Developments in the screening for Chlamydia trachomatis: A review☆
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
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