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From Silent to Serious: Chlamydia Infections in Teens and Young Adults
Chlamydia trachomatis is the most common reportable sexually transmitted disease in the United States. It is epidemic among sexually active adolescents and young adults. Surveys and state reports have revealed rates from 2 to 20% in this age group, with adolescent females having the highest rate of infection. The rate of infection in teens in general and among young adult males has been estimated at 4%.
A Sneaky InfectionWhat makes chlamydia infections so common and such a big health problem is that people who are infected often have no symptoms until they have progressed enough to cause painful conditions which can lead to lifelong gynecologic and fertility problems. Because of this, many young women are unaware that they are infected and continue to spread disease among their sexual partners. Untreated chlamydia infections in both males and females can persist for months to years, adding to the risk of unintentional spread of the infection and reinfection with this bacteria is common.
The good news is that chlamydia can be diagnosed with a urine specimen and does not require a pelvic examination or vaginal or urethral culture. So improving our ability to screen for and treat Chlamydia infections is relatively easy-to-achieve preventive health measure, if we can just find the right way to do it.
What the Infection DoesIn adolescent and adult females, chlamydial infection can cause inflammation of the urethra (urine tube), the cervix, the endometrium (lining of the uterus), the fallopian tubes (passage for the egg from ovary to uterus), and the area around the liver.
Asymptomatic chlamydia infections can develop into acute or chronic inflammation of the reproductive structures in a woman's pelvis, called pelvic inflammatory disease or PID. Chronic pelvic pain is one complication. PID can also cause tubal pregnancies because inflammation of the fallopian tubes makes it difficult or impossible for a fertilized egg to travel and implant normally in the uterus. Such pregnancies are both dangerous to the mother and unsuccessful in producing healthy newborns Similarly, it can cause infertility because a blocked, scarred, or inflamed tube makes it impossible for the egg and sperm to meet for the normal process of fertilization.
In males, chlamydial infection can cause inflammation of the urethra and the epididymis (part of the sperm storage and transport system) as well as a trio of symptoms that includes arthritis, urethritis and conjunctivitis (inflammation of the membranes around the eye).
Risks to NewbornsIf a pregnant woman has chlamydia at the time of delivery, her infant has a high probability of catching the infection as she passes through the birth canal. Newborns may have no symptoms, may develop conjunctivitis or may develop pneumonia from this exposure. If the newborns are asymptomatic and do not receive treatment, they may continue to carry chlamydia in their nasal passages and pneumonia may develop as late as 15 weeks after birth. Fortunately, carrier infants do not pass infection to others.
The Limitations of Current Screening MethodsSince the consequences of chlamydial infections are significant, but infections remain asymptomatic for long periods of time, medical guidelines recommend annual screening for chlamydia among all sexually active female adolescents and young adults until age 26. Screening tests are typically performed when teens come in for preventive care visits. But this age group tends to see doctors for acute medical problems rather than routine annual physicals aimed at prevention and counseling, so they tend to fall through the cracks. A national telephone survey showed only 21% of 18-19 year olds and 16.6% of 25-29 year olds had received counseling or testing for chlamydia.
Adolescents and young adults who primarily use urgent visit/emergency room services are most likely to be sexually active and at higher risk for exposure to sexually transmitted diseases, according to one study. Another found that 8 to 9% of the girls who were screened during an urgent care visit unrelated to a gynecologic problem had positive chlamydia tests. (1)(2)(3)
A recent study in the June issue of Archives of Pediatrics and Adolescent Medicine(4) reported on an effort to increase the rate of screening for chlamydia by incorporating it into urgent care visits, rather than relying on annual check-ups. This approach is a creative and reality-based approach to providing a critically needed service to teens and young adults. The researchers were interested in whether the young women who came to urgent care for other reasons would be willing to discuss their sexual history and accept the recommendation for chlamydia screening, and whether it could be done confidentially and without disrupting the flow of patient care in a busy urgent care setting.
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