Urine Tests Will Do Better Than Pelvic Exams To Save Teens From Serious Effects Of Sexually Transmitted Diseases, UCSF Analysis Shows

the chances that the disease will spread and prevent serious complications like Pelvic Inflammatory Disease (PID). The long term effects of PID, including infertility and ectopic or tubal pregnancies, can be painful, costly and life-threatening.

Shafer is professor of pediatrics and associate director of the adolescent medicine at UCSF. Her co-authors are Robert H. Pantell, MD, professor and chief of the division of general pediatrics, and Julius Schachter, PhD, professor of laboratory medicine. Shafer and Pantell care for children and adolescents as members of Lucile Packard Children's Health Services at UCSF. Schachter has been a leader in identifying the effects of chlamydia and other sexually transmitted diseases. He and Shafer first proposed using urine tests to screen adolescents for STDs in a letter to the New England Journal of Medicine in November, 1996, because urine test accuracy had been dramatically improved by new methods called amplified nucleic acid tests.

For their current study, Shafer and Schachter teamed up with Pantell to mathematically model the costs and benefits of urine test screening based on amplified nucleic acid tests such as the ligase chain reaction or LCR. In their mathematical model, the researchers calculated that if 90 percent of a population of 100,000 sexually active adolescent women received urine-based screening tests, the tests would detect 1,620 cases of gonorrhea and 4,860 cases of chlamydia.

Treatment of STDs detected in this cohort would help prevent 1,093 cases of PID. If pelvic exams were used as the sole screening method, only about 70 percent of adolescent women could be expected to agree to an exam, and an estimated 898 cases of PID would be prevented. The researchers calculated that the cost to protect each young woman from serious disease would be twice as much with a pelvic exam as with a urine test.

"Sexually transmitted diseases continue to be epidemic among adolescents, especially females," Sha

Contact: Janet Basu
University of California - San Francisco

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