Risk-based screening for Chlamydia trachomatis and Neisseria gonorrhoeae prior to intrauterine device insertion

Jaclyn M. Grentzer, Jeffrey F. Peipert, Qiuhong Zhao, Colleen McNicholas, Gina M. Secura, Tessa Madden

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

Objective The objective was to compare three strategies for Chlamydia trachomatis and Neisseria gonorrhoeae screening prior to intrauterine device (IUD) insertion. Study design This was a secondary analysis of the Contraceptive CHOICE Project. We measured the prevalence of C. trachomatis and/or N. gonorrhoeae at the time of IUD insertion. We then compared sensitivity, specificity, negative and positive predictive values, and likelihood ratios for three screening strategies for C. trachomatis and N. gonorrhoeae prior to IUD insertion: (a) "age-based" - age ≥ 25 years alone; (b) "age/partner-based" - age ≥; 25 and/or multiple sexual partners; and (c) "risk-based" - age ≥ 25, multiple sexual partners, inconsistent condom use and/or history of prior sexually transmitted infection (STI). Results Among 5087 IUD users, 140 (2.8%) tested positive for C. trachomatis, 16 (0.3%) tested positive for N. gonorrhoeae, and 6 (0.1%) were positive for both at the time of IUD insertion. The "risk-based" screening strategy had the highest sensitivity (99.3%) compared to "age-based" and "age/partner-based" screening (80.7% and 84.7%, respectively.) Only one (0.7%) woman with a chlamydia or gonorrhea infection would not have been screened using "risk-based" screening. Conclusion A risk-based strategy to screen for C. trachomatis and N. gonorrhoeae prior to IUD insertion has higher sensitivity than screening based on age alone or age and multiple sexual partners. Implications Using a risk-based screening strategy (age≥;25, multiple sexual partners, inconsistent condom use and/or history of an STI) to determine who should be screened for C. trachomatis and N. gonorrhoeae prior to IUD insertion will miss very few cases of infection and obviates the need for universal screening.

Original languageEnglish
Pages (from-to)313-318
Number of pages6
JournalContraception
Volume92
Issue number4
DOIs
StatePublished - Oct 1 2015

Keywords

  • Chlamydia
  • Contraception
  • Gonorrhea
  • Intrauterine device
  • Sexually transmitted infections

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