摘要：Objectives. We sought to determine the effectiveness of a systems-based intervention designed to increase Chlamydia trachomatis (CT) screening among adolescent boys. Methods. An intervention aimed at increasing CT screening among adolescent girls was extended to adolescent boys (14–18 years). Ten pediatric clinics in a health maintenance organization with an ethnically diverse population were randomized. Experimental clinics participated in a clinical practice improvement intervention; control clinics received traditional information on screening. Results. The intervention significantly increased CT screening at the experimental sites from 0% (baseline) to 60% (18-month posttest); control sites evidenced a change only from 0% to 5%. The overall prevalence of CT was 4%. Conclusions. Although routine CT screening is currently recommended only for young sexually active women, the present results show that screening interventions can be successful in the case of adolescent boys, among whom CT is a moderate problem. Chlamydia trachomatis (CT) infection is a major public health epidemic, with 3 million new cases occurring annually, a disproportionate number of which involve adolescents. 1 Most infections are asymptomatic. 2 , 3 Young women, if not treated, are at risk for developing pelvic inflammatory disease, tubal infertility, ectopic pregnancy, and chronic pelvic pain. 2 Untreated young men are at risk for developing urethritis and epididymitis 4 – 6 ; more important, however, they may transmit CT to their female partners. The reproductive health care costs incurred by the US health system as a result of CT are estimated at $3 to $4 billion per year. 2 Consequently, all major policy groups recommend screening sexually active young women aged 15 to 25 years for CT infection, 7 – 10 but only the American Medical Association guidelines recommend screening sexually active male adolescents for genital CT via urine leukocyte esterase analysis. 11 The CT epidemic, especially asymptomatic infection, has been well documented among sexually active female adolescents. 12 , 13 Earlier studies in which prevalence data were gathered from sexually active male adolescents primarily involved high-risk populations of poor urban youths, youths in detention, young military populations, and school-based clinic samples. 14 – 18 Three recent studies focusing on prevalence rates among young adult men at lower risk are more indicative of rates among the overall young male population: the National Longitudinal Study of Adolescent Health documented a rate of 3.7% 19 ; we found a rate of 3.8% in our study of healthy, asymptomatic young adolescent males receiving routine care in the pediatric departments of a large health maintenance organization (HMO) 20 ; and a study conducted among young male army recruits revealed an infection rate of 5.3%. 21 This potentially significant but largely undetected pool of CT infection in the general young adult male population can contribute to the overall CT epidemic and merits further attention. With the advent of urine-based testing technologies, CT testing is more accessible, less invasive, and less expensive. The aim of this study was to increase CT screening among asymptomatic sexually active male adolescents and determine whether implementing a systems-based CT screening intervention was acceptable, feasible, and effective in a large HMO serving a multiethnic population of youths during pediatric health maintenance visits (HMVs).
