Vol. 18 • Issue 2
• Page 16
Associated Table
Chlamydia trachomatis infection is the most common bacterial sexually transmitted infection (STI) in the United States.1Approximately 1.1 million cases were reported to the CDC in 2007, and more than half occurred in women 15 to 25 years old.1,2The chlamydia rate among women was three times higher than that of men in 2007.3
Background
Symptoms of chlamydia infection in women can include abnormal vaginal discharge, mucopurulent cervicitis, dyspareunia, pelvic inflammatory disease, abnormal vaginal bleeding, postcoital bleeding and dysuria.2But chlamydia infections are usually asymptomatic in women (56% to 80% do not experience symptoms). Thus, several organizations recommend annual screening of all sexually active women 25 and younger.2,4-7Women older than 25 should be screened if they had a previous STI, have a new or multiple sexual partners, or live in a community where chlamydia is common.2Up to 40% of untreated chlamydia infections in women can result in pelvic inflammatory disease.3Tubal infertility, chronic pelvic pain, ectopic pregnancy, death from ectopic pregnancy, and other serious health problems can also develop from untreated chlamydia.4,8 ncomplicated chlamydia infections are effectively treated with azithromycin, doxycycline, erythromycin, ofloxacin or levofloxacin.2
Chlamydia infections in women can be diagnosed using several different testing methods: endocervical specimen obtained via a speculum examination, provider-collected or patient self-collected vaginal swab, and residual specimen from a liquid-based Pap test or urine sample.8
Barriers to Screening
Even though chlamydia screening is ranked as one of the top 10 priority preventive services based on its clinically preventable burden, feasibility and cost effectiveness, it remains underutilized.2,9In a national telephone survey, 21% of 18- to 19-year-olds and 16.6% of 25- to 29-year-olds reported receiving any type of STI care - including counseling or testing.10 ata reported by commercial and Medicaid health plans to the Healthcare Effectiveness Data and Information Set from 2000 to 2007 showed an annual screening rate increase from 25.3% in 2000 to 43.6% in 2006, with a slight decrease to 41.6% in 2007.1Some barriers to provider screening include lack of awareness that patients are sexually active and at risk for STIs, lack of reimbursement for time to conduct testing and counseling of patients, and lack of knowledge that screening can be performed without a pelvic exam.1Numerous strategies have been evaluated to change provider behavior with regard to chlamydia. Structural interventions such as computerized reminders, placing a chlamydia collection swab next to Pap test collection materials, and bundling chlamydia screening with other laboratory testing have been effective.9Using these may decrease the number of patients with chlamydia-related complications.
Kristine Hackett is a women's health nurse practitioner who is a major in the U.S. Air Force stationed at Langley Air Force Base in Virginia. Views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the United States Air Force, Department of Defense or the U.S. government.
References
1. Centers for Disease Control and Prevention. Chlamydia screening among sexually active young female enrollees of health plans-United States, 2000-2007. MMWR Morb Mortal Wkly Rep. 2009;58(14):362-365.
2. Hoover K, et al. Low rates of both asymptomatic chlamydia screening and diagnostic testing of women in U.S. outpatient clinics. Obstet Gynecol. 2008;112(4):891-898.
3. Women and STIs. Nursing for Women's Health. 2009;13(2):104.
4. Mangione-Smith R, McGlynn EA. Screening for chlamydia in adolescents and young women. Arch Pediatr Adolesc Med. 2000;154(11):1108-1113.
5. ACOG Committee on Gynecologic Practice. ACOG Committee Opinion No. 357: Primary and preventative care: periodic assessments. Obstet Gynecol. 2006;108(6):1615-1622.
6. U.S. Preventive Services Task Force. Screening for chlamydial infection: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2007;147(2):128-134.
7. Hollblad-Fadiman K, Goldman SM. American College of Preventive Medicine practice policy statement: screening for Chlamydia trachomatis. Am J Prev Med. 2003;24(3):287-92.
8. Hoover K, Tao G. Missed opportunities for chlamydia screening of young women in the United States. Obstet Gynecol. 2008;111(5):1097-1102.
9. Christiansen-Lindquist L, et al. Chlamydia screening of young sexually active, Medicaid-insured women by race and ethnicity, 2002-2005. Sex Transm Dis. 2009;36(10):642-646.
10. Tebb KP, Wibbelsman C, Neuhaus JM, Shafer MA. Screening for asymptomatic chlamydia infections among sexually active adolescent girls during pediatric urgent care. Arch Pediatr Adolesc Med. 2009;163(6):559-564.
11. GEN-Probe APTIMA Assay for Chlamydia trachomatis (package insert). San Diego, Calif., Gen-Probe Incorporated; 2004.
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