Igm. Van Valkengoed et al., Low diagnostic accuracy of selective screening criteria for asymptomatic Chlamydia trachomatis infections in the general population, SEX TRANS I, 76(5), 2000, pp. 375-380
Objectives: To develop and validate selective screening criteria for asympt
omatic Chlamydia trachomatis infections in the general population.
Methods: 11 505 people, aged 15-40 years, registered in 16 general practice
s in Amsterdam were invited to return by mail a home obtained first void ur
ine sample and a questionnaire. Participants were randomly allocated into a
development group (75%) or a validation group (25%). C trachomatis infecti
on was determined by the ligase chain reaction. In the development group a
set of criteria was identified by means of stepwise logistic regression ana
lysis. The diagnostic accuracy (area under the ROC curve; AUG) and sensitiv
ity, and the corresponding percentage of people selected for screening were
calculated. The criteria developed in this study were applied to the valid
ation 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 m
en, based on Surinam/Antillean origin and painful micturition, yielded an A
UC 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, yi
elded an AUC of 0.67 (0.65-0.69). Application of the criteria for men to th
e 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 Amst
erdam is less than 3%. No suitable selective screening criteria for the gen
eral population could be identified.