1 PUB 220 Chrisunta Palma May 5th, 2018 The Center for Disease Control (CDC) estimates that half of the nearly 20 million new sexually transmitted infections (STI) that occur every year in the United States are prevalent in young people ages 15-24. Chlamydia genital tract infection is a sexually transmitted disease caused by bacteria known as Chlamydia trachomatis. Chlamydia trachomatis is the leading cause of bacterial sexually transmitted infection internationally. The World Health Organization estimates 131 new cases of C. trachomatis genital infection occur annually (O’Connell & Ferone, 2016). Symptoms that can occur in women are changes in vaginal discharge, intermittent, and post-coital bleeding. The risk factors of contacting a chlamydial infection are asymptomatic infection, marital status, multiple partners, lack of safe sex and the use of contraceptives, and use of oral contraceptives.
In many cases the systems of chlamydia are difficult to detect. Approximately 70-80 percent of women have asymptomatic infection. In 2014, the rate among 15-19 year olds was 1,804.0 cases per 100,000, and the rate among 20-24 year olds was 2,484.6 cases per 100,000 (O’Connell & Ferone, 2016). The prevalence rate is high because asymptomatic individuals do not seek treatment and repeat infection. Failure to tend to the infection can lead to Pelvic Inflammatory Disease (PID), resulting in ectopic pregnancy, infertility, and chronic pelvic pain. 2% to 5% of untreated women developed PIB within a ~2-week elapse between testing positive and reproductive sequelae (Malhotra, Sood, Mukherjee, Muralidhar, & Bala, 2013).
Sexually transmitted infections such as Chlamydia have an impact on both the individual and community level. Currently, chlamydia screening for sexually active women aged less than 25 years is recommended by the U.S Preventative Services Task Force. The primary aim of chlamydia screening is to reduce morbidity in individuals by early detection and treatment of uncomplicated lower genital tract infections (Land, Van Bergen, Morre, & Postma, 2009). The secondary aim is to decrease the overall prevalence of chlamydia infections and subsequently reduce transmission in populations (Land, Van Bergen, Morre, & Postma, 2009). Screening women for Chlamydia has been detected as a cost effective approach to prevent Pelvic Inflammatory Disease (PID). Through advancements in technology, epidemiologists hope to create an effective vaccine that protects against upper tract disease or that limits transmission (Malhotra, Sood, Mukherjee, Muralidhar, & Bala, 2013).
The prevalence rate for Chlamydia is highest among non-Hispanic blacks. Prevalence of chlamydia among non-Hispanic blacks was approximately seven times the prevalence among non-Hispanic whites, and prevalence among Mexican Americans was approximately three times the prevalence among non-Hispanic whites (Torrone, Papp, & Weinstock, 2014). Among sexually active females age 14-24 years, the population targeted for routine screening, chlamydia prevalence was 4.7% overall and 13.5% among non-Hispanic black females (Torrone, Papp, & Weinstock, 2014). Although studies have shown an increase in detection of sexually transmitted diseases in non-Hispanic black individuals, case report data is an unreliable indicator of population prevalence or incidence due to the volume of unreported cases.
The National Health and Nutrition Examination Survey (NHANES) tested samples of the U.S population aged 14-39 years for genital C. trachomatis, and found that the overall Chlamydia burden in the U.S decreased during 1999-2008. Although, the burden of disease has decreased, the burden is underestimated because most infections are asymptomatic, undiagnosed, or not reported. In addition, the burden of sexually transmitted infection is underestimated because of the unreported rectal Chlamydia infection, which might facilitate transmission of human immunodeficiency virus (HIV). Sex partners should receive timely treatment to prevent the cycle of infection and reinfection. In young adults, reinfection rates 10-30% have been found, and sexual risk behaviour is an important determinant (Land, Van Bergen, Morre, & Postma, 2009). If detected early, antibiotics can treat infection in the lower genital tract effectively.
The behavioral issues that contribute to chlamydia include disease screening practices, sexual practices, and pregnancy. Screening for diseases reduce morbidity and mortality; 2 however, because of factors such as fear, shame, ignorance, or inadequate accessibility, more than 68 million Americans now have an incurable sexually transmitted infection (Tanne, 1998). For example, women with a history of multiple sexual partners, early sexual relations, or both, are at highest risk of cervical cancer. The incidence of invasive cervical cancer has decreased greatly over the past 40 years, due to largely to organized screening programs to detect early-stage disease (U.S Preventative Services Task Force, 1996). In recent years, screening for chlamydia was demonstrated to reduce the incidence of subsequent pelvic inflammatory disease by 56% in a screened group. (Scholes, 1996; USDHHS, 2000). 2 Moreover, Data are becoming available indicating that chlamydia screening is reducing burden and preventing associated complications (USDHHS, 2000). For diseases that are often asymptomatic, research has proven screening and proper treatment benefits people who are likely to suffer acute complications if infections are not detected and treated early.
Practicing unprotected sexual acts with one or multiple partners increases risk of infection. 2 The risk of sexually transmitted infection dramatically rises depending on a person’s amount of sexual partners. Sexually transmitted infections are more prevalent in teenagers and young adults than in older persons, partly because of the greater propensity of younger persons to engage in unprotected sex and to switch sexual partners relatively frequently (Laumann, 1994). The stigma of sexuality hinders sexual education programs for young adults, and discourages open dialogue regarding STD’s. 2 The most commonly reported sexually transmitted infection in the United States is chlamydia, with 3 million new cases each year (Tanne, 1998). About 85% of women and about 50% of men with chlamydia have no symptoms (Fish. ) Because majority of sexually transmitted infections are asymptomatic people do not seek immediate medical care. Chlamydia varies in the severity of its consequences; however, when left untreated or undiagnosed it can cause grave health effects and become life threatening.
Unprotected can sex result in STD’s and pregnancy. Sexually transmitted diseases affect women, as well as, causes serious health problems in pregnant women, [resulting] in the death of the fetus or newborn (Brunhamn, 1990; USDHHS, 2000). STD’s pose a risk to unborn children and complicate pregnancies, affecting the newborns auditory skills, motor skills, spinal cord, brain, and immune system. 2 Likewise, STD’s can complicate a pregnancy even without directly reaching the fetus or newborn, causing spontaneous abortion, stillbirth, premature membrane rupture, or premature delivery (Goldenberg et al., 1997; USDHHS, 2000).
The behavioral issues that contribute to chlamydia include disease screening practices, sexual practices, and pregnancy. Screening for diseases reduce morbidity and mortality; 2 however, because of factors such as fear, shame, ignorance, or inadequate accessibility, more than 68 million Americans now have an incurable sexually transmitted infection (Tanne, 1998). For example, women with a history of multiple sexual partners, early sexual relations, or both, are at highest risk of cervical cancer. The incidence of invasive cervical cancer has decreased greatly over the past 40 years, due to largely to organized screening programs to detect early-stage disease (U.S Preventative Services Task Force, 1996). In recent years, screening for chlamydia was demonstrated to reduce the incidence of subsequent pelvic inflammatory disease by 56% in a screened group. 3 (Scholes et al., 1996; USDHHS, 2000). 2 Moreover, Data are becoming available indicating that chlamydia screening is reducing burden and preventing associated complications (USDHHS, 2000). For diseases that are often asymptomatic, research has proven screening and proper treatment benefits people who are likely to suffer acute complications if infections are not detected and treated early.
Practicing unprotected sexual acts with one or multiple partners increases risk of infection. 2 The risk of sexually transmitted infection dramatically rises depending on a person’s amount of sexual partners. Sexually transmitted infections are more prevalent in teenagers and young adults than in older persons, partly because of the greater propensity of younger persons to engage in unprotected sex and to switch sexual partners relatively frequently (Laumann, 1994). The stigma of sexuality hinders sexual education programs for young adults, and discourages open dialogue regarding STD’s. 2 The most commonly reported sexually transmitted infection in the United States is chlamydia, with 3 million new cases each year (Tanne, 1998). About 85% of women and about 50% of men with chlamydia have no symptoms (Fish 1989; Handsfield, 1986; 2 Stamm and Holmes, 1990; USDHSS, 2000).) Because majority of sexually transmitted infections are asymptomatic people do not seek immediate medical care. Chlamydia varies in the severity of its consequences; however, when left untreated or undiagnosed it can cause grave health effects and become life threatening.
2 Sexually transmitted diseases affect women, as well as, causes serious health problems in pregnant women, [resulting] in the death of the fetus or newborn (Brunham et al., 1990; USDHHS, 2000). STD’s pose a risk to unborn children and complicate pregnancies, affecting the newborns auditory skills, motor skills, spinal cord, brain, and immune system. 2 Likewise, sexually transmitted infection can complicate a pregnancy even without directly reaching the fetus or newborn, causing spontaneous abortion, stillbirth, premature membrane rupture, or premature delivery (Goldenberg, 1997; USDHHS, 2000). Women with one or less children were at a five times greater risk for chlamydia than women with two or more children. Higher risk in women with more than two children may be an affect of involuntary infertility following 'silent' chlamydial PID. Exposure to chlamydia or having an asymptomatic partner is associated with an increase in risk of the infection. As chlamydia becomes more prevalent, contact tracing will become an important control strategy.
The social factors that contribute to chlamydia include race and socioeconomics, age, and contraceptive use. Only 10 of 23 studies in females and one of four studies in males indicated a higher risk of chlamydial infection in nonwhite people compared with white people in multivariate analysis. SES was not associated with chlamydia in multivariate analysis using any measure for males and females, including employment status (Hart, 1992; 4 Hart, 1993), income (Jolly AM, Hammond G, Orr PH, 1995; Ramstedt, Forssman, Giesecke, 1992; Stergachis, Scholes, Heidrich FE, 1993) level of parents' education (McCormack, Rosner, McComb, 1985) use of Medicaid (Phillipis, Hanff, Holmes, 1989) or occupation (Sellors, Pickard, 1992). Chlamydia shows no correlation between low-income, minority communities and infection; however, it remains prevalent throughout the sexually active population. The rate of chlamydial infection in some low-SES minority communities may be lower than expected because of frequent exposure to dual antibiotic treatment. For example, women of higher SES may be more likely to have routine examinations, and thus, the detection of asymptomatic cases may create upward bias reporting of chlamydia. In addition, chlamydia may become solely concentrated in groups where access to screenings is limited. Nonwhite men and women are at a higher risk of recurrent chlamydia infections than white people. The possibility remains that studies could be affected by diagnostic bias. More nonwhite males and females were screened and reported than their white counterparts; thus, making the evidence systematically overrepresented. Although, SES has not been a high risk factor of chlamydia, race and ethnicity have played an important role.
Adolescents are at a greater risk of chlamydial infection than older adults. The highest incidence rates of infection are reported consistently in adolescents and young adults in Canada and the United States (Division of Sexual Health Promotion and STD Prevention and Control, 1991-2000; 5 Center for Disease Control and Prevention, 1999). Incidence rates can be higher in adolescents due to physical development. Physical development in adolescents impacts the persistence of columnar epithelium on the cervix, which supports the growth of C trachomatis, and changes in vaginal flora and mucus production (Bolan, Ehrhardt, Wasserheit, 1999; Berman, Hein, 1999). Another underlying issue is premarital intercourse. In the United States, the proportion of adolescent women who reported having had premarital intercourse increased from 28.6% in 1970 to 51.5% in 1988 (MMWR Morb Mortal Wkly Rep, 1991), and sexual debut during early adolescence is often associated with greater numbers of sex partners (MMWR Morb Mortal Wkly Rep, 1991; Tanfer, 1990). There is an increasing demand in public health for more sexual health education programs for adolescents and young adults for primary prevention of STD’s.
The use of condoms and barrier methods of contraceptives have been proven to show inconsistent results. Studies have not shown significant evidence stating that barrier contraceptive use reduces risk of infection compared to other contraceptives. Studies did not account for consistency of use, yet when accounted for the results paralleled. Consistent users of barrier contraceptives were not shown to have a significantly reduced risk of infection compared with inconsistent users in multivariate analysis in six studies in women and one study in men (25,34,35,72,82,97). Likewise, oral contraceptive pills (OCP) can increase the risk of chlamydial infection by making more cervical epithelial cells susceptible to infection. The connection between OCP use and chlamydia is still unclear. However, while eight of 10 studies examining this risk factor found that women with cervical ectopy were more likely to be infected with C trachomatis (32,55,70,72,81,94,96,103), only two of those studies showed this relationship to be significant after adjusting for other variables (Stergachis, Scholes, Heidrich FE, 1993; Johnson, Poses, Fortner, 1990). Despite unreliable results, constant use of condoms and barriers contraceptives is still highly encouraged.
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