COMMENTARY

CDC Commentary: Preventing Chlamydia

Catherine Satterwhite, MSPH, MPH

Disclosures

June 28, 2010

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Hello. I'm Catherine Satterwhite, the national epidemiologist for the Infertility Prevention Project at the Centers for Disease Control and Prevention. I'm here to talk with you about chlamydia -- the leading known preventable cause of infertility in the United States -- and what providers can do to prevent it.

Chlamydia is the most common sexually transmitted bacterial infection in the nation. CDC estimates that 2.8 million new chlamydia infections occur each year in the United States. Chlamydia prevalence is high among teenage girls and young women of all races, and African-American women 15 to 19 years of age are the most heavily affected, with an infection rate that far exceeds that of young white women. Socioeconomic factors such as discrimination, poverty, and lack of access to quality healthcare contribute to higher rates among African-American women.

While chlamydia is easily diagnosed and treated, many cases occur without symptoms and go undetected and untreated. In fact, CDC estimates that half of new infections go undiagnosed each year. This is a major public health concern because 10%-20% of untreated chlamydia infections in women progress to pelvic inflammatory disease, which can cause ectopic pregnancy and infertility.

To reduce the burden of chlamydia in the United States, CDC recommends annual chlamydia screening for all sexually active women under the age of 26, as well as older women with risk factors such as new or multiple sex partners.

Today I'd like to talk about 3 simple steps you can take to incorporate chlamydia testing into the excellent care that you already provide to your patients:

1. First, make chlamydia screening a priority issue for your practice. Train receptionists so they understand that individuals with chlamydia or other STD symptoms qualify for urgent appointments due to the time-sensitive nature of diagnosis and treatment. Also, make sure that your office has procedures in place to ensure patients who need to be screened are screened. For example, staff could alert you via electronic or hand written notes -- in a patient's file -- reminding you that your patient has not been tested within the previous year.

2. Second, make chlamydia screening a normal part of patient visits. Providers can dramatically increase screening rates simply by testing for chlamydia at the time they conduct a Pap test. This can easily be done by placing a chlamydia swab next to a Pap test in the room where you will be conducting a pelvic exam. For those patients not receiving a pelvic exam, I encourage you to offer them urine-based tests. Consider instituting a standing order for a staff member to routinely obtain urine samples from young women who have not been screened for chlamydia in the past year.

3. Third, work with your patients to prevent reinfection. Encourage patients who test positive for chlamydia to talk with their sexual partners from the last 60 days, so they can seek testing and treatment. In some states, it's legal for a diagnosed patient to deliver medications or a prescription directly to sexual partners without their being tested. This helps ensure partners also get treated. Encouraging patients to pursue getting their partners treated reduces the risk of reinfection. Lastly, CDC recommends that women be re-tested for chlamydia 3 months after initial treatment to ensure they have not been unknowingly reinfected.

I know that you're asked to squeeze an enormous amount of information and care into very brief patient visits. To help, CDC has developed tools for physicians to help diagnose, treat, and care for patients with chlamydia. In partnership with the National Chlamydia Coalition and the Partnership for Prevention, CDC created the Chlamydia Screening Implementation Guide, which outlines the strategies I discussed here today, as well as others.

Additionally, online courses on diagnosing, treating, and managing patients with chlamydia are offered by the CDC-funded National Network of STD/HIV Prevention Training Centers. Links to these resources are available on the Medscape website.

While chlamydia can lead to infertility, the good news is that such severe health consequences can be prevented by early detection and treatment. As healthcare providers, you have the ability to help ensure that your patients are armed with the information they need to protect themselves and their partners from the severe and long-term health consequences of chlamydia.

Web Resources

Chlamydia Screening Implementation Guide (PDF)

National Network of STD/HIV Prevention Training Centers

Catherine Satterwhite is an Epidemiologist in the Division of STD Prevention, an expert in the epidemiology and surveillance of sexually-transmitted Chlamydia trachomatis infections. From 2006 to 2010, Satterwhite has been the national epidemiologist for the Infertility Prevention Project. The Infertility Prevention Project, or IPP, is a nationwide program targeting socioeconomically disadvantaged young women who are under the age of 26 years for annual chlamydia screening to prevent the development of adverse reproductive sequelae. IPP was first piloted in 1988 and was fully expanded by 1995. Over 3 million tests are reported through IPP each year.

In addition to her extensive involvement in IPP, Catherine Satterwhite is a member of the National Chlamydia Coalition, a coalition committed to increasing chlamydia providers and the public.

Prior to her role in the Division of STD Prevention, Satterwhite worked on HIV prevention research and development of HIV surveillance systems.

Satterwhite is an author of more than 40 scientific publications and presentations. She is a graduate of New York University, and received her MPH in Epidemiology and MSPH in Public Health Informatics from Emory University. Satterwhite is currently a PhD candidate at Emory University.

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