title: Risk-based screening for Chlamydia trachomatis and Neisseria gonorrhoeae prior to intrauterine device insertion.
abstract: OBJECTIVE
  The objective was to compare three strategies for Chlamydia trachomatis and Neisseria gonorrhoeae screening prior to intrauterine device (IUD) insertion.
  
  
  METHODS
  This was a secondary analysis of the Contraceptive CHOICE Project. We measured the prevalence of C. trachomatis and/or N. gonorrhoeae at the time of IUD insertion. We then compared sensitivity, specificity, negative and positive predictive values, and likelihood ratios for three screening strategies for C. trachomatis and N. gonorrhoeae prior to IUD insertion: (a) "age-based" — age ≤25 years alone; (b) "age/partner-based" — age ≤25 and/or multiple sexual partners; and (c) "risk-based" — age ≤25, multiple sexual partners, inconsistent condom use and/or history of prior sexually transmitted infection (STI).
  
  
  RESULTS
  Among 5087 IUD users, 140 (2.8%) tested positive for C. trachomatis, 16 (0.3%) tested positive for N. gonorrhoeae, and 6 (0.1%) were positive for both at the time of IUD insertion. The "risk-based" screening strategy had the highest sensitivity (99.3%) compared to "age-based" and "age/partner-based" screening (80.7% and 84.7%, respectively.) Only one (0.7%) woman with a chlamydia or gonorrhea infection would not have been screened using "risk-based" screening.
  
  
  CONCLUSIONS
  A risk-based strategy to screen for C. trachomatis and N. gonorrhoeae prior to IUD insertion has higher sensitivity than screening based on age alone or age and multiple sexual partners.
  
  
  CONCLUSIONS
  Using a risk-based screening strategy (age≤25, multiple sexual partners, inconsistent condom use and/or history of an STI) to determine who should be screened for C. trachomatis and N. gonorrhoeae prior to IUD insertion will miss very few cases of infection and obviates the need for universal screening.
authors.affiliation: Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, Saint Louis, MO, 63110. Electronic address: grentzerj@wudosis.wustl.edu.
authors.forename: Jaclyn M
authors.initials: JM
authors.lastname: Grentzer
authors.affiliation: Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, Saint Louis, MO, 63110.
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Peipert
authors.affiliation: Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, Saint Louis, MO, 63110.
authors.forename: Qiuhong
authors.initials: Q
authors.lastname: Zhao
authors.affiliation: Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, Saint Louis, MO, 63110.
authors.forename: Colleen
authors.initials: C
authors.lastname: McNicholas
authors.affiliation: Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, Saint Louis, MO, 63110.
authors.forename: Gina M
authors.initials: GM
authors.lastname: Secura
authors.affiliation: Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, Saint Louis, MO, 63110.
authors.forename: Tessa
authors.initials: T
authors.lastname: Madden
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016015:Logistic Models; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Chlamydia; Contraception; Gonorrhea; Intrauterine device; Sexually transmitted infections