Hidden Epidemic of Chlamydia Infections in Young Women?

William T. Basco, Jr, MD, FAAP


May 22, 2007

Burden of Recurrent Chlamydia trachomatis Infections in Young Women: Further Uncovering the "Hidden Epidemic"

Niccolai LM, Hochberg AL, Ethier KA, Lewis JB, Ickovics JR.
Arch Pediatr Adolesc Med. 2007;161:246-251

This study sought to add to what is known about reinfection with Chlamydia trachomatis among adolescent females by actively following a cohort of subjects for 18 months at 10 public health clinics in 1 state. The authors were also able to passively follow the cohort (through laboratory and reportable-disease records) thereafter.

The subjects were all sexually active 14-19 year olds, nulliparous (but approximately half were pregnant at enrollment), and HIV-negative at enrollment. Subjects were evaluated in the clinics at enrollment, and at 6-, 12-, and 18-month visits with enrollment occurring over a roughly 3-year period.

The authors sought to identify chlamydia infection by multiple methods: ligase chain reaction testing of urine at each visit; by patient report (structured interview) at each visit; medical record review (if a patient was seen at multiple sites, all records for that patient were reviewed); and records of positive test results submitted to the state health department. A "reinfection" was any one diagnosed more than 30 days after the index infection.

There were 411 subjects enrolled; 40% black, 36% Latina, and 23% "other" ethnicities/races. The subjects had a mean follow-up time in the study of 1.4 years. With additional, "passive" follow-up, the authors had a mean follow-up of more than 3 years per participant.

Just over 50% of the subjects (52.6%) were diagnosed with chlamydia during the study period, with 29.9% having a recurrent infection during the study period. The rate of recurrent infections was slightly higher in subjects younger than 16 years old at 62% vs 52% for those 17 or older, but this difference was not statistically significant. The median time to recurrent infection was approximately 5 months.

The authors conclude that Chlamydia trachomatis infections occur often in young women and suggest that aggressive follow-up and treatment are needed.

As the authors note, current CDC guidelines recommend repeat testing at 3-4 months after an index infection (see Related Links), and treatment of partners has always been a cornerstone of reducing sexually transmitted infections. This study lends support to both of those recommendations, but more novel ways may be needed to adequate treat (and prevent) sexually transmitted infections in tough-to-reach adolescent populations. The authors review several of those options, including providing the patient with treatment to be given to the sexual partners. That's a novel idea to many, but it may be worth considering in high repeat-infection areas.



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