By Gretchen Voss
You'd never buy a car without test-driving it first, right? So why settle
into a lifelong marriage before trying one on for size?
"I'm just really not ready to be committed like this." That's what
Andi said to Tucker, her husband of 11 months, after she came home from a crazy
day at work two years ago with an overwhelming urge to quit her marriage.
Today. Right now. "This just isn't for me."
She spoke stoically — no tears, no histrionics. She had been imagining...
Three out of four infected women -- and one in two infected men
-- don't get early symptoms. But this doesn't mean it just goes away.
Two of five infected women will go on to develop pelvic
inflammatory disease, or PID. PID means infertility 20% of the time; debilitating chronic
pelvic pain 18% of the time; and a life-threatening tubal pregnancy 9% of the time. It can make men sterile, too.
And if a woman with chlamydia does become pregnant, she has up to a 50-50
chance of passing it on to her newborn child. Infants can die or become blind
as a result.
"PID is very serious," says Kimberly A. Workowski, MD,
FACP, chief of the guidelines unit of the CDC's Division of STD Prevention and
associate professor of medicine at Emory University, in Atlanta. "The issue
is to screen women and detect chlamydia before serious complications
A Reservoir of Chlamydia
That sounds easy, but the numbers tell a different story. In
2000, the CDC had 379,078 reported cases of chlamydia infection. By the end of
July 2001, improved screening led to 362,229 reported cases. These reports
usually mean a case that has been detected and cured -- in other words, the tip
of the iceberg.
"Part of problem is there is such a reservoir of people out
there carrying the infection and not knowing it," says Workowski,
frustration evident in her voice. "Treatment is effective. There are
good therapies and in fact one medicine that is available can be given in the
office so you can watch the patient take it."
The problem is finding people who are at risk and convincing
them that their lives -- and those of their loved ones -- are in danger.
Who's at risk? The short answer is, all sexually active people.
Since men more frequently get unmistakable early symptoms -- a discharge from
the penis, a burning sensation during urination, or swollen testicles -- they
are more likely to get treated.
It is young, sexually active women aged 25 and younger who are
most at risk. These women, the U.S. Preventive Services Task Force this year
advised, should get chlamydia screening as a part of their routine
Does screening work? Workowski points to the northwestern
states of Oregon, Idaho, Washington, and Alaska.
"They had an initial prevalence rate of 13% [of women aged
15-24] in the late '80s, and now it is less than 5%," she says. "It is
due to large-scale screening programs in family-planning clinics. These have
proven very effective. Now we need funding to develop the information systems
needed to monitor patients for reporting so that case reports go into an
automated information system."
The task force also recommended chlamydia screening for
pregnant women aged 25 and younger. However, it did not recommend routine
screening for all asymptomatic men or for asymptomatic women older than 25
because there is not enough evidence that the benefits of such screening would
justify the cost.