Effectiveness and efficiency of selective vs universal screening for chlamydial infection in sexually active young women.
ABSTRACT 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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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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ABSTRACT: Knowledge of the natural history and clinical management of anogenital human papillomavirus (HPV) infection is changing rapidly. Consequently, it is important for family physicians to keep current. This article updates the epidemiology, detection, and treatment of HPV-related disease and discusses commonly confused conditions and answers to patients' questions.Canadian family physician Médecin de famille canadien 02/1994; 40:93-101. · 1.40 Impact Factor