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July 8, 1988, Vol 260, No. 2 >
ARTICLE | July 8, 1988

Cost-effectiveness of Screening Women at Moderate Risk for Genital Infections Caused by Chlamydia trachomatis FREE

Mary D. Nettleman, MD; Robert B. Jones, MD, PhD
[+] Author Affiliations

Reprint requests to University of Iowa Hospitals and Clinics, C 41 GH, Iowa City, IA 52242 (Dr Nettleman).


JAMA. 1988;260(2):207-213. doi:10.1001/jama.1988.03410020073031
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References

We evaluated the cost-effectiveness of screening women at moderate (prevalence, 7.9%) risk for urogenital infections with Chlamydia trachomatis. The characteristics of culture and direct antigen tests were based on published values. Those of serology were based on a comparative study in 434 college women. Three serological tests were evaluated: microimmunofluorescence, an indirect fluorescent antibody assay, and an enzyme-linked immunoassay. Their sensitivities and specificities were 97% and 64% 87% and 64%, and 84% and 51%, respectively, compared with culture. Screening all patients with a direct antigen test costing less than $12 was more cost-effective than neither testing nor treating patients, although only 53% of patients with positive test results would actually be infected. The use of culture alone or as a confirmatory test was less cost-effective but had high positive predictive values. Seropositivity was not highly predictive of active infection. Chlamydial screening can be cost-effective in moderate-risk women.

(JAMA 1988;260:207-213)

REFERENCES

1 +
Thompson SE, Washington AE:  Epidemiology of sexually transmitted Chlamydia trachomatis infections . Epidemiol Rev 1983;;5:96-123.
2 +
Holmes KK:  The chlamydia epidemic . JAMA 1981;;245:1718-1723.
3 +
Kuo C-C, Wang S-P, Wentworth BB, et al:  Primary isolation of TRIC organisms in HeLa 229 cells treated with DEAE-dextran . J Infect Dis 1972;;125:665-668.
4 +
Schachter J:  Chlamydial infections . N Engl J Med 1978;;298:428-432.
5 +
Tam MR, Stamm WE, Handsfield HH, et al:  Culture independent diagnosis of Chlamydia trachomatis using monoclonal antibodies . N Engl J Med 1984;;310:1146-1150.
6 +
Lipkin ES, Moncada JV, Shafer MA:  Comparison of monoclonal antibody staining and culture in diagnosing cervical chlamydial infection . J Clin Microbiol 1986;;23:114-117.
7 +
Stamm WE, Harrison HR, Alexander ER, et al:  Diagnosis of Chlamydia trachomatis infections by direct immunofluorescence staining of genital secretions: A multicenter trial . Ann Intern Med 1984;;101:638-641.
8 +
Smith JW, Rogers RE, Katz BP, et al:  Diagnosis of chlamydial infection in women attending antenatal and gynecologic clinics . J Clin Microbiol 1987;;25:868-872.
9 +
Howard LV, Coleman PF, England BJ, et al:  Evaluation of Chlamydiazyme for detection of genital infections caused by Chlamydia trachomatis . J Clin Microbiol 1986;;23:329-332.
10 +
Wang SP, Grayston JR:  Microimmunofluorescence antibody responses in Chlamydia trachomatis infection: A review , in Mardh PA, Holmes KK, Oriel JD, et al (eds): Chlamydial Infections . Amsterdam, Elsevier Biomedical Press, 1982;, pp 301-316.
11 +
Wang S-P, Grayston JR, Kuo C-C, et al:  Serodiagnosis of Chlamydia trachomatis infection with the micro-immunofluorescence test , in Hobson D, Holmes KK (eds): Nongonococcal Urethritis and Related Infections . Washington, DC, American Society for Microbiology, 1977;, pp 237-248.
12 +
Darougar S:  The humoral immune response to chlamydial infection in humans . Rev Infect Dis 1985;;7:726-730.
13 +
Jones RB, Katz BP, Van Der Pol B, et al:  Effect of blind passage and multiple sampling on recovery of Chlamydia trachomatis from urogenital specimens . J Clin Microbiol 1986;;24:1029-1033.
14 +
Grayston JT, Wang S-P:  New knowledge of Chlamydiae and the diseases they cause . J Infect Dis 1975;;132:87-104.
15 +
Schachter J, Cles L, Ray R, et al:  Failure of serology in diagnosing chlamydial infections of the female genital tract . J Clin Microbiol 1979;;10:647-649.
16 +
McCormack WM, Rosner B, McComb DE, et al:  Infection with Chlamydia trachomatis in female college students . Am J Epidemiol 1985;;121:107-115.
17 +
Jones RB, Bruins SC, Newhall WJ:  Comparison of reticulate and elementary body antigens in the detection of antibodies against Chlamydia trachomatis by an enzyme-linked immunosorbent assay . J Clin Microbiol 1983;;17:466-471.
18 +
Nettleman MD, Jones RB, Roberts SD, et al:  Cost-effectiveness of serology and cell culture for Chlamydia trachomatis in low prevalence women , in Oriel D, Ridgway G, Schachter J, et al (eds): Chlamydial Infections . Cambridge, England, Cambridge University Press, 1986;, pp 205-208.
19 +
Nettleman MD, Jones RB, Roberts SD, et al:  Cost-effectiveness of culturing for Chlamydia trachomatis: A study in a clinic for sexually transmitted diseases . Ann Intern Med 1986;;105:189-196.
20 +
Sweet RL, Schachter J, Landers DV:  Chlamydial infections in obstetrics and gynecology . Clin Obstet Gynecol 1983;;26:143-164.
21 +
Fraser JJ, Rettig PJ, Kaplan DW:  Prevalence of cervical Chlamydia trachomatis and Neisseria gonorrhoeae in female adolescents . Pediatrics 1983;;71:333-336.
22 +
Schachter J, Hanna L, Hill EC, et al:  Are chlamydial infections the most prevalent venereal disease? JAMA 1975;;231:1252-1255.
23 +
Bowie WR, Borrie-Hume CJ, Manzon LM, et al:  Prevalence of Chlamydia trachomatis and Neisseria gonorhoeae in two different populations of women . Can Med Assoc J1981 ;124:1477-1479.
24 +
Pauker SG, Kassirer JP:  Decision analysis . N Engl J Med 1987;;316:250-258.
25 +
Weinstein MC, Fineberg HV: Clinical Decision Analysis . Philadelphia, WB Saunders Co, 1980;.
26 +
Wang S-P, Grayston JT:  Human serology in Chlamydia trachomatis infection with microimmunofluorescence . J Infect Dis 1974;;130:388-397.
27 +
Jones RB, Rabinovitch RA, Katz BP, et al:  Chlamydia trachomatis in the pharynx and rectum of heterosexual patients at risk for genital infection . Ann Intern Med 1985;;102:757-762.
28 +
Dunlop EM, Goh BT, Darougar S, et al:  Triple-culture tests for diagnosis of chlamydial infection of the female genital tract . Sex Transm Dis 1985;;12:68-71.
29 +
Embil JA, Thiebaux HJ, Manuel FR, et al:  Sequential cervical specimens and the isolation of Chlamydia trachomatis: Factors affecting detection . Sex Transm Dis 1983;;10:62-66.
30 +
Uyeda CT, Welborn P, Ellison-Birang N, et al:  Rapid diagnosis of chlamydial infection with the Micro-Trak direct test . J Clin Microbiol 1984;;20:948-950.
31 +
Schachter J:  Immunodiagnosis of sexually transmitted disease . Yale J Biol Med 1985;;58:4343-4352.
32 +
Washington AE, Cates W, Zaidi AA:  Hospitalizations for pelvic inflammatory disease: Epidemiology and trends in the United States, 1975 to 1982 . JAMA 1984;;251:2529-2533.
33 +
Washington AE, Arno PS, Brooks MA:  Economic cost of pelvic inflammatory disease . JAMA 1986;;255:1735-1738.
34 +
Washington AE, Sweet RL, Shafer M:  Pelvic inflammatory disease and its sequelae in adolescents . J Adolesc Health Care 1985;;6:298-310.
35 +
Washington AE, Johnsonn RE, Sanders LL:  Chlamydia trachomatis infections in the United States: What are they costing us? JAMA 1987;;257:2070-2072.
36 +
Chlamydia trachomatis infections:  Policy guidelines for prevention and control . MMWR 1985;;35:53S-74S.
37 +
Westrom L:  Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries . Am J Obstet Gynecol 1980;;138:880-892.
38 +
Westrom L:  Effect of acute pelvic inflammatory disease on fertility . Am J Obstet Gynecol 1975;;121:707-713.
39 +
Schachter J, Martin DH:  Failure of multiple passages to increase chlamydial recovery . J Clin Microbiol 1987;;25:1851-1853.
40 +
Rogan WJ, Gladen B:  Estimating prevalence from the results of a screening test . Am J Epidemiol 1978;;107:71-76.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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1 +
Thompson SE, Washington AE:  Epidemiology of sexually transmitted Chlamydia trachomatis infections . Epidemiol Rev 1983;;5:96-123.
2 +
Holmes KK:  The chlamydia epidemic . JAMA 1981;;245:1718-1723.
3 +
Kuo C-C, Wang S-P, Wentworth BB, et al:  Primary isolation of TRIC organisms in HeLa 229 cells treated with DEAE-dextran . J Infect Dis 1972;;125:665-668.
4 +
Schachter J:  Chlamydial infections . N Engl J Med 1978;;298:428-432.
5 +
Tam MR, Stamm WE, Handsfield HH, et al:  Culture independent diagnosis of Chlamydia trachomatis using monoclonal antibodies . N Engl J Med 1984;;310:1146-1150.
6 +
Lipkin ES, Moncada JV, Shafer MA:  Comparison of monoclonal antibody staining and culture in diagnosing cervical chlamydial infection . J Clin Microbiol 1986;;23:114-117.
7 +
Stamm WE, Harrison HR, Alexander ER, et al:  Diagnosis of Chlamydia trachomatis infections by direct immunofluorescence staining of genital secretions: A multicenter trial . Ann Intern Med 1984;;101:638-641.
8 +
Smith JW, Rogers RE, Katz BP, et al:  Diagnosis of chlamydial infection in women attending antenatal and gynecologic clinics . J Clin Microbiol 1987;;25:868-872.
9 +
Howard LV, Coleman PF, England BJ, et al:  Evaluation of Chlamydiazyme for detection of genital infections caused by Chlamydia trachomatis . J Clin Microbiol 1986;;23:329-332.
10 +
Wang SP, Grayston JR:  Microimmunofluorescence antibody responses in Chlamydia trachomatis infection: A review , in Mardh PA, Holmes KK, Oriel JD, et al (eds): Chlamydial Infections . Amsterdam, Elsevier Biomedical Press, 1982;, pp 301-316.
11 +
Wang S-P, Grayston JR, Kuo C-C, et al:  Serodiagnosis of Chlamydia trachomatis infection with the micro-immunofluorescence test , in Hobson D, Holmes KK (eds): Nongonococcal Urethritis and Related Infections . Washington, DC, American Society for Microbiology, 1977;, pp 237-248.
12 +
Darougar S:  The humoral immune response to chlamydial infection in humans . Rev Infect Dis 1985;;7:726-730.
13 +
Jones RB, Katz BP, Van Der Pol B, et al:  Effect of blind passage and multiple sampling on recovery of Chlamydia trachomatis from urogenital specimens . J Clin Microbiol 1986;;24:1029-1033.
14 +
Grayston JT, Wang S-P:  New knowledge of Chlamydiae and the diseases they cause . J Infect Dis 1975;;132:87-104.
15 +
Schachter J, Cles L, Ray R, et al:  Failure of serology in diagnosing chlamydial infections of the female genital tract . J Clin Microbiol 1979;;10:647-649.
16 +
McCormack WM, Rosner B, McComb DE, et al:  Infection with Chlamydia trachomatis in female college students . Am J Epidemiol 1985;;121:107-115.
17 +
Jones RB, Bruins SC, Newhall WJ:  Comparison of reticulate and elementary body antigens in the detection of antibodies against Chlamydia trachomatis by an enzyme-linked immunosorbent assay . J Clin Microbiol 1983;;17:466-471.
18 +
Nettleman MD, Jones RB, Roberts SD, et al:  Cost-effectiveness of serology and cell culture for Chlamydia trachomatis in low prevalence women , in Oriel D, Ridgway G, Schachter J, et al (eds): Chlamydial Infections . Cambridge, England, Cambridge University Press, 1986;, pp 205-208.
19 +
Nettleman MD, Jones RB, Roberts SD, et al:  Cost-effectiveness of culturing for Chlamydia trachomatis: A study in a clinic for sexually transmitted diseases . Ann Intern Med 1986;;105:189-196.
20 +
Sweet RL, Schachter J, Landers DV:  Chlamydial infections in obstetrics and gynecology . Clin Obstet Gynecol 1983;;26:143-164.
21 +
Fraser JJ, Rettig PJ, Kaplan DW:  Prevalence of cervical Chlamydia trachomatis and Neisseria gonorrhoeae in female adolescents . Pediatrics 1983;;71:333-336.
22 +
Schachter J, Hanna L, Hill EC, et al:  Are chlamydial infections the most prevalent venereal disease? JAMA 1975;;231:1252-1255.
23 +
Bowie WR, Borrie-Hume CJ, Manzon LM, et al:  Prevalence of Chlamydia trachomatis and Neisseria gonorhoeae in two different populations of women . Can Med Assoc J1981 ;124:1477-1479.
24 +
Pauker SG, Kassirer JP:  Decision analysis . N Engl J Med 1987;;316:250-258.
25 +
Weinstein MC, Fineberg HV: Clinical Decision Analysis . Philadelphia, WB Saunders Co, 1980;.
26 +
Wang S-P, Grayston JT:  Human serology in Chlamydia trachomatis infection with microimmunofluorescence . J Infect Dis 1974;;130:388-397.
27 +
Jones RB, Rabinovitch RA, Katz BP, et al:  Chlamydia trachomatis in the pharynx and rectum of heterosexual patients at risk for genital infection . Ann Intern Med 1985;;102:757-762.
28 +
Dunlop EM, Goh BT, Darougar S, et al:  Triple-culture tests for diagnosis of chlamydial infection of the female genital tract . Sex Transm Dis 1985;;12:68-71.
29 +
Embil JA, Thiebaux HJ, Manuel FR, et al:  Sequential cervical specimens and the isolation of Chlamydia trachomatis: Factors affecting detection . Sex Transm Dis 1983;;10:62-66.
30 +
Uyeda CT, Welborn P, Ellison-Birang N, et al:  Rapid diagnosis of chlamydial infection with the Micro-Trak direct test . J Clin Microbiol 1984;;20:948-950.
31 +
Schachter J:  Immunodiagnosis of sexually transmitted disease . Yale J Biol Med 1985;;58:4343-4352.
32 +
Washington AE, Cates W, Zaidi AA:  Hospitalizations for pelvic inflammatory disease: Epidemiology and trends in the United States, 1975 to 1982 . JAMA 1984;;251:2529-2533.
33 +
Washington AE, Arno PS, Brooks MA:  Economic cost of pelvic inflammatory disease . JAMA 1986;;255:1735-1738.
34 +
Washington AE, Sweet RL, Shafer M:  Pelvic inflammatory disease and its sequelae in adolescents . J Adolesc Health Care 1985;;6:298-310.
35 +
Washington AE, Johnsonn RE, Sanders LL:  Chlamydia trachomatis infections in the United States: What are they costing us? JAMA 1987;;257:2070-2072.
36 +
Chlamydia trachomatis infections:  Policy guidelines for prevention and control . MMWR 1985;;35:53S-74S.
37 +
Westrom L:  Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries . Am J Obstet Gynecol 1980;;138:880-892.
38 +
Westrom L:  Effect of acute pelvic inflammatory disease on fertility . Am J Obstet Gynecol 1975;;121:707-713.
39 +
Schachter J, Martin DH:  Failure of multiple passages to increase chlamydial recovery . J Clin Microbiol 1987;;25:1851-1853.
40 +
Rogan WJ, Gladen B:  Estimating prevalence from the results of a screening test . Am J Epidemiol 1978;;107:71-76.

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