Chlamydia trachomatis Infection in Women: A Need for Universal Screening in High Prevalence Populations?

Abstract

Chlamydia trachomatis is the most prevalent sexually transmitted bacterial pathogen. Nevertheless, selective, rather than universal, screening for chlamydia has been recommended, largely because testing is expensive and requires considerable technical expertise. A total of 1,348 women in four family planning clinics in San Francisco, California, were screened from March 1987 to January 1988 to identify criteria for selective screening. Of these, 9.2% had a positive chlamydia test using direct fluorescence. Logistic regression analysis identified five factors associated with infection: age less than 25 years, cervical friability, single marital status, a new sexual partner within the past 3 months, and lack of barrier contraceptive use. No single risk factor or combination of risk factors had both a high sensitivity and a high positive predictive value for infection. While screening all women who were unmarried would detect 93% of those with chlamydia, the positive predictive value of 10.7% was not much higher than the overall prevalence. Conversely, screening all women with cervical friability, which had a positive predictive value of 23.2%, would only detect 11% of those with chlamydia. On the basis of the authors' findings, selective screening should not be used in high prevalence populations in which all women are at risk and should be screened for chlamydia.

Assessing Age-Related Risk for Gonococcal and Chlamydial Infections Among Females in Hawaii, 2001: A Comparison of Morbidity Rates With Screening Test Positivity

“…2 Our findings of highest screening test positivity among the youngest females and the inverse age correlation with positivity are consistent with family planning chlamydia screening data from San Francisco 6 and United States Public Health Service Region X (Alaska, Idaho, Oregon, and Washington). 7 The State of Hawaii offers free and confidential STD screening services to adolescents age 14 years or older without parental consent or mandated notification.…”

Risk factors for genital chlamydial infection

“…Compared with no contraceptives, use of a barrier method was protective against chlamydia for females in three of five studies (32,69,81,88,89). Only one of 10 studies found female barrier users to be significantly less likely to be infected than female nonusers (37,55,79,(90)(91)(92)(93)(94)(95)(96). Although these studies did not consider consistency of use, when this factor is accounted for, the results are similar.…”

“…Users of OCP may also be less likely to use barrier contraceptives. OCP users tend to have higher prevalences of infection compared with nonusers, but this association is not significant after adjusting for other variables in the majority of studies reviewed (24,32,33,51,55,56,72,81,87,(90)(91)(92)94,95,103,104). Only two studies found that oral contraceptive users were significantly more likely to have chlamydia than nonusers after controlling for other risk factors (69,79), while Mosure et al (89) found that OCP users had a 20% decreased risk of being infected with chlamydia compared with females who did not use any method of contraception.…”

“…Chlamydia rates tend to be highest in men and women who are single, although only three studies identified marital status as a significant risk factor in multivariate analysis (52,55,90). The effect of marital status is mediated largely through its impact on number of partners (105,108,109).…”

Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection

“…[128][129][130][131] Young age, being from a black minority ethnic group, not using condoms, having new sexual partners or a partner with an STI, douching in women and intermenstrual bleeding have all been reported to be associated with chlamydia in some, but not all studies. Young age has, however, been found to be the only consistently identified risk factor.…”