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Chlamydia screening in US found to be flawed

Robin Wulffson MD's picture
chlamydia, screening, risk, STD, infertility

Chlamydia infection is the most common sexually transmitted disease in the United States. It is caused by the bacterium bacteria Chlamydia trachomatis. A new study has found that current screening guidelines might be overlooking some high risk women aged 25 or older. The findings were presented at the American Congress of Obstetricians and Gynecologists (ACOG) 60th Annual Clinical Meeting in San Diego California, which ran from May 5 through May 9.

A research team led by Mark Martens, MD, from the Jersey Shore Medical Center in Neptune, New Jersey reviewed data on more than 320,000 cervical samples from women tested for chlamydia in 40 states. All the women were screened for chlamydia with a nucleic acid amplification test or polymerase chain reaction at Bio-Reference Laboratories, a microbiology testing lab in New Jersey.

Current guidelines from the Centers for Disease Control and Prevention (CDC) recommend annual testing for chlamydia in all women younger than 25; however, it recommends screening only women older than 25 with risk factors. The ACOG also advises yearly screening for women older than 25 years if they are at high risk. According to Dr. Martens, these guidelines should be revisited.

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The investigators noted that national chlamydia rates were similar to those used to develop current CDC screening recommendations: approximately 5%-6% in women younger than 25 and less than 1% in women older than 25. However, Dr. Martens noted that when they reviewed the data by state, they found more variation in the younger and older women than the national statistics indicated. The investigators found that chlamydia rates in women younger than 25 in states including Arkansas, Louisiana, and Mississippi were above 10%: a rate much higher than the national average. In addition, eight states, including Arkansas, Delaware, New Hampshire, and New Mexico, had chlamydia rates of more than 2% in women older than 25, which was a rate higher than the national average. Chlamydia rates also varied by ethnicity; the rate was highest among non-Hispanic blacks.

Chlamydia infections in women can result in inflammation of the cervix. Furthermore, an untreated chlamydia infection may spread to the uterus or the fallopian tubes, causing salpingitis or pelvic inflammatory disease. These conditions can lead to infertility and increase the risk of ectopic pregnancy. If a women is infected with chlamydia during her pregnancy, the infection can cause premature labor and delivery. It may also cause infection in the uterus after delivery (late postpartum endometritis). In addition, the infant may develop chlamydia-related conjunctivitis (eye infection) and pneumonia.

Take home message:
This study may lead to a modification of recommended guidelines. However, regardless of what the CDC recommends, it would be prudent for any woman to request a test for chlamydia at her annual exam. Women with multiple partners are at increased risk; however, a woman who believes that she is in a monogamous relationship, whether short-term or long-term) may be at risk due to a partner with tendencies to wander from faithfulness.

Reference: American Congress of Obstetricians and Gynecologists

See Also: Many women unaware of their chlamydia infection reports CDC