Chen M Y, Fairley C K, De Guingand D, Hocking J, Tabrizi S, Wallace E M, Grover S, Gurrin L, Carter R, Pirotta M, Garland S
School of Population Health, University of Melbourne, Melbourne, Australia.
Sex Transm Infect. 2009 Feb;85(1):31-5. doi: 10.1136/sti.2008.030700. Epub 2008 Aug 15.
To determine the risk factors associated with chlamydial infection in pregnancy and the sensitivity and specificity of these when used for selective screening.
A prospective, cross-sectional study of pregnant women aged 16-25 years attending four major public antenatal services across Melbourne, Australia. Between October 2006 and July 2007, women were approached consecutively and asked to complete a questionnaire and to provide a first-pass urine specimen for Chlamydia trachomatis testing using PCR.
Of 1180 eligible women, 1087 were approached and 1044 (88%) consented to participate. Among the 987 women for whom a questionnaire and a definitive diagnostic assay were available, the prevalence of chlamydia was 3.2% (95% CI 1.8 to 5.9). In a multiple logistic regression model, more than one sexual partner in the past year (AOR 11.5; 95% CI 7.1 to 18.5) was associated with chlamydia infection. The use of any antibiotic within 3 months (AOR 0.2; 95% CI 0.1 to 0.6) was associated with a decreased risk of infection. Screening restricted to women who reported more than one sexual partner in the past year would have detected 44% of infections in women aged 16-25 years and would have required only 7% of women to be screened. The addition of those women aged 20 years and under would have required 27% of women to be screened and detection of 72% of infections.
Selective chlamydia screening of pregnant women based on risk factors can improve the yield from screening. However, the potential harm of missed infections among excluded women would need to be considered.
确定与孕期衣原体感染相关的风险因素，以及将这些因素用于选择性筛查时的敏感性和特异性。
对澳大利亚墨尔本四大主要公共产前服务机构中年龄在16 - 25岁的孕妇进行一项前瞻性横断面研究。在2006年10月至2007年7月期间，连续接触这些女性，要求她们填写问卷，并提供首段尿液样本，采用聚合酶链反应（PCR）检测沙眼衣原体。
在1180名符合条件的女性中，接触了1087名，其中1044名（88%）同意参与。在987名有问卷和确诊诊断检测结果的女性中，衣原体感染率为3.2%（95%置信区间1.8至5.9）。在多元逻辑回归模型中，过去一年有多个性伴侣（比值比11.5；95%置信区间7.1至18.5）与衣原体感染相关。在3个月内使用过任何抗生素（比值比0.2；95%置信区间0.1至0.6）与感染风险降低相关。仅对过去一年报告有多个性伴侣的女性进行筛查，可检测出16 - 25岁女性中44%的感染病例，且仅需对7%的女性进行筛查。若将20岁及以下女性纳入，将需要对27%的女性进行筛查，并能检测出72%的感染病例。
基于风险因素对孕妇进行选择性衣原体筛查可提高筛查效率。然而，需要考虑被排除女性中漏诊感染的潜在危害。
