Chlamydial infection: screening and treatment – adapted from Annals of Internal Medicine 1996;124;1-7 – Tips from Other Journals
Complications of Chlamydia trachomatis infection in women include pelvic inflammatory disease, infertility and chronic pain, while in men complications include urethritis and epididymitis. Infected pregnant women who deliver vaginally can infect the infant with chlamydial conjunctivitis and pneumonia. Identification of infected persons is difficult because symptoms may not prompt treatment, yet identification is important to prevent further spread of the infection. Genc, and Mardh used decision trees to perform a cost-effectiveness analysis of common screening tests and treatments, including the DNA amplification assay and single-dose treatment with azithromycin.
The authors considered a theoretic cohort of 1,000 women who were attending youth, gynecology and family planning clinics and who were undergoing endocervical testing for C. trachomatis. Demographics of these women were based on a group of women considered in a previous study. The prevalence of C. trachomatis in this group was 8.5 percent. Treatment with 1 g of azithromycin was further postulated.
Cost analysis revealed that when the prevalence of chlamydial infection exceeds 6 percent, screening with the DNA amplification assay and treatment with 1 g of azithromycin constitute the most cost-effective intervention strategy. At a prevalence of less than 6 percent, the value is less clear and the clinician must consider the benefit of preventing an illness caused by untreated chlamydial infection. In settings where concomitant infection with Neisseria gonorrhoea is common, treatment with cefiriaxone, 250 mg by intramuscular injection, is recommended.
The authors conclude that screening with DNA amplification assays, combined with single-dose azithromycin treatment for patients with positive results, combined with partner notification, is the mos cost-effective intervention strategy for women, especially in populations in which the prevalence of chlamydial infection is greater than 6 percent. (Gene M, et al. A cost-effectiveness analysis of screening and treatment for Chlamydia trachomatis infection in asymptomatic women. Ann Intern Med 1996;124:1-7.)
COPYRIGHT 1996 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group