Feb. 9, 2001 -- Nearly one-third of young women who came to a medical clinic in Baltimore had a sexually transmitted infection that, if left untreated, could result in infertility. And not many of them knew it -- or had any symptoms.
This high rate of chlamydia, a bacterial infection that is easily cured with antibiotics, so alarmed researchers that they are recommending that all sexually active girls and women under age 25 have a test to detect the illness at least every six months. Their study appears in the February issue of the journal Sexually Transmitted Infections.
According to the researchers, an estimated 3 million cases of chlamydia are diagnosed in the U.S. each year, making it the most frequently reported infectious disease in the nation and the most common sexually transmitted disease caused by bacteria. Still, this number is believed to be lower than the actual number of cases. Chlamydia is also the most common preventable cause of serious gynecological problems such as infertility, chronic pelvic pain, and ectopic pregnancy, a potentially fatal condition in which the embryo is implanted outside of the uterus.
Seventy-five percent of women and 50% of men who have chlamydia show no symptoms and can spread the disease unknowingly. Current medical guidelines call for sexually active young women to be tested for this infection once a year or whenever they have a pelvic exam. However, newer tests have been developed that use a urine sample to determine if an infection is present, which means that women can more easily be screened than in the past. In addition, a one-dose antibiotic has also become available to treat this infection.
Researchers from the Johns Hopkins University and the CDC analyzed medical information from nearly 4,000 females aged 12-60 who sought care at a Baltimore facility or school clinic to determine the rate of chlamydia among the women. They found more than 30% of those under age 25 had the infection, compared to nearly 10% of women older than 25.
Baltimore City has one of the highest rates of sexually transmitted diseases in the nation. The study also showed that the younger women were frequently reinfected, some in a little more than 7 months from their first infection, most likely because they were reinfected by the same partner. The research was conducted from 1994 to 1997.
"We found very high rates among young females," says lead author Gale Burstein, MD, MPH. "If we only offered [women] annual screening, we would miss a lot of infections." Burstein is an epidemiologist with the CDC's Division of Adolescent and School Health in Atlanta.
Burstein tells WebMD that she hopes medical organizations and panels that develop preventive health care guidelines will adopt their recommendation for semi-annual screening. Physicians would also be more likely to order such screenings if insurance companies agreed to cover them more often than once a year. The CDC has not yet endorsed the recommendation, nor has the American College of Obstetricians and Gynecologists.
"This article shows us there is a lot more chlamydia out there than we know," says Jennifer Gunter, MD, who independently reviewed the study for WebMD. "It is a huge problem globally. No one is immune from it. We see a lot of sexually transmitted diseases in young kids. All it takes is one kid, and it can spread like wildfire." Gunter is an assistant professor in the department of obstetrics and gynecology at the University of Kansas Medical Center in Kansas City.
But Gunter and other public health experts tell WebMD that doing such tests every 6 months is not necessary in parts of the country where the infection rate is lowest. In those areas, they say, all sexually active females regardless of their age should be screened at least once a year.
"The best message to give to women who do not accept abstinence, which is the best preventive measure, is to use condoms to prevent infection -- and not to rely on screening," says Deborah A. Cohen, MD, MPH, an associate professor of public health at Louisiana State University and a medical director in the Louisiana Department of Health and Hospitals. "Screening does not prevent infection, but leads to treatment after the fact. Although chlamydia is curable with single dose therapy, the infection may damage their reproductive tracts if it is not detected and treated early."