Gonorrhea screening in family planning clinics when should it become selctive?

Routine screening of females for gonococcal infection has become common in many clinic settings, particularly in public family planning clinics. The results of such routine screening in one large family planning program operated by the Seattle-King County Department of Public Health was examined. From 1973 to 1975 a trend toward decreasing rates of positivity for gonorrhea was observed. Use of computer information on the population being served by the program and a review of individual patient's charts enabled identification of certain high-yield subpopulations, including blacks, welfare recipients, new patients over age 19, and new patients who were not using any contraception when first screened. The cost of detecting a case of gonorrhea through screening was related to the positivity rate with the demonstration of a very high cost per case found when the positivity rate is less than 1 percent. Consideration should be given to identifying high and low-yield subpopulations for gonorrhea screening in large family planning programs so that, as cost considerations demand, funds now used for routine gonorrhea screening may be used instead for selective screening and provision of family planning services to high-yield groups.