Selective testing criteria for gonorrhea among young women screened for Chlamydial infection: contribution of race and geographic prevalence.

BACKGROUND

Selective screening criteria have been widely implemented for genital Chlamydia trachomatis (CT) infections but have rarely been developed for Neisseria gonorrhoeae (GC) infection.

METHODS

Women tested for CT in Washington State Infertility Prevention Project clinics in 2003 were also tested for GC using the Gen-Probe APTIMA COMBO 2 TMA assay. We derived 3 sets of selective testing criteria (STC) for gonorrhea, incorporating risk factors identified using logistic regression (STC-1), self-identified race (STC-2), and local rates of gonorrhea in men (STC-3).

RESULTS

Of 55,781 women, 173 (0.3%) tested positive for GC. STC-1 included exposure to sexually transmitted diseases, presumptive CT treatment at screening, a pregnancy-related visit, report of a symptomatic partner, dysuria, abnormal vaginal discharge, or a new sex partner during the preceding 60 days. These criteria identified 80% of cases while testing 47% of women. STC-2 added race (black/Native American) to STC-1 and identified 89% of cases while testing 52%. STC-3 added clinic location in a ZIP code area with male urethral GC infection rates in the top quartile of Washington State rates to STC-1 and identified 86% of cases while testing 58%.

CONCLUSIONS

Although testing criteria incorporating race were most specific, criteria including local area rates of GC infection in men had similar sensitivity and required testing only slightly more women.