Chlamydia trachomatis infection in women: a need for universal screening in high prevalence populations?
Chlamydia trachomatis infection in women: a need for universal screening in high prevalence populations?
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女性沙眼衣原体感染：是否需要对高流行人群进行普遍筛查？
DOI：
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发表时间：
1992
影响因子：
5
通讯作者：
Geraldine Oliva
中科院分区：
文献类型：
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作者：
Hillard Weinstock;Gail Bolan;Robert M. Kohn;Carlos Balladares;Arthur Back;Geraldine Oliva
沙眼衣原体是最普遍的性传播细菌病原体。尽管如此，还是建议对衣原体进行选择性而不是普遍的筛查，主要是因为检测费用昂贵，需要相当多的技术专长。从1987年3月至1988年1月，在加州州弗朗西斯科市的四个计划生育诊所，共对1 348名妇女进行了筛查，以确定选择性筛查的标准。其中，9.2%有阳性衣原体测试使用直接荧光。Logistic回归分析确定了5个与感染相关的因素：年龄小于25岁，宫颈脆弱，单身婚姻状况，过去3个月内的新性伴侣，以及缺乏屏障避孕药具的使用。没有一个单一的风险因素或风险因素的组合具有高敏感性和高阳性预测值的感染。虽然筛查所有未婚女性将检测出93%的衣原体感染者，但10.7%的阳性预测值并不比总体患病率高出多少。相反，筛查所有宫颈脆弱的妇女，其阳性预测值为23.2%，只能检测到11%的衣原体感染者。根据作者的研究结果，选择性筛查不应用于所有妇女都有风险的高患病率人群，而应进行衣原体筛查。
Chlamydia trachomatis is the most prevalent sexually transmitted bacterial pathogen. Nevertheless, selective, rather than universal, screening for chlamydia has been recommended, largely because testing is expensive and requires considerable technical expertise. A total of 1,348 women in four family planning clinics in San Francisco, California, were screened from March 1987 to January 1988 to identify criteria for selective screening. Of these, 9.2% had a positive chlamydia test using direct fluorescence. Logistic regression analysis identified five factors associated with infection: age less than 25 years, cervical friability, single marital status, a new sexual partner within the past 3 months, and lack of barrier contraceptive use. No single risk factor or combination of risk factors had both a high sensitivity and a high positive predictive value for infection. While screening all women who were unmarried would detect 93% of those with chlamydia, the positive predictive value of 10.7% was not much higher than the overall prevalence. Conversely, screening all women with cervical friability, which had a positive predictive value of 23.2%, would only detect 11% of those with chlamydia. On the basis of the authors' findings, selective screening should not be used in high prevalence populations in which all women are at risk and should be screened for chlamydia.