Developing and validating a risk algorithm to diagnose Neisseria gonorrhoeae and Chlamydia trachomatis in symptomatic Rwandan women

Wall, Kristin M.; Nyombayire, Julien; Parker, Rachel; Ingabire, Rosine; Bizimana, Jean de Dieu; Mukamuyango, Jeannine; Mazzei, Amelia; Price, Matt A.; Unyuzimana, Marie Aimee; Tichacek, Amanda; Allen, Susan; Karita, Etienne

doi:10.1186/s12879-021-06073-z

Cited by 2 publications

(6 citation statements)

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“…31s Prediction criteria included in these studies encompassed characteristics including age, sex, education, relationship status, number of sexual partners, HIV status, past pregnancy, perceived STI risk, new sexual partner, condom use, STI history, genital symptoms, and clinical signs of cervicitis. Like other risk scores, the score developed in this population included younger age 15,17,19,30 . Our finding that alcohol is predictive of CT infection is somewhat unique, and likely relates to sexual behaviors associated with alcohol use.…”

Section: Discussionmentioning

confidence: 93%

“…First, age <25 years has been used in many studies to define a population of women at higher risk for CT infection. 17,19,24 Second, the categorical inputs will make the risk score easier to implement in a low-resource clinical setting.…”

Section: Discussionmentioning

confidence: 99%

“…In another risk score developed in 15- to 29-year-old women in the Netherlands, predictors included age, area of residence, ethnicity, education status, urogenital symptoms, condom use, and number of sexual partners 30 . Other risk scores have combined multiple STIs as a single outcome 13–18 . 31s Prediction criteria included in these studies encompassed characteristics including age, sex, education, relationship status, number of sexual partners, HIV status, past pregnancy, perceived STI risk, new sexual partner, condom use, STI history, genital symptoms, and clinical signs of cervicitis.…”

Section: Discussionmentioning

confidence: 99%

“…In Africa, risk scores for CT have been developed for young adults, men who have sex with men, pregnant women, high-risk groups, women with HIV, and symptomatic women. [13][14][15][16][17][18][19] The present study aimed to assess the prevalence and correlates of chlamydial infections among Kenyan women planning to become pregnant and to develop and internally validate a risk score that could be used to identify women for secondary screening using NAATs.…”

Section: Introductionmentioning

confidence: 99%

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Derivation and Internal Validation of a Risk Score for Predicting Chlamydia trachomatis Infection in Kenyan Women Planning Conception

et al. 2023

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Background: Availability of laboratory confirmation of sexually transmitted infections is increasing in low-and middle-income countries, but costs continue to limit their access. Chlamydia trachomatis (CT) is a sexually transmitted infection of significant clinical importance, particularly among women. This study aimed to develop a risk score to identify women with a higher likelihood of CT infection, who could then be prioritized for laboratory testing, in a population of Kenyan women planning pregnancies.Methods: Women with fertility intentions were included in this cross-sectional analysis. Logistic regression was used to estimate odds ratios for the association between demographic, medical, reproductive, and behavioral characteristics and the prevalence of CT infection. A risk score was developed and validated internally based on the regression coefficients in the final multivariable model. Results:The prevalence of CT was 7.4% (51 of 691). A risk score for predicting CT infection, with scores 0 to 6, was derived from participants' age, alcohol use, and presence of bacterial vaginosis. The prediction model yielded an area under the receiver operating curve of 0.78 (95% confidene interval [Cl], 0.72-0.84). A cutoff of ≤2 versus >2 identified 31.8% of women as higher risk with moderate sensitivity (70.6%; 95% Cl, 56.2-71.3) and specificity (71.3%; 95% Cl, 67.7-74.5). The bootstrap-corrected area under the receiver operating curve was 0.77 (95% Cl, 0.72-0.83). Conclusions:In similar populations of women planning pregnancies, this type of risk score could be useful for prioritizing women for laboratory testing and would capture most women with CT infections while performing more costly testing in less than half of the population.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Derivation and Internal Validation of a Risk Score for Predicting Chlamydia trachomatis Infection in Kenyan Women Planning Conception

et al. 2023

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“…However, comparable data for men are scarce. Notably, youth are at much higher risk of STIs than adults [ 9 , 12 – 14 ]. An individual participant data meta-analysis including women participating in 18 HIV prevention studies in sub-Saharan Africa recruited mostly before 2010 showed that chlamydia and gonorrhoea prevalence was generally higher among the 15-24 year olds compared to the 25–49 year olds [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Identifying youth at high risk for sexually transmitted infections in community-based settings using a risk prediction tool: a validation study

et al. 2021

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Background Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most common bacterial sexually transmitted infections (STIs) worldwide. In the absence of affordable point-of-care STI tests, WHO recommends STI testing based on risk factors. This study aimed to develop a prediction tool with a sensitivity of > 90% and efficiency (defined as the percentage of individuals that are eligible for diagnostic testing) of < 60%. Methods This study offered CT/NG testing as part of a cluster-randomised trial of community-based delivery of sexual and reproductive health services to youth aged 16–24 years in Zimbabwe. All individuals accepting STI testing completed an STI risk factor questionnaire. The outcome was positivity for either CT or NG. Backwards-stepwise logistic regression was performed with p ≥ 0.05 as criteria for exclusion. Coefficients of variables included in the final multivariable model were multiplied by 10 to generate weights for a STI risk prediction tool. A maximum likelihood Receiver Operating Characteristics (ROC) model was fitted, with the continuous variable score divided into 15 categories of equal size. Sensitivity, efficiency and number needed to screen were calculated for different cut-points. Results From 3 December 2019 to 5 February 2020, 1007 individuals opted for STI testing, of whom 1003 (99.6%) completed the questionnaire. CT/NG prevalence was 17.5% (95% CI 15.1, 19.8) (n = 175). CT/NG positivity was independently associated with being female, number of lifetime sexual partners, relationship status, HIV status, self-assessed STI risk and past or current pregnancy. The STI risk prediction score including those variables ranged from 2 to 46 with an area under the ROC curve of 0.72 (95% CI 0.68, 0.76). Two cut-points were chosen: (i) 23 for optimised sensitivity (75.9%) and specificity (59.3%) and (ii) 19 to maximise sensitivity (82.4%) while keeping efficiency at < 60% (59.4%). Conclusions The high prevalence of STIs among youth, even in those with no or one reported risk factor, may preclude the use of risk prediction tools for selective STI testing. At a cut-point of 19 one in six young people with STIs would be missed.

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Developing and validating a risk algorithm to diagnose Neisseria gonorrhoeae and Chlamydia trachomatis in symptomatic Rwandan women

Cited by 2 publications

References 28 publications

Derivation and Internal Validation of a Risk Score for Predicting Chlamydia trachomatis Infection in Kenyan Women Planning Conception

Derivation and Internal Validation of a Risk Score for Predicting Chlamydia trachomatis Infection in Kenyan Women Planning Conception

Identifying youth at high risk for sexually transmitted infections in community-based settings using a risk prediction tool: a validation study

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