Clinical predictors of Chlamydia trachomatis endocervicitis in adolescent women. Looking for the right combination
G. Remafedi and S. E. Abdalian
Department of Pediatrics, Adolescent University of Minnesota, Minneapolis 55455.
Chlamydial disease in adolescent women is a serious public health problem,
but secondary preventive efforts through early detection and treatment are
encumbered by the cost and complexity of mass screening. This study was
undertaken to identify clinical predictors of infection that might narrow
the scope of screening adolescent populations. Demographic/clinical data
and endocervical smears for the direct-specimen fluorescein-conjugated
monoclonal antibody test for Chlamydia trachomatis were collected from 244
consecutive women, 21 years of age or less, attending an adolescent health
clinic. Positive direct-specimen fluorescein-conjugated monoclonal antibody
test for C trachomatis results were associated with a past history of
chlamydial infection, multiple sexual partners, sexual contact with men
with urethritis, nonuse of condoms, metrorrhagia, exocervicitis,
mucopurulent endocervical discharge, abnormal cervical cytologic features,
and isolation of Neisseria gonorrhoeae from the endocervix. These variables
were entered into a discriminant analysis to predict direct-specimen
fluorescein-conjugated monoclonal antibody test for C trachomatis results.
The discriminant function was statistically significant but explained only
17% of between-group variance. Two variables alone, exocervicitis and
partners with urethritis, correctly predicted direct-specimen
fluorescein-conjugated monoclonal antibody test for C trachomatis results
in 79% of all cases (negative predictive value 90%; positive predictive
value 35%). When routine screening with reliable laboratory tests is not
feasible, selective testing or empirical treatment of adolescent women with
either risk factor may be cost-effective alternatives.
