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Sex Transm Infect. Feb 2005; 81(1): 24–30.
PMCID: PMC1763735

A prediction rule for selective screening of Chlamydia trachomatis infection

Abstract

Background: Screening for Chlamydia trachomatis infections is aimed at the reduction of these infections and subsequent complications. Selective screening may increase the cost effectiveness of a screening programme. Few population based systematic screening programmes have been carried out and attempts to validate selective screening criteria have shown poor performance. This study describes the development of a prediction rule for estimating the risk of chlamydial infection as a basis for selective screening.

Methods: A population based chlamydia screening study was performed in the Netherlands by inviting 21 000 15–29 year old women and men in urban and rural areas for home based urine testing. Multivariable logistic regression was used to identify risk factors for chlamydial infection among 6303 sexually active participants, and the discriminative ability was measured by the area under the receiver operating characteristic curve (AUC). Internal validity was assessed with bootstrap resampling techniques.

Results: The prevalence of C trachomatis (CT) infection was 2.6% (95% CI 2.2 to 3.2) in women and 2.0% (95% CI 1.4 to 2.7) in men. Chlamydial infection was associated with high level of urbanisation, young age, Surinam/Antillian ethnicity, low/intermediate education, multiple lifetime partners, a new contact in the previous two months, no condom use at last sexual contact, and complaints of (post)coital bleeding in women and frequent urination in men. A prediction model with these risk factors showed adequate discriminative ability at internal validation (AUC 0.78).

Conclusion: The prediction rule has the potential to guide individuals in their choice of participation when offered chlamydia screening and is a promising tool for selective CT screening at population level.

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Selected References

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  • Götz Hannelore, Lindback Johan, Ripa Torvald, Arneborn Malin, Ramsted Kristina, Ekdahl Karl. Is the increase in notifications of Chlamydia trachomatis infections in Sweden the result of changes in prevalence, sampling frequency or diagnostic methods? Scand J Infect Dis. 2002;34(1):28–34. [PubMed]
  • van der Snoek EM, Götz HM, Mulder PGH, Verkooyen RP, van der Meijden WI. Prevalence of STD and HIV infections among attenders of the Erasmus MC STD clinic, Rotterdam, The Netherlands, during the years 1996 to 2000. Int J STD AIDS. 2003 Feb;14(2):119–124. [PubMed]
  • Wilson JS, Honey E, Templeton A, Paavonen J, Mårdh PA, Stray-Pedersen B. A systematic review of the prevalence of Chlamydia trachomatis among European women. Hum Reprod Update. 2002 Jul-Aug;8(4):385–394. [PubMed]
  • Egger M, Low N, Smith GD, Lindblom B, Herrmann B. Screening for chlamydial infections and the risk of ectopic pregnancy in a county in Sweden: ecological analysis. BMJ. 1998 Jun 13;316(7147):1776–1780. [PMC free article] [PubMed]
  • Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes KK, Stamm WE. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med. 1996 May 23;334(21):1362–1366. [PubMed]
  • Andersen B, Ostergaard L, Møller JK, Olesen F. Home sampling versus conventional contact tracing for detecting Chlamydia trachomatis infection in male partners of infected women: randomised study. BMJ. 1998 Jan 31;316(7128):350–351. [PMC free article] [PubMed]
  • Morré SA, van Valkengoed IG, de Jong A, Boeke AJ, van Eijk JT, Meijer CJ, van den Brule AJ. Mailed, home-obtained urine specimens: a reliable screening approach for detecting asymptomatic Chlamydia trachomatis infections. J Clin Microbiol. 1999 Apr;37(4):976–980. [PMC free article] [PubMed]
  • Morré SA, Van Valkengoed IG, Moes RM, Boeke AJ, Meijer CJ, Van den Brule AJ. Determination of Chlamydia trachomatis prevalence in an asymptomatic screening population: performances of the LCx and COBAS Amplicor tests with urine specimens. J Clin Microbiol. 1999 Oct;37(10):3092–3096. [PMC free article] [PubMed]
  • Ostergaard L, Andersen B, Olesen F, Moller JK. Efficacy of home sampling for screening of Chlamydia trachomatis: randomised study. BMJ. 1998 Jul 4;317(7150):26–27. [PMC free article] [PubMed]
  • Marrazzo JM, Fine D, Celum CL, DeLisle S, Handsfield HH. Selective screening for chlamydial infection in women: a comparison of three sets of criteria. Fam Plann Perspect. 1997 Jul-Aug;29(4):158–162. [PubMed]
  • Miller WC, Hoffman IF, Owen-O'Dowd J, McPherson JT, Privette A, Schmitz JL, Woodlief G, Leone PA. Selective screening for chlamydial infection: which criteria to use? Am J Prev Med. 2000 Feb;18(2):115–122. [PubMed]
  • Andersen Berit, van Valkengoed Irene, Olesen Frede, Møller Jens K, Østergaard Lars. Value of self-reportable screening criteria to identify asymptomatic individuals in the general population for urogential Chlamydia trachomatis infection screening. Clin Infect Dis. 2003 Apr 1;36(7):837–844. [PubMed]
  • van Valkengoed IG, Morré SA, van den Brule AJ, Meijer CJ, Devillé W, Bouter LM, Boeke AJ. Low diagnostic accuracy of selective screening criteria for asymptomatic Chlamydia trachomatis infections in the general population. Sex Transm Infect. 2000 Oct;76(5):375–380. [PMC free article] [PubMed]
  • van Bergen J, Götz HM, Richardus JH, Hoebe CJPA, Broer J, Coenen AJT. Prevalence of urogenital Chlamydia trachomatis increases significantly with level of urbanisation and suggests targeted screening approaches: results from the first national population based study in the Netherlands. Sex Transm Infect. 2005 Feb;81(1):17–23. [PMC free article] [PubMed]
  • Harrell FE, Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996 Feb 28;15(4):361–387. [PubMed]
  • Steyerberg Ewout W, Bleeker Sacha E, Moll Henriëtte A, Grobbee Diederick E, Moons Karel G M. Internal and external validation of predictive models: a simulation study of bias and precision in small samples. J Clin Epidemiol. 2003 May;56(5):441–447. [PubMed]
  • Steyerberg EW, Harrell FE, Jr, Borsboom GJ, Eijkemans MJ, Vergouwe Y, Habbema JD. Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. J Clin Epidemiol. 2001 Aug;54(8):774–781. [PubMed]
  • Harrell F. Regression coefficients and scoring rules. J Clin Epidemiol. 1996 Jul;49(7):819–819. [PubMed]
  • Van Houwelingen JC, Le Cessie S. Predictive value of statistical models. Stat Med. 1990 Nov;9(11):1303–1325. [PubMed]
  • Moons Karel G M, Harrell Frank E, Steyerberg Ewout W. Should scoring rules be based on odds ratios or regression coefficients? J Clin Epidemiol. 2002 Oct;55(10):1054–1055. [PubMed]
  • Krijnen P, van Jaarsveld BC, Steyerberg EW, Man in 't Veld AJ, Schalekamp MA, Habbema JD. A clinical prediction rule for renal artery stenosis. Ann Intern Med. 1998 Nov 1;129(9):705–711. [PubMed]
  • Fenton KA, Korovessis C, Johnson AM, McCadden A, McManus S, Wellings K, Mercer CH, Carder C, Copas AJ, Nanchahal K, et al. Sexual behaviour in Britain: reported sexually transmitted infections and prevalent genital Chlamydia trachomatis infection. Lancet. 2001 Dec 1;358(9296):1851–1854. [PubMed]
  • van den Hoek JA, Mulder-Folkerts DK, Coutinho RA, Dukers NH, Buimer M, van Doornum GJ. Opportunistische screening op genitale infecties met Chlamydia trachomatis onder de seksueel actieve bevolking in Amsterdam. I. Meer dan 90% deelname en bijna 5% prevalentie. Ned Tijdschr Geneeskd. 1999 Mar 27;143(13):668–672. [PubMed]
  • Verhoeven V, Avonts D, Meheus A, Goossens H, Ieven M, Chapelle S, Lammens C, Van Royen P. Chlamydial infection: an accurate model for opportunistic screening in general practice. Sex Transm Infect. 2003 Aug;79(4):313–317. [PMC free article] [PubMed]
  • Miller WC. Screening for chlamydial infection. A model program based on prevalence. Sex Transm Dis. 1998 Apr;25(4):201–210. [PubMed]
  • Paukku Maarit, Kilpikari Riika, Puolakkainen Mirja, Oksanen Hanna, Apter Dan, Paavonen Jorma. Criteria for selective screening for Chlamydia trachomatis. Sex Transm Dis. 2003 Feb;30(2):120–123. [PubMed]
  • Ennis M, Hinton G, Naylor D, Revow M, Tibshirani R. A comparison of statistical learning methods on the Gusto database. Stat Med. 1998 Nov 15;17(21):2501–2508. [PubMed]
  • Marshall RJ. The use of classification and regression trees in clinical epidemiology. J Clin Epidemiol. 2001 Jun;54(6):603–609. [PubMed]
  • van Dijk MR, Steyerberg EW, Stenning SP, Dusseldorp E, Habbema JDF. Survival of patients with nonseminomatous germ cell cancer: a review of the IGCC classification by Cox regression and recursive partitioning. Br J Cancer. 2004 Mar 22;90(6):1176–1183. [PMC free article] [PubMed]
  • van Valkengoed IG, Boeke AJ, Morré SA, van den Brule AJ, Meijer CJ, Devillé W, Bouter LM. Disappointing performance of literature-derived selective screening criteria for asymptomatic Chlamydia trachomatis infection in an inner-city population. Sex Transm Dis. 2000 Oct;27(9):504–507. [PubMed]

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