Screening for Chlamydia trachomatis in asymptomatic women in Hungary - An epidemiological and cost-effectiveness analysis

Background. A multicenter survey was carried out in order to determine the prevalence and risk factors for Chlamydia trachomatis infection in the popu lation of asymptomatic: women in Hungary. Results were used to carry out a cost-effectiveness analysis of screening for chlamydial infection in women with asymptomatic genital infections. Methods. The non-amplified nucleic acid hybridization method (PACE 2 Gen-Pr obe) was used to diagnose C. trachomatis and Bayes' theorem was applied to assess the prevalence of the infection. Multiple logistic regression analys is was performed to differentiate the risk factors for chlamydial infection s. Results. According to the test, the prevalence of Chlamydia trachomatis amo ng 1300 pregnant women was 4.5%. The sensitivity and specificity of the tes t are estimated to be 70% and 99%. respectively. After Bayes' correction, t he overall estimated prevalence of chlamydial infection was 5.1%. There wer e significant differences in proportions of chlamydial infection in differe nt regions, and also in different age groups and different family status gr oups. The highest rate was for women aged below 20 years: 16.9%. Cost-effec tiveness analysis, with associated sensitivity analysis was carried out for women aged below 20 years. Three screening strategies were compared: using the ELISA method, using amplified Gen-Probe method and no screening. The a mplified Gen-Probe method was best provided, the infection prevalence excee ded 16.7%, the PID rate exceeded 24% and the probability of tubal infertili ty in untreated women exceeded 25%. Conclusion. We conclude that screening with amplified Gen-Probe assays (fol lowed by treatment of positive patients) is the preferred screening strateg y for young women in Hungary.