GENITAL CHLAMYDIA INFECTIONS IN SEXUALLY ACTIVE FEMALE ADOLESCENTS - DO WE REALLY NEED TO SCREEN EVERYONE

Purpose: To evaluate current Chlamydia trachomatis screening guideline s, which recommend that all sexually active female adolescents undergo ing a pelvic examination be tested for chlamydial infection, and deter mine if instead providers should target particular subpopulations of t hese adolescents. Methods: Data were collected from 148,650 sexually a ctive females, ages 15-19 years, tested by direct immunofluorescent an tibody in 160 family planning clinics from 1988-92. Trends in chlamydi a prevalence by demographic, behavioral, and clinical risk factors wer e analyzed. Logistic regression modeling was used to identify selectiv e screening criteria. Predictive models were developed for all years c ombined, as well as for the years when prevalence was highest and lowe st. Results: The prevalence of C, trachomatis in this population was 1 0%, with a 42% decrease (13.2-7.6%) over the 5-year period. Logistic r egression identified nine demographic, behavioral, and clinical predic tors (p < 0.0001) associated with chlamydial infections. Predictor mod els from the highest and lowest prevalence years varied little from th e combined model. Individual year predictor models showed poor sensiti vity and were similar for these 2 years. The screening criteria could not identify a group of adolescents with a prevalence less than 6%. Co nclusions: Several individual risk factors were strongly associated wi th C. trachomatis, but no single risk factor or combination of risk fa ctors used for selective screening could identify more than 42% of inf ections in our population. These findings support earlier national rec ommendations and the need for universal screening of sexually active f emale adolescents. (C) Society for Adolescent Medicine, 1997