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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
Doctors can screen women for chlamydia by using either a swab of the cervix taken during a pelvic examination or urine samples. Until recently, the Centers for Disease Control and Prevention has recommended yearly screening for chlamydia in sexually active women younger than 25 years of age. Studies show that this strategy is cost-effective, which means that the benefits are worth the costs. However, because the Centers for Disease Control and Prevention noticed increases in repeated infection after treatment, it has changed its recommendation to include repeated testing after treatment for women who test positive. Also, since new studies show increases in infection in women older than 25 years of age, it has been suggested that screening continue up through 29 years of age. The cost-effectiveness of the new recommendations is unknown.
SUMMARIES FOR PATIENTS
The Cost-Effectiveness of Screening for Chlamydia in Women 15 to 29 Years of Age
5 October 2004 | Volume 141 Issue 7 | Page I-29
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
The summary below is from the full report titled "Screening for Chlamydia trachomatis in Women 15 to 29 Years of Age: A Cost-Effectiveness Analysis." It is in the 5 October 2004 issue of Annals of Internal Medicine (volume 141, pages 501-513). The authors are D. Hu, E.W. Hook III, and S.J. Goldie.
What is the problem and what is known about it so far?
Sexually transmitted diseases are infections that spread from one person to another during sexual relations. Chlamydia trachomatis is a bacterium causing a common sexually transmitted infection (chlamydia) in the United States. Chlamydia can cause discharge from the vagina or penis, pain with urination, or abdominal pain. However, some people with chlamydia have no symptoms. Treatment with antibiotic drugs is important to get rid of symptoms, stop the spread of infection to others, and prevent complications of the infections. In women, chlamydia can cause difficulties in becoming pregnant (infertility). Infections in pregnant women can lead to premature birth and other problems in newborns.
Why did the researchers do this particular study?
To find out whether the costs of the new chlamydia screening recommendations are worth the potential benefits.
Who was studied?
Rather than studying actual patients, the researchers used computers to simulate what would happen to a "virtual" group of sexually active women 15 to 29 years of age.
How was the study done?
The researchers used published information to estimate what might happen (and how much it would cost) if doctors followed each of the 4 following screening strategies: 1) no chlamydia screening, 2) yearly screening for sexually active women 15 to 29 years of age, 3) yearly screening followed by a repeated test within 6 months of any positive test result, and 4) screening every 6 months for women with previous infection.
What did the researchers find?
Yearly chlamydia screening for women 15 to 29 years of age followed by screening every 6 months for those with a history of infection was the most effective and most cost-effective strategy.
What were the limitations of the study?
The study was a computer simulation, so we cannot be sure what the results would be with actual patients.
What are the implications of the study?
Extending chlamydia screening to include women up through 29 years of age and to provide more frequent screening for women with previous infections seems to be a cost-effective use of resources in comparison to other well-accepted medical practices.
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