# Environmental scan of available guidelines for chlamydia and gonorrhea screening recommendations for non-pregnant adolescents/adults in developed countries

## TL;DR

This paper reviews guidelines for chlamydia and gonorrhea screening in non-pregnant adolescents and adults in developed countries to inform updated Canadian recommendations.

## Contribution

The study provides a comprehensive environmental scan and evaluation of international screening guidelines for chlamydia and gonorrhea.

## Key findings

- Most international guidelines recommend universal screening for chlamydia and targeted/risk-based screening for gonorrhea.
- Only one guideline fully met the AGREE II assessment criteria.
- The findings will inform the revision of Canada's Public Health Agency screening recommendations.

## Abstract

Over the past ten years, there has been a steady increase in the reported rates of gonorrhea and chlamydia in Canada, with gonorrhea rising by 171% and chlamydia by 26%.

To collect and synthesize national and international chlamydia and gonorrhea screening guidelines to inform the revision of the current Public Health Agency of Canada (PHAC) recommendations.

A scan of published chlamydia and gonorrhea screening guidelines of high-income countries was conducted. Guidelines were appraised using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) and PROGRESS-Plus tools.

A total of 17 guidelines on chlamydia and gonorrhea screening published between 2015 and 2023 were included in this review. The overall score of the AGREE II methodological assessment ranged from a rating of three to seven out of seven points. Only one guideline fully met the considerations identified in the assessment tool. Most international organizations recommend universal screening for chlamydia, and a few organizations recommend opportunistic screening and targeted/risk-based screening. As for gonorrhea screening, organizations mostly recommend targeted/risk-based screening and a few organizations recommend universal screening. None of the international gonorrhea guidelines recommended opportunistic screening. The implementation of universal screening has been shown to have minimal negative impact on the individuals being screened, while increasing testing rates. Most guidelines recommend screening individuals <25 years of age, while only two organizations recommend screening individuals <30 years of age.

The findings of this review will be used to inform the revision of the current PHAC recommendations on chlamydia and gonorrhea screening, which will be published in early 2025. International organizations recommend either universal or opportunistic screening. The majority of Canadian provinces and territories follow PHAC’s Sexually Transmitted and Blood-Borne Infections: Guides for Health Professionals and recommend universal screening for individuals <25 years of age.