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

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: eeggleston@rti.org


Chlamydia trachomatis ct
Chlamydia Trachomatis (CT) adults in Baltimore, MD

  • 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 adults in Baltimore, MD

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 adults in Baltimore, MD

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) adults in Baltimore, MD

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 adults in Baltimore, MD

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 adults in Baltimore, MD

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 by age group
MSSP: Estimated prevalence gender and raceof chlamydia by age group



Mssp estimated prevalence of chlamydia by risk factors
MSSP: Estimated prevalence and education of chlamydia by risk factors


Mssp estimated prevalence of chlamydia by sti history
MSSP: Estimated prevalence and education of chlamydia by STI history


Surveillance data
Surveillance data and education

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: and education Estimated chlamydia prevalence, ages 15-34


Surveillance data v mssp estimated ct prevalence by gender and race
Surveillance data v. MSSP: and education Estimated CT prevalence, by gender and race


Surveillance data v mssp estimated ct prevalence by age
Surveillance data v. MSSP: and education Estimated CT prevalence, by age


Conclusion
Conclusion and education

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 and education

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.