Effectiveness and efficiency of selective vs universal screening for chlamydial infection in sexually active young women

Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
Archives of Internal Medicine (Impact Factor: 17.33). 10/1992; 152(9):1837-44. DOI: 10.1001/archinte.1992.00400210067011
Source: PubMed


Since chlamydial cervicitis is not associated with specific complaints, screening asymptomatic women is an important initiative to prevent pelvic inflammatory disease and its sequelae. Compared with universal screening, selective screening is less costly but less effective so the cost savings vs the consequences of missing infected women need to be weighed carefully.
In two family planning clinics, 1002 women were surveyed for chlamydial infection (prevalence, 7%) and its predictors to determine whether universal or selective screening is the most efficient strategy. Two rules for the selection of patients were determined by logistic regression modeling and their relative efficiencies were compared by incremental cost-effectiveness and sensitivity analysis. The validity of the screening rules was tested in 191 students attending a university health clinic.
If those with cervical friability, suspicious discharge, urinary frequency, or intermenstrual bleeding had been tested, 55.3% of all women would have been screened and 83.3% of all cases would have been detected. If those reporting a new sex partner in the preceding year had also been tested, 75.4% would have been screened, identifying 93.3% of all cases. The predictive power and practicality of the selection rules were validated in the university health clinic sample. Sensitivity analyses showed selective screening using cervical enzyme immunoassay with blocking confirmation was efficient if the prevalence of chlamydial infection was 16% or less, 11% or less, or 5% or less depending on whether base analyses, overestimated costs, or worst performance scenarios, respectively, were used.
Selective screening based on four or five predictors and confirmed cervical enzyme immunoassay is an effective and efficient strategy in low prevalence settings.

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    • "The best evidence to date about the effectiveness of screening for chlamydia infection in preventing pelvic inflammatory disease is a randomized controlled trial conducted in Seattle, USA.19 Two Swedish studies have supported its findings.20,21 Selective screening is more cost-effective than universal screening, although the latter may be indicated when prevalence of infection is high.22,23 "
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    ABSTRACT: Chlamydia trachomatis infection is a worldwide-distributed sexually transmitted infection that may lead to infertility. This study aims to report the prevalence of Chlamydia trachomatis infection among infertile women in Saudi Arabia. A community-based study carried out at the obstetrics and gynecology clinic at Jazan General Hospital, Saudi Arabia. The study group included 640 Saudi infertile women who were aged between 18 and 40 years and who attended the gynecology clinic for infertility examination throughout 1 year of study (from July 1, 2011 to June 30, 2012). The randomized control group included 100 Saudi fertile women who attended the obstetrics clinic for routine antenatal care. All recruited women were screened for chlamydia infection by enzyme-linked immunosorbent assay (ELISA) for detection of serum-specific antibodies and then retested by the McCoy cell culture technique. The prevalence of Chlamydia trachomatis infection among infertile women was high, at 15.0%. The rate of chlamydia infection detected by ELISA was 9.84%, and it was 12.03% by the culture method (P = 0.2443). The high prevalence of Chlamydia trachomatis infection among Saudi infertile women demands a national screening program for early detection among infertile couples. ELISA is available as a simple screening test alternative to the culture method.
    International Journal of Women's Health 06/2013; 5(1):277-84. DOI:10.2147/IJWH.S46678
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    ABSTRACT: Klinische Symptome, die auf eine Infektion im weiblichen Genitaltrakt hinweisen, werden erhoben und mit einer symtomfreien Patientinnengruppe verglichen. Dabei werden mit Antikörpertiterbestimmung auf Chalmydia trachomatis und Fluoreszenztechnik, sowie DNA-Hybridisierung der Immunstatus bezüglich einer Chalmydia trachomatis-Infetkion bestimmt und verglichen. Die DNA-Hybridisierung als Technik eignet sich dabei als Screenigmethode. Die Fluoreszenztechnik zusammen mit der DNA-Hybridisierung ergibt noch bessere Detektionsraten. Dies geht konform mit der Forderung der FDA mindestens 2-3 Non-culture-Techniken durchzuführen um eine gute Detektion der Infektion zu gewährleisten. DNA-amplificationtechnic and direct immunfluoreszenz-technic are used with Chlamydia trachomatis titers to copare to groups of patients. One with clinical symtoms of a gynecological infection an a controll group. The dna-hybridisation-tecnic was a good tecnic to detect chlamydial infections. Two non-culture-technics showed a better detection rate. This result support the requirement of 2 or better3 non-cutlure technics for a good detection rate of a chlamydial infection.
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