检查已注册的机会性衣原体筛查干预的有效性的系统性评价发现支持证据有限,需要高质量研究。[25]Low N, Bender N, Nartey L, et al. Effectiveness of chlamydia screening: systematic review. Int J Epidemiol. 2009;38:435-448.http://ije.oxfordjournals.org/cgi/content/full/38/2/435?view=long&pmid=19060033http://www.ncbi.nlm.nih.gov/pubmed/19060033?tool=bestpractice.com[26]Nelson HD, Helfand M. Screening for chlamydial infection. Am J Prev Med. 2001;20:95-107.http://www.ncbi.nlm.nih.gov/pubmed/11306238?tool=bestpractice.com[27]Roberts TE, Robinson S, Barton PM, et al. Cost effectiveness of home based population screening for Chlamydia trachomatis in the UK: economic evaluation of chlamydia screening studies (ClaSS) project. BMJ. 2007;335:291.http://www.bmj.com/cgi/content/full/335/7614/291?view=long&pmid=17656504http://www.ncbi.nlm.nih.gov/pubmed/17656504?tool=bestpractice.com[28]Taylor BD, Haggerty CL. Management of chlamydia trachomatis genital tract infection: screening and treatment challenges. Infect Drug Resist. 2011;4:19-29.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108753/pdf/idr-4-019.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/21694906?tool=bestpractice.com此外,一项招募了 2500 名16~27 岁女性的随机对照试验并不能清楚回答筛查沙眼衣原体是否可以有效降低盆腔炎性疾病的发病率。[29]Oakeshott P, Kerry S, Aghaizu A, et al. Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial. BMJ. 2010;340:c1642.http://www.bmj.com/cgi/content/full/340/apr08_1/c1642?view=long&pmid=20378636http://www.ncbi.nlm.nih.gov/pubmed/20378636?tool=bestpractice.com
然而,对关于筛查的随机对照试验和对照观察性研究的证据进行重新评估后发现,对沙眼衣原体的年度筛查可以预防 61% 的与沙眼衣原体有关的盆腔炎性疾病。[30]Price MJ, Ades AE, De Angelis D, et al. Risk of pelvic inflammatory disease following Chlamydia trachomatis infection: analysis of prospective studies with a multistate model. Am J Epidemiol. 2013;178:484-492.http://aje.oxfordjournals.org/content/178/3/484.longhttp://www.ncbi.nlm.nih.gov/pubmed/23813703?tool=bestpractice.com
美国预防服务工作组 (USPSTF) 建议对所有性活跃女性,包括孕妇,如果感染风险增加,均应进行淋病奈瑟菌和沙眼衣原体筛查。[15]US Preventive Services Task Force. Screening for chlamydial infection: US
Preventive Services Task Force recommendation statement. Ann Intern Med. 2007;147:128-134.http://www.annals.org/content/147/2/128.longhttp://www.ncbi.nlm.nih.gov/pubmed/17576996?tool=bestpractice.com这包括来自高发病率社区(患病率增加)15 岁~ 24 岁的女性;或者具有个体高危因素的女性(诸如近来多个性伴侣、STD 病史、性伴侣患有 STD);以及那些与社会隔绝、商业性交易或吸毒有关的女性。USPSTF 还建议对低风险无症状女性不应进行筛查。因此,目前不提倡对无症状人群进行衣原体的常规筛查来防治 PID。