Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Sex Transm Dis. 2013 Feb;40(2):97-102. doi: 10.1097/OLQ.0b013e31827bd637.
We critically reviewed randomized controlled trials evaluating chlamydia screening to prevent pelvic inflammatory disease (PID) and explored factors affecting interpretation and translation of trial data into public health prevention. Taken together, data from these trials offer evidence that chlamydia screening and treatment is an important and useful intervention to reduce the risk of PID among young women. However, the magnitude of benefit to be expected from screening may have been overestimated based on the earliest trials. It is likely that chlamydia screening programs have contributed to declines in PID incidence through shortening prevalent infections, although the magnitude of their contribution remains unclear. Program factors such as screening coverage as well as natural history factors such as risk of PID after repeat chlamydia infection can be important in determining the impact of chlamydia screening on PID incidence in a population. Uptake of chlamydia screening is currently suboptimal, and expansion of screening among young, sexually active women remains a priority. To reduce transmission and repeat infections, implementation of efficient strategies to treat partners of infected women is also essential. Results of ongoing randomized evaluations of the effect of screening on community-wide chlamydia prevalence and PID will also be valuable.
我们批判性地回顾了评估衣原体筛查以预防盆腔炎 (PID) 的随机对照试验，并探讨了影响将试验数据转化为公共卫生预防措施的解释和翻译的因素。综上所述，这些试验的数据提供了证据，表明衣原体筛查和治疗是减少年轻女性 PID 风险的重要且有用的干预措施。然而，基于最早的试验，预计筛查带来的益处可能被高估了。衣原体筛查计划可能通过缩短流行感染来降低 PID 的发病率，尽管其贡献的程度仍不清楚。计划因素，如筛查覆盖率，以及复发性衣原体感染后 PID 的风险等自然史因素，在确定衣原体筛查对人群中 PID 发病率的影响方面可能很重要。目前，衣原体筛查的接受度并不理想，扩大对年轻、有性行为活跃的女性的筛查仍然是当务之急。为了减少传播和重复感染，对受感染女性的伴侣进行有效治疗的实施也至关重要。正在进行的关于筛查对社区范围内衣原体流行率和 PID 影响的随机评估的结果也将具有重要价值。
