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Many women unaware of their chlamydia infection reports CDC

Robin Wulffson MD's picture
chlamydia, STD, infertility, pelvic infection, ectopic pregnancy, testing

MINNEAPOLIS, MN – Chlamydia is the most commonly reported sexually transmitted disease (STD) in the United States. Most infected individuals are unaware of their infection because they often experience no symptoms. According to a new study by the Centers for Disease Control and Prevention (CDC), although 68% of the 23 million American women aged 15 to 25 years of age are sexually active, only 38% reported that they had been tested for chlamydia. For women in this age group, the CDC recommends annual chlamydia testing. The findings were presented on March 13, at National STD Prevention Conference, held this week in Minneapolis, Minnesota.

In 2010, 1.3 million cases of chlamydia were diagnosed; however, the CDC estimates that the actual number is likely to be at least double: 2.8 million or more cases each year. Chlamydia readily responds to antibiotic treatment. However, if left untreated it can result in long-term health problems, such as chronic pelvic pain, chronic pelvic inflammatory disease, infertility, or an ectopic pregnancy (a pregnancy, which implants in a fallopian tube, which can result in hemorrhage and death).

Women who were more likely to receive testing were those who had two or more partners, lacked healthcare insurance, were African American, or who were provided healthcare by Medicaid or the State Children's Health Insurance Program. Furthermore, women who had received a pelvic examination, Pap smear, or a pregnancy test in the preceding 12 months were more likely to be tested.

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In addition to the recommendation for annual testing, the CDC recommends that any woman who has been infected with the disease should be retested each year. Furthermore, women and men with chlamydia should be retested three months after the treatment of an initial infection, regardless of whether they believe that their sex partner (or partners) has been treated. Another study, which was presented at the same conference, reported that retesting rates are low; thus, many infections are probably being missed. Kelly Morrison Opdyke, MPH, from Cicatelli Associates in New York City, and her colleagues reviewed data on more than 60,000 men and women who tested positive for chlamydia from 2007 to 2009 in New York, New Jersey, and the Virgin Islands. Of those individuals, only 21% of the women and11% of the men were retested within 30 to 180 days. Among those individuals who had been retested, 16 % of the women and 25% of the men again tested positive.

Chlamydia is caused by the bacterium, Chlamydia trachomatis. Most women experience no symptoms; if symptoms do surface, they usually appear within one to three weeks after exposure from bacteria in the cervix or urethra (urinary outlet). Symptoms might include an abnormal vaginal discharge or a burning sensation when urinating. If the infection spreads from the cervix to the fallopian tubes, some women still have no signs or symptoms; others have lower abdominal pain, low back pain, nausea, fever, pain during intercourse, or bleeding between menstrual periods. Chlamydial infection of the cervix can spread to the rectum. Many infected men experience a discharge from their penis.

Chlamydia can be transmitted during vaginal, anal, or oral sex. Chlamydia can also be passed from an infected mother to her infant during vaginal childbirth. Any sexually active person can be infected with the disease. The greater the number of sex partners, the greater the risk of infection. Because the cervix (opening to the womb) of teenage girls and young women is not fully matured it is often more susceptible to infection; thus, this age group is at particularly high risk for infection if sexually active.

Take home message:
Unless you are in a stable, monogamous relationship, it would be prudent to request a chlamydia test during your annual pelvic exam. Also, some individuals wrongly assume that their partner is monogamous. Furthermore, nice people can have nasty diseases. For example, I once had a patient who met a handsome young medical student (or at least he told her he was) while on vacation. He gifted her with a case of gonorrhea.