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Screening for Chlamydia trachomatis: A Case for Empirical Treatment

Robert A. Gunn, MD, MPH; Christopher E. Spitters, MD, MPH
JAMA. 1994;271(22):1741-1742. doi:10.1001/jama.1994.03510460033018.
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To the Editor.  —The article by Dr Shafer and colleagues1 regarding urine-based screening strategies to detect Chlamydia trachomatis infection among sexually active asymptomatic young men provided valuable information. As part of a Chlamydia Prevention Initiative in San Diego County, California, we advocate that sexually active asymptomatic adolescent males be screened during routine preventive health care visits, such as during sports physicals. We recommend first-void urine leukocyte esterase (LE) testing because it can be done in the physician's office at negligible cost (approximately 30 cents). For adolescents with a positive LE, especially those engaging in high-risk sexual behavior, we recommend strong consideration of empirical treatment, and for others, further evaluation and confirmatory testing.Confirmatory testing may not be available in certain settings, mainly because of cost concerns, and even when it can be done, some adolescents may not return to obtain results or treatment. Therefore, there is a need for a


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