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Chlamydia Still #1 Sex Disease

Love Bug With a Bite
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WebMD Feature

Aug. 20, 2001 -- You probably don't know whether you have chlamydia. And that's why it's the number 1 sexually transmitted disease in the U.S.

 

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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 develop."

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 healthcare.

 

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.

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