Untreated chlamydial infection among adolescents and young adults in baltimore md
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Untreated chlamydial infection among adolescents and young adults in Baltimore, MD. Elizabeth Eggleston, DrPH 1 ; Susan M. Rogers, PhD 1 ; Charles F. Turner, PhD 2 , Anthony Roman, MA 3 ; Sylvia Tan, MS 1 ; Emily Erbelding, MD, MPH 4

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Untreated chlamydial infection among adolescents and young adults in Baltimore, MD

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Untreated chlamydial infection among adolescents and young adults in baltimore md

Untreated chlamydial infection among adolescents and young adults in Baltimore, MD

Elizabeth Eggleston, DrPH1; Susan M. Rogers, PhD1; Charles F. Turner, PhD2, Anthony Roman, MA3; Sylvia Tan, MS1; Emily Erbelding, MD, MPH4

(1) Statistics and Epidemiology, Research Triangle Institute, Washington, DC; (2) Queens College, City University of New York; (3) Center for Survey Research, University of Massachusetts-Boston; (4) Johns Hopkins University School of Medicine, Baltimore, MD.

Presented atThe 136th Annual Meeting of the American Public Health Association San Diego, CA • October 25–29, 2008

Phone: 202.728.2080 Email: [email protected]


Chlamydia trachomatis ct

Chlamydia Trachomatis (CT)

  • Most frequently reported bacterial sexually transmitted infection in the U.S.

  • 348 cases per 100,000 population reported to CDC in 2006 – up 5.6% from 2005

  • Reported rate among women 3 times higher than among men


Chlamydia morbidity

Chlamydia: morbidity

Among women, untreated chlamydia may result in pelvic inflammatory disease (a major cause of infertility, ectopic pregnancy, chronic pelvic pain)

Among men, CT associated with urethritis & epididymitis.

Untreated CT infections facilitate HIV transmission among both men & women


Chlamydia surveillance

Chlamydia surveillance

Laboratories and medical providers required by law to report diagnosed cases of chlamydia.

Reported cases represent only those infections that are detected and, presumably, treated.

Chlamydia infections are usually asymptomatic; 75% women and 50% men have no symptoms.

Surveillance data reflect standard screening practices – CDC recommends testing all sexually active women under age 26 annually.


Monitoring stis survey program mssp

Monitoring STIs Survey Program (MSSP)

Continuous monitoring of three STIs (CT, Tv, GC) over three years in Baltimore, starting in 2006

Designed to address shortcomings of current surveillance methods (incomplete coverage, skewed in response to screening norms)

Funding provided by NICHD

Collaboration between RTI, Univ. of Mass-Boston, UNC-Chapel Hill, Johns Hopkins Univ. School of Medicine/BCHD


Mssp continued

MSSP, continued

Data collection via TACASI interview and mailed-in urine specimens

Study participants: aged 15-35, male and female, English speaking


Mssp year 1 analysis

MSSP, Year 1 analysis

In Year 1 (Sept 06 – Aug 07), 1248 Baltimore residents aged 15-35 completed a TACASI interview; 69% (n=866) provided a urine specimen.

We calculate prevalence estimates of CT in the population.

We assess associations between demographic/behavioral characteristics and CT prevalence using chi-square tests.

We compare our study data to BCHD surveillance data.

All MSSP data are weighted.


Mssp estimated prevalence of chlamydia overall and by gender and race

MSSP: Estimated prevalence of chlamydia, overall and by gender and race


Mssp estimated prevalence of chlamydia by age group

MSSP: Estimated prevalence of chlamydia by age group


Mssp estimated prevalence of chlamydia by marital status and education

MSSP: Estimated prevalence of chlamydia by marital status and education


Mssp estimated prevalence of chlamydia by risk factors

MSSP: Estimated prevalence of chlamydia by risk factors


Mssp estimated prevalence of chlamydia by sti history

MSSP: Estimated prevalence of chlamydia by STI history


Surveillance data

Surveillance data

Cases of CT infection reported to Baltimore City Health Dept. (BCHD) by medical providers and laboratories

Percentages for population prevalences calculated using 2000 U.S. Census reports of population size as denominator

Surveillance data grouped by age using U.S. Census age categories

MSSP data presented for comparison with same age categories


Surveillance data v mssp estimated chlamydia prevalence ages 15 34

Surveillance data v. MSSP: Estimated chlamydia prevalence, ages 15-34


Surveillance data v mssp estimated ct prevalence by gender and race

Surveillance data v. MSSP:Estimated CT prevalence, by gender and race


Surveillance data v mssp estimated ct prevalence by age

Surveillance data v. MSSP:Estimated CT prevalence, by age


Conclusion

Conclusion

Nearly 5% of 15-35 year-olds had an undetected chlamydial infection in MSSP.

CT prevalence slightly higher among males and among blacks, but small sample sizes limit generalizability of these findings.

Infections most prevalent among 18-23 year olds, those with least education

Having multiple partners strongly associated with CT infection, even as few as 2 in past year.

Previous infection strong predictor of current infection.


Conclusion continued

Conclusion, continued

Comparison of MSSP to surveillance data suggests that undiagnosed, untreated CT infections among 15-34 year-olds exceed diagnosed/reported infections by a factor of 1.3.

Ct prevalence in MSSP higher among males than females, while opposite pattern emerges in surveillance data -- suggesting need for increased Ct screening among males.


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