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Background: Diagnostic chlamydia testing is recommended for all young women demonstrating sexually transmitted infection (STI) symptoms. Differential testing among symptomatic women may contribute to disparities in chlamydia rates. Our objective was to determine whether providers test young women with STI symptoms for chlamydia differently by age, race/ethnicity, or insurance status, and whether testing patterns differ by documentation of previous STI. Methods: Retrospective cohort analysis using electronic medical records and billing data of women 14 to 25 years old with one or more diagnostic or procedure codes indicative of STI symptoms (N = 61,498 women). Random effects logistic regression analysis was performed to assess the odds of chlamydia testing given a woman presented for a nonpregnancy-related visit with STI symptoms. All analyses controlled for history of STI, setting, and year, and adjusted for within-person correlation. Results: A chlamydia test was performed in 38% of visits with codes indicating STI symptoms. Women aged < 18 or > 19 were less likely to be tested than women aged 18 to 19, with young women aged 14 to 15 having the lowest odds of being tested (Odd Ratio [OR]: 0.52). Providers were more likely to test minority ([OR.sub.black]: 2.87; [OR.sub.Latina]: 2.10) compared with white women. Women were also more likely to be tested if they had public insurance (OR: 2.41) or were self-pay (OR: 2.35) compared with if they had private insurance. Women aged 14 to 15 and 16 to 17 with prior history of STI had increased odds of chlamydia testing (OR: 1.79 and 1.43, respectively) compared with women aged 18 to 19, changing the overall direction of association compared with women with no history of STI. The odds of testing were dramatically reduced for minority and nonprivately insured young women with history of STI, although significant differences persisted. Conclusions: Provider chlamydia testing differs by age, race/ethnicity, and insurance status when a woman presents with STI symptoms and no prior history of STI. This bias may contribute to higher reported rates of chlamydia among younger, minority, and poor women. 2010. DOI: 10.1097/OLQ.0b013e3181e50044

Background: Expedited partner therapy (EPT) has been shown to reduce the risk of persistent or recurrent gonorrhea and chlamydial infection in heterosexuals, and to increase the proportion of sex partners receiving treatment. The objective of this analysis was to evaluate the consistency of EPT's effect across sociodemographic and behavioral subgroups. Methods: Subset analyses from a randomized controlled trial compared EPT to standard partner referral (SPR) in sociodemographic and behaviorally defined subgroups. Outcomes included persistent or recurrent infection in study participants and participants' report that their partners received treatment. Results: Reinfection risk was lower among EPT recipients than non-recipients in 21 of 22 subgroups, with relative risks (RRs) varying from 0.4 to 0.94. Compared to persons receiving SPR, persons receiving EPT were more likely to report that their partners were very likely to have been treated in 33 of 34 subgroups (RRs range, 1.03-1.36). Although EPT reduced the risk of persistent or recurrent infection somewhat more in men (RR, 0.56; 95% CI, 0.3-1.08) than in women (RR, 0.81; 95% CI, 0.611.07) and more in persons with gonorrhea (RR, 0.32; 95% CI, 0.13-0.78) than those with chlamydial infection (RR, 0.82; 95% CI, 0.63-1.07), the RR of partners being treated associated with EPT was similar in men (RR, 1.21; 95% CI, 1.05-1.39) and women (RR, 1.18; 95% CI, 1.10-1.27), and also in persons with gonorrhea (RR, 1.33; 95% CI, 0.80-2.23) and chlamydial infection (RR, 1.33; 95% CI, 1.07-1.66). Conclusions: In this study, EPT is shown to be superior to SPR across a wide spectrum of sociodemographic and behaviorally defined subgroups. DOI: 10.1097/OLQ.0b013e3181e1a296

Background: Chlamydia notifications are increasing in Australia, and the use of a computer alert prompting general practitioners to test young women is a potential way to increase opportunistic chlamydia testing. The aim of this trial was to determine the effectiveness of a computer alert in general practice on chlamydia testing in young women. Methods: In 2006, clinics (n = 68) in Melbourne, Australia were cluster randomized into 2 groups: the intervention group received a computerized alert advising the general practitioner to discuss chlamydia testing with their patient which popped up when the medical record of a 16- to 24-year-old woman was opened; the control group received no alert. The outcome was whether or not that patient received a chlamydia test at the level of a single consultation with an eligible patient. A mixed effects logistic regression model adjusting for clustering was used to assess the impact of the alert on the proportion of women tested for chlamydia during the trial period. Results: Testing increased from 8.3% (95% confidence interval (CI): 6.8, 9.8) to 12.2% (95% CI: 9.1, 15.3) (P < 0.01) in the intervention group, and from 8.8% (95% CI: 6.8, 10.7) to 10.6% (95% CI: 8.5, 12.7) (P < 0.01) in the control group. Overall, the intervention group had a 27% (OR = 1.3; 95% CI: 1.1, 1.4) greater increase in testing. Conclusion: The results of this study suggest that alerts alone may not be sufficient to get chiamydia testing levels up sufficiently high enough to have an impact on the burden of chlamydia in the population but that they could be included as part of a more complex intervention. DOI: 10.1097/OLQ.0b013e3181cfcb4c

Background: Our aim was to determine whether the proportion of women testing positive for chlamydia had changed over time after adjusting for demographic, clinical, and sexual risk factors. Methods: Computerized records for all heterosexual women attending a large urban sexual health clinic for the first time between 2003 and 2007 and were tested for chlamydia, were included. Chlamydia positivity and 95% confidence intervals were calculated and logistic regression was used to assess any possible change in chlamydia positivity over time after adjusting for demographic, clinical, and sexual risk factors. National chlamydia surveillance and testing data and data of the use of antibiotics effective against chlamydia were analyzed and trends over time evaluated using linear regression. Results: There were 10,498 chlamydia tests conducted among female clients presenting to the clinic for their first time over the 5 years (2003-2007). Chlamydia positivity was 5.9% (95% CI: 5.5%-6.4%). Chlamydia positivity increased each year from 4.2% in 2003 to 6.7% in 2007 (P < 0.01). After adjusting for other factors, chlamydia positivity increased on average 12% per year (OR = 1.12; 95% CI: 1.05-1.20). The average daily defined dose of antibiotics effective against chlamydia prescribed in Australia declined significantly between 1992 and 2002 (from 20.2 to 12.6 per 1000 population; P < 0.01) at a time when chlamydia positivity across Australia was increasing (from 9.4% to 10.7%; P = 0.06). Conclusions: These data suggest that the true prevalence of chlamydia in Australia is rising. One biologically plausible explanation that requires further study is that fewer antibiotics are being prescribed that would inadvertently also treat chlamydia infection. DOI: 10.1097/OLQ.0b013e3181b12765

Background: Prevalence of Chlamydia trachomatis and risk factors for infection are not well described in male college students enrolled in the Reserved Officer Training Corps (ROTC). Goal: The goal was to determine prevalence of C. trachomatis infection, percentage of asymptomatic infections, and risk factors for infection in a population of male college ROTC students. Study Design: We conducted a prevalence survey of C. trachomatis infection and risk factors using urine ligase chain reaction and questionnaire. Participants were 1443 ROTC male college cadets at Ft. Lewis, Washington, from June to July 2001. Results: Prevalence of C. trachomatis infection was 31 of 1252 (2.48%); 93.6% of the infections were asymptomatic. Black race, exposure to a partner with a prior sexually transmitted disease, and self-reported symptoms were significant risk factors. Conclusions: The prominence of asymptomatic infection in a male population with comparatively low prevalence suggests that risk factor rather than clinically based screening could be beneficial in this population.

Background: Since 1995, the incidence of Chlamydia trachomatis infection has been increasing in Finland, although there have been no major changes in public sexually transmitted disease (STD) services or screening practice. Objectives: The objective was to study whether the change in C. trachomatis incidence is significant and to identify specific risk groups. Methods: The incidence rates for all C. trachomatis cases notified by laboratories to the National Infectious Disease Register (NIDR) in Finland in 1995-2000 were calculated by gender, age, and domicile. Data from a sentinel STD surveillance network was used to analyze changes of risk-taking behavior in age groups with the highest C. trachomatis rates. Results: During the 6-year study period, laboratory surveillance data documented an increase in the incidence rate from 23.4 per 10,000 to 29.2 per 10,000. The increase was most evident among people living in nonurban densely populated areas. Highest increase, 1.37-fold (95% confidence interval [CI], 1.29-1.46) in women and 1.69-fold (CI, 1.47-1.92) in men, occurred in the youngest age group (10-19 years old). In 2000, more women, but not men, in the age group of 10-29 years reported 5 or more annual sex partners (18.8%; CI, 16.3-21.6) than in 1995 (8.3%; CI, 5.7-11.5). Conclusion: National surveillance of C. trachomatis infection based on laboratory notification documented increasing incidence rates, especially among adolescents and young people. This risk group should be a target for screening and educational programs to control the epidemic of C. trachomalis infections.

Background: Chlamydia trachomatis infectious are prevalent among young sexually active females, have serious sequelae, and are mostly asymptomatic. Screening and treatment of infected females has been demonstrated to prevent sequelae such as pelvic inflammatory disease. Goal: To assess prevalence and risk factors for chlamydia infection in US Army female recruits, whether these changed over time, and to examine variables contributing to any observed patterns. Study Design: Prevalence study of 23,010 non--healthcare-seeking female Army recruits enrolled in a chlamydia screening program at Fort Jackson, SC, from January 1996 through June 1999. Each of the 4-year cohorts was examined separately for prevalence and risk factors. Main Outcome Measures: Urine-based testing for C trachomatis by ligase chain reaction was used to determine prevalence, and questionnaires were used to collect demographic and risk information. State home of record for each recruit was transformed into Public Health reporting region: West, Midwest, South, Northeast, and Territories. Results: Prevalence for all years was 9.51%, but a progressive increase from 8.51% to 9.92% occurred over the course of study (P = 0.018). The proportion of individuals reporting specific risk factors during the 90 days preceding the study generally decreased over time. In a regression model, significant risk factors for infection included black race, age 25 years or younger, home-of-record from the South, being screened during years 3 and 4 of the study, more than one sex partner, a new sex partner, and history of any sexually transmitted disease. Condom use was protective. In another model controlling for age and home-of-record from the South, being screened in years 2, 3, and 4 of the study were significantly predictive for being chlamydia positive. Conclusion: A high and slightly increasing prevalence of C trachomatis infection was observed among young females entering the military over 4 consecutive years. Young age, black race, home-of-record from the South, more than one sex partner, a new sex partner, condom use, and a history of having a sexually transmitted disease were correlates of chlamydia infection. Sustained high rates of C trachomatis infection in this population provide clear justification for a chlamydia control program for young women entering the Army consisting of screening at entry on the basis of age and possibly home-of-record together with continued periodic rescreening. Summary: A study of 23,010 female Army recruits demonstrated that a high prevalence of C trachomatis was sustained during 4 years of observation. Year of study, young age, and being from the South were significant predictors of infection.

Background: Little is known about the epidemiology of Chlamydia trachomatis infection in female sex workers (FSWs) in Mexico. Goal: The goal of the study was to determine the prevalence of C trachomatis infection in registered FSWs from northern Mexico and to determine the sociodemographic characteristics associated with the infection. Study Design: An enzyme immunoassay was used to test 354 FSWs in three northern Mexican cities for cervical C trachomatis infection. All participants were registered in a government health office. Recruitment was consecutive and voluntary. The association between clinical and sociodemographic characteristics of FSWs and C trachomatis infection was evaluated. Results: The overall prevalence of C trachomatis infection among participants in the three cities was 12.4%. Women of low socioeconomic level and those younger than 25 years were the most frequently infected. Among FSWs in Durango, a higher frequency of C trachomatis infection was found for those who did not use condoms. Conclusion: C trachomatis is an important pathogen in the sexually transmitted diseases of registered FSWs in northern Mexico.

Background: Public health authorities want to evaluate their sexually transmitted disease (STD) surveillance systems to promote the most effective use of health resources. Goal: The goal of this study was to estimate the sensitivity of national laboratory reports of Chlamydia trachomatis in Switzerland (the proportion of cases detected by national laboratory reports). Study Design: A cross sectional prevalence study was conducted by the Swiss Sentinel Surveillance Network of Gynecologists in 1998. Two groups of women aged less than 35 years were included in the study: those having a first consultation for pregnancy and those having a routine check-up. Results: A total of 1589 women were tested for C trachomatis. The prevalence among pregnant women (n = 817) was 1.3%, and that among sexually active women (n = 772) was 2.8%. Using the prevalences observed among check-up women, we estimate that there were at least 24,400 C trachomatis infections in Switzerland among women aged 20 to 34 years in 1998 (95% CI: 14,300-34,300). The number of laboratory reports of C trachomatis in this age group was 1150 in 1998. Conclusion: Our study suggests that the sensitivity of national laboratory reports of C trachomatis in 1998 was less than 5% for women aged 20 to 34 years.

Background: Information on the characteristics and behaviors of persons at high risk for gonorrhea and chlamydial infection has typically been derived from studies of sexually transmitted disease (STD) clinic populations. The Baltimore STD and Behavior Survey (BSBS) used urine-based nucleic acid amplification testing (NAAT) to assess the prevalence and behavioral correlates of gonorrhea and chlamydial infection in a population-based cross-sectional survey of adults in Baltimore, Maryland. Goal: The goal of this study was to examine the demographic characteristics and behavioral markers of gonorrhea and chlamydial infection as reported by adults with a self-reported history of gonorrhea and chlamydial infection and to compare these to the characteristics and behaviors of individuals with current NAAT-identified gonorrhea and/or chlamydial infection. Study Design: A probability sample of adults aged 18 to 35 years residing in Baltimore was evaluated with collection of urine specimens and administration of a health and behavior survey. Data and specimens were collected between January 1997 and September 1998. Results: Respondents with NAAT-detected gonorrhea and/or chlamydial infection (7.9%) did not report a history of high-risk behaviors or more recent occurrences of those behaviors, and the majority were asymptomatic. However, adults in our study who self-reported a history of infection (26.0%) were more likely than those with no history of infection to report multiple partners, paid sex, partners with prior STDs, and STD symptoms--a pattern consistent with findings described in previous clinic-based reports. Conclusion: The risk profile generated from studies of clinic populations, with a focus on symptomatic disease, may not characterize the broader population with current, untreated, largely asymptomatic infection.

Background: Contact tracing is one of the measures used to control genital Chlamydia trachomatis infections. Goal of this Study: To assess important variables of contact tracing in an everyday clinical setting. Study Design: Patients reported according to the STD Act were studied in a prospective, consecutive county-based study. Results: A total of 149 patients had a mean of 2.2 partners. The social worker's patients reported significantly more partners than the physicians' patients. The median number of patients at the 26 involved institutions was 3. Treatment without a prior examination was prescribed to 4% of the partners; 95% of all notified partners were examined, and a majority of them were chlamydia-infected. Conclusion: The requirements of the STD Act in Sweden are being followed reasonably well by health providers responsible for contact tracing, although an experienced social worker seems to get better results., The sexual partner tracing program to control the spread of sexual diseases in Sweden appears to be effective. The Sexually Transmitted Disease (STD) Act requires physicians and medical staff to anonymously trace the sexual contacts of people diagnosed with chlamydia and other STDs. Researchers traced the recent sexual partners of 149 people with chlamydia, who reported an average of 2.2 sexual contacts. Ninety-five percent of contacts were examined, and most were infected with chlamydia. Social workers may get more accurate contact information than physicians when interviewing patients.

Goal: To determine prevalence and incidence of Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infection and assess risk factors predictive for such infections in a middle school-based clinic sample. Study Design: 170 female students and 43 male students making 256 and 47 visits, respectively, [is greater than or equal to] 30 days apart, in urban middle school clinics for primary care screening, reproductive health, or illness/injury were routinely asked to provide urine specimens for GC and CT ligase chain reaction testing if sexually active in the preceding 3-month period. Information regarding prior sexually transmitted diseases, reason for visit, and sexual risk behaviors was obtained. Results: GC: 11.4% of female student and 2.1% of male student tests were positive. Incidence was 34.0 cases/1,000 person months (95% Confidence interval [CI]: 19.5-67.5). Median time to first positive and repeat positive test was 4.6 and 2.6 months, respectively. For CT: 16.4% of female student and 2.1% of male student tests were positive. Incidence was 57.5 cases/1,000 person months (95% CI: 35.2-93.8). Median time to first positive and repeat positive CT test was 6.0 and 4.8 months, respectively. Assessed risk factors failed to specify a candidate screening population. Conclusion: These data suggest that all sexually active adolescent girls in this high risk setting should be offered testing for GC and CT at least twice per year, regardless of age or other sexual risk behaviors and that STD control efforts in high risk middle schools should be encouraged., Sexually active teenage girls should be offered regular screening tests for chlamydia and gonorrhea. Researchers examined sexually transmitted disease rates among 213 middle-school students attending campus medical clinics. Chlamydia was diagnosed in 16% of girls and 2% of boys, and gonorrhea was diagnosed in 11% of girls and 2% of boys. Many girls were infected with both sexually transmitted diseases, and more than 86% of infected girls had no symptoms of disease. Twice-annual testing of girls, who can suffer permanent injury from untreated infection, would improve their health.

Background: The prevalence of Chlamydia trachomatis genital infection in the United States population is unknown. Using a new urine test for C. trachomatis, we conducted a pilot survey as part of the National Health and Nutrition Examination Survey III (NHANES III). Goal: To determine whether the prevalence of chlamydial infection in a convenience sample of NHANES participants was high enough to justify testing for C. trachomatis in a national survey. Study Design: NHANES III, conducted from 1988 to 1994, was based on a stratified multistage probability sample of the United States population. Non-Hispanic blacks and Mexican-Americans were oversampled. Using the ligase chain reaction assay for C. trachomatis, we tested urine from participants 12 to 39 years of age from 10 of the 89 sites of NHANES III. The prevalence of infection was calculated by racial or ethnic group. Results: We tested 1,144 study participants, of whom 65% were female, 30% were non-Hispanic blacks, and 30% were Mexican-American. Prevalence was higher for non. Hispanic blacks (7%) than for Mexican-Americans (3%) and non-Hispanic whites (2%). Prevalence was higher for women than men in non-Hispanic blacks (7% vs. 6%), Mexican-Americans (5% vs. 2%), and non-Hispanic whites (2% vs. 1%). In 15- to 19-year-old women, prevalence was 13% in non-Hispanic blacks, 11% in Mexican-Americans, and 5% in non-Hispanic whites. Conclusion: The prevalence of C. trachomatis genital infection was high enough to suggest that a reliable national prevalence estimate could be obtained in a national probability sample survey., There appears to be enough Chlamydia trachomatis genital infections in the US to justify a national disease prevalence survey. Chlamydia can cause pelvic inflammatory disease, pain, and infertility in women. Researchers tested 1,144 people for the condition, and found that 7% of blacks, 3% of Mexican-Americans, and 2% of whites were infected. Women were consistently infected at higher rates than men, and the infection was most common among 15-19 year old women.

Background: The comparative prevalences and predictors of chlamydia and gonorrhea have not been studied in the family planning clinic population. Goals: To determine the comparative prevalences and predictors of chlamydia and gonorrhea among Colorado family planning clinic patients. Study Design: Cross-sectional study of public and private family planning clinic patients in Colorado tested for both chlamydia and gonorrhea (n = 12,926). Results: Among women tested for both infections, the chlamydia prevalence rate was 4.5% and the gonorrhea prevalence rate was 0.5%. Multivariate analysis showed that independent predictors of chlamydia were age younger than 25 years, black or Hispanic race-ethnicity, cervical friability, mucopus, exposure to a sex partner with chlamydia, or multiple recent sex partners. Independent predictors of gonorrhea were age younger than 20 years, black or Hispanic race-ethnicity, or exposure to a sex partner with gonorrhea; adjusted odds ratios for exposure to gonorrhea and black race were the highest for either infection. Conclusions: The gonorrhea prevalence rate was very low compared to that of chlamydia in patients at Colorado family planning clinics. Cost-effective gonorrhea testing strategies are needed for this population., Gonorrhea infection rates may be very low among family planning clinic patients whereas chlamydia infection may be relatively common. Identifying who is more likely to be infected could permit more selective screening. Nearly 13,000 Colorado women attending public and private family planning clinics were tested for both diseases. Forty-five women per thousand had chlamydia whereas only five women per thousand had gonorrhea. Women with either disease were more likely to be younger than 20, non-white, and exposed to a sex partner with chlamydia or gonorrhea.

Background and Objectives: Acute pelvic inflammatory disease (PID) affects women in their reproductive years and is often a complication of a sexually transmitted disease (STD), particularly Neisseria gonorrhoeae and Chlamydia trachomatis. Infertility, ectopic pregnancy, and chronic lower abdominal pain are common long-term sequelae to acute PID. Through different preventive measures, endemic N. gonorrhoeae is almost eliminated, and C. trachomatis has been reduced almost fourfold in Sweden. Goals: To investigate variations in STD-associated acute PID and the extent to which this influenced the yearly incidences of patients hospitalized for this complication during a 25-year-period. Study Design: Hospital records of 2499 patients admitted and treated for acute PID from January 1, 1970 to December 31, 1994 were analyzed for infection with N. gonorrhoeae. Routine laboratory diagnosis for C. trachomatis infection started June 1, 1980. Detailed statistical analysis for chlamydial-associated PID in this study, therefore, covers the period January 1, 1981 to December 31, 1994 and includes 1030 patients. Results: Gonorrhea occurred in 42% of patients with acute PID in 1970 and decreased continuously to zero in 1988 and beyond. Concomitant urogenital chlamydial infection reduced almost fourfold from 28.4% in 1985 to 7.7% in 1994. Yearly admissions for acute PID fluctuated slightly ([greater than or equal to]16%) in the early 1970s and early 1980s but increased greatly (>60%) in the middle and late 1970s; the highest was 180 per year in 1976. This coincided with high incidence rates of gonorrhea in the general population, and probably of genital C. trachomatis infection as well, coupled with an increased use of intrauterine contraceptive device in nulliparous women. The largest increase in admissions for acute PID was in the 15- to 29-year-old group. A steady decrease started in 1987 and reached the low figure of 26 admissions in 1994. The greatest decrease occurred in the 15- to 19-year-old group, from the relative age distribution of 28.9% in the period 1970 to 1974 to 12.9% in 1990 to 1994. Yearly admissions for the [less than or equal to]35-year-old group remained almost constant during the study period, but the relative age distribution shifted from second lowest (excluding those 14 years or younger, totaling 15 admissions for the entire study period), 9.1% at the beginning of the study period, to the second largest, 24.9% at the end of it. The study also showed that the total and relative rates of recurrence decreased. Conclusions: Measures aimed at reducing incidences of gonorrhea and genital chlamydial infection will reduce the incidences of one of the most serious complications of these STDs, acute PID, and, in turn, its long-term sequelae., Rates of acute pelvic inflammatory disease (PID) may be reduced by controlling epidemics of gonorrhea and chlamydia infections. Researchers in Sweden analyzed hospital records of 2,499 patients with acute PID over a 25-year period. Rates were highest in 1976, with 180 admissions. Usage of intrauterine devices was also high in the mid-1970s, as were rates of gonorrhea and chlamydia infections. Rates of acute PID dropped steadily after 1987, with only 26 admissions in 1994. The age distribution of women with acute PID shifted from younger women in the 1970s to older women in the 1990s.

Background and Objectives: In rural and suburban populations in developing countries, there is a lack of knowledge about the occurrence of Chlamydia trachomatis infection and the risk factors involved. Knowledge of the prevalence of infection is necessary to develop screening policies. Goals: To estimate the prevalence of C. trachomatis infection in a rural and a suburban area of Oaxaca, Mexico, and to identify behavioral and demographic risk factors, as well as clinical findings, that may be related to this disease. Study Design: A cross-sectional survey was conducted among 559 women attending the Rural Hospital of Tlacolula, Oaxaca in 1994. Genitourinary signs and symptoms were recorded using a structured questionnaire and a speculum examination of the cervix. Endocervical specimens were obtained for the direct immunofluorescent diagnosis of chlamydial infection. Results: Results for 41 women (7.3%) were positive for chlamydia. The prevalence was the same in rural and suburban women. In a multiple logistic regression analysis, chlamydial infection was correlated highly with young age (OR, 2.3; 95% Cl, 1.2 to 4.6), oral contraceptives (OR, 2.2; 95% CI, 0.7 to 6.9), number of sex partners, and genitourinary signs or symptoms. The simultaneous presence of mucopurulent cervical discharge, cervix friability, inflammatory signs of the cervix, and urinary symptoms had the highest specificity (99.6%) and positive predictive value (86.7%) for chlamydial infection detection. Conclusion: C. trachomatis infection is a common sexually transmitted disease in rural and suburban women in Mexico. Nearly 1 of 8 women 15 to 25 years of age may be infected. A risk factor-based screening program should be implemented in rural and urban populations in Mexico. In rural settings, women with mucopurulent cervical discharge should be treated for chlamydial infection, even without a laboratory diagnosis., A screening program targeting young, sexually active women in Mexico may prevent the spread and promote the treatment of Chlamydia (C.) trachomatis infection. C. trachomatis infection is a common sexually transmitted disease (STD) in North America, and its symptoms may go undetected in women. Researchers tested 559 rural and suburban Mexican women for C. trachomatis infection and found that 41 women (7.3%) were infected. One out of eight women aged 15 to 25 years were infected. Women who used oral contraceptives had a higher risk of infection. Women with infectious cervical discharge should receive presumptive treatment.

Background and Objectives: Chlamydial control programs that identify and treat infected persons have been used as a means of reducing prevalence and morbidity. The overall objective of the current study was to examine the prevalence of chlamydial infection during the course of such a program. Goals: To determine whether a reduction in isolation rates was evident among adolescent girls during the 8.75 years that the control program has been in place. Study Design: The study population consisted of all 4,329 sexually active girls between the ages of 13 and 19 attending the four adolescent health clinics in Indianapolis, Indiana, during the period beginning October 1, 1985, and ending June 30, 1994. All girls were cultured for Chlamydia trachomatis, and behavioral data were collected for those attending the clinics before 1989. The trend in quarterly isolation rates was examined using linear regression analysis. Results: Results showed that there was a significant decrease (P = 0.0001), from 25.9% to 9.7%, in the first-visit chlamydial isolation rate over the study period. Behavioral data showed decreases in the frequency of sexual intercourse and in lifetime years of sexual activity, as well as an increase in condom use. Conclusions: The quarterly isolation rates showed that there has been a 63% decline in chlamydial infection among adolescent girls attending the clinics for the first time., Chlamydia infections may be decreasing within the adolescent population. In October 1985, four Indianapolis clinics serving teenaged girls began systematically identifying and counseling teenaged girls diagnosed with Chlamydia infection. Between 1985 and 1994, the percentage of adolescent girls with first-time diagnoses of Chlamydia infection fell steadily from 26% to 10%. However, a behavioral study carried out between 1985 and 1988 also found a decline in average frequency of sexual activity per month from 6.2 to 5.0, a decline in average years of lifetime sexual activity from 2.0 to 1.2, and an increase in condom use to a maximum of 25%. The control program could not have directly affected first-time diagnoses; however, it could have reduced the pool of infected persons transmitting Chlamydia in the population. Other behavioral factors also appear to have played a role in the decline in infection rates.

Strengthened testing and prevention programs may have contributed to the overall decline in chlamydia infection rates in Uppsala, Sweden. Chlamydia is a common bacterial sexually transmitted disease (STD) that can cause inflammation in the genital and urinary areas. However, many patients with chlamydia have no symptoms. Since 1988, Swedish clinics have routinely tested and treated suspected chlamydia patients free of charge. Sweden has also opened a number of youth health clinics aimed at testing and treating STDs in youth. Researchers analyzed the data from 119,892 chlamydia exams performed over a 9 year period. Overall chlamydia detection rates declined over the 9 year period (124.7 cases per 1000 exams to 40.0 cases per 1000 exams). However, chlamydia infection rates for male youths increased over the same time period. The newly established youth clinics identified a greater number of the male youth chlamydia infections as compared to other clinics.

Background and Objectives: Despite the public health importance of herpes simplex virus infection in Nigeria, attempts have not been made to isolate and identify the virus. Goal of the Study: To isolate, identify, and type the virus from patients attending a sexually transmitted disease (STD) clinic in Ibadan, Nigeria. Study Design: One hundred fifty-three clinical samples from 116 patients were taken and inoculated into tissue culture for virus isolation. The isolates were identified and typed using chloroform sensitivity test, histocytological study, Complement Fixation Test (CFT), and indirect immunofluorescent antibody technique (IFAT). Result: Virus was isolated from seven of the 153 samples. Two of the seven were HSV-1, and five were HSV-2. Conclusion: This is the first documented isolation of the herpes simplex virus in Nigeria. The study has provided baseline data for future studies on genital herpes in Nigeria. These results may have interesting implications with respect of HIV transmission and other related sexually transmitted diseases in Nigeria., Herpes simplex virus (HSV) has been isolated from Nigerian patients at a for sexually transmitted disease clinic. . Genital ulcerations had been noted, but no one had ever attempted to identify the causative agent. In this case, 153 samples were taken from 116 patients. They were cultured and the virus identified and typed. Seven of the samples tested positive for HSV. Two samples were identified as HSV-1 and five as HSV-2. This should provide baseline data for future studies of herpes virus infections in Nigeria.

Background and Objectives: In Minnesota, physicians have been required to report cases of Chlamydia trachomatis infection since 1985. The distribution of reported cases suggests that there is substantial geographic variation in the rate of chlamydia infection. Goal of this Study: We conducted chlamydia screening at selected sites and a survey of primary care physicians in counties with high and low rates of reported chlamydia infection. We hypothesized that chlamydia infections are uniformly distributed in nonmetropolitan areas, and the geographic differences in reported cases can be attributed to variable testing and reporting practices by physicians. Study Design: The number of reported female chlamydia cases per 1,000 women was calculated for each rural Minnesota county in 1990. Fourteen counties with high and low rates of reporting were selected for further investigation. From September to December 1991, universal chlamydia screening was carried out at 11 clinics serving patients in these counties. A questionnaire was mailed to all primary care physicians in these counties. Results: In 1990, the rate of reported chlamydia cases was 4.7/100,000 and 0.1/100,000 for women living in the high-reporting and low-reporting counties, respectively. Chlamydia infection was present in 5.5% and 9.7% of women screened at selected clinics in high- and low-reporting counties, respectively. Physicians in high- and low-reporting counties did not differ significantly in terms of age, gender, number of pelvic exams, or frequency of chlamydia testing. However, physicians in high-reporting counties were significantly more likely to test for chlamydia when evaluating mucopurulent cervicitis or salpingitis, and they were more likely to test a woman whose sex partner had urethritis. Physicians in high-reporting counties were also more likely to have reported a case of chlamydia., Differences among women in reported rates of infection with the bacterium Chlamydia trachomatis may be a result more of physician practice and reporting than of real differences in infection. Chlamydia infection is sexually transmitted, can lead to pelvic inflammatory disorder and occurs most frequently among young women with multiple sexual partners. Rates as reported vary widely across geographic areas. In Minnesota, for example, some rural counties reported one case per 1,000 women between 15 and 24 years of age. Others reported 10 cases per 1,000 such women. A study of 1,101 women who were screened at 11 clinics in rural Minnesota found infection rates of between 4.5% and 16.7%. The rate found by testing was actually higher in the low-reporting counties. Physicians practicing in counties with high reports of chlamydia are themselves more likely to report cases. They were also more likely to have seen their female patients' male partner for a urinary infection and to test female patients for chlamydia if other conditions were present.