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Læknablaðið - 15.08.1995, Qupperneq 38

Læknablaðið - 15.08.1995, Qupperneq 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
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