Gaydos C A, Howell M R, Pare B, Clark K L, Ellis D A, Hendrix R M, Gaydos J C, McKee K T, Quinn T C
Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
N Engl J Med. 1998 Sep 10;339(11):739-44. doi: 10.1056/NEJM199809103391105.
Asymptomatic genital Chlamydia trachomatis infections in women can lead to pelvic inflammatory disease, infertility, and ectopic pregnancy. To design a chlamydia-control program, we conducted a large survey of women in the U.S. military.
From January 1996 through December 1997, urine samples from 13,204 new female U.S. Army recruits from 50 states were screened by ligase chain reaction for C. trachomatis infection. Information on potential risk factors was obtained by questionnaire. With multivariate analysis, we identified criteria for a screening program.
The overall prevalence of chlamydial infection was 9.2 percent, with a peak of 12.2 percent among the 17-year-old recruits. The prevalence was 15 percent or more among the recruits from five southern states. The following risk factors were independently associated with chlamydial infection: having ever had vaginal sex (odds ratio for infection, 5.9), being 25 years of age or less (odds ratio, 3.0), being black (odds ratio, 3.4), having had more than one sex partner in the previous 90 days (odds ratio, 1.4), having had a new partner in the previous 90 days (odds ratio, 1.3), having had a partner in the previous 90 days who did not always use condoms (odds ratio, 1.4), and having ever had a sexually transmitted disease (odds ratio, 1.2). A screening program for subjects 25 years of age or less (87.9 percent of our sample) would have identified 95.3 percent of the infected women.
Among female military recruits, the prevalence of chlamydial infection is high. A control program that screens female recruits who are 25 years old or younger with urine DNA-amplification assays has the potential to reduce infection, transmission, and the sequelae of chlamydial infection.
女性无症状生殖系统沙眼衣原体感染可导致盆腔炎、不孕和异位妊娠。为设计衣原体控制项目，我们对美国军队中的女性进行了一项大型调查。
从1996年1月至1997年12月，采用连接酶链反应对来自美国50个州的13204名新入伍的美国陆军女性新兵的尿液样本进行沙眼衣原体感染筛查。通过问卷调查获取潜在风险因素的信息。通过多变量分析，我们确定了筛查项目的标准。
衣原体感染的总体患病率为9.2%，17岁新兵中的患病率最高，为12.2%。来自南部五个州的新兵中患病率为15%或更高。以下风险因素与衣原体感染独立相关：曾有过阴道性行为（感染比值比为5.9）、年龄在25岁及以下（比值比为3.0）、为黑人（比值比为3.4）、在过去90天内有多个性伴侣（比值比为1.4）、在过去90天内有新伴侣（比值比为1.3）、在过去90天内有不经常使用避孕套的伴侣（比值比为1.4）以及曾患性传播疾病（比值比为1.2）。对25岁及以下的受试者（占我们样本的87.9%）进行筛查的项目可识别出95.3%的感染女性。
在女性新兵中，衣原体感染患病率很高。用尿液DNA扩增检测法对25岁及以下的女性新兵进行筛查的控制项目有可能减少感染、传播以及衣原体感染的后遗症。
