A School-based Chlamydia Control Program Using DNA Amplification Technology

Cohen, Deborah A.; Nsuami, Malanda; Etame, Roger Bedimo; Tropez-Sims, Susanne; Abdalian, Sue Ellen; Farley, Thomas A.; Martín, David H.

doi:10.1542/peds.101.1.e1

Cited by 108 publications

(62 citation statements)

References 26 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%

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%

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

2001

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“…In the U.S., 4.2% of young adults are infected [1], with prevalence rates of 5-25% being reported in sexually active teenagers [2,3]. Infection with genital serovars leads to complications such as pelvic inflammatory disease (PID) and infertility.…”

Section: Introductionmentioning

confidence: 99%

Host-Cell Survival and Death During Chlamydia Infection

Ying¹,

Pettengill²,

Ojcius³

et al. 2007

CIR

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Different Chlamydia trachomatis strains are responsible for prevalent bacterial sexually-transmitted disease and represent the leading cause of preventable blindness worldwide. Factors that predispose individuals to disease and mechanisms by which chlamydiae cause inflammation and tissue damage remain unclear. Results from recent studies indicate that prolonged survival and subsequent death of infected cells and their effect on immune effector cells during chlamydial infection may be important in determining the outcome. Survival of infected cells is favored at early times of infection through inhibition of the mitochondrial pathway of apoptosis. Death at later times displays features of both apoptosis and necrosis, but pro-apoptotic caspases are not involved. Most studies on chlamydial modulation of host-cell death until now have been performed in cell lines. The consequences for pathogenesis and the immune response will require animal models of chlamydial infection, preferably mice with targeted deletions of genes that play a role in cell survival and death.

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“…Nucleic acid amplification tests (NAAT), including PCR, ligase chain reaction (LCR), strand displacement assay, and transcription-mediated amplification, are more sensitive for the diagnosis of C. trachomatis than culture, nonamplified DNA probe, and antigen detection tests and maintain relatively high specificity (1, 2). Equally important, the ability to perform NAAT on urine and self-collected vaginal swabs has expanded opportunities for screening men and women (7,10,11,14,21,26,28,29).…”

mentioning

confidence: 99%

Impact of Patient Characteristics on Performance of Nucleic Acid Amplification Tests and DNA Probe for Detection of Chlamydia trachomatis in Women with Genital Infections

et al. 2005

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The performance of nucleic acid amplified tests (NAAT) for Chlamydia trachomatis at the cervix and in urine was examined in 3,551 women, and the impacts of clinical findings (age, endocervical and urethral inflammation, menses, and gonococcal coinfection) were assessed. Ligase chain reaction (LCR) and first-generation uniplex PCR were studied relative to an unamplified DNA probe (PACE2) and to an expanded, independent diagnostic reference standard. Relative to the expanded standard, cervical or urine LCR was generally the most sensitive test in most subgroups. Increased detection by NAAT of cervical C. trachomatis over PACE2 was highest among women without mucopurulent endocervical discharge versus those with (relative increase in positivity with cervical LCR, 46%) and among women >20 years old versus younger women (relative increase in positivity with cervical LCR, 45%). The sensitivity of cervical PCR was highest when mucopurulent endocervical discharge was present (84%) and highest for cervical LCR when cervical gonococcal coinfection was detected (91%). Urethral inflammation was associated with higher sensitivities of urine LCR (86 compared to 70% when inflammation was absent) and PCR (82 compared to 62% when inflammation was absent). Menses had no effect on test performance. The effects of patient characteristics on test specificities were less pronounced and were closely related to observed sensitivities. These findings support expanded use of NAAT for screening and diagnosis of C. trachomatis in diverse clinical populations of women.Genital infection with Chlamydia trachomatis is the most commonly reported bacterial disease in the United States and has well-established adverse effects on the reproductive health of women (4, 23). Nucleic acid amplification tests (NAAT), including PCR, ligase chain reaction (LCR), strand displacement assay, and transcription-mediated amplification, are more sensitive for the diagnosis of C. trachomatis than culture, nonamplified DNA probe, and antigen detection tests and maintain relatively high specificity (1, 2). Equally important, the ability to perform NAAT on urine and self-collected vaginal swabs has expanded opportunities for screening men and women (7,10,11,14,21,26,28,29).Our understanding of the clinical manifestations of chlamydial infections in women, including endocervical and urethral inflammation, has been based largely on studies using non-NAAT for detection of infection. Similarly, selective screening criteria for identifying cervical chlamydial infection have been based on risk factors as defined by various non-NAAT. NAAT, however, can detect the presence of fewer chlamydial elementary bodies than non-NAAT (1). Accordingly, among men with urethral chlamydial infection, NAAT demonstrate the greatest increase in sensitivity over non-NAAT in asymptomatic men without urethral inflammation (22). One possible explanation for this is that the quantity of elementary bodies appears to correlate directly with signs of inflammation in men and women and with the prese...

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A School-based Chlamydia Control Program Using DNA Amplification Technology

Abstract: (ABSTRACT TRUNCATED)

Cited by 108 publications

References 26 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

Host-Cell Survival and Death During Chlamydia Infection

Impact of Patient Characteristics on Performance of Nucleic Acid Amplification Tests and DNA Probe for Detection of Chlamydia trachomatis in Women with Genital Infections

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