You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT JAMA
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 270 No. 17, November 3, 1993 TABLE OF CONTENTS
  JAMA
  •  Online Features
  ARTICLE
 This Article
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Contact me when this article is cited
 Related Content
 •Similar articles in JAMA

Evaluation of urine-based screening strategies to detect Chlamydia trachomatis among sexually active asymptomatic young males

M. A. Shafer, J. Schachter, J. Moncada, J. Keogh, R. Pantell, L. Gourlay, S. Eyre and C. B. Boyer
Department of Pediatric, University of California, San Francisco 94143.

OBJECTIVE--To evaluate the performances of diagnostic screening tests alone or in combination to detect asymptomatic chlamydial urethral infection in young males. DESIGN--Comparisons of the performance profiles of the following chlamydia screening strategies were done: urethral culture; identification of polymorphonucleocytes (PMNs) on spun first-void urine (FVU); urinary leukocyte esterase test (LET) on unspun FVU; chlamydial enzyme immunoassay (EIA) applied to FVU sediment; combining LET on unspun FVU followed by EIA with or without direct fluorescent antibody (DFA) confirmation on FVU sediment; and combining PMNs on spun FVU followed by EIA with or without DFA confirmation. SETTING--General clinics at a youth detention center, university-based teen clinic, college health service, and a military screening clinic. PATIENTS--A total of 618 males aged 12 to 35 years (mean, 17 years) were recruited as a convenience sample; site participation rates ranged from 50% to 80%. Eligible subjects were sexually active, denied symptoms of urethritis, and had taken no antibiotics in the prior 2 weeks. MAIN OUTCOME MEASURES--Sensitivity, specificity, and positive and negative predictive values of each test strategy's ability to detect Chlamydia trachomatis infection, and cost to confirm each positive case. RESULTS--With a 7% prevalence of chlamydial infection, tissue culture had a sensitivity of only 61%. However, two strategies yielded significantly better performance profiles compared with the others: EIA confirmed by DFA test with a sensitivity of 84%, a specificity of 100%, and a cost to identify each positive case of $434; and PMNs followed by EIA confirmed by DFA test with a sensitivity of 78%, a specificity of 100%, and a cost to identify each positive case of $199. The LET followed by EIA-DFA had a similar performance profile to the PMN test strategies. CONCLUSIONS--A combination of a nonspecific screening of FVU for PMNs or LET followed by specific testing with EIA with DFA confirmation has superior clinical and cost-effective performance for detecting asymptomatic C trachomatis urethritis in young males compared with other strategies. However, an evaluation of the medical, fiscal, and psychological benefits and risks associated with a specific screening strategy for sexually transmitted diseases must be made before adopting a specific strategy for a particular population.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Male Genital Tract Chlamydial Infection: Implications for Pathology and Infertility
Cunningham and Beagley
Biol. Reprod. 2008;79:180-189.
ABSTRACT | FULL TEXT  

Low Sensitivity of the Leukocyte Esterase Test (LET) in Detecting Chlamydia trachomatis Infections in Asymptomatic Men Entering a County Jail
Ratelle et al.
JOURNAL OF CORRECTIONAL HEALTH CARE 2004;10:217-226.
ABSTRACT  

The accuracy and efficacy of screening tests for Chlamydia trachomatis: a systematic review
WATSON et al.
J Med Microbiol 2002;51:1021-1031.
ABSTRACT | FULL TEXT  

Detection of Chlamydia trachomatis in an Australian high school student population
Debattista et al.
Sex. Transm. Infect. 2002;78:194-197.
ABSTRACT | FULL TEXT  

Chlamydial Serology: Comparative Diagnostic Value of Immunoblotting, Microimmunofluorescence Test, and Immunoassays Using Different Recombinant Proteins as Antigens
Bas et al.
J. Clin. Microbiol. 2001;39:1368-1377.
ABSTRACT | FULL TEXT  

The prevalence of Chlamydia trachomatis infection in male undergraduates: a postal survey
Rogstad et al.
Sex. Transm. Infect. 2001;77:111-113.
ABSTRACT | FULL TEXT  

Prevalence of Chlamydia trachomatis in young men in north west London
Pierpoint et al.
Sex. Transm. Infect. 2000;76:273-276.
ABSTRACT | FULL TEXT  

A School-based Chlamydia Control Program Using DNA Amplification Technology
Cohen et al.
Pediatrics 1998;101 :e1-e1.
ABSTRACT | FULL TEXT  

Gonococcal and Chlamydial Genitourinary Infections in Symptomatic and Asymptomatic Adolescent Women
Biro et al.
CLIN PEDIATR 1995;34:419-423.
ABSTRACT  

SCREENING AND TREATING ASYMPTOMATIC CHLAMYDIA
JWatch General 1993;1993:4-4.
FULL TEXT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1993 American Medical Association. All Rights Reserved.