Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective

Do the characteristics of sexual health centre clients predict chlamydia infection sufficiently strongly to allow selective screening?

Jane Hocking A B D and Christopher K. Fairley B C
+ Author Affiliations
- Author Affiliations

A Macfarlane Burnet Institute for Medical Research and Public Health, GPO Box 2284, Melbourne, VIC 3001, Australia.

B Sexual Health Unit, School of Population Health, University of Melbourne, Melbourne, VIC 3010, Australia.

C Melbourne Sexual Health Centre, Carlton, VIC 3053, Australia.

D Corresponding author. Email:

Sexual Health 2(3) 185-192
Submitted: 8 March 2005  Accepted: 20 May 2005   Published: 20 September 2005


Objectives: This study aimed to estimate chlamydia prevalence and risk factors for infection and to assess the performance of chlamydia-selective screening criteria among clients attending a large sexually transmitted infection (STI) clinic. Methods: Computerised records for all attendances between 1 July 2002 and 30 June 2003 were analysed. Chlamydia prevalence and risk factors for infection were determined for all new clients. The sensitivity and specificity of risk factors for chlamydia were assessed. Results: 2642 male and 2084 female new clients were tested for chlamydia with a prevalence of 7.3% (95% CI: 6.3%, 8.4%) among men and 3.9% (95% CI: 3.1%, 4.9%) among women. Screening heterosexual men based on a positive contact or symptoms of non-specific urethritis or any two of age < 25 years, 4+ partners last 12 months, inconsistent condom use or not presenting for an asymptomatic screen detected 88% of infections by screening 62%. Screening women based on a positive contact or injecting drug use or any two of age < 25 years, 2+ partners last 12 months or inconsistent condom use would detect 86% of infections by screening 57%. Conclusions: Selective screening could be used to more efficiently identify heterosexual men and women at risk of chlamydia.


JH was supported by the Victorian Health Promotion Foundation (VicHealth). The authors would like to thank Tim Kuo from the Melbourne Sexual Health Centre for extracting the data.


[1] National Notifiable Diseases Surveillance System. Number of notifications of chlamydial (NEC), Australia, 2003 by age group and sex, 2003.

[2] Peipert JF. Genital chlamydial infections. N Engl J Med 2003; 349 2424–30.
CrossRef | PubMed |

[3] Miller WC,  Hoffman IF,  Owen-O’Dowd J,  McPherson JT,  Privette A,  Schmitz JL, et al. Selective screening for chlamydial infections: which criteria to use? Am J Prev Med 2000; 18(2): 115–22.
CrossRef | PubMed |

[4] Van Valkengoed IGM,  Morré SA,  van den Brule AJC,  Meijer CJLM,  Devillé W,  Bouter LM, et al. Low diagnostic accuracy of selective screening criteria for asymptomatic Chlamydia trachomatis infections in the general population. Sex Trans Inf 2000; 76 375–80.
CrossRef |

[5] LaMontagne DS,  Fine DN,  Marrazzo JM. Chlamydia trachomatis infection in asymptomatic men. Am J Prev Med 2003; 24(1): 36–42.
CrossRef | PubMed |

[6] Chen MY,  Donovan B. Screening for genital Chlamydia trachomatis infection: are men the forgotten reservoir? Med J Aust 2003; 179 124–5.
PubMed |

[7] Williams H,  Tabrizi SN,  Lee W,  Kovacs GT,  Garland S. Adolescence and other risk factors for Chlamydia trachomatis genitourinary infection in women in Melbourne, Australia. Sex Trans Inf 2003; 79 31–4.
CrossRef |

[8] Heal C,  Jones B,  Veitch C,  Lamb S,  Hodgens S,  Browning S, et al. Screening for chlamydia in general practice. Aust Fam Phys 2002; 31(8): 779–82.

[9] Victorian Venereology Society and the Australasian College of Sexual Health Physicians. National management guidelines for sexually transmissible infections. Carlton: Venerology Society of Victoria Incorporated; 2002.

[10] Australasian College of Sexual Health Physicians. Sexually transmitted infection testing guidelines for men who have sex with men. 2004. Available online at: (verified August 2005).

[11] Gaydos CA,  Theodore M,  Dalesio N,  Wood BJ,  Quinn TC. Comparison of three nucleic acid amplification tests for detection of Chlamydia trachomatis in urine specimens. J Clin Microbiol 2004; 42(7): 3041–5.
CrossRef | PubMed |

[12] Prostitution Control Act 1994 (Victoria) and Prostitution Control (Amendment) Act 1997. Available online at: (verified August 2005).

[13] LaMontagne DS,  Patrick E,  Fine DN,  Marrazzo JM. Re-evaluating selective screening criteria for chlamydial infection among women in the U.S. Pacific northwest. Sex Trans Dis 2004; 31(5): 283–9.
CrossRef |

[14] Stata Statistical Software. Release 8.1 [program]: College Station, TX: Stata Corporation, 2003.

[15] Marrazzo J,  Celum CL,  Hillis SD,  Fine D,  DeLisle S,  Handsfield HH. Performance and cost-effectiveness of selective screening criteria for Chlamydia trachomatis infection in women. SexTrans Dis 1997; 24(3): 131–41.

[16] Handsfield HH,  Jasman LL,  Roberts PL,  Hanson VW,  Kothenbeutel RL,  Stamm WE. Criteria for selective screening for Chlamydia trachomatis infection in women attending family planning clinics. JAMA 1986; 255(13): 1730–4.
CrossRef | PubMed |

[17] Weinstock HS,  Bolan GA,  Kohn R,  Balladeres C,  Back A,  Oliva G. Chlamydia trachomatis infection in women: a need for universal screening in high prevalence populations. Am J Epidemiol 1992; 135(1): 41–7.
PubMed |

[18] Addiss DG,  Vaughn ML,  Holzhueter MA,  Bakken LL,  Davis JP. Selective screening for Chlamydia trachomatis infection in nonurban family planning clinics in Wisconsin. Fam Plan Persp 1987; 19(6): 252–6.

[19] Stergachis A,  Scholes D,  Heidrich FE,  Sherer DM,  Holmes KK,  Stamm WE. Selective screening for Chlamydia trachomatis infection in a primary care population of women. Am J Epidemiol 1993; 138(3): 143–53.
PubMed |

[20] Marrazzo JM,  Fine D,  Celum CL,  DeLisle S,  Handsfield HH. Selective screening for chlamydial infection in women: a comparison of three sets of criteria. Fam Plan Persp 1997; 29 158–62.

[21] Han Y,  Coles FB,  Hipp S. Screening criteria for Chlamydia trachomatis in family planning clinics: accounting for prevalence and clients’ characteristics. Fam Plan Persp 1997; 29 163–6.

[22] Addiss DG,  Vaughn ML,  Golubjatnikov R,  Pfister J,  Kurtycz DF,  Davis J. Chlamydia trachomatis infection in women attending urban midwestern family planning and community health clinics: risk factors, selective screening, and evaluation of non-culture techniques. Sex Trans Dis 1990; 17(3): 138–46.

[23] Verhoeven V,  Avonts D,  Meheus A,  Goossens H,  Ieven M,  Chapelle S, et al. Chlamydial infection: an accurate model for opportunistic screening in general practice. Sex Trans Inf 2003; 79 313–7.
CrossRef |

[24] National Centre in HIV Epidemiology and Clinical Research. HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2003. Sydney, NSW: National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales; 2003.

[25] Anderson RM . Transmission dynamics of sexually transmitted infections. In: Holmes KK, Mardh P-A, Sparling PF, et al., editors. Sexually transmitted diseases. 3rd edn. New York: McGraw Hill; 1999. pp. 25–38.

Rent Article (via Deepdyve) Export Citation Cited By (6)