity > 1% was used as the criteria for continued screening.

Result:
The majority of clinics demonstrated a gonorrhea positivity > 1% in women under age 25, and < 1% in women 25 and older. Nine clinics observed a positivity > 1% in women aged 25 to 29, and 12 clinics observed a positivity < 1% across all age groups.

Conclusion:
The following screening criteria were proposed: in general, clinics were recommended to screen women under age 25 for gonorrhea annually and to perform only diagnostic testing in women 25 and older. The nine clinics that observed a significant positivity in women aged 25-29 were recommended to screen women under age 30 and to test women 30 and older diagnostically. The 12 clinics that observed no significant positivity were recommended to eliminate broad-based gonorrhea screening and provide only diagnostic testing.

Implications:
Gonorrhea screening criteria based on age- and clinic-level prevalence data provide an acceptable method of targeting screening resources to high-risk patients.