The utility and cost of Chlamydia trachomatis and Neisseria gonorrhoeae screening of a male infertility population

Abstract

Objective: To determine the utility and cost of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) screening in infertile males.

Design: Cohort study.

Setting: Canadian tertiary-level male infertility clinic and university-affiliated laboratories.

Patient(s): 5,588 male infertility patients.

Intervention(s): CT and NG testing on 8,972 urine and semen samples.

Main outcome measure(s): Prevalence of CT and NG infection in infertile males versus general male population in Canada over 8 years (2003-2010) and the reagent cost to detect one case of CT or NG.

Result(s): In infertile males, the prevalence rate for CT and NG was 0.304% and 0.0537%, which was statistically significantly lower (3.4- and 8.1-fold lower, respectively) than the age-adjusted general population prevalence. With the reagents costing $86.20 per patient tested, the reagent cost alone to diagnose one case of CT or NG was $38,669.

Conclusion(s): The prevalence of CT and NG in this study are among the lowest reported in the male infertility literature. These findings question the utility of CT/NG screening in this low-risk population and emphasize that decisions about the utility of screening must be based on the prevalence rates of the disease in the studied population.