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Sensitivity, Specificity, Prevalence, and Disease Stage
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IN RESPONSE:
I appreciate Dr. Redd's comment and agree that, in a statistical sense, neither sensitivity nor specificity should vary with disease prevalence. However, with chlamydial infection (and others as well), biologic factors may influence the sensitivity and specificity of the test in populations having different prevalences [1, 2]. For example, in patients infected with chlamydia who have recently acquired infection (usually seen in populations with a high prevalence), the number of organisms (and amount of antigen or DNA) present is greater than in populations characterized by low prevalence. In the latter populations, more infections are long-lived, are subacute, and characterized by fewer chlamydial organisms. Hence, test performance will change because infections will be more difficult to detect in a population composed largely of patients harboring fewer organisms.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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