The US Chlamydia trachomatis control program: successes, shortcomings and ideas for the future

Chlamydia Screening in Juvenile Corrections: Even Females Considered to Be at Low Risk Are at High Risk

The Centers for Disease Control and Prevention recommends chlamydia screening at intake for all females in juvenile detention facilities. Identifying factors predictive of chlamydia could enable targeted screening, reducing costs while still identifying most infections. This study used demographic, arrest, and health data to identify factors associated with chlamydia among females aged 12 to 18 years entering a juvenile detention facility in San Diego during January 2009 to June 2010. The study created different screening criteria based on combinations of factors associated with infection and calculated sensitivity and proportion screened for each criterion. Overall chlamydia prevalence was 10.3% and was 4.2% among females reporting no sexual risk factors. No acceptable targeted screening approach was identified. High prevalence, even among females without risk factors, supports universal screening at intake.

Chlamydia positivity in New Orleans public high schools, 1996-2005: implications for clinical and public health practices

OBJECTIVE

To describe the trends in chlamydia positivity among New Orleans high school students tested in a schoolwide screening between 1996 and 2005, and to determine factors associated with chlamydia positivity among students during the 10-year period.

METHODS

Between school years 1995-1996 and 2004-2005, students in New Orleans public high schools were tested for chlamydia using nucleic acid amplification tests (NAAT) in urine specimens (LCx assay until 1999-2000; BD assay from 2000-2001 to 2004-2005). For each year, we calculated chlamydia positivity by dividing the number of students testing positive by the total number of students tested. Data were analyzed separately by gender. Logistic regressions were performed to determine independent predictors of chlamydia positivity during the 10-year period.

RESULTS

Between 1996 and 2005, the average chlamydia positivity was 7.0% (95% confidence interval 6.6-7.4) in boys and 13.1% (95% confidence interval 12.6-13.7) in girls (P < .001). Chlamydia detection increased with the switch from LCx to BD assay. In multivariate analyses, chlamydia positivity among boys and girls was significantly associated with age, black race, and gonorrhea coinfection. Additionally, positivity was significantly different by school year among boys (P = .03) and by NAAT used among girls (P = .008).

CONCLUSIONS

The trends in chlamydia positivity observed between 1996 and 2005 more likely reflected a high and stable prevalence of chlamydia in the New Orleans school-age adolescent population. Any benefit of screening on individuals tested was likely to be mitigated by participants' uninterrupted social interactions with the dynamic forces that sustain the sexual transmission of chlamydia in the population.