The findings and conclusions in these presentations have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.

Thursday, May 11, 2006 - 9:30 AM
342

Selective screening for female gonococcal infection: including local area rates of male gonococcal urethritis as a criterion

Lisa Manhart, Department of Epidemiology, University of Washington, UW Center for AIDS and STD, 325 9th Ave., Box 359931, Seattle, WA, USA, David Fine, Center for Health Training, 1809 Seventh Avenue, Suite 400, Seattle, WA, USA, Roxanne P. Kerani, Public Health, Seattle King County, Seattle, WA, USA, Jeanne Marrazzo, Department of Medicine, University of Washington, 325 9th Ave, Mailbox 359931, Seattle, WA, USA, and Matthew R. Golden, Infectious Diseases, Public Health - Seattle & King County, University of Washington, Harborview Medical Center, 325 9th Ave., Box 359777, Seattle, WA, USA.


Background:
Selective screening criteria (SSC) for female Chlamydia trachomatis (CT) infection are broadly used, yet no such criteria exist for Neisseria gonorrhoeae (GC). Given the low population prevalence of GC, selective screening could significantly reduce the number of unnecessary tests.

Objective:
Develop SSC for female gonococcal infection in non-sexually transmitted disease (STD) clinic settings.

Method:
Women tested for CT in Washington State Region X Infertility Prevention Project (IPP) clinics in 2003 were also tested for GC using Aptima Combo 2. We defined risk factors for GC using logistic regression (GEE); estimated local gonorrhea rates for men using case report and census data aggregated by clinic zip code; and derived three sets of SSC from the risk factors and rates.

Result:
Of 61,189 women tested for CT, 57,534 (94%) had GC test results, and 193 (0.3%) tested positive. SSC-1 included basic risk factors [symptomatic partner, exposure to STD, new partner-past 60 days, attendance for STD screening, mucopurulent cervical discharge], and ectopy. SCC-2 included basic risk factors plus race (black or Native American), testing in correctional facilities, dysuria, and pregnancy. SCC-3 included basic risk factors, and presumptive treatment for CT, plus testing in clinics in the top quartile for GC rates in men, and testing in correctional facilities. SCC-1 (risk-factor-based) identified 85% of cases while screening 56% of women. SSC-2 (race-based) identified 91% of cases while screening 59% of women. SCC-3 (geography-based) identified 90% of cases while screening 63% of women.

Conclusion:
Although race-based screening criteria were more specific, geography-based criteria had equivalent sensitivity, and only slightly increased the number of women tested.

Implications:
Selective screening criteria can significantly reduce the number of unnecessary GC tests, with only a modest decrease in the total number of cases identified. Incorporating local GC rates in men may provide a more acceptable alternative to race-based screening.

See more of Gonorrhea and Chlamydia Screening and Interventions
See more of Oral and Poster

See more of The 2006 National STD Prevention Conference