Which tests are unnecessary?

2 minute read

The use of tests for herpes, chlamydia and gonorrhoea are under microscope


The use of tests for herpes, chlamydia and gonorrhoea are under the the microscope in the latest raft of Choosing Wisely recommendations, according to the Royal Australasian College of Physicians specialist group.

Unless there was a clear indication, ordering herpes serology risked exposing patients to a test that would not accurately confirm whether they were infected or posed a transmission risk, according to the Sexual Health Medicine chapter of the college.

Serological tests for chlamydia had no role as a screening test, as antibodies were long-lived and the test was non-specific for genital serovars, the authors said.

And while nucleic acid amplification (NAAT) technologies remained the best option for chlamydia diagnosis, it should not be used to investigate gonorrhoea in low prevalence populations.

The introduction of an MBS item number for duplex chlamydia and gonorrhoea testing had led to laboratories testing for gonorrhoea even if a test for only one organism was requested, the group said.

But in low prevalence populations (<1%), the positive predictive value of tests for gonorrhoea was low, exposing the patient to the risk of false positive results.

The suite of new recommendations is part of the Choosing Wisely initiative to reduce unnecessary screening, testing and treatment.

Alongside five new sexual health recommendations, the Human Genetics Society of Australasia, Gastroenterological Society of Australia and the Royal Australian and New Zealand College of Radiology all issued recommendations.

Clinicians were advised not to continue prescribing PPIs without attempting to reduce the dose or cease the drug, which has been associated with fractures, pneumonia and vitamin and mineral deficiencies.

And screening for coeliac disease using genetic tests should be avoided, given the tests for coeliac genes were useful largely as a negative test, the gastroenterologists advised.

More recommendations for tests or treatments to question are available on the Choosing Wisely website.

J Gen Intern Med 2016; online 6 September 

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