Developments in the screening for Chlamydia trachomatis: A review

https://doi.org/10.1016/S0889-8545(03)00076-7Get rights and content

Section snippets

Public health importance

Probably the most serious complication of C trachomatis infections in women–occurring in 20% to 40% of untreated infections–is the development of pelvic inflammatory disease, which can lead to infertility, chronic pelvic pain, and ectopic pregnancy. Young women (aged 15–25 years) represent the group with the highest rate of infection and are most likely to experience complications and long-term sequelae. They are also the most likely to experience re-infection, which further increases the risk

New technical developments

A review of existing guidelines and the studies that informed them are useful because new technical developments in the testing for C trachomatis infections will affect screening programs and providers who perform screening. These developments include the development of second-generation nucleic acid amplification tests (NAATs), a better understanding of the sensitivity and specificity of NAATs, and information on the use of alternative specimen collection methods, such as urine.

Nucleic acid

Methods

A literature search of Medline from 1996 through April 2003 using the terms “chlamydia” and “screening” was conducted. Articles with earlier dates of publication were included if they provided the most recently available or comprehensive treatment of a pertinent topic. References in published articles were reviewed and included if not identified through the search criteria. Abstracts presented at two meetings of the International Society for Sexually Transmitted Diseases Research (Denver 1999

Screening women

Screening can be either universal or selective. Although screening of all ever-sexually active women would theoretically detect all infections, such universal screening could have negative consequences because tests are not 100% specific [17], [18] and this approach might not be cost effective. Useful selective screening criteria should have a high sensitivity (ie, identify a large proportion of all infected women), a high positive predictive value (ie, a high proportion of women fulfilling the

Summary

Many studies have evaluated selective screening criteria for women in various settings. Most have concluded and all guidelines recommend that all women aged < 25 be screened yearly for C trachomatis infection. Behavioral criteria, such as the number of sex partners, new or more than one sex partners, and previous infection, also can serve as criteria for screening women aged > 25. Because re-infection rates are high and occur within a few months, complications may be reduced further if partners

First page preview

First page preview
Click to open first page preview

References (116)

  • L.M. Niccolai et al.

    Pregnant adolescents at risk: sexual behaviors and sexually transmitted disease prevalence

    Am J Obstet Gynecol

    (2003)
  • J. Paavonen et al.

    Cost-benefit analysis of first-void urine Chlamydia trachomatis screening program

    Obstet Gynecol

    (1998)
  • Recommendations for the prevention and management of Chlamydia trachomatis infections, 1993

    MMWR Morb Mortal Wkly Rep

    (1993)
  • Sexually transmitted disease surveillance 2001: Division of STD Prevention

    (2002)
  • S.L. Groseclose et al.

    Estimated incidence and prevalence of genital Chlamydia trachomatis infections in the United States, 1996

    Sex Transm Dis

    (1999)
  • Sexually transmitted disease surveillance 2001 (supplement): chlamydia prevalence monitoring project, annual report

    (2001)
  • A.E. Washington et al.

    Chlamydia trachomatis infections in the United States. What are they costing us?

    JAMA

    (1987)
  • W.E. Stamm et al.

    Chlamydia trachomatis infections of the adult

  • M.R. Golden et al.

    Duration of untreated genital infections with Chlamydia trachomatis: a review of the literature

    Sex Transm Dis

    (2000)
  • C.R. Cohen et al.

    Increased interleukin-10 in the endocervical secretion of women with non-ulcerative sexually transmitted diseases: a mechanism for enhanced HIV-1 transmission?

    AIDS

    (1999)
  • D.T. Fleming et al.

    From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection

    Sex Transm Infect

    (1999)
  • J.N. Wasserheit

    Epidemiological synergy: interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases

    Sex Transm Dis

    (1992)
  • G. Foglia et al.

    Completeness of and duration of time before treatment after screening women for Chlamydia trachomatis infections

    Sex Transm Dis

    (1999)
  • D.G. Addiss et al.

    Decreased prevalence of Chlamydia trachomatis infection associated with a selective program in family planning clinics in Wisconsin

    Sex Transm Dis

    (1993)
  • K.J. Mertz et al.

    Trends in the prevalence of chlamydial infections: the impact of community-wide testing

    Sex Transm Dis

    (1997)
  • B.P. Katz et al.

    Declining prevalence of chlamydial infection among adolescent girls

    Sex Transm Dis

    (1996)
  • D. Scholes et al.

    Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection

    N Engl J Med

    (1996)
  • C.M. Black et al.

    Head-to-head multicenter comparison of DNA probe and nucleic acid amplification tests for Chlamydia trachomatis infection in women performed with an improved reference standard

    J Clin Microbiol

    (2002)
  • Screening tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae infections 2002

    MMWR Morb Mortal Wkly Rep

    (2002)
  • M.A. Chernesky et al.

    Diagnosis of Chlamydia trachomatis urethral infection in symptomatic and asymptomatic men by testing first-void urine in a ligase chain reaction assay

    J Infect Dis

    (1994)
  • J.E. Bauwens et al.

    Diagnosis of Chlamydia trachomatis urethritis in men by polymerase chain reaction assay of first-catch urine

    J Clin Microbiol

    (1993)
  • G. Jaschek et al.

    Direct detection of Chlamydia trachomatis in urine specimens from symptomatic and asymptomatic men by using a rapid polymerase chain reaction assay

    J Clin Microbiol

    (1993)
  • M.A. Chernesky et al.

    Ability of commercial ligase chain reaction and PCR assays to diagnose Chlamydia trachomatis infections in men by testing first-void urine

    J Clin Microbiol

    (1997)
  • J.B. Mahony et al.

    Multiplex PCR for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in genitourinary specimens

    J Clin Microbiol

    (1995)
  • K.C. Carroll et al.

    Evaluation of the Abott LCx ligase chain reaction assay for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in urine and genital swab specimens from a sexually transmitted disease clinic population

    J Clin Microbiol

    (1998)
  • K.Y.A. Crotchfelt et al.

    Detection of Neisseria gonorrhoeae and Chlamydia trachomatis in genitourinary specimens from men and women by a coamplification PCR assay

    J Clin Microbiol

    (1997)
  • R.W. Peeling et al.

    Pooling of urine specimens for PCR testing: a cost saving strategy for Chlamydia trachomatis control programmes

    Sex Transm Dis

    (1998)
  • J. Krepel et al.

    The impact on accuracy and cost of ligase chain reaction testing by pooling urine specimens for the diagnosis of Chlamydia trachomatis infection

    Sex Transm Dis

    (1999)
  • K.A. Kacena et al.

    Pooling urine samples for ligase chain reaction screening for genital Chlamydia trachomatis infection in asymptomatic women

    J Clin Microbiol

    (1998)
  • HEDIS 2000. The health plan employer data and information set. Volume 1:What's in it and why it matters

    (2000)
  • H.S. Weinstock et al.

    Chlamydia trachomatis infection in women: a need for universal screening in high prevalence populations?

    Am J Epidemiol

    (1992)
  • J.M. Marrazzo et al.

    Performance and cost-effectiveness of selective screening criteria for Chlamydia trachomatis infection in women: implications for a national Chlamydia control strategy

    Sex Transm Dis

    (1997)
  • J.M. Marrazzo et al.

    Selective screening for chlamydial infection in women: a comparison of three sets of criteria

    Fam Plann Perspect

    (1997)
  • Y. Han et al.

    Screening criteria for Chlamydia trachomatis in family planning clinics: accounting for prevalence and clients' characteristics

    Fam Plann Perspect

    (1997)
  • T.M. Hilger et al.

    Predictors of Chlamydia trachomatis infection among women attending rural Midwest family planning clinics

    Infect Dis Obstet Gynecol

    (2001)
  • G.R. Burstein et al.

    Incident Chlamydia trachomatis infections among inner-city adolescent females

    JAMA

    (1998)
  • G.R. Burstein et al.

    Screening for gonorrhea and chlamydia by DNA amplification in adolescents attending middle school health centers

    Sex Transm Dis

    (1998)
  • R.L. Cook et al.

    Screening for Chlamydia trachomatis infection in college women with a polymerase chain reaction assay

    Clin Infect Dis

    (1999)
  • D.J. Mosure et al.

    Predictors of Chlamydia trachomatis infection among female adolescents: a longitudinal analysis

    Am J Epidemiol

    (1996)
  • C.A. Rietmeijer et al.

    Incidence and repeat infection rates of Chlamydia trachomatis among male and female patients in an STD clinic: implications for screening and rescreening

    Sexually Transmitted Diseases

    (2002)
  • Cited by (31)

    • Update of Chlamydia trachomatis infection in women

      2021, Revista Medica Clinica Las Condes
    • Menstrual disorders in the college age female

      2005, Pediatric Clinics of North America
    View all citing articles on Scopus

    Use of trade names is for identification purposes only and does not imply endorsements by the U.S. Department of Health and Human Services or the U.S. Government.

    View full text