The findings and conclusions in these presentations have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.

Tuesday, May 9, 2006

Development and Implementation of Region IX Infertility Prevention Project Gonorrhea Screening Guidelines for Women in Family Planning and Primary Care Settings

Holly Howard1, Heidi M. Bauer2, Joan M. Chow1, Charlotte K. Kent3, Patricia A. Blackburn4, Michael Policar5, Barbara Allen6, and Gail A. Bolan2. (1) STD Control Branch, CA Department of Health Services, 850 Marina Bay Parkway, Bldg. P, 2nd Floor, Richmond, CA, USA, (2) CA Dept of Health Services, STD Control Branch, 850 Marina Bay Parkway, Bldg. P, 2nd Floor, Richmond, CA, USA, (3) Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-80, Atlanta, GA, USA, (4) Center for Health Training, 614 Grand Avenue, Suite 400, Oakland, CA, USA, (5) California State Office of Family Planning, 1615 Capitol Avenue, PO Box 997413, MS 8400, Sacramento, CA, USA, (6) Alameda County Department of Public Health, 1000 Broadway, Suite 500, Oakland, CA, USA

Although gonorrhea is the second most common bacterial STD in Region IX, rates have declined over the past decade and remain relatively low, especially among women in family planning settings. Screening continues to be important for detecting asymptomatic infections and is facilitated by combined chlamydia/gonorrhea testing technologies, but over-screening in low prevalence populations wastes resources.

To develop and implement regional gonorrhea screening guidelines for women in family planning and primary care settings that would minimize over-screening in low prevalence populations and better target high risk patients.

The guideline development process involved analysis of screening coverage, prevalence monitoring and behavioral data from family planning clinics, and consultation with key stakeholders. In addition to wide-spread dissemination, implementation plans include systematic evaluation using screening coverage and prevalence data.

The overall prevalence of gonorrhea in family planning settings was <1%, with higher rates among young women and women with high-risk sexual behaviors. Final recommendations included: (1) routine screening for women age ≤25, except when prevalence in this group is <1%, (2) targeted screening for women >25 years of age if there is a history/report of gonorrhea in the previous two years, >1 sex partner in the previous 12 months, or a partner with other partners. The guidelines also included recommendations for diagnostic and repeat testing. Implementation is underway.

Screening guidelines that are data-driven and responsive to the issues of key stakeholders can provide a more effective use of limited resources. These recommendations include more specific risk factors for older women than are seen in other guideline documents.

Clinical guideline development is essential to improve the cost-effectiveness of prevention programs. In order to evaluate guideline adherence and effectiveness, agencies need to monitor screening practices and prevalence, and include monitoring by specific patient demographics in order to detect higher-prevalence sub-groups among low-prevalence clinic populations.