Looking for an asymptomatic infection: usefulness of screening for Chlamydia trachomatis and genital herpes.

Chlamydia trachomatis (CT) and Herpes simplex virus type 2 (HSV-2) genital infections are among the more frequent sexually transmissible infections with different prevalence by age, populations and geographical areas. Both are widespread, have an asymptomatic latent stage detectable only by laboratory and can have serious consequences such as tubal infertility and neonatal herpes. The direct isolation of CT in cervical or urethral discharge through Nucleic Acid Amplification Test (NAATs) allows to detect and to treat the infection with effective antibiotic medication. The screening of all women younger than 25 year old showed to be effective in reducing tubal complications but not in decreasing the incidence of the infection in the general population. Only a proactive screening of younger women, repeated yearly and associated with an effective partner notification could achieve a decrease of the incidence rate in the general population. The detection of type specific herpetic antibodies allows to identify persons with herpetic infection regardless of symptoms. While a population-based screening of general population cannot be proposed at the moment, a selective screening (attenders of STI clinic, HIV-positive patients, pregnant women) is a debated issue between those who consider it an effective means to detect persons with unrecognized symptoms who are infectious and those who think that preventive measures and antiviral medication are not effective enough to be proposed.