Chlamydia trachomatis cervical infection in women seeking routine gynecologic care: criteria for selective testing.
OBJECTIVE
Chlamydia trachomatis infection is one of the most common sexually transmitted diseases. Developing methods to identify patients who are at higher risk would enable clinicians to perform selective testing for C. trachomatis infection, which may reduce morbidity, sequelae, and overall costs. Risk factors for C. trachomatis infection of the cervix in women seen for routine gynecologic care were therefore analyzed.


METHODS
Extensive clinical data and cervical cultures were obtained from 1,141 women between the ages of 18 and 50. Multivariate techniques were used to develop and prospectively test a model to predict infection.


RESULTS
In the model development series of 530 patients seen in a hospital-based practice, 24 (4.5%) had a positive culture result. In the validation series of 611 patients seen in private practice, 17 (2.8%) had positive culture results. The majority of infected patients (61%) were asymptomatic. For sexually active women 18 to 35 years of age, the optimal predictive model was based on three factors: level of education (high school or less), a sex partner with other partners during the prior three months, and endocervical bleeding induced by the initial swab. In the validation series, the prevalence of infection for women with one or more of these factors was 5.8% (95% confidence interval, 4.0 to 8.6) compared with 0.9% in patients without these factors (p = 0.005).


CONCLUSIONS
Clinical information can be used in a low-prevalence population to predict a patient's risk for C. trachomatis infection and to select patients for testing.
Phillips
R S
RS
Department of Medicine, Beth Israel Hospital, Boston, Massachusetts 02215.
Hanff
P A
PA
Holmes
M D
MD
Wertheimer
A
A
Aronson
M D
MD
D000293:Adolescent; D000328:Adult; D001900:Boston; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology*; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D004522:Educational Status; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D008962:Models, Theoretical; D012307:Risk Factors; D012725:Sexual Behavior; D002577:Uterine Cervical Diseases / Q000175:diagnosis / Q000453:epidemiology*; D014592:Uterine Hemorrhage / Q000209:etiology