Screening Young Adults for Prevalent Chlamydial Infection in Community Settings

Purpose

Community-based testing may identify young adults in the general population with sexually transmitted chlamydial infection. To develop selective screening guidelines appropriate for community settings, the authors conducted a cross-sectional analysis of the National Longitudinal Study of Adolescent Health Wave III (April 2, 2001, to May 9, 2002).

Methods

Separately for women and men, we developed three predictive models by using unconditional multiple logistic regression for survey data. To account for racial/ethnic disparity in prevalence, initial models included identical predictor characteristics plus information on 1) respondent's race/ethnicity; or 2) respondent's most recent partner's race/ethnicity; or 3) no information on race/ethnicity.

Results

Chlamydia trachomatis diagnosis was available for 10,928 (88.6%) of the sexually experienced respondents. A combination of five characteristics for women and six characteristics for men identified approximately 80% of infections when testing ≤50% of the population. Information regarding race/ethnicity dramatically affected algorithm performance.

Conclusion

The use of race/ethnicity in any screening algorithm is problematic and controversial, but the model without race information missed many diagnoses in the minority groups. Universal screening in high-prevalence regions and selective screening in low-prevalence regions may be one method of reaching the affected populations while avoiding the stigma of guidelines incorporating race/ethnicity.

Key Words: Chlamydia Trachomatis, Epidemiology, Mass Screening, Sexually Transmitted Disease

Selected Abbreviations and Acronyms: STI, sexually transmitted infection, Add Health, National Longitudinal Study of Adolescent Health, OR, odds ratio, 95% CI, 95% confidence interval, ROC, receiver operating characteristic, SE, standard error