Age-Based Screening Is Cost-Effective Method To Control Chlamydial Infection

February 17, 1998

Screening all women younger than 30 years of age may be the most cost-effective method of stopping or limiting chlamydial infections and their consequences according to an article in the February 15 issue of Annals of Internal Medicine.

Investigators from the National Institute of Allergy and Infectious Diseases (NIAID) and Johns Hopkins University compared three strategies to screen 7,699 women without symptoms who attended two family planning clinics in Baltimore, Md. In addition to the age-based screening found to be most effective, investigators evaluated universal screening and screening with the criteria recommended by the Centers for Disease Control and Prevention (CDC). All women were tested with polymerase chain reaction (PCR). They calculated the cost-effectiveness of chlamydial screening by comparing total costs, including screening program costs, and estimating future medical costs of all sequelae.

"Certainly one of the great values of this study," says Anthony S. Fauci, M.D., director of NIAID, "is the confirmation that screening enables clinicians to identify and treat women with chlamydial infections and no symptoms, thus preventing many occurrences of serious sequelae, such as infertility."

Chlamydial infection is one of the leading sexually transmitted diseases in the United States today. The CDC estimates that more than 4 million new cases occur each year. Pelvic inflammatory disease, a serious complication of chlamydial infection, has emerged as a major cause of infertility among women of childbearing age.

Genital chlamydial infection is caused by the bacterium, Chlamydia trachomatis, and is transmitted during vaginal or anal sexual contact with an infected partner. A pregnant woman may pass the infection to her newborn during delivery, with subsequent neonatal eye infection or pneumonia. The annual cost of chlamydial infections and their sequelae in the United States exceeds $2.7 billion.

"The majority of women infected with Chlamydia do not have symptoms, and damage to their fallopian tubes resulting in infertility can occur silently over time if the infection remains undiagnosed and not treated," said author Thomas C. Quinn, M.D., of NIAID and Johns Hopkins University, Baltimore, Md. "In our study, 6.6 percent of women attending the Baltimore family planning clinics were found to be infected. Because of the initial lack of symptoms and signs, most of these women would not have been diagnosed or treated if they had not undergone routine screening for Chlamydia using either urine or cervical specimens. New and simple tests make screening easier."

Currently, the CDC recommends testing all women with evidence of an inflamed cervix and all women younger than 20 years of age. They also suggest: (1) testing women 20 to 23 years of age who have not consistently used barrier contraception or have had a new sex partner or more than one sex partner during the past 90 days; and (2) testing women 24 years of age or older who have not consistently used barrier contraception and have had a new sex partner or more than one sex partner during the past 90 days.

The investigators compared each screening strategy's ability to identify women at risk and thus trigger testing and treatment, which in turn would result in fewer or no sequelae and reduced overall medical costs. They defined medical outcomes as prevented cases of pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy, infertility, male urethritis and epididymitis in adults, and conjunctivitis and pneumonia in infants.

The results were dramatic. Without screening, there would have been 152 cases of pelvic inflammatory disease and other sequelae in women, men and infants with an associated cost of $676,000. Screening according to CDC criteria would have prevented 64 cases of pelvic inflammatory disease and saved $231,000.

Screening all women younger than 30 years of age would have prevented 85 cases of pelvic inflammatory disease and saved $305,000. Universal screening would have prevented an additional six cases, but would have cost considerably more than age-based screening -- approximately $3,000 more per case of pelvic inflammatory disease prevented.

The authors caution that although the study results suggest that age-based screening provides the greatest cost savings, universal screening is desirable is some situations. In general, screening with any criteria and a highly sensitive diagnostic test should be part of any chlamydial prevention and control program.

NIAID has a major commitment to develop new sexually transmitted disease (STD) diagnostic tests that are rapid, inexpensive, easy-to-use and do not require an invasive sample. If such tests were available and acceptable to the patient, screening for "silent" STDs would be even more cost-effective.

Authors, in addition to Dr. Quinn, are M. Rene Howell, M.A., and Charlotte A. Gaydos, Dr.P.H., both of the Division of Infectious Diseases at Johns Hopkins University in Baltimore, Md.

NIAID, part of the National Institutes of Health (NIH), supports biomedical research to prevent, diagnose and treat illnesses such as AIDS, tuberculosis, malaria, asthma and allergies. NIH is an agency of the U.S. Department of Health and Human Services.

Press releases, fact sheets and other NIAID-related materials are available via the NIAID home page at http://www.niaid.nih.gov.
-end-


NIH/National Institute of Allergy and Infectious Diseases

Related Infectious Diseases Articles from Brightsurf:

Understanding the spread of infectious diseases
Physicists at M√ľnster University (Germany) have shown in model simulations that the COVID-19 infection rates decrease significantly through social distancing.

Forecasting elections with a model of infectious diseases
Election forecasting is an innately challenging endeavor, with results that can be difficult to interpret and may leave many questions unanswered after close races unfold.

COVID-19 a reminder of the challenge of emerging infectious diseases
The emergence and rapid increase in cases of coronavirus disease 2019 (COVID-19), a respiratory illness caused by a novel coronavirus, pose complex challenges to the global public health, research and medical communities, write federal scientists from NIH's National Institute of Allergy and Infectious Diseases (NIAID) and from the Centers for Disease Control and Prevention (CDC).

Certain antidepressants could provide treatment for multiple infectious diseases
Some antidepressants could potentially be used to treat a wide range of diseases caused by bacteria living within cells, according to work by researchers in the Virginia Commonwealth University School of Medicine and collaborators at other institutions.

Opioid epidemic is increasing rates of some infectious diseases
The US faces a public health crisis as the opioid epidemic fuels growing rates of certain infectious diseases, including HIV/AIDS, hepatitis, heart infections, and skin and soft tissue infections.

Infectious diseases could be diagnosed with smartphones in sub-Saharan Africa
A new Imperial-led review has outlined how health workers could use existing phones to predict and curb the spread of infectious diseases.

The Lancet Infectious Diseases: Experts warn of a surge in vector-borne diseases as humanitarian crisis in Venezuela worsens
The ongoing humanitarian crisis in Venezuela is accelerating the re-emergence of vector-borne diseases such as malaria, Chagas disease, dengue, and Zika virus, and threatens to jeopardize public health gains in the country over the past two decades, warn leading public health experts.

Glow-in-the-dark paper as a rapid test for infectious diseases
Researchers from Eindhoven University of Technology (The Netherlands) and Keio University (Japan) present a practicable and reliable way to test for infectious diseases.

Math shows how human behavior spreads infectious diseases
Mathematics can help public health workers better understand and influence human behaviors that lead to the spread of infectious disease, according to a study from the University of Waterloo.

Many Americans say infectious and emerging diseases in other countries will threaten the US
An overwhelming majority of Americans (95%) think infectious and emerging diseases facing other countries will pose a 'major' or 'minor' threat to the U.S. in the next few years, but more than half (61%) say they are confident the federal government can prevent a major infectious disease outbreak in the US, according to a new national public opinion survey commissioned by Research!America and the American Society for Microbiology.

Read More: Infectious Diseases News and Infectious Diseases Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.