title: Bacterial Sexually Transmitted Disease Screening Outside the Clinic--Implications for the Modern Sexually Transmitted Disease Program.
abstract: BACKGROUND
  The development of noninvasive nucleic acid amplification tests for chlamydia and gonorrhea has facilitated innovation in moving sexually transmitted disease (STD) screening to nonclinical settings. However, limited data are available to inform local STD programs on evidence-based approaches to STD screening in nonclinical settings in the United States.
  
  
  METHODS
  We conducted a systematic review of the literature published since 2000 related to chlamydia, gonorrhea, and syphilis screening in US correctional settings, bathhouses and sex venues, self-collected at-home testing, and other nonclinical sites.
  
  
  RESULTS
  Sixty-four articles met eligibility criteria and were reviewed. Although data on testing volume and positivity were available, there were scarce data on the proportion of new positives treated and the programmatic costs for the various screening programs. Screening in correctional settings identified a sizable amount of asymptomatic infections. The value and sustainability of screening in the other nonclinical settings examined was not clear from the published literature.
  
  
  CONCLUSIONS
  Local and state health departments should explore the development of sustainable jail and juvenile detention screening programs for STDs. Furthermore, local programs should pilot outreach and home-based STD screening programs to determine if they are identifying asymptomatic persons who would not have otherwise been found. Local programs are encouraged to present and publish their findings related to non-clinic-based screening to enhance the limited body of literature; data on the proportion of new infections treated and the local program costs are needed.
authors.affiliation: From the *Division of STD Prevention, Centers for Disease Control & Prevention, Atlanta, GA; †Sexually Transmitted Disease Control Branch, California Department of Public Health, Richmond, CA; and ‡New York City Department of Health and Mental Hygiene, Bureau of STD Control, New York, NY.
authors.forename: Kyle T
authors.initials: KT
authors.lastname: Bernstein
authors.forename: Joan M
authors.initials: JM
authors.lastname: Chow
authors.forename: Preeti
authors.initials: P
authors.lastname: Pathela
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Gift
mesh_terms: D002690:Chlamydia Infections / Q000517:prevention & control; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D055317:Evidence-Based Practice; D006069:Gonorrhea / Q000517:prevention & control; D006801:Humans; D008403:Mass Screening; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D021141:Nucleic Acid Amplification Techniques; D015995:Prevalence; D011330:Prisons; D016730:Program Development; D015397:Program Evaluation; D011633:Public Facilities; D011634:Public Health / Q000379:methods / Q000639:trends; D011477:Sex Work; D015231:Sexually Transmitted Diseases, Bacterial / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control*; D013048:Specimen Handling; D013587:Syphilis / Q000517:prevention & control; D014210:Treponema pallidum / Q000302:isolation & purification*; D014481:United States / Q000453:epidemiology