World Health Organization · 2025 · 62 pages
Evidence-based recommendations on screening for asymptomatic gonorrhoea and chlamydia in pregnant women, young people, sex workers and men who have sex with men
- Issuer
- World Health Organization
- Edition
- 2025
- Audience
- STI programme managers, health-care workers, lay providers, community health workers, implementers of HIV/sexual and reproductive health/maternal and child health services, nongovernmental and community-based organisations, key population networks
- Evidence
- GRADE-rated recommendations based on systematic review and decision-tree modelling; all recommendations conditional with low certainty of evidence
- Reviewed
- 15 Oct 2026 · GMJ
What this guideline says
GMJ summary
These WHO guidelines provide new and updated recommendations for screening asymptomatic sexually transmitted infections (STIs), specifically Neisseria gonorrhoeae and Chlamydia trachomatis, among key populations. Globally, an estimated 128.5 million new chlamydia cases and 82.4 million new gonorrhoea cases occurred in 2020 among people aged 15–49 years, with 50–97% of infections potentially asymptomatic, particularly cervical infections in women and infections at anorectal and oropharyngeal sites.
The guidelines recommend conditional screening with quality-assured molecular assays or rapid tests (minimum sensitivity 80%, specificity 90%) for four target groups: pregnant women in high-prevalence settings (≥10% combined prevalence); sexually active adolescents and young people (10–24 years) in high-prevalence settings (≥15–20%); sex workers; and men who have sex with men. All recommendations are conditional with low certainty of evidence, recognising that screening should be voluntary with informed consent, implemented where resources and capacity are available, and accompanied by treatment based on test results using national guidelines. Sexual partners of those testing positive should also be tested and treated if positive.
These recommendations complement existing WHO guidance on syphilis screening and form part of the broader strategy to achieve a 90% reduction in gonorrhoea and syphilis infections by 2030. Implementation requires consideration of local prevalence data, available diagnostic infrastructure, antimicrobial stewardship principles, and integration with comprehensive STI prevention interventions including condom use, health education, and accessible treatment services for symptomatic infections.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Screen pregnant women for <i>N. gonorrhoeae</i> and/or <i>C. trachomatis</i> in settings where combined prevalence is ≥10%, using nucleic-acid amplification testing or rapid tests with ≥80% sensitivity and ≥90% specificity
- Screen sexually active adolescents and young people (10–24 years) in settings where combined prevalence is ≥15–20%; prioritise adolescent girls and young women when balancing resources
- Offer screening to sex workers at anatomical sites based on sexual behaviour; pooling samples can reduce costs and increase yield
- Offer screening to men who have sex with men at anatomical sites based on sexual behaviour, at least annually or every 6 months
- All screening must be voluntary with informed consent; treat positive cases using national treatment guidelines
- Sexual partners of people testing positive should be tested and treated if positive
- Screening is not recommended where quality-assured diagnostic tests, treatment or capacity are unavailable
- Continue to follow recommendations for management of symptomatic STIs regardless of screening programmes
Summary of recommendations on screening asymptomatic sexually transmitted infections
Table extracted from the guideline
| Population | Recommendation | Strength & certainty |
|---|---|---|
| Pregnant women | Screen for <i>N. gonorrhoeae</i> and/or <i>C. trachomatis</i> in high-prevalence settings (≥10% combined) where resources available | Conditional, low certainty |
| Adolescents & young people (10–24 years) | Screen sexually active individuals in high-prevalence settings (≥15–20% combined) where resources available; prioritise girls and young women | Conditional, low certainty |
| Sex workers | Screen those accessing health-care services with no STI symptoms; anatomical site depends on sexual behaviour | Conditional, low certainty |
| Men who have sex with men | Screen those accessing health-care services with no STI symptoms; anatomical site depends on sexual behaviour | Conditional, low certainty |
Source: World Health Organization, Guidelines for the management of asymptomatic sexually transmitted infections. Reproduced in summary form.
What changed in this edition
Versus the previous edition
- New recommendations for pregnant women: screening for asymptomatic <i>N. gonorrhoeae</i> and <i>C. trachomatis</i> in high-prevalence settings (2024)
- New recommendations for sexually active adolescents and young people aged 10–24 years (2024)
- Updated recommendations for sex workers: now includes specific guidance on test performance characteristics and anatomical site selection (2024)
- Updated recommendations for men who have sex with men: now includes specific guidance on test performance characteristics and frequency (2024)
- All recommendations now specify minimum test performance (≥80% sensitivity, ≥90% specificity) and emphasise population-level prevalence over individual risk assessment
- Recommendations now explicitly state screening frequency for key populations: at least annually or every 6 months for sex workers and men who have sex with men
From the guideline
Verbatim
“WHO suggests that pregnant women who have no symptoms of a sexually transmitted infection and are accessing health-care services for antenatal visits be screened for N. gonorrhoeae and/or C. trachomatis in settings where prevalence is high and resources and capacity are available.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Editor of GMJ and WHO consultant, I view these guidelines as a necessary strategic document for our region, though implementation will face substantial barriers. The emphasis on population-level prevalence data is critical: Georgia and neighbouring countries lack robust surveillance for asymptomatic <i>N. gonorrhoeae</i> and <i>C. trachomatis</i> infections, making it impossible to determine whether we meet the screening thresholds. I would stress to Georgian clinicians that these conditional recommendations require local prevalence studies and cost-effectiveness analyses before programme implementation—screening is not recommended where quality-assured diagnostics and treatment are unavailable, which describes most of our primary care facilities today. The realistic implementation pathway is incremental: first, establish sentinel surveillance among pregnant women and key populations to determine burden; second, integrate screening into existing antenatal syphilis programmes if prevalence justifies it; third, strengthen community-based services for key populations where stigma and legal barriers currently prevent access. The guideline's antimicrobial stewardship principles are particularly relevant given rising resistance; we must ensure that any screening programme includes partner notification, quality-assured diagnostics to avoid overtreatment, and gonorrhoea antimicrobial resistance monitoring aligned with WHO GASP protocols.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 15 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus region, these guidelines highlight critical gaps in STI surveillance and service delivery. National programmes will need to establish prevalence data for N. gonorrhoeae and C. trachomatis among the target populations to determine whether screening thresholds are met. Georgia’s existing antenatal care infrastructure and syphilis screening programmes provide a platform for integrating chlamydia and gonorrhoea screening for pregnant women if prevalence data support it. Key population services remain limited in the region due to stigma and criminalisation of sex work and same-sex relations in some countries; implementing acceptable, confidential screening services will require strengthening community-based approaches and training health-care providers in non-discriminatory care. The requirement for quality-assured molecular assays or validated rapid tests represents a substantial resource challenge; most facilities currently rely on syndromic management. Countries will need to assess cost-effectiveness, procure appropriate diagnostics, ensure treatment availability (including for antimicrobial-resistant strains), and establish laboratory quality assurance systems before implementing routine screening. Integration with existing HIV and syphilis testing services for key populations and pregnant women offers the most feasible implementation pathway.
Questions this guideline answers
Quick answers
Which populations should be screened for asymptomatic gonorrhoea and chlamydia?
WHO suggests screening four groups: (1) pregnant women in settings with ≥10% combined prevalence; (2) sexually active adolescents and young people aged 10–24 years in settings with ≥15–20% prevalence, prioritising girls and young women; (3) sex workers; and (4) men who have sex with men. All screening must be voluntary with informed consent and only where quality-assured tests and treatment are available.
What test performance is required for screening?
Screening should use either a quality-assured molecular assay such as nucleic-acid amplification testing (NAAT), or a rapid test with minimum sensitivity of 80% and specificity of 90%. The gold standard is molecular-based testing such as real-time PCR. Tests must be validated against a reference standard before use in screening programmes.
How often should screening be performed?
For sex workers and men who have sex with men, screening should be offered at least annually or every 6 months, depending on sexual exposure, rates of partner exchange, cost of testing, and consequences of not screening. For pregnant women, screening should occur at the first antenatal visit, ideally in the first trimester. Evidence suggests that more frequent screening (every 2–3 months) detects more cases than less frequent screening (every 4–6 months) in men who have sex with men, but this must be balanced against cost.
What should happen after a positive screening result?
All people testing positive should be treated for <i>N. gonorrhoeae</i> and/or <i>C. trachomatis</i> based on results of the quality-assured test, using national treatment guidelines. Sexual partners of people testing positive should also be tested and treated if positive. This ensures rational antibiotic use and adherence to antimicrobial stewardship principles. Treatment should be immediate, ideally on the same day at first contact between patient and health-care provider.
Related on GMJ
Interconnected resources
Dictionary of Public Health
GMJ News coverage
- UK Launches First National Gonorrhoea Vaccination Programme Using 4CMenB VaccineJun 2026
- Chlamydia Vaccination Could Save $1.8 Billion Annually in US Healthcare CostsJun 2026
- Gonorrhea burden in sub-Saharan Africa remains stubbornly high: new meta-analysis reveals 3.2% general population prevalenceSep 2026
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- Issuer
- World Health Organization
- Type
- Guideline
- Edition
- 2025
- Replaces
- Guidelines for the management of sexually transmitted infections, 2003
- Status
- Current
- Published
- 2025-05-29
- Languages
- English
- Scope
- Screening for asymptomatic Neisseria gonorrhoeae and Chlamydia trachomatis infections in pregnant women, adolescents and young people, sex workers, and men who have sex with men
- Audience
- STI programme managers, health-care workers, lay providers, community health workers, implementers of HIV/sexual and reproductive health/maternal and child health services, nongovernmental and community-based organisations, key population networks
- Pages
- 62
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-4-010490-7
- Evidence
- GRADE-rated recommendations based on systematic review and decision-tree modelling; all recommendations conditional with low certainty of evidence
- Next review
- Not specified; monitoring system for new evidence to be established
- Record history
- Created 15 Oct 2026 · updated 15 Oct 2026 · next check Apr 2027
Guidelines for the management of asymptomatic sexually transmitted infections. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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