Selective testing criteria for gonorrhea among young women screened for Chlamydial infection: contribution of race and geographic prevalence.

BACKGROUND: Selective screening criteria have been widely implemented for genital Chlamydia trachomatis (CT) infections but have rarely been developed for Neisseria gonorrhoeae (GC) infection.
METHODS: Women tested for CT in Washington State Infertility Prevention Project clinics in 2003 were also tested for GC using the Gen-Probe APTIMA COMBO 2 TMA assay. We derived 3 sets of selective testing criteria (STC) for gonorrhea, incorporating risk factors identified using logistic regression (STC-1), self-identified race (STC-2), and local rates of gonorrhea in men (STC-3).
RESULTS: Of 55,781 women, 173 (0.3%) tested positive for GC. STC-1 included exposure to sexually transmitted diseases, presumptive CT treatment at screening, a pregnancy-related visit, report of a symptomatic partner, dysuria, abnormal vaginal discharge, or a new sex partner during the preceding 60 days. These criteria identified 80% of cases while testing 47% of women. STC-2 added race (black/Native American) to STC-1 and identified 89% of cases while testing 52%. STC-3 added clinic location in a ZIP code area with male urethral GC infection rates in the top quartile of Washington State rates to STC-1 and identified 86% of cases while testing 58%.
CONCLUSIONS: Although testing criteria incorporating race were most specific, criteria including local area rates of GC infection in men had similar sensitivity and required testing only slightly more women.