The reliability of eight self-reported risk factors as criteria for screening women for Chlamydia trachomatis was evaluated in four family planning clinics in New York State that serve diverse populations. In all, 8,920 women were screened in these clinics; the rates of infection ranged from 2% to 7%. Results of multivariate analyses showed that age was the most important predictor of chlamydial infection in the three clinics where prevalence was 4% or higher; women aged 20-24 were 3-4 times as likely as older women to be infected, and those aged 13-19 were 4-6 times as likely. In these three clinics, screening all women aged 26 or younger (62-80% of the clinic population) would identify about 90% of infected women; in the clinic with the lowest prevalence rate, age was not a reliable criterion. The prevalence of self-reported risk factors varied by clinic, and these factors generally were not reliable indicators of infection. Using the presence of at least one self-reported risk factor as a screening criterion, 80-87% of clinic clients would be screened, and about 90% of infected women would be identified. The presence of clinical signs of chlamydial infection does not increase the reliability of age as a screening criterion.

In addition to clinical expertise, pathologists are required to have a background in areas of management, administration, and computer operations. During their training, it is imperative that pathology residents have exposure to the subject of modern laboratory management. The authors feel that a rotation in administration is not adequate to give the necessary training but that a formal program is needed to achieve this goal. They have developed a course in laboratory management that uses the available resources of their own department and hospital to meet these needs.

A regulation mandating a syphilis serology test at delivery was implemented on December 6, 1989. To assess any impact on congenital syphilis reporting, we compared all cases reported in Upstate New York for the year directly preceding the regulation (n = 69) to those born in the three-year period following its implementation (n = 239). After implementation, the percentage of cases not tested at delivery decreased from 10 percent to 1 percent and reports of syphilitic stillbirths tripled. Asymptomatic infection of both mothers and babies increased significantly and at-birth detection of cases in women with negative prenatal serologies increased by 43 percent. Delivery screening failed to identify seven cases due to incubating maternal infection.