Abstract
Background: Higher education students belong to the group of young sexually active persons, which is at high risk for Chlamydia Trachomatis Infection (CTI), a Sexually Transmitted Infection (STI) with worldwide increasing notifications. Recommendations for potential cost-effective screening programs are hindered by the lack of recent student population based data.
Objectives: To assess the current prevalence of CTI among asymptomatic students attending higher education through an opportunistic screening, and to identify factors strongly associated with CTI.
Methods: This cross-sectional study was conducted at a French student health center between October 2015 and March 2016. CTI testing, using nucleic acid amplification tests on first-void urine samples was proposed to all students attending the medical center except for STI-related consultation. Voluntary students were surveyed through an anonymous self-administered questionnaire about their sexual health history, sexual behavior and level of deprivation (EPICES score). Factors associated with CTI were identified using bivariate analysis and multivariate logistic regression.
Results: Among the 400 eligible students who accepted to be screened, 384 had interpretable laboratory results and were included in analysis. Overall prevalence of CTI was 6.3% [95%CI=4.1-9.3] (24 CTI positive students). Lifetime number of sexual partners (>2), and high deprivation score (EPICES ≥ 48.5) were identified as independent significant risk factors to be CTI carrier, with respective adjusted prevalence odds ratio (POR) of 12.9 [95%CI=2.6-234] and 6.8 [95%CI=2.3-18.9]. In this sample, using the lifetime number of sexual partners as a dichotomous screening factor (>2 or not) detected most of CTI cases (96%) and would have avoided 37% of students to be screened.
Conclusions: CTI prevalence is above previously described prevalence’s in France, consistent with reports showing a continuous increase in notified CTI. Cost-effective threshold may be reached, thus supporting a screening among asymptomatic students attending higher education in France regardless of gender and year of study. Targeted screening based on one element of the sexual activity pattern (“more than 2 lifetime sexual partners”) can identify most of the cases and be even more cost-effective. However, to be a relevant strategy, opportunistic screening must have an extended acceptance rate.
Citation
Chabanas B, Gerbaud L and Perreve A. Asymptomatic Chlamydia Trachomatis Infection: The Case for Screening Students Attending Higher Education, Targeted by the Lifetime Number of Sexual Partners. SM Journal of Infect Dis. 2018; 3(1): 1010s.