Læknablaðið - 15.08.1995, Blaðsíða 38

614
LÆKNABLAÐIÐ 1995; 81
Chlamydia trachomatis infections
— is screening cost-effective?
Jorma Paavonen
Paavonen ,!
Læknblaðið 1995; 81: 614-7
Sexually transmitted Chlamydial infections are
widespread, and cause major social, medical, and
economic problems. Chlamydial infections are ap-
proximately 15 times more common than gonococcal
infections. Chlamydial infections are usually asymp-
tomatic. Thus, universal screening is the key to the
prevention of Chlamydial infections and their long-
term sequelae. The key for screening is a rapid and
reliable high performance diagnostic test. Many
women can benefit from PCR-based screening.
However, comprehensive socio-economic analyses
are urgently needed to augment decision makers to
make informed decisions of allocation of health re-
sources. Preliminary studies suggest that Chlamydia
screening is cost-effective since Chlamydial infec-
tions can be treated. The cost of Chlamydia screen-
ing is minimal compared to the costs created by
undetected Chlamydial infections. Such evaluations
are important to link prevention of STDs to preven-
tion of infertility and adverse pregnancy outcome in
public mind, and also help to link the cost of IVF or
adverse pregnancy outcome to STDs in health care
providers and legislators minds.
Introduction
Chlamydia is an intracellular bacteria-like
micro-organism. Chlamydia trachomatis pri-
marily causes genital infections, whereas Chla-
mydia pneumoniae primarily causes respira-
tory tract infections. Chlamydia psittacii is an
animal pathogen but can sometimes cause zoo-
nooses in humans. Of the 18 recognized sero-
types of C. trachomatis, serotypes D to K cause
Frá kvennadeild Háskólasjúkrahússins í Helsinki. Fyrir-
spurnir, bréfaskipti: Jorma Paavonen MD, Department of
Obstetrics and Gynecology, University of Helsinki, 00290
Helsinki, Finland.
Rannsóknin var kynnt á fundi sem haldinn var í Domus
Medica 29. apríl 1995. Greinar um aörar rannsóknir sem
kynntar voru á sama fundi birtust í 7. tbl. Læknablaösins
1995. Þessi grein barst of seint fyrir þá útgáfu.
genital and neonatal infections. Although the
serotypes E, F and D account for 60-70% of
the infections, there is no evidence that specif-
ic genital syndromes or clinical manifestations
are serotype specific.
C. trachomatis infections have been report-
able in Finland since 1987. However, the de-
cline in the incidence of Chlamydial infections
has been very slow, and much slower than in
the other Nordic countries. In 1993 10,204
Chlamydial infections were reported which is
almost the same as in the end of the 1980s. On
the other hand, gonococcal infections have de-
clined rapidly, and in 1993 only approximately
700 cases were reported in Finland. This sug-
gests that the epidemiologic control measures
that are effective against gonorrhea are gener-
ally not effective against Chlamydia. Low
screening activity for Chlamydial infections is
one probable explanation for the slow decline
of Chlamydial infections in Finland. Thus, de-
velopment and implementation of safe and ef-
fective intervention programs for prevention
and control of Chlamydial infections is the ma-
jor challenge in the 1990s.
Clinical manifestations of
Chlamydial infection
C. trachomatis is the major cause of muco-
purulent cervicitis (MPC) and pelvic inflam-
matory disease (PID) in women and urethritis
in men. The morbidity associated with Chla-
mydial infections is significantly higher in
women than in men. The proportion of all
cases with proven PID caused by C. trachoma-
tis varies depending on the clinical setting and
the study population, but in general well over
half of PID cases are caused by C. trachomatis,
with or without N. gonorrhoeae. While the
relative role of C. trachomatis in the etiology of
PID has increased, the clinical spectrum of the
manifestations of PID has also changed. An
increasing proportion of cases with PID are