HIV-1 seroprevalence rates in women and relinquishment of infants to the state in St Petersburg, Russia, 2002.

The effectiveness of rapid HIV-1 testing and nevirapine prophylaxis for HIV-infected mothers without prenatal care has been shown. We found that from 1998 to 2002, HIV-1 seroprevalence in women giving birth in St Petersburg, Russia increased 100-fold: from 0.013% to 1.3% (p<0.0001). HIV-1 seroprevalence was 8% (114 of 1466) in women without prenatal care and 1% (376 of 37645) in those with prenatal care (p<0.0001). All 376 HIV-1-infected women with, and 41% (47 of 114) of HIV-1-infected women without prenatal care received intrapartum antiretroviral therapy (p<0.0001). In women who were HIV-1 positive, 26% (30 of 114) of those without prenatal care and 4% (13 of 371) of those with prenatal care relinquished their infants to the custody of the state, compared with 1% (354 of 37 621) of HIV-1-negative women (p<0.0001).

Day care center attendance and diarrheal morbidity in Colombia.

This study was designed to determine whether day care center attendance was associated with increased risk of diarrheal disease among poor children in an urban, developing country setting. From July 17 to December 18, 1988, mothers of 493 Colombian children less than 5 years old (241 attendees and 252 nonattendees) were interviewed weekly about diarrheal events during the previous week. The incidence of diarrhea was greater for day care center attendees than for nonattendees (3.2 vs 2.0 episodes per child-year, P < .0005). For children less than 2 years of age, attendees experienced 7.2 episodes/child-year vs 3.5 episodes per child-year for nonattendees (P < .0005). Analyses controlling for water source and availability, excreta disposal, socioeconomic status, and duration of follow-up showed that the increased diarrheal risk was limited to children younger than 3 years of age spending more than 30 hours per week in the centers. In addition, although the risk among attendees of suffering diarrheal episodes of longer duration was fairly constant across levels of socioeconomic status, this risk was inversely proportional to socioeconomic status for nonattendees. In summary, the increase in risk of diarrhea among young, full-time day care attendees was modest, yet important, because diarrhea continues to be a major cause of morbidity and mortality in Colombian children.

Uterine size and risk of complications among women undergoing abdominal hysterectomy for leiomyomas.

OBJECTIVE: To measure the influence of uterine size on the risk of operative complications among women undergoing abdominal hysterectomy for uterine leiomyomas. METHODS: Four hundred forty-six women undergoing abdominal hysterectomy for pathologically confirmed leiomyomas were analyzed using data from a previously reported prospective cohort study. We compared the risk of operative complications among women with uterine weights less than 250 g, 251-500 g, and greater than 500 g. Logistic regression was used to estimate the independent effect of uterine size on the probability of operative complications. RESULTS: The risk of blood transfusion increased with increasing uterine weight; 13.7, 14.2, and 26.7% of women with uterine weight less than 250 g, 251-500 g, and greater than 500 g, respectively, required transfusion (P for trend < .05). After adjustment for race, previous surgery, preoperative weight, concurrent endometriosis, and type of insurance coverage, women with uterine weight greater than 500 g had increased odds of having a transfusion (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.3-4.3). These women also had increased odds of having an estimated blood loss greater than 500 mL (OR 2.5, 95% CI 1.5-4.2), vaginal cuff cellulitis (OR 2.8, 95% CI 1.3-6.2), and at least one of a number of operative complications (OR 1.6, 95% CI 1.0-4.0). CONCLUSION: Women with leiomyomas whose uterine weight exceeds 500 g have an increased risk of complications from abdominal hysterectomy.

Clinical and pathologic characteristics of women undergoing hysterectomy after tubal sterilization.

OBJECTIVE: To examine differences in clinical and pathologic characteristics between women undergoing hysterectomy who had had prior tubal sterilization and those who had not. METHODS: One thousand eight hundred fifty-one women undergoing hysterectomy were enrolled as part of a multicenter, prospective cohort study. We used logistic regression to describe the association between prior tubal sterilization and patient characteristics at hysterectomy. RESULTS: Although sterilized women were not more likely than nonsterilized women to have a menstrual disorder as a presenting complaint, they were more likely to have a primary discharge diagnosis of menstrual disorder (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.2-2.0). After adjustment for menstrual indices, sterilized women had an increased probability of having normal findings on pathologic examination, which differed by age (women less than 30 years: OR 3.4, 95% CI 2.0-5.8; women 30 years of age and older: OR 1.7, 95% CI 1.3-2.3). CONCLUSION: Differences in clinical and pathologic characteristics between sterilized and nonsterilized women suggest that nonbiologic factors may influence decision making regarding hysterectomy among sterlized women.

The effectiveness of hysterectomy for chronic pelvic pain.

OBJECTIVE: To evaluate the effectiveness of hysterectomy in treating chronic pelvic pain, and to identify risk factors for persistent pelvic pain. METHODS: A group of 308 women who had hysterectomy for chronic pelvic pain of at least 6 months' duration was followed-up for 1 year after surgery, as part of a large, prospective, multicenter cohort study. Persistent pain was defined as a trichotomous variable, and ordinal logistic regression was used to identify independent predictors of the trichotomous outcome. RESULTS: Overall, 74% of women experienced complete resolution of pelvic pain, 21% reported continued but decreased pain, and 5% reported either unchanged or increased pain after hysterectomy. In unadjusted analyses, women at increased risk for persistent pain (eg, continued but decreased, and unchanged or increased) included those who were under age 30 (36 versus 22%, P < .05), had a history of pelvic inflammatory disease (41 versus 25%, P < .05), were uninsured or covered under Medicaid (41 versus 22%, P < .001), had no identified pelvic pathology (38 versus 23%, P < .05), or had a history of at least two pregnancies (31, 27, and 15% for those with at least four, two or three, and one or none, respectively; P < .05). After adjustment, an increased probability of persistent pain was observed among women who had no identified pelvic pathology (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.0-3.6), were uninsured or covered under Medicaid (OR 2.3, 95% CI 1.2-4.3), or had experienced at least two pregnancies (OR 2.3, 95% CI 1.0-5.3). CONCLUSION: Most women with chronic pelvic pain have long-term improvement after hysterectomy. However, up to 40% of women in specific subgroups may continue to experience long-term pain.

Tubal sterilization and long-term risk of hysterectomy: findings from the United States collaborative review of sterilization. The U.S. Collaborative Review of Sterilization Working Group.

OBJECTIVE: To estimate the long-term probability of hysterectomy after sterilization according to demographic and clinical characteristics before the procedure. METHODS: We used a prospective, multi-center cohort study of 10,698 women undergoing tubal sterilization to examine the cumulative probability of hysterectomy up to 14 years after sterilization. Independent risk factors for subsequent hysterectomy were examined using the life-table approach and the Cox proportional hazards model. RESULTS: The cumulative probability of undergoing hysterectomy 14 years after sterilization was 17%. The highest long-term cumulative probabilities of hysterectomy occurred among women who, at the time of sterilization, reported a history of endometriosis (35%) or were older than 30 years and reported prolonged bleeding during menses (46%). Multivariate modeling demonstrated an independently increased risk of hysterectomy among women who, at the time of tubal sterilization, reported a history of heavy menstrual flow (relative risk [RR] 1.4; 95% confidence interval [CI] 1.1, 1.7), severe menstrual pain (RR 1.3; 95% CI 1.1, 1.6), bleeding of more than 7 days during menstrual cycles (RR 1.8; 95% CI 1.1, 2.8), pelvic inflammatory disease (RR 1.3; 95% CI 1.04, 1.7), ovarian cysts (RR 1.6; 95% CI 1.2, 2.0), endometriosis (RR 2.5; 95% CI 1.7, 3.9), or uterine leiomyomata (RR 2.7; 95% CI 2.0, 3.7). CONCLUSIONS: Although women with gynecologic disorders before tubal sterilization were at greater risk of hysterectomy during the 14 years after sterilization than were women without these disorders, the majority of sterilized women in both categories did not undergo subsequent hysterectomy.

Higher hysterectomy risk for sterilized than nonsterilized women: findings from the U.S. Collaborative Review of Sterilization. The U.S. Collaborative Review of Sterilization Working Group.

OBJECTIVE: To compare the risk of hysterectomy among previously sterilized women and women whose husbands had undergone vasectomy, and to evaluate whether this risk differed by age at surgical procedure or by method of tubal occlusion. METHODS: Our study population comprised 7718 women enrolled in a prospective, multicenter cohort study between 1978 and 1986. After stratifying by the woman's age at surgical procedure, we used the life-table approach and adjusted hazards ratios to examine whether the relative risk of hysterectomy during the 5 years after enrollment differed between the 7174 women who had been sterilized and the 544 women whose husbands had undergone vasectomy. RESULTS: The 5-year cumulative probability of hysterectomy was 8% among the previously sterilized women and 2% among the women whose husbands had undergone vasectomy. Among women 34 years of age and younger at enrollment, sterilized women were 4.4 times as likely to have a hysterectomy as women whose husbands had undergone vasectomy (95% confidence interval [CI] 1.9, 10.0). Findings were similar for women 35 years of age and older (rate ratio = 4.6; 95% CI 1.4, 14.5). Each of the six most commonly used methods of tubal occlusion was associated with an increased risk of hysterectomy. CONCLUSION: Women undergoing tubal sterilization were more likely than women whose husbands underwent vasectomy to undergo hysterectomy within 5 years after sterilization, regardless of age at sterilization. An increased risk of hysterectomy was observed for each method of tubal occlusion.

Complications of interval laparoscopic tubal sterilization: findings from the United States Collaborative Review of Sterilization.

OBJECTIVE: To estimate the risk of intraoperative or postoperative complications for interval laparoscopic tubal sterilizations. METHODS: We used a prospective, multicenter cohort study of 9475 women who had interval laparoscopic tubal sterilization to calculate the rates of intraoperative or postoperative complications. The relative safety of various methods was assessed by calculating overall complication rates for each major method of tubal occlusion. Method-related complication rates also were calculated and included only complications attributable to a method of occlusion. We used logistic regression to identify independent predictors of one or more complications. RESULTS: When we used a more restrictive definition of unintended major surgery, the overall rate of complications went from 1.6 to 0.9 per 100 procedures. There was one life-threatening event and there were no deaths. Complications rates for each of the four major methods of tubal occlusion ranged from 1.17 to 1.95, with no significant differences between them. When complication rates were calculated, the spring clip method had the lowest method-related complication rate (0.47 per 100 procedures), although it was not significantly different from the others. In adjusted analysis, diabetes mellitus (adjusted odds ratio [OR] 4.5; 95% confidence interval [CI] 2.3, 8.8), general anesthesia (OR 3.2; CI 1.6, 6.6), previous abdominal or pelvic surgery (OR 2.0; CI 1.4, 2.9), and obesity (OR 1.7; CI 1.2, 2.6) were independent predictors of one or more complications. CONCLUSION: Interval laparoscopic sterilization generally is a safe procedure; serious morbidity is rare.

Poststerilization regret: findings from the United States Collaborative Review of Sterilization.

OBJECTIVE: To evaluate the cumulative probability of regret after tubal sterilization, and to identify risk factors for regret that are identifiable before sterilization. METHODS: We used a prospective, multicenter cohort study to evaluate the cumulative probability of regret within 14 years after tubal sterilization. Participants included 11,232 women aged 18-44 years who had tubal sterilizations between 1978 and 1987. Actuarial life tables and Cox proportional hazards models were used to identify those groups at greatest risk of experiencing regret. RESULTS: The cumulative probability of expressing regret during a follow-up interview within 14 years after tubal sterilization was 20.3% for women aged 30 or younger at the time of sterilization and 5.9% for women over age 30 at sterilization (adjusted relative risk [RR] 1.9; 95% confidence interval [CI] 1.6, 2.3). For the former group, the cumulative probability of regret was similar for women sterilized during the postpartum period (after cesarean, 20.3%, 95% CI 14.5, 26.0; after vaginal delivery, 23.7%, 95% CI 17.6, 29.8) and for women sterilized within 1 year after the birth of their youngest child (22.3%, 95% CI 16.4, 28.2). For women aged 30 or younger at sterilization, the cumulative probability of regret decreased as time since the birth of the youngest child increased (2-3 years, 16.2%, 95% CI 11.4, 21.0; 4-7 years, 11.3%, 95% CI 7.8, 14.8; 8 or more years, 8.3%, 95% CI 5.1, 11.4) and was lowest among women who had no previous births (6.3%, 95% CI 3.1, 9.4). CONCLUSION: Although most women expressed no regret after tubal sterilization, women 30 years of age and younger at the time of sterilization had an increased probability of expressing regret during follow-up interviews within 14 years after the procedure.

Visits to emergency departments for gynecologic disorders in the United States, 1992-1994.

OBJECTIVE: To assess rates of visits to emergency departments for gynecologic disorders among women of reproductive age in the United States. METHODS: Data from the National Hospital Ambulatory Medical Care Survey for 1992-1994 were analyzed to determine rates of visits to emergency departments among women, ages 15-44 years. Average annual rates per 1000 women were calculated using age, race, and region-specific population estimates. Rate ratios were used to compare rates among subgroups. RESULTS: Approximately 1.4 million gynecologic visits were made to emergency departments annually, for an average annual rate of 24.3 visits per 1000 women, ages 15-44 years (95% confidence interval [CI] 22.0, 26.6). The most frequent diagnoses were pelvic inflammatory disease (average annual rate 5.8, 95% CI 5.0, 6.6), lower genital tract infections including sexually transmitted diseases (average annual rate 5.7, 95% CI 4.8, 6.6), and menstrual disorders (average annual rate 2.9, 95% CI 2.3, 3.5). Nearly half of all gynecologic visits resulted in diagnoses of genital tract infections. Younger women (ages 15-24 years) were 2.3 (95% CI 2.0, 2.6) times as likely as older women (ages 25-44 years), and black women were 3.6 (95% CI 2.9, 4.3) times as likely as white women, to visit emergency departments for gynecologic disorders. Rate ratios for genital tract infections were 10-20 times higher for younger black women than for older, white women. CONCLUSION: Almost half of gynecologic visits to emergency departments were related to genital tract infections, which largely are preventable.

Requesting information about and obtaining reversal after tubal sterilization: findings from the U.S. Collaborative Review of Sterilization.

OBJECTIVE: To determine the cumulative probabilities over 14 y of requesting information on sterilization reversal and of obtaining a reversal and to identify risk factors observable at sterilization for both measures of regret. DESIGN: The U.S. Collaborative Review of Sterilization, a prospective cohort study. SETTING: Fifteen medical centers in 9 cities. PATIENT(S): 11,232 women. MAIN OUTCOME MEASURE(S): Cumulative probabilities of requesting information on reversal and undergoing reversal. RESULT(S): The 14-y cumulative probability of requesting reversal information was 14.3% (95% confidence interval [CI], 12.4%-16.3%). Among women aged 18 to 24 y at sterilization, the cumulative probability was 40.4% (95% CI, 31.6%-49.2%). Women aged 18 to 24 y were almost 4 times as likely to request reversal information as were women > or = 30 years of age (adjusted rate ratio [RR], 3.5; 95% CI, 2.8-4.4). Number of living children was not associated with requesting reversal information. The overall cumulative probability of obtaining reversal was 1.1% (95% CI, 0.5-1.6). Younger women (18 to 30 y) were more likely to obtain reversal (RR, 7.6; 95% CI, 3.2-18.3). CONCLUSION(S): Women who were sterilized at a young age had a high chance of later requesting information about reversal, regardless of their number of living children.

Multicity HIV seroprevalence in street youth, Ukraine.

We conducted the first systematic, community-based, multicity assessment outside the USA of HIV seroprevalence, risk factors and linkage into clinical services among 929 street youth. After city-wide mapping, we used time-location sampling and randomly selected 74 venues in Odesa, Kyiv and Donetsk, Ukraine. Rapid HIV testing with post-test counselling was offered to all eligible youths aged 15-24 years. Overall, 18.4% (95% confidence interval 16.2-20.2) were HIV positive and 85% had previously unknown status. Rates were identical by sex. Subgroups with highest rates included orphans (26%), youths with histories of exchanging sex (35%), sexually transmitted infections (STIs) (37%), injection drug use (IDU) (42%) and needle sharing (49%). Independent predictors, similar across age groups and city, included being orphaned, time on the street, history of anal sex, STIs, exchanging sex, any drug use, IDU and needle sharing. Two-thirds (68%) of HIV-positive youths were linked to services. This high-risk population has many immediate needs.

PID prevention: clinical and societal stakes.

Pelvic inflammatory disease continues to take its physical, psychological, and financial tolls. Prompt treatment of symptomatic disease and screening of asymptomatic or mildly symptomatic women for the major causative organism--Chlamydia trachomatis--are the keys to preventing serious sequelae, such as chronic pelvic pain, ectopic pregnancy, and infertility.

The cost effectiveness of azithromycin for Chlamydia trachomatis infections in women.

BACKGROUND AND OBJECTIVES: Azithromycin, an approved single-dose therapy for cervical chlamydia infections, costs four times as much as doxycycline, the standard multidose theapy. GOAL OF THIS STUDY: This study examined whether azithromycin is cost effective for treating cervical chlamydia infections. STUDY DESIGN: Two diagnostic strategies were compared: 1) laboratory confirmation of chlamydia, and 2) presumptive diagnosis from the perspective of the healthcare system and the publicly funded clinic. RESULTS: From the healthcare perspective, the cost per case of pelvic inflammatory disease prevented with azithromycin ranges from a savings of $3,502 for laboratory confirmation to a cost of $792 for presumptive diagnosis. From the publicly funded clinic perspective, the cost per case of pelvic inflammatory disease prevented ranges from $709 for lab-confirmed diagnosis to $3,969 for presumptive treatment. CONCLUSION: For the healthcare system, azithromycin is a cost-effective alternative to doxycycline. However, the cost of azithromycin must decrease markedly for it to be less costly to the publicly funded clinic.

Adverse childhood experiences and sexual risk behaviors in women: a retrospective cohort study.

CONTEXT: Adverse childhood experiences such as physical abuse and sexual abuse have been shown to be related to subsequent unintended pregnancies and infection with sexually transmitted diseases. However, the extent to which sexual risk behaviors in women are associated with exposure to adverse experiences during childhood is not well-understood. METHODS: A total of 5,060 female members of a managed care organization provided information about seven categories of adverse childhood experiences: having experienced emotional, physical or sexual abuse; or having had a battered mother or substance-abusing, mentally ill or criminal household members. Logistic regression was used to model the association between cumulative categories of up to seven adverse childhood experiences and such sexual risk behaviors as early onset of intercourse, 30 or more sexual partners and self-perception as being at risk for AIDS. RESULTS: Each category of adverse childhood experiences was associated with an increased risk of intercourse by age 15 (odds ratios, 1.6-2.6), with perceiving oneself as being at risk of AIDS (odds ratios, 1.5-2.6) and with having had 30 or more partners (odds ratios, 1.6-3.8). After adjustment for the effects of age at interview and race, women who experienced rising numbers of types of adverse childhood experiences were increasingly likely to see themselves as being at risk of AIDS: Those with one such experience had a slightly elevated likelihood (odds ratio, 1.2), while those with 4-5 or 6-7 such experiences had substantially elevated odds (odds ratios, 1.8 and 4.9, respectively). Similarly, the number of types of adverse experiences was tied to the likelihood of having had 30 or more sexual partners, rising from odds of 1.6 for those with one type of adverse experience and 1.9 for those with two to odds of 8.2 among those with 6-7. Finally, the chances that a woman first had sex by age 15 also rose progressively with increasing numbers of such experiences, from odds of 1.8 among those with one type of adverse childhood experience to 7.0 among those with 6-7. CONCLUSIONS: Among individuals with a history of adverse childhood experiences, risky sexual behavior may represent their attempts to achieve intimate interpersonal connections. Having grown up in families unable to provide needed protection, such individuals may be unprepared to protect themselves and may underestimate the risks they take in their attempts to achieve intimacy. If so, coping with such problems represents a serious public health challenge.

Adverse childhood experiences and sexually transmitted diseases in men and women: a retrospective study.

OBJECTIVE: Adverse childhood experiences (ACEs) may have long-term consequences on at-risk behaviors that lead to an increased risk of sexually transmitted diseases (STDs) during adulthood. Therefore, we examined the relationship between ACEs and subsequent STDs for both men and women. METHODS: A total of 9323 (4263 men and 5060 women) adults >/=18 years of age participated in a retrospective cohort study evaluating the association between ACEs and self-reported STDs. Participants were adult members of a managed care organization who underwent routine medical evaluations and completed standardized questionnaires about 7 categories of ACEs, including emotional, physical, or sexual abuse; living with a battered mother; and living with a substance-abusing, mentally ill, or criminal household member. Logistic regression was used to model the association between the cumulative categories of ACEs (range: 0-7) and a history of STDs. RESULTS: We found that 59% (2986) of women and 57% (2464) of men reported 1 or more categories of adverse experiences during childhood. Among those with 0, 1, 2, 3, 4 to 5, and 6 to 7 ACEs, the proportion with STDs was 4.1%, 6.9%, 8.0%, 11.6%, 13.5%, and 20.7% for women and 7.3%, 10.9%, 12.9%, 17.1%, 17.1%, and 39.1% for men. After adjustment for age and race, all odds ratios for reporting an STD had confidence intervals that excluded 1. Among those with 1, 2, 3, 4 to 5, and 6 to 7 ACEs, the odds ratios were 1.45, 1.54, 2.22, 2. 48, and 3.40 for women and 1.46, 1.67, 2.16, 2.07, and 5.3 for men. CONCLUSIONS: We observed a strong graded relationship between ACEs and a self-reported history of STDs among adults.

Risk factors for a complicated clinical course among women hospitalized with pelvic inflammatory disease.

The aim of this study was to identify factors ascertainable at initial presentation that predict a complicated clinical course in HIV-negative women hospitalized with pelvic inflammatory disease (PID). We used data from a cross-sectional study of women admitted for clinically diagnosed PID to a public hospital in New York City. A complicated clinical course was defined as undergoing surgery, being readmitted for PID, or having a prolonged hospital stay (> or = 14 days) but no surgery. Logistic regression was used to identify independent predictors of complications. In adjusted analyses, older age (> or = 35 years) was a risk factor for prolonged hospital stay (adjusted odds ratio [OR] = 3.9; 95% confidence interval [CI] = 1.3-11.6) and surgery (OR = 10.4; CI = 2.5-44.1); self-reported drug use was a risk factor for readmission for PID (OR = 7.7; CI = 1.4-41.1) and surgery (OR = 6.2; CI = 1.8-20.5). Older age and self-reported drug use appear to be independent risk factors for a complicated clinical course among women hospitalized with PID.

Risk factors for recurrent Chlamydia trachomatis infections in women.

OBJECTIVE: We evaluated risk factors for recurrent Chlamydia trachomatis infections in women. STUDY DESIGN: We used a retrospective cohort design to examine predictors of recurrent infection in the 38,866 female residents of Wisconsin whose first reported C. trachomatis infection occurred between 1985 and 1989. RESULTS: Young age at first reported infection was the strongest predictor of recurrent C. trachomatis infection, after adjustment for covariates. Adolescents < 15 years old had an eightfold increased risk, those 15 to 19 years old had a fivefold increased risk, and women 20 to 29 years old had a twofold increased risk of recurrent C. trachomatis infection, compared with that among women 30 to 44 years old. In 54% of those aged < 15 at initial infection and 30% of those aged 15 to 19, recurrence developed. Other characteristics associated with recurrence included black race, residence in Milwaukee County, coinfection with gonorrhea, and past sexually transmitted diseases; receiving care in a family-planning clinic appeared protective. CONCLUSIONS: Implementation of strategies to reduce the markedly elevated risk of recurrent chlamydia infections is urgently needed in female adolescents.

Chlamydia trachomatis infection among Hispanic women in the California-Mexico border area, 1993: establishing screening criteria in a primary care setting.

BACKGROUND: Chlamydia prevalence and transmission patterns in California-Mexico border communities are unknown, and selective screening strategies for Hispanic populations have not been evaluated. GOAL OF THIS STUDY: To determine chlamydia prevalence among Hispanic women in the California-Mexico border area and established screening criteria. STUDY DESIGN: This was a cross-sectional prevalence survey of family planning/prenatal Hispanic clients (n = 2378) in San Diego and Imperial Counties, California, and Tijuana, Mexico. RESULTS: Overall, chlamydia prevalence was 3.2% (3.3% in California; 2.1% in Mexico). Women born in Mexico or those who visited Mexico for at least 1 week in the recent past had a prevalence rate similar to women without those characteristics. Multivariate analysis showed that young age (less than 25 years old), unmarried status, or having clinical signs of a chlamydia syndrome (primarily cervicitis) or vaginosis independently predicted chlamydia infection. Applying minimum screening criteria recommended by the Centers for Disease Control would require screening less than half of the clients. However, only 69% of infections would be identified. Using survey-based criteria (less than 25 years old, unmarried, and clinical signs of a chlamydia syndrome) would require screening 64% of clients, but would identify 92% of those infected. CONCLUSION: Chlamydia prevalence among Hispanic women seeking reproductive healthcare was similar (< 5%) on both sides of the California-Mexico border. Among Hispanic women, using easily obtained demographic data (age and marital status) and clinical signs (primarily cervicitis), an effective selective screening strategy can be implemented.

PIP: During January 1-October 15, 1993, three clinics in Imperial County, California, located east of the coastal mountain range which borders Baja California; a large community health center in San Diego County, California; and a public health/family planning clinic in Tijuana in Baja California, Mexico, successfully screened 2378 Hispanic women for Chlamydia trachomatis. The overall chlamydia prevalence was 3.2% (2.1% in Tijuana; 3.3% in California). Chlamydia was more common among the prenatal clients than family planning clients (4.7% vs. 2.6%; p 0.02). Adolescents had the highest chlamydia infection rate (7.5%). Women born in Mexico or those who visited Mexico for at least one week during the last three months had a similar chlamydia prevalence rate as those born in the US or those who had not visited Mexico recently. The multivariate analysis revealed that significant independent predictors of chlamydia infection included young age (25 years) (prevalence ratio [PR] = 4.5 for 20 years and 2.5 for 20-24 years), unmarried status (PR = 2), high risk sex behavior (PR = 1.1), exposure to a sexually transmitted disease (PR = 2.6), discharge/bleeding (PR = 1.4), vaginosis (PR = 3.6), and cervicitis (i.e., chlamydia syndrome) (PR = 6). If the clinics had applied the minimum screening criteria recommended by the US Centers for Disease Control, less than 50% of the clients would have been screened. Yet it would have identified only 69% of chlamydia infections. If clinics would apply the criteria identified in this survey, they would need to screen 64% of their clients, which would identify 92% of clients infected with chlamydia. These findings indicate that, in the California-Mexico border region, chlamydia prevalence among Hispanic women seeking reproductive health care was comparable. They also show that clinics can implement an effective selective screening strategy.