Genital chlamydia infections in sexually active female adolescents: Do we really need to screen everyone?

Mosure, Debra J.; Berman, Stuart M.; Fine, David; Delisle, Susan; Cates, Willard; Boring, John R.

doi:10.1016/s1054-139x(96)00157-7

Cited by 76 publications

(60 citation statements)

References 17 publications

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“…The guidelines for vaginitis [13] recommend STI testing for those "at risk." The literature contains many reports that link patient history variables to STI risk; however, our findings confirm those of others [14][15][16] who have shown that risk factors alone are inadequate at delineating a sample that requires STI screening. In addition, we demonstrated that there is a large overlap in self-reported vaginal and urinary symptoms in adolescent women.…”

Section: Discussionsupporting

confidence: 85%

Urinary Symptoms in Adolescent Females: STI or UTI?

Huppert

Biro

Lan

et al. 2007

Journal of Adolescent Health

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Purpose-To determine if urinary symptoms or urinary tract infections (UTI) were associated with sexually transmitted infections (STI) and which history, clinical, and laboratory findings could distinguish these infections in symptomatic women.Methods-A cross sectional sample of 296 sexually-active females aged 14-22 attending a hospital-based teen health center or emergency department were recruited. Genitourinary symptoms, medical and sexual history, and urinalysis results were recorded. STI was defined as a vaginal swab positive for Trichomonas vaginalis or urine nucleic acid amplification test positive for Neisseria gonorrheae or Chlamydia trachomatis. A urine culture with >10,000 colonies of a single pathogen was considered a positive UTI.Results-In the full sample, prevalence of UTI and STI were 17% and 33%, respectively. Neither urinary symptoms nor UTI was significantly associated with STI. Further analyses are reported for the 154 (51%) with urinary symptoms: Positive urine leukocytes, >1 partner in the last 3 months and history of STI predicted STI. Urinalysis results identified four groups: (1)Normal urinalysis -67% had no infection; (2)Positive nitrites or protein -55% had UTI; (3)Positive leukocytes or blood -62% had STI; and (4)Both nitrites/protein and leukocytes/blood positive -28% had STI and 65% had UTI. Those without a documented UTI were more likely to have trichomoniasis than those with a UTI, and 65% of those with sterile pyuria had STI, mainly trichomoniasis or gonorrhea.Conclusions-Adolescent females with urinary symptoms should be tested for both UTI and STIs. Urinalysis results may be helpful to direct initial therapy.

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Section: Discussionsupporting

confidence: 85%

Urinary Symptoms in Adolescent Females: STI or UTI?

Huppert

Biro

Lan

et al. 2007

Journal of Adolescent Health

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“…Use of a barrier method was shown to be associated with reduced risk of infection compared with the use of other methods of contraception in two of five studies in females (33,54,70,71,87). Compared with no contraceptives, use of a barrier method was protective against chlamydia for females in three of five studies (32,69,81,88,89). Only one of 10 studies found female barrier users to be significantly less likely to be infected than female nonusers (37,55,79,(90)(91)(92)(93)(94)(95)(96).…”

Section: Risk Factors For Genital Chlamydial Infectionmentioning

confidence: 96%

Risk factors for genital chlamydial infection

Navarro

Jolly²,

Nair³

et al. 2003

J Sex Reprod Med

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OBJECTIVE:To discuss the occurrence of genital chlamydia in developed countries and review the literature assessing the potential risk factors for this sexually transmitted disease. DATA SOURCES: A MEDLINE search was performed for all English citations from 1985 to 2000 that contain the keywords "Chlamydia trachomatis", "chlamydial infections", "risk factors" and "sex behaviour". All relevant references cited in articles that were obtained from the search were also included. DATA EXTRACTION: All articles obtained from the above sources were examined, and were included in the review if they met the following criteria: primary study examining sociodemographic or behavioural risk factors associated with genital chlamydial infection using multivariate analysis; study subjects 12 years of age and older; and study setting in a developed country. DATA SYNTHESIS AND CONCLUSIONS:Genital chlamydial infection has become the most commonly reported bacterial infection in North America over the past decade. Thirty-eight cross-sectional studies and six cohort studies were included in the present review. Most studies demonstrated that young men and women are at higher risk of being infected with chlamydia than older subjects. Chlamydia seems to be found in a diverse group of people, and unlike gonorrhea, is not concentrated in low income, minority core groups with high rates of partner change. However, a number of studies have shown that communities with well-established control programs are beginning to demonstrate this pattern. There is no clear evidence that chlamydia is associated with type of partners, contraceptive use, or age at first intercourse. Future research should follow this sexually transmitted disease as it evolves through the epidemiological stages to ensure that preventive and treatment services are reaching those people who are most likely to be infected.

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“…14 This recommendation is supported by several studies. 9,15,16 However, the limited number of published provider surveys has shown that the percentage of physicians who report testing all sexually active adolescents ranges from 29% to 51%. 17,18 Not only do providers have a critical role in testing, they also have an important role in controlling STDs through risk assessment and counseling.…”

mentioning

confidence: 99%

“…Even less is known about the practice patterns of nonphysician clinicians (physician assistants and nurse practitioners), a group of health care professionals that is increasingly providing primary care. 22 We undertook the current descriptive study to assess levels of chlamydia testing, sexual history taking, and prevention practices in adolescent females (13)(14)(15)(16)(17)(18)(19) years old) by physician and nonphysician clinician primary care providers in Colorado, and to determine correlates of these clinical practices.…”

mentioning

confidence: 99%

Testing for Chlamydia and Sexual History Taking in Adolescent Females: Results From a Statewide Survey of Colorado Primary Care Providers

et al. 2000

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ABSTRACT. Objectives. Little is known about the practice patterns of primary care providers as they relate to assessing risk of and screening for chlamydial infections, an important cause of preventable reproductive morbidity in young women in the United States. The present cross-sectional study was undertaken to assess levels of chlamydia testing, sexual history taking, and prevention practices by Colorado primary care physicians, nurse practitioners, and physician assistants who provide gynecologic care to adolescent females (13-19 years old).Methods. Between July 1998 and October 1998, an anonymous, self-administered questionnaire was mailed to a 25% random sample (n ‫؍‬ 1265) of Colorado physicians (family practitioners, internal medicine specialists, obstetrician-gynecologists, and pediatricians), nurse practitioners, and physician assistants. Practitioners were identified through professional organization membership, state-licensing bodies, and listings in the yellow pages.Results. After estimating the eligibility rate among nonrespondents, the adjusted response rate was 71.5%. Only 53.8% of providers reported regularly testing sexually active female adolescents for chlamydia; 71.8% of providers regularly took a sexual history. Female providers reported significantly higher levels of regularly taking a sexual history (87.2% vs 60.6% of males), feeling comfortable discussing sex (94.4% vs 77.8%), discussing sexually transmitted disease (STD) prevention (81.5% vs 71.3%), and testing for chlamydia (64.4% vs 38.6%). Among provider types, obstetrician-gynecologists, nurse practitioners, and pediatricians were most likely to report regularly taking a sexual history (90.1%, 88.6%, and 76.0%, respectively). Internal medicine specialists were the least likely to report taking a sexual history (43.9%). Pediatricians and nurse practitioners were the most likely to report testing sexually active adolescent females for chlamydia (74.1% and 70.1%, respectively), whereas physician assistants and internal medicine specialists were the least likely (46.0% and 38.5%, respectively).In multivariate analysis, variables independently associated with regularly taking a sexual history included female provider gender (odds ratio [OR]: 5.5; 95% confidence interval [CI]: 2.9 -10.9), obstetrics/gynecology specialty (OR: 4.0; 95% CI: 1.7-10.3; referent group: family practitioners), and provider comfort level in discussing sex (OR: 4.9; 95% CI: 2.3-11

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Genital chlamydia infections in sexually active female adolescents: Do we really need to screen everyone?

Cited by 76 publications

References 17 publications

Urinary Symptoms in Adolescent Females: STI or UTI?

Urinary Symptoms in Adolescent Females: STI or UTI?

Risk factors for genital chlamydial infection

Testing for Chlamydia and Sexual History Taking in Adolescent Females: Results From a Statewide Survey of Colorado Primary Care Providers

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