Selective Screening for Chlamydia trachomatis Infection in Nonurban Family Planning Clinics in Wisconsin

Addiss, David G.; Vaughn, Michael; Holzhueter, Margi A.; Bakken, Lori L.; Davis, Jeffrey P.

doi:10.2307/2135105

Cited by 22 publications

(7 citation statements)

References 4 publications

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“…Although it did not achieve statistical significance, it would appear that cervicitis was a clinically significant factor with the risk elevated more than three-fold. Other studies also have detected elevated rates of this clinical characteristic in women with chlamydia 21,22 .…”

Section: Discussionmentioning

confidence: 84%

Predictors of Chlamydia trachomatis Infection Among WomenAttending Rural Midwest Family Planning Clinics

Hilger

Smith

Ault

2001

Infectious Diseases in Obstetrics and Gynecology

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Objective: To determine predictors of Chlamydia trachomatis infection among women 14-24 years of age attending family planning clinics throughout a rural Midwestern state. Methods: The study population included 16 756 women between the ages of 14 and 24 years attending family planning clinics for annual examinations throughout the state of Iowa in 1997. All women under 25 years of age having annual exams were tested for C. trachomatis during the visit. At the time of exam, both behavioral and demographic data were collected on all women participating in the study. Results: The majority of women in the study (96%) reported no symptoms of chlamydia. Only 2.5% of all women had a positive test result. In the multivariate model, the odds ratios were significantly increased among the youngest age (14-17 years; OR = 2.2), those with mucopurulent cervicitis (OR = 3.4), cervical friability (OR = 2.2), symptomatic for infection (OR = 1.8), risk history (OR = 1.6), and black race (OR = 1.2) and predictive of a C. trachomatis infection. Conclusions: Risk factors predictive of C. trachomatis infection among younger aged women attending family planning clinics in a Midwest rural population are consistent with predictors of infection among women attending family planning clinics across the United States. The overall findings suggest the importance of developing screening guidelines as a means of lowering chlamydia rates. This may be a particularly difficult task in light of the low rate of symptoms that would lead a woman to seek medical care, even in younger age women who are at higher risk. In addition, screening guidelines would be more difficult to implement in a rural setting.

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Section: Discussionmentioning

confidence: 84%

Predictors of Chlamydia trachomatis Infection Among WomenAttending Rural Midwest Family Planning Clinics

Hilger

Smith

Ault

2001

Infectious Diseases in Obstetrics and Gynecology

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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).…”

Section: Risk Factors For Genital Chlamydial Infectionmentioning

confidence: 93%

“…First, a number of studies that did not demonstrate a significant relationship between racial group and chlamydia had samples that were either predominantly white or predominantly black (32,50,(70)(71)(72)(73)(74), and a small proportion of subjects with the exposure of interest make it difficult to detect differences among groups. Second, some studies may be affected by a diagnostic bias.…”

Section: Race And/or Ethnicity and Socioeconomic Statusmentioning

confidence: 99%

“…This may be due to involuntary infertility following 'silent' chlamydial PID. Suspected exposure to chlamydia (24,51,52,91,110) or having a symptomatic partner (32,35,71) is associated with an increase in risk of the infection in a number of studies, which highlights that, as chlamydia becomes more concentrated in core groups, contact tracing will become an increasingly important control strategy.…”

Section: Other Risk Factorsmentioning

confidence: 99%

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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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“…The strategy of two-step evaluation, using a combination of historical factors and a low-tech laboratory test for screening, could increase the predictive value of positive test results to satisfactory values when applied to low-prevalence populations. However, not all studies have confirmed the value of historical and clinical factors in diagnosing C. trachomatis infections, and it may be that clinical diagnosis and low-tech methods are applicable only to certain patient groups (1,82,113,190).…”

Section: Test Selectionmentioning

confidence: 99%

Laboratory diagnosis of human chlamydial infections

Barnes

1989

Clin Microbiol Rev

167

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Chlamydia trachomatis is a human pathogen that causes ocular disease (trachoma and inclusion conjunctivitis), genital disease (cervicitis, urethritis, salpingitis, and lymphogranuloma venereum), and respiratory disease (infant pneumonitis). Respiratory chlamydioses also occur with infection by avian strains of C. psittaci or infection by the newly described TWAR agent. Diagnosis of most acute C. trachomatis infections relies on detection of the infecting agent by cell culture, fluorescent antibody, immunoassay, cytopathologic, or nucleic acid hybridization methods. Individual non-culture tests for C. trachomatis are less sensitive and specific than the best chlamydial cell culture system but offer the advantages of reduced technology and simple transport of clinical specimens. Currently available nonculture tests for C. trachomatis perform adequately as screening tests in populations in which the prevalence of infection is greater than 10%. A negative culture or nonculture test for C. trachomatis does not, however, exclude infection. The predictive value of a positive nonculture test may be unsatisfactory when populations of low infection prevalence are tested. Tests that detect antibody responses to chlamydial infection have limited utility in diagnosis of acute chlamydial infection because of the high prevalence of persistent antibody in healthy adults and the cross-reactivity due to infection by the highly prevalent C. trachomatis and TWAR agents. Assays for changes in antibody titer to the chlamydial genus antigen are used for the diagnosis of respiratory chlamydioses. A single serum sample that is negative for chlamydial antibody excludes the diagnosis of lymphogranuloma venereum.

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Selective Screening for Chlamydia trachomatis Infection in Nonurban Family Planning Clinics in Wisconsin

Cited by 22 publications

References 4 publications

Predictors of Chlamydia trachomatis Infection Among WomenAttending Rural Midwest Family Planning Clinics

Predictors of Chlamydia trachomatis Infection Among WomenAttending Rural Midwest Family Planning Clinics

Risk factors for genital chlamydial infection

Laboratory diagnosis of human chlamydial infections

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