Dataset Information

Screening for Syphilis in Cases of Suspected Gonorrhea and Chlamydia Infections.

ABSTRACT: Background. In all cases of suspected sexually transmitted infections (STIs), it has been routine practice to screen for syphilis with a blood sample. The incidence of syphilis seems to be lower than that of commonly screened STIs. Objective. The objective of our study was to determine whether it is cost-effective to screen for syphilis with serological testing in cases of suspected gonorrhea and chlamydia infections. Hypothesis. Our hypothesis is that it is not cost-effective to screen for syphilis in cases of presumed gonorrhea and chlamydia infections. Methods. Our study is a New York Medical College institutional review board-approved retrospective study. During the period January 2004 to August 12, 2006, the laboratory work of all patients tested for gonorrhea and chlamydia in our emergency department was reviewed. The charts were reviewed for the following tests: gonorrhea DNA probe, chlamydia DNA probe, and syphilis IgG (immunoglobulin G)/RPR (rapid plasma reagin). The results of these tests were obtained and analyzed. Results. The total number of patients screened for gonorrhea and chlamydia during this period was 196. Seventy-eight patients tested positive for gonorrhea and chlamydia. All these 78 patients, tested negative for syphilis. The overall prevalence of positivity for STIs was 39.8% (78/196). The prevalence of chlamydia alone was 85.9% (67/78) and gonorrhea alone was 7.69% (6/78). The prevalence of combined both chlamydia and gonorrhea was 6.4% (5/78). Statistics. We used online SILICO 2 × 4 Fisher exact test. By comparing positive and negative results of serology RPR, GC, and chlamydia trap, the resultant 2-tailed P value is <.0001, which is statistically significant. Conclusions. Per our study, the yield of syphilis testing was negligible. It may not be cost-effective to screen for syphilis in cases of STIs such as gonorrhea and chlamydia.

SUBMITTER: Nibhanipudi KV

PROVIDER: S-EPMC5528914 | biostudies-other | 2017

REPOSITORIES: biostudies-other

ACCESS DATA

Similar Datasets

Project description:BackgroundA large trial to investigate the effectiveness of population based screening for chlamydia infections was conducted in the Netherlands in 2008-2012. The trial was register based and consisted of four rounds of screening of women and men in the age groups 16-29 years in three regions in the Netherlands. Data were collected on participation rates and positivity rates per round. A modeling study was conducted to project screening effects for various screening strategies into the future.Methods and findingsWe used a stochastic network simulation model incorporating partnership formation and dissolution, aging and a sexual life course perspective. Trends in baseline rates of chlamydia testing and treatment were used to describe the epidemiological situation before the start of the screening program. Data on participation rates was used to describe screening uptake in rural and urban areas. Simulations were used to project the effectiveness of screening on chlamydia prevalence for a time period of 10 years. In addition, we tested alternative screening strategies, such as including only women, targeting different age groups, and biennial screening. Screening reduced prevalence by about 1% in the first two screening rounds and leveled off after that. Extrapolating observed participation rates into the future indicated very low participation in the long run. Alternative strategies only marginally changed the effectiveness of screening. Higher participation rates as originally foreseen in the program would have succeeded in reducing chlamydia prevalence to very low levels in the long run.ConclusionsDecreasing participation rates over time profoundly impact the effectiveness of population based screening for chlamydia infections. Using data from several consecutive rounds of screening in a simulation model enabled us to assess the future effectiveness of screening on prevalence. If participation rates cannot be kept at a sufficient level, the effectiveness of screening on prevalence will remain limited.

Project description:BackgroundCholera surveillance relies on clinical diagnosis of acute watery diarrhea. Suspected cholera case definitions have high sensitivity but low specificity, challenging our ability to characterize cholera burden and epidemiology. Our objective was to estimate the proportion of clinically suspected cholera that are true Vibrio cholerae infections and identify factors that explain variation in positivity.Methods and findingsWe conducted a systematic review of studies that tested ≥10 suspected cholera cases for V. cholerae O1/O139 using culture, PCR, and/or a rapid diagnostic test. We searched PubMed, Embase, Scopus, and Google Scholar for studies that sampled at least one suspected case between January 1, 2000 and April 19, 2023, to reflect contemporary patterns in V. cholerae positivity. We estimated diagnostic test sensitivity and specificity using a latent class meta-analysis. We estimated V. cholerae positivity using a random-effects meta-analysis, adjusting for test performance. We included 119 studies from 30 countries. V. cholerae positivity was lower in studies with representative sampling and in studies that set minimum ages in suspected case definitions. After adjusting for test performance, on average, 52% (95% credible interval (CrI): 24%, 80%) of suspected cases represented true V. cholerae infections. After adjusting for test performance and study methodology, the odds of a suspected case having a true infection were 5.71 (odds ratio 95% CrI: 1.53, 15.43) times higher when surveillance was initiated in response to an outbreak than in non-outbreak settings. Variation across studies was high, and a limitation of our approach was that we were unable to explain all the heterogeneity with study-level attributes, including diagnostic test used, setting, and case definitions.ConclusionsIn this study, we found that burden estimates based on suspected cases alone may overestimate the incidence of medically attended cholera by 2-fold. However, accounting for cases missed by traditional clinical surveillance is key to unbiased cholera burden estimates. Given the substantial variability in positivity between settings, extrapolations from suspected to confirmed cases, which is necessary to estimate cholera incidence rates without exhaustive testing, should be based on local data.

Dataset Information

Screening for Syphilis in Cases of Suspected Gonorrhea and Chlamydia Infections.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets