Screening for Chlamydia and Gonorrhea: A Draft Update of the Systematic Review Adapted from the USPSTF Review for the Japan Preventive Services Task Force

抄録

Background:

Chlamydia trachomatis and Neisseria gonorrhoeae infections are among the most common sexually transmitted infections in Japan. Following the 2021 U.S. Preventive Services Task Force (USPSTF) evidence review on screening for these infections, we conducted a systematic review commissioned by the Japan Preventive Services Task Force to update and adapt it for the Japanese context, incorporating Japanese-language literature and recent international evidence.

Methods:

We searched PubMed, the Cochrane Library, and Ichushi-Web for studies published from May 29, 2020, through September 9, 2025, with no date restriction for Ichushi-Web. Among asymptomatic sexually active adolescents and adults, including pregnant persons, we evaluated four key questions (KQs): the effectiveness of screening (KQ1), the accuracy of risk stratification methods and alternative screening strategies (KQ2), the diagnostic accuracy of tests by anatomic site and specimen collection methods (KQ3), and the potential harms of screening (KQ4).

Results:

Of 1,571 citations screened, 18 unique studies met eligibility criteria (KQ1: 6; KQ2: 1; KQ3: 11; KQ4: 1; one systematic review contributed to both KQ1 and KQ4). Evidence on screening effectiveness was limited and inconclusive, with no study demonstrating a statistically significant reduction in infection-related complications or population-level transmission. A single risk stratification tool from a high-prevalence African setting showed moderate discriminative performance (area under the curve 0.72) but lacked validation. Nucleic acid amplification tests (NAATs) demonstrated consistently high sensitivity and specificity across assay types, specimen types, and collection methods, including self-collected samples and pooled testing. Evidence on psychosocial harms was limited to a single systematic review, which suggested that harms are generally modest.

Conclusion:

Although direct evidence that screening improves clinically important outcomes remains limited and indirect for Japan, findings from this present review provide a foundation for informed decision-making and highlight priority areas for future research.