The clinical and economic consequences of screening young men for genital chlamydial infection

Sex Transm Dis. 2003 Feb;30(2):99-106. doi: 10.1097/00007435-200302000-00001.


Background: Wide-scale application of urine-based screening of asymptomatic men for chlamydial infection has not been thoroughly assessed.

Goal: The goal was to compare clinical and economic consequences of three strategies: (1). no screening, (2). screening with ligase chain reaction (LCR) assay of urine, and (3). prescreening urine with a leukocyte esterase test (LE) and confirming positives with LCR.

Study design: We used a decision analytic model.

Results: At a chlamydia prevalence of 5%, the no screening cost was US dollars 7.44 per man screened, resulting in 522 cases of pelvic inflammatory disease (PID) per 100000 men. LE-LCR was most cost-effective, preventing 242 cases of PID over no screening at an additional cost of US dollars 29.14 per male screened. The LCR strategy prevented 104 more cases of PID than LE-LCR but cost US dollars 22.62 more per male screened. For this to be more efficient than LE-LCR, the LCR assay cost needed to decline to <or=US dollars 18.

Conclusion: At a chlamydia prevalence of 5%, LE-LCR is the most efficient use of resources. If LCR cost decreases or chlamydia prevalence increases, the LCR strategy is favored.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Bacteriological Techniques
  • Carboxylic Ester Hydrolases / urine*
  • Chlamydia Infections / diagnosis*
  • Chlamydia Infections / epidemiology
  • Chlamydia Infections / prevention & control
  • Chlamydia trachomatis / genetics
  • Chlamydia trachomatis / isolation & purification*
  • Cost-Benefit Analysis
  • Decision Trees
  • Female
  • Genital Diseases, Male / diagnosis*
  • Genital Diseases, Male / epidemiology
  • Genital Diseases, Male / prevention & control
  • Humans
  • Ligase Chain Reaction / methods*
  • Male
  • Mass Screening* / economics
  • Pelvic Inflammatory Disease / prevention & control
  • Prevalence
  • Sensitivity and Specificity
  • Urine / microbiology


  • leukocyte esterase
  • Carboxylic Ester Hydrolases