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Clinical question: What is the diagnostic value and effectiveness of the following screening methods in identifying genital Chlamydia: age, urine testing, endocervical swabs, serum antibody testing, history?

Bibliographic referenceReason for exclusion
Title: Association between bacterial vaginosis or chlamydial infection and miscarriage before 16 weeks’ gestation: prospective community based cohort study Authors: Oakeshott P;Hay P;Hay S;Steinke F;Rink E;Kerry S; Journal: British Medical Journal Year: 2002 Dec 7Data given for bacterial vaginosis only
Title: Detection of Chlamydia trachomatis infection in early pregnancy using self-administered vaginal swabs and first pass urines: a cross-sectional community-based survey Authors: Oakeshott P;Hay P;Hay S;Steinke F;Rink E;Thomas B;Oakeley P;Kerry S; Journal: British Journal of General Practice Year: 2002 OctNot relevant for the guideline question
Title: Detection of Chlamydia trachomatis in pregnant women by the Papanicolaou technique, enzyme immunoassay and polymerase chain reaction. Authors: Banuelos Panuco CA; Journal: Acta Cytologica Year: 2000 MarStudy population not relevant for the guideline question -predominantly symptomatic pregnant women
Title: Enzyme immunoassay for detection of asymptomatic chlamydia cervical infection in pregnant adolescents Authors: Oh MK; Journal: Adolescent and Pediatric Gynecology Year: 1989Population not relevant -pregnant teenagers below 17 years
Title: Prevalence of Chlamydia trachomatis infection among women in a multiphysician primary care practice Authors: Nelson ME; Journal: American Journal of Preventive Medicine Year: 1992 SepNot relevant for the guideline question -study on prevalence and risk factors for chlamydia
Title: Detection of Chlamydia trachomatis and Trichomonas vaginalis by polymerase chain reaction in introital specimens from pregnant women Authors: Witkin SS; Journal: American Journal of Obstetrics and Gynecology Year: 1996 JulComparison of PCR results from two different sites, no reference test
Title: The Preterm Prediction Study: association of second-trimester genitourinary chlamydia infection with subsequent spontaneous preterm birth Authors: Andrews WW; Journal: American Journal of Obstetrics and Gynecology Year: 2000 SepNot relevant for the guideline question -study on association between chlamydia ans spontaneous preterm labour
Title: Genital infections with Chlamydia trachomatis in women attending an antenatal clinic Authors: Wood PL; Journal: British Journal of Obstetrics and Gynaecology Year: 1984 DecNot relevant for the guideline question -isolation rate and follow up of pregant women with chlamydia (no comparison group)
Title: Prevalence of Chlamydia trachomatis and genital mycoplasmas in asymptomatic women Authors: Embil JA; Journal: Canadian Medical Association Journal Year: 1985 Jul 1Not relevant for the guideline question -determine the prevalence of chlamydia infection
Title: Study on vertical transmission of Chlamydia trachomatis using PCR and DNA sequencing Authors: Wu S; Journal: Chinese Medical Journal Year: 1999 MayNot relevant for the guideline question -study of vertical transmission of chlamydia infection
Title: Comparison of serological assays for detection of Chlamydia trachomatis antibodies in different groups of obstetrical and gynecological patients Authors: Bax CJ; Journal: Clinical and Diagnostic Laboratory Immunology Year: 2003 JanStudy population not relevant for the guideline question
Title: Screening for chlamydial infection Authors: Centre for Reviews and Dissemination.; Journal: Database of Abstracts of Reviews of Effects Year: 2007Abstract of quality assessment of a systematic review
Title: Accuracy of two enzyme immunoassays and cell culture in the detection of Chlamydia trachomatis in low and high risk populations in Senegal Authors: Van DE; Journal: European Journal of Clinical Microbiology and Infectious Diseases Year: 1992 JunPoor quality study -selected population, small sample, blinding not specified.
Title: Chlamydia trachomatis antigen detection in pregnancy and its verification by antibody blocking assay Authors: Malenie R; Journal: Indian Journal of Medical Microbiology Year: 2006 AprReference test not a standard one, blinding not specified.
Title: Chlamydia trachomatis infection & female infertility Authors: Malik A; Journal: Indian Journal of Medical Research Year: 2006Study population not relevant for the guideline question (women with primary and secondary infertility)
Title: A study of prevalence of Chlamydia trachomatis infection in women with first trimester pregnancy losses Authors: Avasthi K; Journal: Indian Journal of Pathology and Microbiology Year: 2003 JanStudy population not relevant for the guideline question -women with ectopic pregnancy and spontaneous abortion
Title: Prevalence of urogenital Chlamydia trachomatis infection in El Salvador. I. Infection during pregnancy and perinatal transmission Authors: Canas Posada AB; Journal: International Journal of STD and AIDS Year: 1992Reference test not a standard one, blinding not specified, study inclusion criterion not specified
Title: Effect of treatment for Chlamydia trachomatis during pregnancy Authors: Rastogi S; Journal: International Journal of Gynecology and Obstetrics Year: 2003Poor quality study -high drop out rate, confounding variables not controlled, no comparison between study population and those lost to follow up, no blinding of outcome assessors
Title: Rapid diagnosis of chlamydial infections with the MicroTrak direct test Authors: Uyeda CT; Journal: Journal of Clinical Microbiology Year: 1984 NovPopulation not relevant – women following termination of pregnancy
Title: Accuracy of Chlamydia trachomatis antigen detection methods in a low-prevalence population in a primary care setting Authors: Gann PH; Journal: Journal of Clinical Microbiology Year: 1990 JulStudy population made of only 18% women coming for prenatal care
Title: Detection of Chlamydia trachomatis in endocervical specimens by polymerase chain reaction Authors: Loeffelholz MJ; Journal: Journal of Clinical Microbiology Year: 1992 NovStudy population not representative and details not given, blinding not specified, better quality studies already included for the relevant test.
Title: Multiplex AMPLICOR PCR screening for Chlamydia trachomatis and Neisseria gonorrhoeae in women attenting non-sexually transmitted disease clinics. Authors: Bassiri M; Journal: Journal of Clinical Microbiology Year: 1997 OctStudy population not relevant for the guideline -women attending contraception clinic
Title: Detection of endocervical anti-Chlamydia trachomatis immunoglobulin A in pregnant women by a rapid, 6-minute enzyme-linked immunosorbent assay: comparison with PCR and chlamydial antigen detection methods Authors: Witkin SS; Journal: Journal of Clinical Microbiology Year: 1997 JulPoor quality study -population not representative, no blinding, reference test not a standard one.
Title: Use of ligase chain reaction with urine versus cervical culture for detection of Chlamydia trachomatis in an asymptomatic military population of pregnant and nonpregnant females attending Papanicolaou smear clinics Authors: Gaydos CA; Journal: Journal of Clinical Microbiology Year: 1998 MayOnly 30% of the study population comprised of pregnant women
Title: Use of pooled urine samples and automated DNA isolation to achieve improved sensitivity and cost-effectiveness of large-scale testing for Chlamydia trachomatis in pregnant women Authors: Rours GI; Journal: Journal of Clinical Microbiology Year: 2005 SepNot relevant for the guideline question -use of pooled samples
Title: Evaluation of near patient testing for Chlamydia trachomatis in a pregnancy termination service Authors: Hopwood J; Journal: Journal of Family Planning and Reproductive Health Care Year: 2001 JulEvaluation of a new procedure for extracting the lipopolysaccharide antigen of chlamydia
Title: Comparison of a DNA probe assay with culture for the detection of Chlamydia trachomatis Authors: Lees MI; Journal: Journal of Medical Microbiology Year: 1991 SepStudy population not relevant for the guideline question (539/909 not pregnant).
Title: Chlamydial infections in pregnancy Authors: FitzSimmons J; Journal: Journal of Reproductive Medicine Year: 1986 JanNot relevant for the guideline question -study on impact of chlamydia on pregnancy
Title: Pathfinder direct fluorescent antigen test for diagnosing maternal chlamydial infections. An evaluation Authors: Grossman JH; Journal: Journal of Reproductive Medicine Year: 1992 FebDrop out rate > 20%, blinding not specified, study population not described
Title: Frequency of Chlamydia trachomatis in pregnant women Authors: Kirmani N; Journal: JPMA -Journal of the Pakistan Medical Association Year: 1994 MarPoor quality study -population not representative, small ‘n’, blinding not specified, reference test not a standard one
Title: Health gains from screening for infection of the lower genital tract in women attending for termination of pregnancy. Authors: Blackwell AL; Journal: Lancet Year: 1993 Jul 24Effectiveness of treating all lower genital tract infections evaluated
Title: Fine-tuning the fluorescent antibody test for chlamydial infections in pregnancy Authors: Pastorek JG; Journal: Obstetrics and Gynecology Year: 1988 DecPopulation not representative (no inclusion/exclusion criterion, small ‘n’), better quality studies already included for the relevant test.
Title: A comparison of culture, direct fluorescent antibody test, and a quantitative indirect immunoperoxidase assay for detection of Chlamydia trachomatis in pregnant women Authors: Osborne NG; Journal: Obstetrics and Gynecology Year: 1988 MarPoor quality study -no blinding, population not representative, small ‘n’
Title: Diagnosis of chlamydial infection in pregnant women using the Testpack Chlamydia diagnostic kit Authors: Grossman III JH; Journal: Obstetrics and Gynecology Year: 1991Population not representative (at high risk of chlamydia infection), blinding not specified.
Title: Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in swab specimens by the Hybrid Capture II and PACE 2 nucleic acid probe tests Authors: Modarress KJ; Journal: Sexually Transmitted Diseases Year: 1999 MayStudy population not relevant for the guideline question -women and men attending STD and family planning clinics
Title: The association between Chlamydia trachomatis genital infection and spontaneous preterm labour Authors: Odendaal HJ; Journal: South African Journal of Obstetrics and Gynaecology Year: 2006Not relevant for the guideline question-study on association between chlamydia and spontaneous preterm labour
Title: Experience with the routine use of erythromycin for chlamydial infections in pregnancy Authors: Schachter J;Sweet RL;Grossman M;Landers D;Robbie M;Bishop E; Journal: New England Journal of Medicine Year: 1986 Jan 30Poor quality study -high drop out rate, confounding variables not controlled, no blinding of outcome assessors
Title: Incidence of chlamydial infection in pregnant women and the effectiveness of treatment in prevention of neonatal disease Authors: Khurana CM; Journal: Clinical Research Year: 1982Poor quality study
Title: Screening for Chlamydia trachomatis in asymptomatic women in Hungary. An epidemiological and cost-effectiveness analysis Authors: Nyari T;Nyari C;Woodward M;Meszaros G;Deak J;Nagy E;Kovacs L; Journal: Acta Obstetricia et Gynecologica Scandinavica Year: 2001 AprNot relevant for the guideline question -an epidemiological analysis
Title: Postabortal endometritis and isolation of Chlamydia trachomatis Authors: Barbacci MB;Spence MR;Kappus EW;Rao L;Quinn TC; Journal: Obstetrics and Gynecology Year: 1986Not relevant for the guideline question -association between chlamydia and postabortal endometritis
Title: Cervico-vaginal Chlamydia trachomatis infection in pregnant adolescent and adult women. A morphologic and immunofluorescent study Authors: Cavaliere MJ;Maeda MY;Shirata NK;Longatto FA;Shih LW;de Siqueira M;Muelenare Correa MG;Oliveira HF; Journal: Archives of Gynecology and Obstetrics Year: 1993Reference test not a standard one (Pap smear compared with DFA)
Title: High prevalence of chlamydia and Pap-smear abnormalities in pregnant adolescents warrants routine screening Authors: Quinlivan JA;Petersen RW;Gurrin LC; Journal: Australian and New Zealand Journal of Obstetrics and Gynaecology Year: 1998Study population not relevant for the guideline question -pregnant adolescents less than 17 years
Title: Screening for Chlamydia trachomatis infection in an inner-city population: a comparison of diagnostic methods Authors: Quinn TC;Warfield P;Kappus E;Barbacci M;Spence M; Journal: Journal of Infectious Diseases Year: 1985 AugAbout half of study population not relevant for the guideline question (women attending STD clinics and symptomatic men), blinding not specified. Better quality studies already included for the relevant test.
Title: Detection of Chlamydia trachomatis cervical infection: a comparison of Papanicolaou and immunofluorescent staining with cell culture Authors: Quinn TC;Gupta PK;Burkman RT;Kappus EW;Barbacci M;Spence MR; Journal: American Journal of Obstetrics and Gynecology Year: 1987 AugSelected population, high drop-out rate for Pap smear, better quality studies already included for the relevant tests
Title: Maternal genital Chlamydia trachomatis infection and the risk of preterm labor Authors: Ngassa PC;Egbe JA; Journal: International Journal of Gynaecology and Obstetrics Year: 1994 DecNot relevant for the guideline question -study on association between chlamydia and risk of preterm labour
Title: Chlamydia trachomatis infection in late pregnancy: A prospective study Authors: Preece PM;Ades A;Thompson RG;Brooks JH; Journal: Paediatric and Perinatal Epidemiology Year: 1989Study on natural history and complications of chlamydia infection in infants
Title: Chlamydia trachomatis infection in infants: A prospective study Authors: Preece PM;Anderson JM;Thompson RG; Journal: Archives of Disease in Childhood Year: 1989Study on natural history and complications of chlamydia infection in infants
Title: Chlamydia trachomatis infection in pregnancy: risk factor for an adverse outcome Authors: Rastogi S;Kapur S;Salhan S;Mittal A; Journal: British Journal of Biomedical Science Year: 1999Poor quality study -high drop-out rate, small sample, confounding variables not controlled, blinding not specified
Title: Screening positive urine pregnancy tests for sexually transmitted diseases expediates the treatment of infected adolescent gravidas. Authors: Stevens-Simon C;Rudnick M;Beach RK;Weinberg A; Journal: Journal of Maternal-Fetal and Neonatal Medicine Year: 2002Comparison of STD treatment rate by universal urine screening vs. clinics practice of endocervical testing at providers discretion -not relevant for the guideline question
Title: Chlamydia trachomatis infection among pregnant women: prevalence and prenatal importance Authors: Paul VK;Singh M;Gupta U;Buckshee K;Bhargava VL;Takkar D;Nag VL;Bhan MK;Deorari AK; Journal: National Medical Journal of India Year: 1999Not relevant for the guideline question -study comparing perinatal outcomes between chlamydia positive and negative pregnant women
Title: Screening for chlamydial infection Authors: Nelson HD;Hefland M; Journal: American Journal of Preventive Medicine Year: 2001Guideline by the US task force
Title: Prevalence of Chlamydia trachomatis infection in pregnant patients Authors: Much DH;Yeh SY; Journal: Public Health Reports Year: 1991 SepPoor quality study -high drop-out rate, confounding variables not controlled, blinding not specified.

From: Excluded studies

Cover of Antenatal Care
Antenatal Care: Routine Care for the Healthy Pregnant Woman.
NICE Clinical Guidelines, No. 62.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2008 Mar.
Copyright © 2008, National Collaborating Centre for Women’s and Children’s Health.

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