Gender-based screening for chlamydial infection and divergent infection trends in men and women.

Susan M Rogers,Sylvia Tan,Ravikiran Muvva,Charles F Turner,Marcia Hobbs,Elizabeth Eggleston,James Chromy,Laxminarayana Ganapathi,Anthony Roman,Emily Erbelding,William C Miller

doi:10.1371/journal.pone.0089035

Abstract

ObjectivesTo assess the potential impact of chlamydial screening policy that recommends routine screening of women but not men.MethodsPopulation surveys of probability samples of Baltimore adults aged 18 to 35 years in 1997–1998 and 2006–2009 collected biospecimens to estimate trends in undiagnosed chlamydial infection. Survey estimates are compared to surveillance data on diagnosed chlamydial infections reported to the Health Department.ResultsPrevalence of undiagnosed chlamydial infection among men increased from 1.6% to 4.0%, but it declined from 4.3% to 3.1% among women (p = 0.028 for test of interaction). The annual (average) number of diagnosed infections was substantially higher among women than men in both time periods and increased among both men and women. Undiagnosed infection prevalence was substantially higher among black than non-black adults (4.0% vs 1.2%, p = 0.042 in 1997–98 and 5.5% vs 0.7%, p<0.001 in 2006–09).ConclusionDivergent trends in undiagnosed chlamydial infection by gender parallel divergent screening recommendations that encourage chlamydial testing for women but not for men.

Highlights

Untreated Chlamydia trachomatis infection increases the risk of pelvic inflammatory disease, chronic pelvic pain, and ectopic pregnancy in women [1]
Both the U.S Preventive Services Task Force (USPSTF) [4] and the Centers for Disease Control and Prevention (CDC) [5] recommend chlamydial screening for sexually active women under 25 years of age plus older women who are thought to be at increased risk based on their previous sexually transmitted infection history or patterns of sexual activity
This recommendation follows from the USPSTF conclusion that there is good evidence that screening for chlamydial infection in women who are at increased risk can reduce the incidence of PID [Pelvic Inflammatory Disease]

Summary

Introduction

Untreated Chlamydia trachomatis infection increases the risk of pelvic inflammatory disease, chronic pelvic pain, and ectopic pregnancy in women [1]. Repeat chlamydial infections are common in women [2,3] increasing their risk of serious reproductive problems Both the U.S Preventive Services Task Force (USPSTF) [4] and the Centers for Disease Control and Prevention (CDC) [5] recommend chlamydial screening for sexually active women under 25 years of age (the CDC recommendation includes women through age 25) plus older women who are thought to be at increased risk based on their previous sexually transmitted infection history or patterns of sexual activity.

Objectives

Methods

Results

Conclusion