There is a widely held public perception that sexually transmitted infections declare themselves by producing symptoms. If this were true, screening would not be necessary. In 1951, the US Commission on chronic illness defined screening as: The presumptive identification of unrecognized disease or defects by the application of tests, examinations or other procedures which can be applied rapidly. Screening tests sort out apparently well persons who probably have a disease from those who probably do not. A screening test is not intended to be diagnostic. Persons with positive or suspicious findings must be referred to their physicians for diagnosis and necessary treatment. Screening in the sphere of reproductive health has been directed predominantly at women, especially in relation to breast and cervical screening. The medical profession has a greater awareness of asymptomatic cervical infection in women. The paper by Scholes et al. (1996) on prevention of pelvic inflammatory disease by screening for cervical chlamydial infection was the first report that screening women for cervical chlamydial infection reduces the risk of developing pelvic infection considerably. This paper has highlighted the potential benefits of screening for sexually transmitted infection, although screening is only part of the management process. Accurate diagnosis, investigation for other pathogens, adequate treatment with an appropriate antibiotic and partner notification (also called contact tracing) are essential if prevalence of infection and complications are to be reduced. Secondary prevention by early detection of sub-clinical disease through screening or case finding is required to prevent lower genital tract infection from ascending to the upper genital tract in women. Once symptoms develop in pelvic infection, substantial damage to the Fallopian tubes has already occurred. Little can be gained by tertiary prevention of more effective antimicrobial therapies. The importance of partner notification in preventing exposure to organisms resulting in repeat episodes of pelvic infection through continuing stimulation of the immune system has been highlighted by Paavonen (1996). There is ample evidence showing that asymptomatic infection is also common in men, particularly with the organism Chlamydia trachomatis, the commonest bacterial sexually transmitted infection in the UK. Screening should be targeted at those groups in which there is likely to be a prevalence of infections such as gonorrhoea, chlamydial urethritis or non-specific urethritis, to prevent pelvic infection and its sequelae most cost effectively. What screening should be undertaken in men? In relation to fertility, screening should identify the organisms that can, if present in the genital tract of women, cause pelvic infection, with the possible sequelae of reduced fertility and ectopic pregnancy. These organisms usually cause urethritis in men. Urethritis may be caused by the organism Neisseria gonorrhoeae or by other organisms, in which case the condition is referred to as non-gonococcal urethritis (NGU). Gonorrhoea Gonorrhoea is diagnosed presumptively on taking a urethral swab and identifying Gram-negative intracellular diplococci in the polymorphonuclear cells (PMN) present on a Gram-stained slide. The diagnosis is made by the growth of N. gonorrhoeae on an appropriate medium and identification of the organism by confirmatory tests. Gonorrhoea usually causes symptoms of urethral discharge and mild dysuria in about 90% of men with urethral infection. However, infection in the oropharynx produces symptoms in only about 20% of cases and > 66% of men with anorectal gonorrhoea have no symptoms of infection. Gonorrhoea is considered of high infectivity, and risk of transmission for a female having intercourse with an infected male is higher than that for a male having intercourse with an infected female (Thelin et al., 1980).
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Sep 30, 2024
Yile Xiao + 11
Open Access
