Mosure D J, Berman S, Kleinbaum D, Halloran M E
Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Am J Epidemiol. 1996 Nov 15;144(10):997-1003. doi: 10.1093/oxfordjournals.aje.a008870.
Screening guidelines recommend testing all sexually active female adolescents for Chlamydia trachomatis during a pelvic examination at each clinic visit. Such criteria have been based on cross-sectional studies; new evaluations should take into account multiple clinic visits and assess whether criteria are appropriate when a prior test is negative and risk factors are absent. Because repeated observations on an individual may be correlated, the authors used the generalized estimating equation method. Little information exists on subsequent risk of infection; as control programs develop, approaches targeting high-risk populations for recurrent infections are needed. Using data on females aged 15-19 years who visited family planning clinics more than once from 1988 to 1992 (n = 26,921) in Region X (Alaska, Idaho, Oregon, and Washington), the authors constructed a retrospective cohort. Teens with chlamydia at their first visit were at high risk for subsequent infection (odds ratio = 1.6, 95% confidence interval 1.4-1.7). Among teens uninfected at the first visit and without risk factors at the second, prevalence at the second visit was 6%. When intervisit correlations using the generalized estimating equation method were taken into account, predictors of chlamydial infection were consistent with those in previous cross sectional studies cervicitis, friable cervix, and multiple, new, or symptomatic sex partner(s). These findings support screening sexually active female adolescents at each visit, even if prior tests results are available.
筛查指南建议，在每次门诊进行盆腔检查时，对所有有性行为的女性青少年进行沙眼衣原体检测。这些标准是基于横断面研究得出的；新的评估应考虑多次门诊情况，并评估当先前检测结果为阴性且不存在风险因素时，这些标准是否合适。由于对个体的重复观察可能存在相关性，作者使用了广义估计方程法。关于后续感染风险的信息很少；随着防控项目的开展，需要针对反复感染的高危人群采取相应措施。作者利用1988年至1992年期间在X地区（阿拉斯加、爱达荷州、俄勒冈州和华盛顿州）多次前往计划生育诊所就诊的15至19岁女性的数据（n = 26,921），构建了一个回顾性队列。首次就诊时感染衣原体的青少年后续感染风险较高（优势比 = 1.6，95%置信区间1.4 - 1.7）。在首次就诊未感染且第二次就诊无风险因素的青少年中，第二次就诊时的患病率为6%。当考虑使用广义估计方程法计算就诊间的相关性时，衣原体感染的预测因素与先前横断面研究中的因素一致，即宫颈炎、宫颈易脆以及有多个新的或有症状的性伴侣。这些发现支持在每次就诊时对有性行为的女性青少年进行筛查，即使已有先前的检测结果。
