Screening Tests for Adults (Ages 30-49)

Chlamydia and gonorrhea are the most common bacterial sexually transmitted diseases (STDs) in the United States today, but many infected people have no symptoms. These infections usually affect the genitals but may also cause infections of other mucous membranes, eyes, or joints. Pregnant women may transmit the infections to their newborns. Often progressing silently, these diseases can cause infertility and other health complications if left untreated. However, both diseases can be cured with antibiotics. 

While rates of chlamydia and gonorrhea are highest in younger people, any sexually active person can get a chlamydia or gonorrhea infection. Many people have both chlamydia and gonorrhea infections at the same time.

Recommendations for Women

• The U.S. Centers for Disease Control and Prevention (CDC), the U.S. Preventive Services Task Force (USPSTF), the American Academy of Family of Physicians (AAFP), and the American College of Obstetricians and Gynecologists (ACOG) recommend chlamydia screening for all sexually active adult women who have risk factors, such as a new or multiple sex partners. The CDC specifically recommends annual screening.
• The CDC, USPSTF, AAFP, and ACOG suggest gonorrhea screening for all sexually active adult women at increased risk.

For screening recommendations during pregnancy, see Pregnancy & Prenatal Testing.

Recommendations for Men

These organizations do not recommend routine screening for healthy, sexually active, heterosexual men. Health care providers may, however, use their judgment and consider risks, such as prevalence in the community. It is important to remember that an infected male can spread these diseases and even re-infect a partner if he does not complete treatment.

• For sexually active males who have sex with other males, the CDC recommends chlamydia and gonorrhea screening at least annually.

Risk

You are at risk of contracting chlamydia and gonorrhea if you:

• Have had one or both of these infections before
• Have other STDs, especially HIV
• Have new or multiple sex partners
• Use condoms inconsistently
• Exchange sex for money or drugs
• Use illegal drugs
• Live in a detention facility
• Are a man who has sex with other men

Because reinfection rates are high, the CDC recommends that both women and men who are treated for chlamydia or gonorrhea infection be retested approximately 3 months after treatment or at their next health care visit, regardless of whether they believe that their sex partners were treated. It is important to continue annual screening for these diseases because reinfection is always possible.

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Links
CDC: Chlamydia 
CDC: Gonorrhea 

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Sources Used in Current Review

United States Preventive Service Task Force. USPSTF Recommendations for STI Screening. Available online at http://www.uspreventiveservicestaskforce.org/uspstf08/methods/stinfections.htm through http://www.uspreventiveservicestaskforce.org. Last updated March 2008. Accessed May 24, 2012.

Kimberly A. Workowski and Stuart Berman. Sexually Transmitted Diseases Guidelines, 2010. Morbidity and Mortality Weekly Report. PDF available for download at http://www.cdc.gov/std/treatment/2010/STD-Treatment-2010-RR5912.pdf through http://www.cdc.gov. Published December 27, 2010. Accessed March 24, 2012.

U.S. Centers for Disease Control and Prevention. Chlamydia and Gonorrhea — Two Most Commonly Reported Infectious Diseases in the United States. Available online at http://www.cdc.gov/Features/dsSTDData/ through http://www.cdc.gov. Last reviewed April 22, 2011. Accessed May 23, 2011.

U.S. Centers for Disease Control and Prevention. STD Prevention Conference 2012. Available online at http://www.cdc.gov/nchhstp/newsroom/stdconference2012summaries.html through http://www.cdc.gov. Last reviewed March 14, 2012. Accessed May 23, 2012.

American College of Obstetricians and Gynecologists. Well-Woman Care: Assessments and Recommendations. Available online through http://www.acog.org/. Issued March 29, 2012. Accessed June 1, 2012.

American Academy of Family Physicians. Gonorrhea. Available online at http://www.aafp.org/online/en/home/clinical/exam/gonorrhea.html through http://www.aafp.org. Accessed June 4, 2012.

American Academy of Family Physicians. Chlamydia. Available online at http://www.aafp.org/online/en/home/clinical/exam/chlamydia.html through http://www.aafp.org. Accessed June 4, 2012.

U.S. Centers for Disease Control and Prevention. 2010 Treatment Guidelines, Special Populations. Available online at http://www.cdc.gov/std/treatment/2010/specialpops.htm#msm through http://www.cdc.gov. Accessed June 2012.

U.S. Centers for Disease Control and Prevention. Chlamydial Infections - 2010 Treatment Guidelines. Available online at http://www.cdc.gov/std/treatment/2010/chlamydial-infections.htm through http://www.cdc.gov. Accessed June 2012. 

Screening for Gonorrhea: Recommendation Statement. Annals of Family Medicine 2005 May; 3(3): 263–267. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1466867/#r7 through http://www.ncbi.nlm.nih.gov. Accessed June 2012. 

Colorectal cancer is the third most common non-skin cancer in adults and the second leading cause of cancer deaths in men and women in the United States. Cancer of the colon and rectum is both preventable and treatable if detected early. Studies show that regular screening could prevent one-third of colorectal cancer deaths in the U.S. The five-year survival rate is 90% if detected early.

Screening tests that look for and remove polyps and lesions in the colon can prevent colorectal cancer. These are found most often in people 50 years of age and older, so experts do not recommend universal screening of average risk people until the age of 50. However, if you have one or more risk factors for colon cancer, described below, you should talk to your healthcare provider. He or she can help you assess your individual risk factors and determine if you should begin screening before age 50 and what tests are appropriate based on your risks. As the Centers for Disease Control and Prevention (CDC) notes, any of the recommended tests is better than no test.

Risk

Earlier, more frequent screening is appropriate at a younger age, often beginning at age 40, if you have certain risk factors and fall into the categories for increased or high risk. Screening can begin even earlier in some cases.

• Increased risk:
  • If you have a family history of colorectal cancer or adenomatous polyps, a specific type of polyp associated with higher risk of colorectal cancer, you are at increased risk and may need earlier screening. Most of these cancers occur in people without a family history of colorectal cancer. Still, as many as 1 in 5 people who develop colorectal cancer have other family members who have been affected by this disease.

    Specifically, if you have a first-degree relative (parents, siblings or children) who had colorectal cancer or adenomatous polyps before age 60, or two or more first-degree relatives who had either of these findings at any age, you have increased risk for colorectal cancer. The risk is about doubled in those with one affected first-degree relative. It is even higher if the first-degree relative is diagnosed at a young age, or if more than one first-degree relative is affected.

  • You may also be at increased risk for colorectal cancer if you have been diagnosed with colon cancer in the past or if you have had a history of polyps on a prior colonoscopy.
  • Race and ethnicity can increase risk. African Americans have the highest incidence of colorectal cancer and Ashkenazi Jews have the highest risk of developing colorectal cancer.
• High risk: You are at high risk for colorectal cancer if you have inflammatory bowel disease, including chronic ulcerative colitis or Crohns disease. If you have a genetic syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (HNPCC), or if you are at an increased risk of HNPCC based on your family history, you are also in the high-risk category.

Types of Tests Used for Screening

• A colonoscopy is usually recommended for people who are at intermediate or high risk of colorectal cancer and require screening before the age of 50. The procedure uses a probing scope and a video camera to view the entire length of the colon. This allows any polyps or other suspicious tissue to be removed and tested for the presence of cancer. Though the most costly and invasive, colonoscopy is the most accurate and thorough test and is especially appropriate for those with risk factors.

Other types of screening tests may be options for people who are considered to be similar to those of average risk. This may include, for example, people with a first degree relative who had colon cancer after the age of 60.

Some of these testing options include laboratory tests performed on stool samples that mainly detect existing cancers:

• Fecal occult blood test (FOBT)
• Immunochemical fecal occult blood test (iFOBT)
• Stool DNA test

If the findings on one of these are abnormal, you will need a colonoscopy.

Besides colonoscopy, other imaging procedures may be used for screening.

• Flexible sigmoidoscopy is similar to colonoscopy in that it uses use a probing scope and a video camera, but it uses a shorter probe that views the entire rectum and only the lower third of the colon. This approach is also able to remove any polyps that are found and allows for them to be tested for the presence of cancer cells.
• Two other procedures use X-rays; however, these approaches only allow visualization of polyps. Removal of the polyps would require a follow-up colonoscopy or flexible sigmoidoscopy:
  • Virtual colonoscopy (computed tomography (CT) colonograph) combines many cross-sectional images into 2-D and 3-D views of the colon. This procedure is less invasive and does not require sedation, thus may be appropriate for those who cannot tolerate a colonoscopy.
  • Double-contrast barium enema (DCBE), also known as air-contrast barium enema or lower GI series, provides X-ray views of lumps, polyps, and/or other abnormalities in the outline of the colon.

Stool sample testing and sigmoidoscopy are easier than colonoscopy but not as accurate. Stool testing and sigmoidoscopy are best used in conjunction with each other.

Recommendations

Several health organizations have colon cancer screening recommendations. While they may differ on which tests to use and how often, they each support screening for colon cancer. In March 2008, screening guidelines for the early detection of pre-cancerous polyps and colon cancer were released jointly by the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Similar guidelines have also been proposed by the U.S. Preventive Services Task Force (USPSTF) and the American College of Gastroenterology. These comprehensive screening guidelines include people who are at increased risk for colorectal cancer, thus candidates for screening before age 50. If you are at increased or high risk for colorectal cancer, your healthcare provider can help you assess the best combination(s) of preventive tests and how frequently you should have them.

The guidelines suggest:

• If you have a family history of colorectal cancer or adenomatous polyps in any first-degree relative diagnosed before the age of 60, or in at least two second-degree relatives at any age, they recommend screening to begin at age 40 or 10 years before the youngest case in the immediate family; if after the age of 60, then options are the same as those offered to someone of average risk.
• Inflammatory bowel disease: the guidelines recommend that screening begin 8 years after the onset of the disease.
• Hereditary non-polyposis colon cancer (HNPCC): the guidelines recommend that screening begin when you are 20 to 25 years old, or 10 years before the youngest case in the immediate family.
• Familial adenomatous polyposis (FAP) diagnosed by genetic testing, or suspected FAP without genetic testing: ACS recommends that screening begin at 10 to 12 years of age.
• People of African descent should begin testing at age 45. However, the USPSTF states that its recommendations for average risk individuals are intended to apply to all ethnic and racial groups.

Decision Aids

Because any invasive procedure carries some level of risk, you should talk to your healthcare provider about the screening tests recommended for you. Some employers, health plans, and health practitioners offer decision aids.

Also, don't neglect the protection of getting re-tested at the interval recommended by your healthcare provider.

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Links
MyBiopsy.org: Colon, Adenomatous polyps
National Cancer Institute: Colorectal Cancer Risk Assessment Tool
Centers for Disease Control and Prevention: Colorectal (Colon) Cancer

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Sources Used in Current Review

American Cancer Society recommendations for colorectal cancer early detection. American Cancer Society. Available online through http://www.cancer.org/index. Accessed February 2015.

Final Recommendation Statement Colorectal Cancer Screening. U.S. Preventive Services Task Force. Available online at http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/colorectal-cancer-screening through http://www.uspreventiveservicestaskforce.org. Accessed February 2015.

Tests to Detect Colorectal Cancer and Polyps. National Cancer Institute. Available online at http://www.cancer.gov/cancertopics/factsheet/detection/colorectal-screening through http://www.cancer.gov. Accessed February 2015.

(February 26, 2014) Centers for Disease Control and Prevention. Colorectal (Colon) Cancer: What are the Risk Factors? Available online at http://www.cdc.gov/cancer/colorectal/basic_info/risk_factors.htm through http://www.cdc.gov. Accessed January 2015.

(Published online 2008 February 13). Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline From the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. American Gastroenterology Association [On-line information]. Available online at http://www.gastrojournal.org/article/S0016-5085%2808%2900232-1/fulltext through http://www.gastro.org/practice/medical-position-statements. Accessed February 2015.

Diabetes is the seventh leading cause of death in the United States. The Centers for Disease Control and Prevention (CDC) estimates that 30.2 million people age 18 and older, or 12.2% of all people in this age group, have diagnosed or undiagnosed diabetes. Of these, 4.6 million are 18-44 and 14.3 million are 45-64 years old. Type 2 diabetes accounts for 90-95% of all diagnosed cases of diabetes among adults. Unhealthy weight and physical inactivity, also significant national health problems, are both contributing factors to the rising incidence of type 2 diabetes.

Another 84.1 million American adults age 18 years or older have prediabetes, meaning that their blood glucose levels are higher than normal but not yet high enough to be diagnosed with diabetes. Detecting prediabetes allows individuals to take steps to stop or slow the development of type 2 diabetes and its complications. These complications include heart attack, stroke, hypertension, blindness and eye problems, kidney disease, and nervous system maladies. More than 60% of lower limb amputations occur in people with diabetes.

Risk Factors
Being overweight – having a body mass index (BMI) equal to or greater than 25 kg/m² – is a major risk factor for type 2 diabetes.

Other risk factors related to your own health include:

• Physical inactivity
• Having high blood pressure (hypertension), meaning blood pressure 140/90 mmHg or higher or receiving therapy for hypertension
• History of cardiovascular disease
• Having a HDL-cholesterol level less than 40 mg/dL (1.00 mmol/L) and/or a triglyceride level greater than 150 mg/dL (1.70 mmol/L)
• Having a previous hemoglobin A1c test result equal to or greater than 5.7%, impaired glucose tolerance (glucose tolerance test result 140 to 199 mg/dL (7.8 to 11.1 mmol/L)), or impaired fasting glucose (fasting glucose level 100 to 125 mg/dL (5.6 to 6.9 mmol/L))
• Having conditions associated with insulin resistance, such as severe obesity and acanthosis nigracans

Family-related risk factors are:

• Having a parent or sibling with diabetes
• Being of African American, Latino, Native American, Asian American, or Pacific Islander descent

Women's risk factors include:

• Delivering a baby weighing more than 9 pounds or having had gestational diabetes
• Having polycystic ovary syndrome

Screening tests for men and non-pregnant women

• Fasting glucose (fasting blood glucose, FBG) – this test measures the level of glucose in the blood after an 8-12 hour fast.
• Hemoglobin A1c (also called A1c or glycated hemoglobin) – this test evaluates the average amount of glucose in the blood over the last 2 to 3 months and has been recommended as another test to screen for diabetes.
• 2-hour glucose tolerance test (OGTT) – this test involves drawing a fasting blood sample for glucose measurement, followed by having the person drink a solution containing 75 grams of glucose and then drawing another sample two hours after the person begins to consume the glucose solution.

If any of these results is abnormal, the test is repeated on another day. If the repeat result is also abnormal, a diagnosis of diabetes is made.

Recommendations
The American Diabetes Association (ADA) and the U.S. Preventive Services Task Force (USPSTF) recommend the following:

• If you are age 45 or older, you should be screened.
• If you are younger than 45 but overweight or have any of the other risk factors, consider diabetes screening.
• Even if initial screening results are normal, get repeat testing at least every 3 years, say the ADA and USPSTF. If you are identified as having prediabetes, get tested yearly.

The American Association of Clinical Endocrinologists (AACE) also recommends diabetes screening for asymptomatic people with these risk factors, as well as those on antipsychotic therapy for schizophrenia or who have severe bipolar disease.

As public health experts work to educate Americans on what to do to avoid diabetes and its serious complications, be aware that healthy eating habits and activity choices can lower your risk of developing type 2 diabetes and of suffering complications from the disease.

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Links
NIDDK: Preventing Type 2 Diabetes
American Diabetes Association
National Diabetes Education Program 
Centers for Disease Control and Prevention: Type 1 or Type 2 Diabetes and Pregnancy 

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Sources Used in Current Review (last reviewed 9/18/17)

(2017). National diabetes Statistics Report, 2017. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed on 8/06/17.

(2015 October). Abnormal Blood Glucose and Type 2 Diabetes Mellitis: Screening. U.S. Preventive Services Task Force. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/screening-for-abnormal-blood-glucose-and-type-2-diabetes?ds=1&s=diabetes. Accessed on 8/06/17.

(2017 July 27, Updated). What’s New in Diabetes. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/diabetes/new/index.html. Accessed on 8/06/17.

(2017 July 25, Updated). Who’s at Risk? Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/diabetes/basics/risk-factors.html. Accessed on 8/06/17.

Genzen, J. et. al. (2017 July, Updated). Diabetes Mellitus. ARUP Consult. Available online at https://arupconsult.com/content/diabetes-mellitus. Accessed on 8/06/17.

(2016 November). Diabetes Tests & Diagnosis. National Institute of Diabetes and Digestive and Kidney Diseases. Available online at https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis. Accessed on 8/06/17.

(2015). Screening and Monitoring of Prediabetes. American Association of Clinical Endocrinologists. Available online at http://outpatient.aace.com/prediabetes/screening-and-monitoring-prediabetes. Accessed on 8/06/17.

Diabetes Management Guidelines, American Diabetes Association (ADA) 2016 Guidelines. National Diabetes Education Initiative. Available online at http://www.ndei.org/ADA-2013-Guidelines-Criteria-Diabetes-Diagnosis.aspx.html#children. Accessed on 8/06/17.

Prostate cancer is the most frequently diagnosed cancer in men, after skin cancer, and the second leading cause of cancer death, after lung cancer. As many as 1 in 7 American men will develop it during their lifetime, with most cases diagnosed in men 65 years of age or older. Some prostate cancers progress quickly and cause death within months or a few years, but most grow slowly and never pose a health threat.

Screening for prostate cancer is important for men to discuss with their healthcare providers. Many complicated issues are involved:

• Current technology cannot tell a slow-growing cancer from a fast one, and the cancer may never affect a man's health or life expectancy.
• Screening tests for prostate-specific antigen (PSA) do not detect all cases, and many positive PSA results do not prove to be cancer.
• Diagnosis through biopsy (potential infection and bleeding) and side effects of treatment (impotence and incontinence) can be more harmful than the cancer itself. Most prostate cancers are slow-growing and may not cause any trouble.
• Results from long-term trials on whether PSA testing improves prostate cancer survival rates have been inconclusive.

Informed decisions
In spite of the questions surrounding prostate cancer screening, most health organizations agree that men should receive balanced information about prostate cancer screening and recommend that men discuss it with their healthcare provider. You need to know the risks, uncertainties, benefits, and limits of prostate cancer testing and treatment and should work with your healthcare provider to understand your options and decide what is best for you. Before choosing prostate screening, you should weigh the pros and cons based on your age, life expectancy, family history, race, overall health, previous test results, and individual risk tolerance.

Risk
One important factor to consider is your personal risk of developing prostate cancer:

• Average risk: Healthy men with no known risk factors
• Increased risk: African American men or men who have a father or brother who was diagnosed before they were 65
• High risk: Men with more than one relative who was affected at a young age

Tests
If you choose to undergo screening, the following tests may be recommended:

• Prostate specific antigen (PSA)—blood test that measures the level of PSA in the blood
• Digital rectal exam (DRE)—part of a physical exam that the health practitioner performs to examine the prostate gland

Recommendations
Most organizations do not recommend prostate cancer screening for men 49 and younger, unless they have increased or high risk. The exception is the National Comprehensive Cancer Network.

• The National Comprehensive Cancer Network recommends a baseline test at age 45 for men who want screening, which will determine when and how often to have future tests. It advises using the DRE and the PSA test, in combination, for the broadest detection of cancer in its early stages. If the result is greater than 1.0 ng/mL, or the man is higher risk, it recommends an annual DRE and PSA test.
• The U.S. Preventive Services Task Force (USPSTF) advises against PSA screening in men of any age, concluding that screening does not improve survival rates for prostate cancer for healthy men. The decision is based on the harm that can come from diagnoses that lead to false-positive test results or harm from the treatment of cases that are slow-growing and non-lethal.
• The American Cancer Society (ACS) recommends that healthy men with average risk who wish to be screened consider waiting to get tested until age 50. The ACS recommends considering earlier testing for higher-risk groups.
• If you are African American or have a father or brother who was diagnosed before they were 65, the ACS recommends considering starting testing at 45 years of age.
• If more than one relative was affected at a young age, you could begin testing at 40 years; then, depending on the results, get tested again at age 45 or earlier as results warrant.

The ACS recommends re-screening every two years if your PSA level is less than 2.5 ng/mL and annual screening if it is 2.5 ng/mL or higher.

• The American Urological Association recommends waiting to have a baseline PSA and DRE done at age 55 for men who wish to be screened. For those at increased or high risk, the group advises that decisions regarding prostate cancer screening be individualized based on patient preferences and an informed discussion about benefits and harms.
• The American College of Physicians advises screening men 50-69 years old who request to be screened.

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Links
National Cancer Institute: Prostate Specific Antigen Test Fact Sheet
National Cancer Institute: Screening and Testing to Detect Prostate Cancer
American Cancer Society: Prostate Cancer, Should I be tested?
Ottawa Health Research Institute: Decision Aids

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Sources Used in Current Review

Brosman, S. (2015 January 13, Updated). Prostate-Specific Antigen Testing. Medscape Drugs & Diseases [On-line information]. Available online at http://emedicine.medscape.com/article/457394-overview. Accessed 06/15/15.

(2015 January 6, Revised). Prostate Cancer Prevention and Early Detection. American Cancer Society [On-line information]. Available online at http://www.cancer.org/cancer/prostatecancer/moreinformation/prostatecancerearlydetection/prostate-cancer-early-detection-tests. Accessed 06/15/15.

Mayo Clinic Staff (2013 May 7). Mayo Clinic. [On-line information]. Available online at http://www.mayoclinic.org/tests-procedures/psa-test/basics/definition/prc-20013324?p=1. Accessed 06/15/15.

Miller, S. (2013 October 2, Updated). Prostate-specific antigen (PSA) blood test. MedlinePlus Medical Encyclopedia. [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003346.htm. Accessed 06/15/15.

Moyer, V. (2012 July 17). Screening for Prostate Cancer: U.S. Preventive Services Task Force. USPSTF Recommendation Statement. Annals of Internal Medicine v 157 (2) 121. [On-line information]. Available online at http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/prostate-cancer-screening?ds=1&s=PSA. Accessed 06/15/15.

Genzen, J. et. al. (2015 March, Updated). Prostate Cancer - PSA. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/PSA.html?client_ID=LTD. Accessed 06/15/15.

Pagana, K. D., Pagana, T. J., and Pagana, T. N. (© 2015). Mosby's Diagnostic & Laboratory Test Reference 12th Edition: Mosby, Inc., Saint Louis, MO. Pp 756-759.

(2015 March 12 Revised). What are the key statistics about prostate cancer? American Cancer Society [On-line information]. Available online at http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-key-statistics. Accessed 9/29/15.

Mulcahy, N. (2014 March 19). New NCCN Guide Seeks 'Middle Ground' on PSA Testing. Medscape Medical News [On-line information]. Available online at http://www.medscape.com/viewarticle/822185. Accessed 9/29/15/.

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria. TB primarily targets the lungs but may affect any area of the body. It can be spread through the air from person to person through droplets of respiratory secretions such as sputum or aerosols released by coughing, sneezing, laughing, or breathing.

Most people who become infected with M. tuberculosis manage to confine the mycobacteria to a few cells in their lungs, where they stay alive but in an inactive form. This latent TB infection does not make the person sick or infectious and, in most cases, it does not progress to active tuberculosis. However, some people - especially those with compromised immune systems - may progress directly from initial TB infection to active tuberculosis. People who have HIV are much more likely to become sick if they contract TB. A person who has latent TB and their immune system becomes weakened may then develop active TB. Another increasing concern is drug-resistant forms of TB that are resistant to the antibiotics typically prescribed to treat the disease.

TB is one of the world's deadliest diseases, although it is relatively uncommon in the U.S. Still, it is a large health issue among at-risk groups. Current guidelines call for targeted screening among such groups.

At Risk

• People who have close contact with a person who has known or suspected TB disease
• People with weakened immune systems such as resulting from HIV infection, malnutrition, advanced age, or substance abuse including alcohol and drugs
• Immigrants from countries with a high rate of TB disease (many countries in Latin America, Africa, Asia, Eastern Europe, and Russia)
• Medically underserved people, such as those from a low-income environment
• Residents of long-term care facilities (such as nursing homes, mental health facilities, prisons, AIDS care facilities, and homeless shelters)
• People who live in unclean or crowded environments and/or without a healthy diet
• Healthcare workers who work in any of the above situations or with patients who are at increased risk
• Laboratorians who work with specimens that may contain TB or with TB cultures

Recommendations

The U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force (USPSTF) recommend use of TB tests to identify people who will likely benefit from treatment, including those at increased risk for M. tuberculosis infection or for progression to active TB if they are infected. There are two types of tests that might be performed (see TB Screening Tests):

• Tuberculin skin test (TST) also called the Mantoux tuberculin skin test, the TST (or PPD for Purified Protein Derivative) is performed by injecting a small amount of fluid (called tuberculin) into the skin in the lower part of the arm. Following this test, you must return within 48 to 72 hours for a trained healthcare worker to measure the reaction and determine if it indicates exposure to M. tuberculosis.
• TB blood test: also known as IGRA (Interferon gamma release assay); requires a blood sample to be drawn.

Your healthcare provider will choose which TB test to use. Factors in selecting the test include the reason for testing, logistical considerations, prior vaccination with BCG, and test availability. Generally, it is recommended to be screened with either a TST or an IGRA, but not both.

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Link
CDC: Tuberculosis (TB)

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Sources Used in Current Review

Screening for Latent Tuberculosis Infection in Adults. US Preventive Services Task Force Recommendation Statement. JAMA. 2016;316(9):962-969. doi:10.1001/jama.2016.11046. Available online at http://jama.jamanetwork.com/article.aspx?articleid=2547762. Accessed October 2016.

U.S. Centers for Disease Control and Prevention. TB Testing & Diagnosis. Available online at http://www.cdc.gov/tb/topic/testing/. Accessed October 2016.

According to the United States Preventive Services Task Force (USPSTF), approximately 700,000 to 2.2 million people in this country have chronic infection with hepatitis B virus (HBV). Many of these people are unaware that they are infected.

HBV is one of five "hepatitis viruses" identified so far that are known to mainly infect the liver. It is spread through contact with blood or other body fluids from an infected person, such as during sex or by sharing needles, razors or toothbrushes, and can also be passed from an infected mother to her baby during or after birth.

HBV infection can be acute or chronic, with the course of infection varying from a mild form that lasts only a few weeks to a more serious form lasting years that can lead to complications such as cirrhosis or liver cancer. According to the Centers for Disease Control and Prevention (CDC), approximately 2,000-4,000 people die every year in the U.S. from HBV-related liver disease.

The vast majority of those with chronic infections will have no symptoms. A test for hepatitis B surface antigen (HBsAg) may be used for screening asymptomatic people who fall into one of the high-risk categories for chronic HBV. Effective vaccines against HBV are available; however, those who have not been vaccinated or who are at high risk and were vaccinated before being screened for HBV infection may want to consider getting tested.

Risk
According to the USPSTF, in the U.S., people considered at high risk for HBV infection include those from countries with a high prevalence of HBV infection, those who are HIV-positive, injection drug users, household contacts of those with HBV infection, and men who have sex with men. Since the prevalence of HBV infection is low in the general U.S. population and most of those infected do not develop complications, HBV screening is not recommended for those who are not at increased risk.

Recommendations
In 2008, the CDC revised its guidelines to recommend that the following groups be screened for HBV:

• Healthcare and public safety workers
• People born in areas of the world that have a greater than 2% prevalence of HBV (for example, much of Asia and Africa)
• People born in the U.S. but who were not vaccinated and whose parents are from an area with greater than 8% prevalence of HBV
• Men who have sex with men
• People who have elevated liver enzymes (ALT and AST) with no known cause
• People with certain medical conditions that require that their immune system be suppressed, such as organ transplant recipients
• Pregnant women
• People who are in close contact with someone infected with HBV
• Those infected with HIV

In 2014, the USPSTF updated its statement to recommend screening for HBV among asymptomatic, non-pregnant adolescents and adults in certain high-risk groups, bringing their recommendations into line with those of the CDC. The USPSTF had previously published the recommendation for HBV screening during pregnancy.

Why get tested?
People with chronic HBV can unwittingly spread the infection to others and remain at risk for serious complications of the infection.

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Link
CDC: Hepatitis B Information for the Public 

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Sources Used in Current Review

USPSTF Urges HBV Screening for High-Risk People. By Michael Smith. MedPage Today. Published May 27, 2014. Available online through http://www.medpagetoday.com. Accessed June 2014.

USPSTF Recommends Hepatitis B Screening for High-Risk Groups. By Amy Orciari Herman. May 27, 2014. Journal Watch. Available online at http://www.jwatch.org/fw108870/2014/05/27/uspstf-recommends-hepatitis-b-screening-high-risk-groups?query=pfw through http://www.jwatch.org. Accessed June 2014.

Screening for Hepatitis B Virus Infection in Nonpregnant Adolescents and Adults: U.S. Preventive Services Task Force Recommendation Statement. Michael L. LeFevre, MD, MSPH, on behalf of the U.S. Preventive Services Task Force. Annals of Internal Medicine. Article published online 27 May 2014. Available online at http://annals.org/article.aspx?articleid=1874740 through http://annals.org. Accessed June 2014.

Centers for Disease Control and Prevention. Hepatitis B FAQs for the Public. Available online at http://www.cdc.gov/hepatitis/b/bFAQ.htm#statistics through http://www.cdc.gov. Accessed June 2014.

Centers for Disease Control and Prevention. Hepatitis B Information for the Public. Available online at http://www.cdc.gov/hepatitis/B/index.htm through http://www.cdc.gov. Accessed June 2014.

Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection. Recommendations and Reports. September 19, 2008 / 57(RR08);1-20. Morbidity and Mortality Weekly Report. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5708a1.htm through http://www.cdc.gov. Accessed June 2014.