Low diagnostic accuracy of selective screening criteria for asymptomatic Chlamydia trachomatis infections in the general population
- Irene G M van Valkengoed1,
- Servaas A Morré2,
- Adriaan J C van den Brule2,
- Chris J L M Meijer2,
- Walter Devillé1,
- Lex M Bouter1,
- A Joan P Boeke1
- 1Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, Netherlands
- 2University Hospital Vrije Universiteit, Department of Pathology, Section of Molecular Pathology, Amsterdam, Netherlands
- Dr A J P Boeke, Institute for Research in Extramural Medicine, Vrije Universiteit, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands ajp.boeke.emgo{at}med.vu.nl
- Accepted 29 June 2000
Abstract
Objectives: To develop and validate selective screening criteria for asymptomatic Chlamydia trachomatis infections in the general population.
Methods: 11 505 people, aged 15–40 years, registered in 16 general practices in Amsterdam were invited to return by mail a home obtained first void urine sample and a questionnaire. Participants were randomly allocated into a development group (75%) or a validation group (25%). C trachomatis infection was determined by the ligase chain reaction. In the development group a set of criteria was identified by means of stepwise logistic regression analysis. The diagnostic accuracy (area under the ROC curve; AUC) and sensitivity, and the corresponding percentage of people selected for screening were calculated. The criteria developed in this study were applied to the validation group.
Results: The prevalence of asymptomatic C trachomatis infections among men was found to be 2.4% (1.7–3.0), and among women 2.8% (2.2–3.4). Screening men, based on Surinam/Antillean origin and painful micturition, yielded an AUC of 0.58 (0.55–0.60). Screening women, based on Surinam/Antillean origin, new sex partner in the previous 2 months, and unmarried/not cohabiting, yielded an AUC of 0.67 (0.65–0.69). Application of the criteria for men to the validation group yielded an AUC of 0.53 (0.48–0.57); by screening 10% of the men, 15% of the cases were detected. The AUC of the criteria for women in the validation group was 0.58 (0.54–0.61); by screening 51% of the women, 63% of the cases were detected.
Conclusion: The prevalence of asymptomatic C trachomatis infections in Amsterdam is less than 3%. No suitable selective screening criteria for the general population could be identified.
