Chlamydia Case Research Articles

Changes in chlamydia control activities in Europe between 2007 and 2012: a cross-national survey.

Background: In 2012, the levels of chlamydia control activities including primary prevention, effective case management with partner management and surveillance were assessed in 2012 across countries in the European Union and European Economic Area (EU/EEA), on initiative of the European Centre for Disease Control (ECDC) survey, and the findings were compared with those from a similar survey in 2007. Methods: Experts in the 30 EU/EEA countries were invited to respond to an online questionnaire; 28 countries responded, of which 25 participated in both the 2007 and 2012 surveys. Analyses focused on 13 indicators of chlamydia prevention and control activities; countries were assigned to one of five categories of chlamydia control. Results: In 2012, more countries than in 2007 reported availability of national chlamydia case management guidelines (80% vs. 68%), opportunistic chlamydia testing (68% vs. 44%) and consistent use of nucleic acid amplification tests (64% vs. 36%). The number of countries reporting having a national sexually transmitted infection control strategy or a surveillance system for chlamydia did not change notably. In 2012, most countries (18/25, 72%) had implemented primary prevention activities and case management guidelines addressing partner management, compared with 44% (11/25) of countries in 2007. Conclusion: Overall, chlamydia control activities in EU/EEA countries strengthened between 2007 and 2012. Several countries still need to develop essential chlamydia control activities, whereas others may strengthen implementation and monitoring of existing activities.

S05.1 Adolescent chlamydia rates adjusted for sexual experience and activity

Rates of reported cases of chlamydia, a sexually transmitted infection, are high among adolescent women in the United States, in particular non-Hispanic black teens. Fewer than half of female teens have ever had sex and are not at risk. We adjusted national chlamydia case rates for sexual behaviour and examined differences in adjusted rates by race. We used chlamydia case data reported to CDC, census population counts, and data from the 2002, 2006–2010, and 2011–2013 National Survey of Family Growth to calculate the adjusted rates for those who have had sex (sexually experienced) and rates for those who had sex in the past year (sexually active) across race groups for female teenagers. Overall, the rates of chlamydia are higher when adjusted for sexual behaviour. The disparity in female rates for blacks relative to whites is reduced when adjusted for sexual behaviour. For example, in 2006–2008, the black to white chlamydia rate ratio decreased from 6.7 to 3.0 after adjusting for sexual experience. From 2002–2013, decreases in female black/white disparities were more pronounced after adjusting for behaviour: 6.4 to 5.3 (crude) vs. 5.1 to 3.5 (adjusted for sexual experience) and 5.9 to 3.5 (adjusted for sexual activity). From 2002–2013, the female Hispanic to white rate ratio also decreased, but was less affected by adjustment for sexual activity: 2.1 to 1.4 (crude) vs. 2.5 to 1.5 (adjusted for sexual experience) vs. 2.7 to 1.7 (adjusted for sexual activity). The impact of adjustments can be attributed to: decrease in proportion of sexually experienced/active blacks; increase in proportion of sexually experienced/active Hispanics; and stable proportion in whites. Adjustments for sexual behaviour attenuate the chlamydia rate disparity between blacks and whites, and not adjusting for behaviour underestimates the reduction in disparities over time. Black teens remain disproportionately burdened by chlamydial infections.

S05.2 Adolescent chlamydia rates adjusted for screening heterogeneity

<h3></h3> After chlamydia became a nationally notifiable condition in the United States, reported case rates increased steadily, likely a result of more complete reporting, expanded screening efforts, and use of more sensitive diagnostic tests. Reported case rates of chlamydia are highest among young women, a consequence of high prevalence in this population (as evidenced by estimates from national population-based surveys) and of targeted screening efforts (current guidelines in the United States recommend screening for all sexually active females aged &lt;25 years). However, after a decade of increasing reported case rates, case rates have recently declined among adolescent women aged 15–19 years: during 2001–2011, case rates increased 49.8% (2,327 to 3,485 per 100,000 females) and then decreased 15.1% during 2011–2014 (3,485 to 2,960 per 100,000 females). We explored possible reasons for decreases in chlamydia case rates among adolescent females using available national data and highlight how decreases in screening coverage among key populations may be impacting reported case rate trends.

Evidence for increased Chlamydia case finding after the introduction of rectal screening among women attending 2 Canadian sexually transmitted infection clinics.

Chlamydia trachomatis is the most common notifiable disease in Canada, and extragenital sites are believed to serve as hidden reservoirs for ongoing transmission of infection. There are no specific Canadian screening guidelines for asymptomatic individuals from extragenital sites. We sought to determine the prevalence and factors associated with rectal C. trachomatis among female sexually transmitted infection (STI) clinic attendees in Alberta, Canada. Between 20 July and 31 December 2012, all female attendees at 2 Provincial STI clinics receiving a pelvic examination, regardless of a history of anal intercourse, were screened for rectal C. trachomatis using the Gen-Probe Aptima COMBO 2 Assay. Demographic and behavior variables were compared between rectal-only chlamydia cases and genitourinary cases using χ(2) or Fisher exact test, Mann-Whitney test, and logistic regression. A total of 3055 women were screened for rectal chlamydia. The prevalence of rectal chlamydia ranged from 11.7% to 13.5%. There were 133 rectal-only cases, increasing case detection by 44.3% from 300 genitourinary cases to 433 total cases, ranging from 21.7% to 88.2% by clinic. Women who were a contact to an STI were less likely to have rectal-only chlamydia for both clinics (P ≤ .001). Our findings add to the growing body of evidence supporting universal rectal screening in high-risk women such as those undergoing pelvic exams at STI clinics.

Evaluation of Chlamydia Case Report Data: Completeness of Key Variables - United States, 2012

Chlamydia, a sexually transmitted infection, is the most commonly reported nationally notifable disease in the United States We assessed the completeness of key variables included in chlamydia case report data submitted to the Centers for Disease Control and Prevention (CDC) during 2012. Most of the reviewed demographic and geographic variables provided to CDC on 2012 chlamydia case reports had complete values. Diagnosis-related variables provided on case reports were less complete, in particular anatomic specimen site. Further investigation is needed to identify barriers to submitting complete data. Additional evaluation of validity (e.g., accuracy) of data provided is needed to fully evaluate chlamydia case report data.

An Assessment of the GYT

Youth in the United States bear a disproportionate burden of sexually transmitted diseases (STDs). Stigma, misconceptions, and access challenges keep many from getting tested or treated. The GYT: Get Yourself Tested campaign was launched in 2009 to reduce stigma and promote STD communication and testing. This evaluation sought to assess the first 2 years of campaign engagement and associations with STD testing among youth. Campaign engagement with select GYT on-the-ground events, social media sites, and STD testing locator tools was measured through process/media tracking metrics. Sexually transmitted disease testing patterns were assessed using data from Planned Parenthood affiliates (2008-2010) and national trend data from clinics participating in national infertility prevention activities (2003-2010). On-the-ground events reached an estimated 20,000 youth in 2009 and 52,000 youth in 2010. Across 2009 to 2010, GYT's Facebook page gained 4477 fans, Twitter feed gained 1994 followers, and more than 140,000 referrals were made to the STD testing locator. From April 2008 to 2010, there was a 71% increase in STD testing and a 41% increase in chlamydia testing at reporting Planned Parenthood affiliates (representing ∼118 health centers). Chlamydia case positivity rates during this period were stable at 6.6% (2008) and 7.3% (2010). Trend data indicate that testing was higher in spring 2009 and 2010 compared with other periods during those years; this pattern is commensurate with STD Awareness Month/GYT activities. Data quality is limited in a manner similar to many STD prevention efforts. Within these limitations, evidence suggests that GYT reaches youth and is associated with increased STD testing.

Screening for Sexually Transmitted Diseases in Short-Term Correctional Institutions

Young persons entering US jails and youth detention facilities have high rates of sexually transmitted diseases (STDs). The Centers for Disease Control and Prevention added STD screening guidelines specific to correctional settings to the 2010 STD Treatment Guidelines. This article summarizes published evidence from 1990 to 2009 used to develop the recommendations. The literature supports routine screening of adolescents and young women (aged ≤35 years, or on the basis of local institutional prevalence data) for chlamydia and gonorrhea because of high prevalence and the subsequent risk of adverse reproductive outcomes. Chlamydia positivity among young women (aged <20 years) in juvenile detention facilities and adult facilities is more than 14%. Men in correctional settings are also at high risk for chlamydia and gonorrhea. Among boys in juvenile detention facilities, chlamydia positivity is estimated at 6.6%; among young men in adult facilities, positivity is 16.6%. Screening men (to reduce sequelae among women) should be considered based on local epidemiology and resource availability. Syphilis screening is not strongly supported in published literature because of low prevalence and is not routinely recommended; however, some screening may be warranted based on local prevalence. Although there is a great diversity in the organization of correctional facilities, implementation of screening recommendations is possible owing to improvements in test technology (urine specimens) and through integration of a standard screening protocol. Based on the high burden of disease and substantial opportunities to reach a high-risk population, correctional facilities are important venues to target efforts to control STDs.

P3.316 Estimating Chlamydia and Gonorrhoea Burden Within the US Army - A Review of Passive Surveillance Systems to Identify Incident Infections

BackgroundThe burden of sexually transmitted infections (STI) within the US military is primarily assessed through review of case reports for notifiable conditions (e.g., Chlamydia, gonorrhoea, and syphilis). The degree to...

P113 Primary health providers' adherence to national chlamydia guidelines

AimTo re-audit district-wide management of genital chlamydia infection following implementation of NZ national chlamydia guidelines.MethodsAll healthcare settings in a single NZ health district that diagnosed 20 or more cases of...

Does a clinical guideline change chlamydia testing? Report from the Waikato Chlamydia Project

Waikato District Health Board was one of three districts chosen to implement a national chlamydia management guideline, with the aim of optimising testing and treatment. Previous New Zealand studies suggest any test increases associated with such an intervention may be short-lived. District-wide chlamydia test volumes were compared for three periods, before (June-Nov 2008), during (June-Nov 2009) and after (June-Nov 2010) guideline implementation by age, gender and ethnicity. Crude estimates of population test uptake were calculated. Azithromycin pharmacy claim volumes were assessed as a measure of treatment. Chlamydia test uptake for women was already high, with 23% of 15- to 24-year-old women tested during the period from June to November 2008. Although tests from under-25-year-olds increased during implementation in 2009, the change was not significant and was not sustained in 2010, p=0.06. Similarly, there were no significant sustained changes by gender or ethnicity following implementation. This includes a continued emphasis on optimal chlamydia case finding and treatment by focusing on those at greater risk of infection. Efforts to improve partner notification should be instigated which may in turn better engage men around sexual health. Local data should be used to identify local issues. There is a need to determine whether <25 years is the optimal age threshold for targeted chlamydia testing in New Zealand and to ensure appropriate resources, training and support are in place for primary care nurses who play a pivotal role in sexual health care delivery.

O1-S01.01 Chlamydia trends in the USA: results from multiple data sources

BackgroundChlamydia is the most commonly reported notifiable disease in the US, with over 1.2 million cases reported in 2009 (409.2 per 100 000 population). While rates based on case reports...

Chlamydia control activities in Europe: cross-sectional survey

Chlamydia is the most commonly reported bacterial sexually transmitted infection in Europe. The objective of the Screening for Chlamydia in Europe (SCREen) project was to describe current and planned chlamydia control activities in Europe. The authors sent a questionnaire asking about different aspects of chlamydia epidemiology and control to public health and clinical experts in each country in 2007. The principles of sexually transmitted infection control were used to develop a typology comprising five categories of chlamydia control activities. Each country was assigned to a category, based on responses to the questionnaire. Experts in 29 of 33 (88%) invited countries responded. Thirteen of 29 countries (45%) had no current chlamydia control activities. Six countries in this group stated that there were plans to introduce chlamydia screening programmes. There were five countries (17%) with case management guidelines only. Three countries (10%) also recommended case finding amongst partners of diagnosed chlamydia cases or people with another sexually transmitted infection. Six countries (21%) further specified groups of asymptomatic people eligible for opportunistic chlamydia testing. Two countries (7%) reported a chlamydia screening programme. There was no consistent association between the per capita gross domestic product of a country and the intensity of chlamydia control activities (P = 0.816). A newly developed classification system allowed the breadth of ongoing national chlamydia control activities to be described and categorized. Chlamydia control strategies should ensure that clinical guidelines to optimize chlamydia diagnosis and case management have been implemented before considering the appropriateness of screening programmes.

Current crisis or artifact of surveillance: insights into rebound chlamydia rates from dynamic modelling

BackgroundAfter initially falling in the face of intensified control efforts, reported rates of sexually transmitted chlamydia in many developed countries are rising. Recent hypotheses for this phenomenon have broadly focused on improved case finding or an increase in the prevalence. Because of many complex interactions behind the spread of infectious diseases, dynamic models of infection transmission are an effective means to guide learning, and assess quantitative conjectures of epidemiological processes. The objective of this paper is to bring a unique and robust perspective to observed chlamydial patterns through analyzing surveillance data with mathematical models of infection transmission.MethodsThis study integrated 25-year testing volume data from the Canadian province of Saskatchewan with one susceptible-infected-treated-susceptible and three susceptible-infected-treated-removed compartmental models. Calibration of model parameters to fit observed 25-year case notification data, after being combined with testing records, placed constraints on model behaviour and allowed for an approximation of chlamydia prevalence to be estimated. Model predictions were compared to observed case notification trends, and extensive sensitivity analyses were performed to confirm the robustness of model results.ResultsModel predictions accurately mirrored historic chlamydial trends including an observed rebound in the mid 1990s. For all models examined, the results repeatedly highlighted that increased testing volumes, rather than changes in the sensitivity and specificity of testing technologies, sexual behaviour, or truncated immunological responses brought about by treatment can, explain the increase in observed chlamydia case notifications.ConclusionsOur results highlight the significant impact testing volume can have on observed incidence rates, and that simple explanations for these observed increases appear to have been dismissed in favor of changes to the underlying prevalence. These simple methods not only demonstrate geographic portability, but the results reassure the public health effort towards monitoring and controlling chlamydia.

Relative efficiency of chlamydia screening in non-clinical settings in two California counties

We examined the relative efficiency of non-clinical sites to screen for chlamydia in youth and young adults. Chlamydia screening targeting youth (under 30 years of age) was performed at non-clinical sites in high-morbidity neighbourhoods of two California counties. Venues were subdivided into community outreach, schools, parenting centres and drug treatment/correctional facilities. Relative efficiency was estimated with multivariate Poisson regression using incidence of chlamydia per person-hours labour adjusting for strategy and county. Among the 1514 youths screened, the overall prevalence of chlamydia was 5.5%. By venue, the highest prevalence was in drug treatment/correction facilities at 11.1% followed by parenting centres at 6.3%, community outreach at 4.9% and schools at 4.6%. Drug treatment/correctional facilities were the most labour time efficient at 9.9 person-hours per chlamydia case. Schools and parenting centres had the lowest cost per screen at 0.9 person-hours per screen. Adjusted relative labour time efficiency (chlamydia cases per paid person-hour) was significantly higher in schools, 2.0 (95% confidence interval [CI] 1.0-4.2), parenting centres, 3.2 (95% CI 1.6-6.6) and drug treatment/correctional facilities, 2.9 (95% CI 1.0-7.8), compared with community outreach. In conclusion, parenting centres and drug treatment centres and correctional facilities are the most efficient venues for chlamydia screening.

Assessment of the Association of Chlamydia trachomatis Infection and Adverse Perinatal Outcomes with the Use of Population-Based Chlamydia Case Report Registries and Birth Records.

We assessed the relationship between Chlamydia trachomatis (CT) infections identified during pregnancy and adverse perinatal birth outcomes (including premature rupture of membranes, preterm delivery, and low birthweight) by matching CT reports and birth records. We merged California birth records from 1997, 1998, and 1999 with California CT reports from the same years to determine the proportion of birth records matched to a female CT report, using maternal last name, first name, date of birth, and county of residence. We used logistic regression to assess the crude and adjusted association between a CT report less than 10 months before the birth record date and premature rupture of membranes, preterm delivery, and low birthweight. These results were adjusted for age, race/ethnicity, level of education, and prenatal care. Of 675,786 birth records and 101,296 female CT reports, 14,039 women had a CT case report and a birth record; 10,917 birth records (1.6%) were matched to a CT report during pregnancy, and 10,940 (10.8%) of CT reports were matched to a birth record date 10 months after date of diagnosis/report. For premature rupture of membranes, the adjusted odds ratio (AOR) was 1.2, 95% confidence interval (CI) 1.0, 1.3; for low birthweight, the AOR was 1.2, 95% CI 1.1, 1.3. The reduction in birthweight associated with prenatal CT infection was 31.7 grams. The increased risk of adverse perinatal outcomes associated with prenatal CT infection supports current prenatal CT screening guidelines. Matching of surveillance and vital statistics data sources was an efficient method to assess this association.

Expedited Partner Therapy for Adolescents Diagnosed with Chlamydia or Gonorrhea: A Position Paper of the Society for Adolescent Medicine

Expedited Partner Therapy for Adolescents Diagnosed with Chlamydia or Gonorrhea: A Position Paper of the Society for Adolescent Medicine

The Contribution of a Urine-Based Jail Screening Program to Citywide Male Chlamydia and Gonorrhea Case Rates in New York City

With noninvasive specimen types, males can be more easily screened for Chlamydia trachomatis and Neisseria gonorrhoeae infections. Long-standing universal screening of males attending New York City (NYC) sexually transmitted diseases (STD) clinics has yielded a substantial number of chlamydia cases. In 2005, screening was expanding to another large group at high risk for STD: males </=35 years old entering 6 adult jails. Surveillance data and data from laboratory practice surveys were examined to evaluate changes in the reported burden of chlamydia and gonorrhea in NYC males over time. Citywide data for male chlamydia and gonorrhea cases were analyzed by report year and provider type (STD clinic, adult jail, juvenile detention, private-sector provider) from 2004 through 2006. In the first year of the adult jail screening program, the number of chlamydia cases among males </=35 years old reported from the jails increased by 1636%, surpassing all other providers in numbers of cases contributed, and increasing the citywide reported male chlamydia case rate by 59%. Adult jails reported 40% more cases than all 10 NYC public STD clinics combined. In 2006, adult jails continued to contribute a similar proportion to citywide male chlamydia case reports. In the first year of the jail screening program, there was an approximately 10-fold increase in the number of gonorrhea cases reported from jails. Young men in adult jails have a large burden of chlamydial infection. Correctional screening and treatment programs present an important opportunity to improve the health of inmates and interrupt disease transmission.

Estimates of Chlamydia trachomatis Infections Among Men: United States

To describe the epidemiology of genital Chlamydia trachomatis infections among men in the United States. Data from the notifiable disease case surveillance system, the National Health and Nutrition Examination Survey (NHANES), the National Longitudinal Study of Adolescent Health (AddHealth), the National Job Training Program, the Men Having Sex with Men (MSM) Prevalence Monitoring Project, and adult and juvenile corrections facilities were used to summarize national chlamydia case and prevalence rates. Data were stratified by age and race/ethnicity. In 2005, 232,781 chlamydia cases among men were reported, corresponding to a rate of 161.1 cases per 100,000 men, an increase of 43.5% compared with the case rate in 2001 (112.3). Population-based chlamydia prevalence rates from NHANES (1999-2002) were highest among men aged 20 to 29 years (3.2%); men aged 18 to 26 years participating in AddHealth (2001-2002) had a 3.7% prevalence rate. Rates were highest among black men in both NHANES (5.3%) and AddHealth (11.1%). The prevalence rate among men (aged 16-24 years) participating in the National Job Training Program was 8.1%. Among MSM, the 2005 median urethral chlamydia prevalence rate was 6%. Overall, chlamydia rates were highest in adult corrections facilities; the 2005 positivity rate among men aged 21 to 25 years was 7.8%. In juvenile corrections facilities, the 2005 positivity rate among men aged 15 to 17 years was 6.7%. Rates of genital C. trachomatis infections among men are persistently high, particularly among men entering the National Job Training Program and men in corrections facilities. The burden of disease is generally highest among young men and black men.

Interactive workshops increase chlamydia testing in primary care--a controlled study

Primary care clinicians suggest that staff education is needed to increase chlamydia testing appropriately. To determine if interactive workshops and modified laboratory request forms could increase testing and case detection. Prospective cluster randomized controlled study, using modified Zelen's design, examining the effect of workshops and modified request forms on primary care clinicians' chlamydia specimen submission and case positivity rate. 82 general practices in six geographical clusters within five primary care trusts (PCTs) in Gloucestershire and County Durham and Darlington. Practices within geographical clusters were randomly assigned to workshops on chlamydia or a control consisting of comparable workshops on the management of urinary symptoms, held in PCT-protected learning time. Half the practices were randomized to receive modified laboratory request forms. Staff were unaware that they were part of a study. Interactive workshops increased chlamydia testing in 16- to 24-year-old women by 33% in intervention practices compared to controls with effect persisting at 10 months (P = 0.003). No associated rise in the number of chlamydia infections was detected (P = 0.91), suggesting that increased testing may have occurred in a lower risk population. Modified forms did not change test submission (P = 0.75). Interactive workshops for general practices can be used to successfully increase chlamydia-testing rates. Chlamydia detection rates will need to be monitored as this type of educational programme may not increase absolute numbers of chlamydia infections detected, if patients at lower risk of infection are inappropriately tested. Other interventions may need to be combined with the workshops, to reach sufficiently high chlamydia screening rates to significantly reduce prevalence of chlamydial infection.

Sexual network structure as an indicator of epidemic phase.

Ascertaining epidemic phase for a sexually transmitted disease (STD) has depended on secular trend data which often contain significant artefacts. The usefulness of sexual network structure as an indicator of STD epidemic phase is explored in an analysis of community wide genital chlamydia reports, with network analysis of interviewed cases and linked sexual partners, in Colorado Springs, USA, 1996 to 1999. In this period, the chlamydia case rate per 100,000 increased by 46%. Three quarters of cases (n=4953) were interviewed, nominating 7365 partners; these, combined with index cases, made up the 9114 persons in the network. Epidemiologic analysis of cases suggests that secular trend increases are artefactual. Network analysis supports this view: overall network structure is fragmented and dendritic, notably lacking the cyclic (closed loops) structures associated with network cohesion and thus with efficient STD transmission. Comparison of network structure with that of an intense STD outbreak (characterised by numerous cyclic structures) suggests low level or declining endemic rather than epidemic chlamydia transmission during the study interval. These observations accord with intuitive and stochastic predictions.