title: Validity of self-reported history of Chlamydia trachomatis infection.
abstract: Chlamydia trachomatis infection is common and largely asymptomatic in women. If untreated, it can lead to sequelae such as pelvic inflammatory disease and infertility. It is unknown whether a patient's self-reported history of Chlamydia trachomatis infection is a valid marker of past infection.
  
  
  
  Our objective was to evaluate the validity of women's self-reported history of Chlamydia trachomatis infection compared with Chlamydia trachomatis serology, a marker for previous infection.
  
  
  
  We analyzed data from the Fertility After Contraception Termination study. We compared participants' survey responses with the question, "Have you ever been told by a health care provider that you had Chlamydia?" to serological test results indicating the presence or absence of antibodies to Chlamydia trachomatis as assessed by a microimmunofluorescence assay. Prevalence of past infection, sensitivity, specificity, predictive values, and likelihood ratios were calculated. The Cohen's kappa statistic was computed to assess agreement between self-report and serology.
  
  
  
  Among 409 participants, 108 (26%) reported having a history of Chlamydia trachomatis infection, whereas 146 (36%) had positive serological test results. Relative to positive microimmunofluorescence assay, the sensitivity and specificity of self-reported history of Chlamydia trachomatis infection were 52.1% (95% confidence interval, 43.6-60.4%) and 87.8% (95% confidence interval, 83.3-91.5%), respectively. The positive predictive value of the self-report was 70.4% (95% confidence interval, 60.8-78.8%), and the negative predictive value was 76.7% (95% confidence interval, 71.6-81.4%). The likelihood ratio was found to be 4.28. Agreement between self-report and serology was found to be moderate (kappa = 0.42, P < .001).
  
  
  
  Self-reported history of Chlamydia trachomatis infection commonly yields false-negative and false-positive results. When definitive status of past Chlamydia trachomatis infection is needed, serology should be obtained.
authors.affiliation: Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University, St Louis School of Medicine, St Louis, MO.
authors.forename: Ann C
authors.initials: AC
authors.lastname: Frisse
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Marrazzo
authors.affiliation: Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University, St Louis School of Medicine, St Louis, MO.
authors.forename: Nhial T
authors.initials: NT
authors.lastname: Tutlam
authors.affiliation: Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Courtney A
authors.initials: CA
authors.lastname: Schreiber
authors.affiliation: Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO.
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Teal
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT.
authors.forename: David K
authors.initials: DK
authors.lastname: Turok
authors.affiliation: Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University, St Louis School of Medicine, St Louis, MO. Electronic address: jpeipert@iu.edu.
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Peipert
mesh_terms: D000328:Adult; D000367:Age Factors; D002690:Chlamydia Infections / Q000453:epidemiology*; D003271:Contraceptive Agents, Female; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006304:Health Status; D006801:Humans; D016013:Likelihood Functions; D008483:Medical Assistance; D008487:Medical History Taking; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D044469:Racial Groups; D015203:Reproducibility of Results; D057566:Self Report; D012680:Sensitivity and Specificity; D012847:Single Person; D012923:Social Class; D019966:Substance-Related Disorders / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D003271:Contraceptive Agents, Female
keywords: Chlamydia trachomatis; microimmunofluorescence assay; self-report; serology; sexually transmitted infection; validity