Mosure D J, Berman S, Fine D, DeLisle S, Cates W, Boring J R
Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
J Adolesc Health. 1997 Jan;20(1):6-13. doi: 10.1016/S1054-139X(96)00157-7.
To evaluate current Chlamydia trachomatis screening guidelines, which recommend that all sexually active female adolescents undergoing a pelvic examination be tested for chlamydial infection, and determine if instead providers should target particular subpopulations of these adolescents.
Data were collected from 148,650 sexually active females, ages 15-19 years, tested by direct immunofluorescent antibody in 160 family planning clinics from 1988-92. Trends in chlamydia prevalence by demographic, behavioral, and clinical risk factors were analyzed. Logistic regression modeling was used to identify selective screening criteria. Predictive models were developed for all years combined, as well as for the years when prevalence was highest and lowest.
The prevalence of C. trachomatis in this population was 10%, with a 42% decrease (13.2-7.6%) over the 5-year period. Logistic regression identified nine demographic, behavioral, and clinical predictors (p < 0.0001) associated with chlamydial infections. Predictor models from the highest and lowest prevalence years varied little from the combined model. Individual year predictor models showed poor sensitivity and were similar for these 2 years. The screening criteria could not identify a group of adolescents with a prevalence less than 6%.
Several individual risk factors were strongly associated with C. trachomatis, but no single risk factor or combination of risk factors used for selective screening could identify more than 42% of infections in our population. These findings support earlier national recommendations and the need for universal screening of sexually active female adolescents.
评估当前沙眼衣原体筛查指南，该指南建议对所有接受盆腔检查的性活跃女性青少年进行衣原体感染检测，并确定医疗服务提供者是否应针对这些青少年中的特定亚人群进行检测。
收集了1988年至1992年期间在160家计划生育诊所接受直接免疫荧光抗体检测的148,650名年龄在15至19岁之间的性活跃女性的数据。分析了衣原体感染率按人口统计学、行为和临床风险因素的变化趋势。采用逻辑回归模型确定选择性筛查标准。针对所有年份综合建立预测模型，以及患病率最高和最低年份的预测模型。
该人群中沙眼衣原体的感染率为10%，在5年期间下降了42%（从13.2%降至7.6%）。逻辑回归确定了与衣原体感染相关的9个人口统计学、行为和临床预测因素（p < 0.0001）。患病率最高和最低年份的预测模型与综合模型差异不大。个别年份的预测模型敏感性较差，这两年相似。筛查标准无法识别出感染率低于6%的青少年群体。
几个个体风险因素与沙眼衣原体密切相关，但用于选择性筛查的单一风险因素或风险因素组合均无法识别出我们人群中超过42%的感染病例。这些发现支持了早期的国家建议以及对性活跃女性青少年进行普遍筛查的必要性。
