Screening women for gonorrhea: demographic screening criteria for general clinical use.

Mertz, Kristen J.; Levine, William C.; Mosure, Debra J.; Berman, Susan; Dorian, Kenneth J.; Hadgu, A

doi:10.2105/ajph.87.9.1535

Cited by 22 publications

(9 citation statements)

References 4 publications

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“…One potential explanation for this finding is that urine LCR assays for CT have lower sensitivity than endocervical and urethral swab tests for CT, although the prevalence we found in sexually active female participants is still lower than the prevalences that other researchers have reported using the same urine-based technology. 2,4,7,8,20,24,25,28,35,37 Testing technology is not a likely explanation for the low prevalence we found in sexually active male adolescents, because urine LCR tests function as good or better than any other tests available for use with male patients. 28 We did not collect data to compare sexual behaviors among sexually active participating and nonparticipating groups and therefore cannot exclude the possibility that participants were at lower STD risk than nonparticipants because of factors such as number of partners and condom use.…”

Section: Discussionmentioning

confidence: 82%

“…One study reported a GC infection prevalence of 2.3% in 15-to by guest on May 9, 2018 http://pediatrics.aappublications.org/ Downloaded from 44-year-old patients of private physicians' offices and 3% in patients aged 15 to 19 years old from a combination of primary care and specialty sites. 20 These 6 studies form the basis of current knowledge of CT and GC prevalence in primary care settings, and all reported prevalences higher than the 2% figure accepted as the cost-effectiveness threshold for CT and GC screening. None of these studies reflect CT or GC prevalence among adolescents and young adults seen in general clinic settings.…”

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confidence: 99%

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Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae Infection in Pediatric Private Practice

2001

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ABSTRACT. Background. Universal screening of sexually active adolescents for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) has been recommended in settings in which prevalence is 2% or greater. Although believed to be above 2%, the prevalence of CT and GC infection in private practice settings has not been clearly established and may affect screening practices.Objectives. To determine CT and GC infection prevalence in 2 pediatric private practices.Design. Cross-sectional study. Setting. Two pediatric private practices in suburban North Carolina.Patients. Convenience sample of patients aged 15 to 24 years who were seen from August 1998 through June 1999. Main Outcome Measures. Prevalence of CT and GC infection.Results. Of 1114 eligible patients, 803 (72%) completed questionnaires and provided urine specimens tested for CT and GC infection using ligase chain reaction assays. Mean age was 17.1 years (standard deviation: 1.8). Most participants were female (63%), white (87%), and from highly educated families (64% of their mothers graduated from college). Sexual activity was reported by 41%. Prevalence of CT infection in all participants was 0.9% (confidence interval [CI]: 0.4%-1.8%); in sexually active participants, 2.1% (CI: 0.9%-4.3%); in sexually active females, 2.7% (CI: 1.0%-5.7%); and in sexually active males, 0.9% (CI: 0.0%-5.1%). One case of GC infection was found.Conclusions. The prevalence of CT and GC infection in this private practice population was much lower than reported in other settings. Screening recommendations may need to be reassessed if other low prevalence populations are found. Pediatrics 2001;108(6). URL: http://www.pediatrics.org/cgi/content/full/108/6/e103; Chlamydia trachomatis, Neisseria gonorrhoeae, pediatrics, primary health care, diagnosis/screening, practice guidelines, sexually transmitted diseases, adolescence.ABBREVIATIONS. CT, Chlamydia trachomatis; GC, Neisseria gonorrhoeae; STD, sexually transmitted disease; CDC, Centers for Disease Control and Prevention; LCR, ligase chain reaction; CI, confidence interval.C hlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) genital infections cause serious and costly sequelae, such as pelvic inflammatory disease and infertility. 1 In the United States, the strongest demographic predictor of infection with CT and GC is age, with most infections diagnosed in adolescents and young adults under 25 years of age. 1 Most recent US studies have reported the prevalence of CT infection in adolescent patients seen in sexually transmitted disease (STD), family planning, detention center, and school clinics to be in the range of 6% to 10%, 2-7 but prevalences as high as 24% have been reported in some settings. 2,8 GC infections are less prevalent but still cause significant morbidity. 1,9 Both the US Preventive Services Task Force and the Centers for Disease Control and Prevention (CDC) recommend routine screening of sexually active female adolescents and high-risk women for CT infection. 10,11 The CDC also recommends screening sexually...

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Section: Discussionmentioning

confidence: 82%

mentioning

confidence: 99%

Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae Infection in Pediatric Private Practice

2001

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“…These results are consistent with those of other validation studies, which have found that sociodemographic and behavioural risk assessment and clinical assessment are rarely suYcient for identifying cervical infections (case finding) in most settings, 2 though they may be helpful in selecting women for further diagnostic tests in settings where these are available (selective screening). [3][4][5][6] In most instances, the syndromic management of vaginal discharge should focus on vaginal infections, especially bacterial vaginosis and trichomoniasis, in recognition of the fact that vaginal discharge is primarily a manifestation of these conditions. 2 In this study, the algorithm usefully selected most women requiring metronidazole treatment, which is eVective against bacterial vaginosis and trichomoniasis, if we accept high levels of overtreatment.…”

Section: Discussionmentioning

confidence: 99%

Syndromic management of vaginal discharge among women in a reproductive health clinic in India

Vishwanath

2000

Sexually Transmitted Infections

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Objectives:To examine the performance of the syndromic approach in the management of vaginal discharge among women attending a reproductive health clinic in New Delhi, India. Methods: Women who sought services from the clinic and who had a complaint of vaginal discharge were interviewed, underwent a pelvic examination, and provided samples for laboratory investigations of bacterial vaginosis, candidiasis, syphilis, trichomoniasis, and Chlamydia trachomatis and Neisseria gonorrhoeae infections. Data analysis focused on the prevalence of infection and on the performance of the algorithm recommended by the national authorities for the management of vaginal discharge. Results: The most common infection among 319 women was bacterial vaginosis (26%). At least one sexually transmitted infection was detected in 21.9% of women. The prevalence of C trachomatis infection was 12.2%; trichomoniasis 10%; syphilis 2.2%; N gonorrhoeae was not isolated. An algorithm based on risk assessment and speculum assisted clinical evaluation was not helpful in predicting cervical infections associated with C trachomatis (sensitivity 5% and PPV 9%). This algorithm was sensitive (95%) though not specific (22%) in selecting women for metronidazole therapy eVective against bacterial vaginosis or trichomoniasis, and overtreatment was a problem (PPV 38%). The sensitivity, specificity, and PPV of this algorithm for the treatment of candidiasis were 46%, 98%, and 88% respectively. The cost per case assessed using the algorithm was $2 and the cost per infection correctly treated was $4.25. Conclusions:The prevalence of cervical infection associated with C trachomatis was high among these "low risk" women. The syndromic approach is not an eYcient tool for detecting this condition, and alternative approaches to evaluation and intervention are required. The syndromic management of vaginal discharge among women seeking family planning and other reproductive health services should focus on vaginal infections, thus enhancing quality of care and addressing women's concerns about their health. (Sex Transm Inf 2000;76:303-306)

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“…The prevalence of gonococcal infection among women in the sample ranged from 0.1% for married women over 25 years of age at low-prevalence provider sites to 7.8% in unmarried women under age 20 at high-prevalence sites. 17 The same authors separately analyzed a community-wide chlamydia screening effort among women at more than 50 provider sites. That analysis assessed trends in chlamydial prevalence from 1989 to 1992 and reported a 33% decline in prevalence during the screening period (from 8.0% in 1989 to 5.4% in 1992).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Gonococcal and Chlamydial Infection in 2009 in 2 Populations in a Midwestern City

Turner¹,

Flynn

Krempasky

et al. 2011

Journal of the National Medical Association

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The purpose of this cross-sectional study was to assess the 2009 prevalence of chlamydial (CT) and gonococcal (GC) infection in two populations in a mid-western city in the United States: patients at a public sexually transmitted disease (STD) clinic, and individuals seeking HIV counseling and testing services at an AIDS community organization. We characterized STD prevalence in a random sample of 592 STD clinic patients and a convenience sample of 471 individuals agreeing to STD testing through outreach efforts at the community organization. The STD clinic population was 59% male, 60% black, with 3.1 mean sex partners in the last year. The community organization population was 72% male, 19% black, with a mean of 4.3 partners in the last year. The prevalence of CT and GC combined was consistently higher in STD clinic patients than at the community organization (18% vs. 4%). CT prevalence was higher than GC prevalence in both populations (CT: 3% and 13% at the STD clinic and community organization, respectively, vs. GC: 1% and 7%, respectively). Factors significantly associated with increased odds of GC/CT at the STD clinic include unmarried status, younger age, at least six partners in the last year, and unprotected sex in the last year. At the community organization, the only factor significantly associated with increased odds of GC/CT was lower educational attainment. Our findings confirm that STD prevalence differs widely by population group. Given these differences, local approaches to STD control should also be carefully targeted to specific subgroups.

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Screening women for gonorrhea: demographic screening criteria for general clinical use.

Cited by 22 publications

References 4 publications

Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae Infection in Pediatric Private Practice

Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae Infection in Pediatric Private Practice

Syndromic management of vaginal discharge among women in a reproductive health clinic in India

Prevalence of Gonococcal and Chlamydial Infection in 2009 in 2 Populations in a Midwestern City

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