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Contraception. 2015 Oct;92(4):313-8. doi: 10.1016/j.contraception.2015.06.012. Epub 2015 Jun 17.

Risk-based screening for Chlamydia trachomatis and Neisseria gonorrhoeae prior to intrauterine device insertion.

Author information

1
Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, Saint Louis, MO, 63110. Electronic address: grentzerj@wudosis.wustl.edu.
2
Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, Saint Louis, MO, 63110.

Abstract

OBJECTIVE:

The objective was to compare three strategies for Chlamydia trachomatis and Neisseria gonorrhoeae screening prior to intrauterine device (IUD) insertion.

STUDY DESIGN:

This was a secondary analysis of the Contraceptive CHOICE Project. We measured the prevalence of C. trachomatis and/or N. gonorrhoeae at the time of IUD insertion. We then compared sensitivity, specificity, negative and positive predictive values, and likelihood ratios for three screening strategies for C. trachomatis and N. gonorrhoeae prior to IUD insertion: (a) "age-based" — age ≤25 years alone; (b) "age/partner-based" — age ≤25 and/or multiple sexual partners; and (c) "risk-based" — age ≤25, multiple sexual partners, inconsistent condom use and/or history of prior sexually transmitted infection (STI).

RESULTS:

Among 5087 IUD users, 140 (2.8%) tested positive for C. trachomatis, 16 (0.3%) tested positive for N. gonorrhoeae, and 6 (0.1%) were positive for both at the time of IUD insertion. The "risk-based" screening strategy had the highest sensitivity (99.3%) compared to "age-based" and "age/partner-based" screening (80.7% and 84.7%, respectively.) Only one (0.7%) woman with a chlamydia or gonorrhea infection would not have been screened using "risk-based" screening.

CONCLUSION:

A risk-based strategy to screen for C. trachomatis and N. gonorrhoeae prior to IUD insertion has higher sensitivity than screening based on age alone or age and multiple sexual partners.

IMPLICATIONS:

Using a risk-based screening strategy (age≤25, multiple sexual partners, inconsistent condom use and/or history of an STI) to determine who should be screened for C. trachomatis and N. gonorrhoeae prior to IUD insertion will miss very few cases of infection and obviates the need for universal screening.

KEYWORDS:

Chlamydia; Contraception; Gonorrhea; Intrauterine device; Sexually transmitted infections

[Indexed for MEDLINE]
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