FEASIBILITY AND YIELD OF SCREENING URINE FOR CHLAMYDIA-TRACHOMATIS BYPOLYMERASE CHAIN-REACTION AMONG HIGH-RISK MALE YOUTH IN FIELD-BASED AND OTHER NONCLINIC SETTINGS - A NEW STRATEGY FOR SEXUALLY-TRANSMITTED DISEASE-CONTROL

Background: Inner city youth are at disproportionate risk for Chlamydi a trachomatis infection. Identification of infected individuals is ham pered by the often asymptomatic nature of infection and access and uti lization barriers to clinic-based screening services. The feasibility and yield of screening urine for C. trachomatis by polymerase chain re action was studied among high-risk male youth outside traditional clin ic settings. Methods: As part of a community-level sexually transmitte d disease (STD) prevention program among high-risk youth in Denver, ou treach workers enrolled subjects, administered questionnaires, and col lected first-catch urine samples in nonclinical facility-based and fie ld-based settings. Facility settings consisted of community/recreation centers, high-schools, and an STD/human immunodeficiency virus preven tion storefront. Field settings included alleys, parking lots, parks, and residences, Individuals who tested C. trachomatis positive were co ntacted by program outreach workers and provided with standard treatme nt and partner notification services. Results: Over a 20 month period, 486 urine specimens were collected, 32 (6.6%) of which were C. tracho matis positive, Rates were higher for subjects screened in the field t han in facility settings (11.9% vs, 4.4%, P < 0.05). Subjects with chl amydial infection were more likely to have had vaginal intercourse in the previous 30 days (adjusted odds ratio: 2.9) and to have been recru ited in field settings (adjusted odds ratio: 2.5). Of subjects with ch lamydial infection, 31/32 (97%) were treated within a median of 8 days after urine collection.Conclusions: Urine chlamydial screening by pol ymerase chain reaction of sexually active male youth in nontraditional settings appears to be feasible and to provide yields similar to thos e reported in standard clinic settings. Evaluation of samples easily c ollected in nonclinic locations holds great promise as an additional s trategy for the control of chlamydial infection and other STD among di fficult-to-reach populations.