Boost chlamydia screens in adolescent females
New chlamydia prevalence estimates confirm that young women — particularly young African American women — continue to bear a disproportionate burden of disease in the United States.1
Researchers at the Centers for Disease Prevention and Control (CDC) used 2007-2012 National Health and Nutrition Examination Survey (NHANES) data to calculate nationally representative estimates for chlamydia prevalence overall, as well as by sex, age, and race. The analysis found an overall chlamydia prevalence of 1.7% among survey participants of men and women ages 14-39, which suggests an estimated 1.8 million prevalent infections nationally. Compared to the 1.4 million infections reported annually, this prevalence estimate suggests that many chlamydial infections go undiagnosed, the researchers note.
When researchers looked at sexually active female adolescents ages 14-19, they found an estimated chlamydia prevalence of 6.4%. For sexually active male adolescents ages 14-19, there was an estimated chlamydia prevalence of 2.4%, researchers report. The estimated prevalence among sexually active black female teens was 18.6%, compared to 3.2% among sexually active white female teens.1
How do these findings compare with earlier figures from NHANES, a survey of a nationally representative sample of the U.S. non-institutionalized, civilian population? The new research underscores that the chlamydia burden in the United States remains high, especially among young women, says Elizabeth Torrone, MSPH, PhD, an epidemiologist in the CDC’s Division of STD Prevention.
The new overall estimate of 1.7% is similar to previous prevalence estimates, says Torrone, lead author of the current report. A similar analysis of NHANES data from 2005-2008 found that there were 1.6 million estimated prevalent infections, observes Torrone. Because NHANES data are based on probability surveys, there is uncertainty in the estimates, she points out.
"We found that in 2012, the estimated number of infections could range from 1.4 to 2.1 million, which is not statistically different than the 2008 estimate," she notes. "Additionally, in recent years, chlamydia prevalence among youth has been stable as well."
Although the rate of chlamydia diagnoses has been increasing over the last two decades, these trends likely reflect increased screening and expanded use of more sensitive tests, says Torrone. Estimates from NHANES data suggest that overall prevalence is stable, she states.
It is critical to increase screening and awareness, especially among young people, says Torrone. "Screening is the essential first step, yet many sexually transmitted diseases [STDs] go untreated because they often have no symptoms and individuals are unaware that they are infected," notes Torrone. "With timely diagnosis and appropriate treatment, however, most STDs are curable."
Providers should screen all sexually active young females annually and ensure that all sex partners of patients diagnosed with chlamydia are treated appropriately, state the CDC researchers. The CDC recommends yearly chlamydia screening of all sexually active women age 25 or younger and older women with risk factors for chlamydial infections, such as those who have a new or more than one sex partner.
To help clinicians address chlamydia in patients, CDC spokesperson Salina Smith offers the following resources:
• Why Screen for Chlamydia: An Implementation Guide for Healthcare Providers is a printable guide from the National Chlamydia Coalition. It provides information on sexual history-taking, consent, and confidentiality, and it provides examples of ways to increase screening rates. Providers can download the guide for free at http://bit.ly/1rHCO9g.
• The National Coalition of Sexual Health offers a guide, Take Charge of Your Sexual Health, which includes a comprehensive guide of preventive sexual health services for women, including information on chlamydia screening. (Download at http://bit.ly/1ldca0q.) To download a checklist on recommended preventive health services for women, go to http://bit.ly/1lNUfNk.
• GYT (Get Yourself Tested), a collaborative effort of the American College Health Association, the Kaiser Family Foundation, MTV, the National Coalition of STD Directors, and Planned Parenthood Federation of America, is designed to promote sexual health and address the disproportionately high rates of STDs among those under age 25. Get materials that address how providers can use GYT in their clinics at http://on.mtv.com/1r3eDzu.
• The California STD/HIV Prevention Training Center offers several online training courses available for practicing clinicians who care for women of reproductive age, including one on chlamydia screening and partner management. Continuing medical education credits are available. Visit http://bit.ly/1r3fBM0.
Everyone can play a role in protecting young people from the potentially devastating effects of STDs, such as chlamydia, says Torrone. Preventing STDs among youth remains a top priority for the CDC, she states.
For clinicians, the CDC is recommending the most effective treatments and encouraging expedited partner therapy (EPT) when appropriate. It also is advancing sound health policy, such as developing disease screening and treatment recommendations that help the most-affected populations gain access to prevention services and overcome barriers, observes Torrone. However, the CDC cannot do it alone. There is a shared responsibility to reduce sexually transmitted inefctions among youth, says Torrone. Individuals should talk openly, get tested, and reduce risk with proven prevention strategies such as abstinence, vaccination, condoms, and mutual monogamy, Torrone says. Clinicians should discuss STDs with patients and increase testing, she states.
"Community leaders should encourage parents to talk to teens about prevention and fight stigma," says Torrone. "Researchers and pharmaceutical companies must jump-start research to identify or develop new, effective drugs or drug combinations."
- Torrone E, Weinstock H. Prevalence of Chlamydia trachomatis — United States, 2007-2012. Presented at the 2014 STD Prevention Conference. Atlanta; June 2014.
