title: Low diagnostic accuracy of selective screening criteria for asymptomatic Chlamydia trachomatis infections in the general population.
abstract: OBJECTIVE
  To develop and validate selective screening criteria for asymptomatic Chlamydia trachomatis infections in the general population.
  
  
  METHODS
  11,505 people, aged 15-40 years, registered in 16 general practices in Amsterdam were invited to return by mail a home obtained first void urine sample and a questionnaire. Participants were randomly allocated into a development group (75%) or a validation group (25%). C trachomatis infection was determined by the ligase chain reaction. In the development group a set of criteria was identified by means of stepwise logistic regression analysis. The diagnostic accuracy (area under the ROC curve; AUC) and sensitivity, and the corresponding percentage of people selected for screening were calculated. The criteria developed in this study were applied to the validation group.
  
  
  RESULTS
  The prevalence of asymptomatic C trachomatis infections among men was found to be 2.4% (1.7-3.0), and among women 2.8% (2.2-3.4). Screening men, based on Surinam/Antillean origin and painful micturition, yielded an AUC of 0.58 (0.55-0.60). Screening women, based on Surinam/Antillean origin, new sex partner in the previous 2 months, and unmarried/not cohabiting, yielded an AUC of 0.67 (0.65-0.69). Application of the criteria for men to the validation group yielded an AUC of 0.53 (0.48-0.57); by screening 10% of the men, 15% of the cases were detected. The AUC of the criteria for women in the validation group was 0.58 (0.54-0.61); by screening 51% of the women, 63% of the cases were detected.
  
  
  CONCLUSIONS
  The prevalence of asymptomatic C trachomatis infections in Amsterdam is less than 3%. No suitable selective screening criteria for the general population could be identified.
authors.affiliation: Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, Netherlands.
authors.forename: I G
authors.initials: IG
authors.lastname: van Valkengoed
authors.forename: S A
authors.initials: SA
authors.lastname: Morré
authors.forename: A J
authors.initials: AJ
authors.lastname: van den Brule
authors.forename: C J
authors.initials: CJ
authors.lastname: Meijer
authors.forename: W
authors.initials: W
authors.lastname: Devillé
authors.forename: L M
authors.initials: LM
authors.lastname: Bouter
authors.forename: A J
authors.initials: AJ
authors.lastname: Boeke
mesh_terms: D000293:Adolescent; D000328:Adult; D019540:Area Under Curve; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology*; D002692:Chlamydia trachomatis; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009426:Netherlands / Q000453:epidemiology; D018579:Patient Selection; D015995:Prevalence; D012372:ROC Curve; D012044:Regression Analysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity