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Screening tests for gonorrhoea should first do no harm

False-positive diagnosis causes important harms and should be minimised

Gonorrhoea infection often has no clinical symptoms in women. Untreated, it may lead to pelvic inflammatory disease and carry risk of chronic pelvic pain, recurrent pelvic inflammatory disease, ectopic pregnancy and infertility. The risk of hospitalisation with pelvic inflammatory disease after gonorrhoea infection may be even greater than for chlamydia.1

Preventing these complications is the rationale behind opportunistic screening. General practitioners are recommended to screen all sexually active Australians aged 15–29 years for chlamydia, but to screen only those at highest risk for gonorrhoea.2 However, as reported by Chow and colleagues in this issue of the Journal,3 gonorrhoea screening appears to have become increasingly common among all Australian women, including those at low risk. Two factors which may partly account for the increase in testing are (i) clinicians misinterpreting guidelines as meaning that opportunistic screening should be done for both infections,4 and (ii) use of dual nucleic acid amplification tests (NAATs) by laboratories to test for both infections, even when clinicians have only requested chlamydia testing.

As shown by Chow et al, the apparent recent increase in gonorrhoea…