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%.
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.
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).
If 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.
A recent study in the June issue of Archives of Pediatrics and Adolescent Medicine 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.
The researchers divided several urgent care clinics into two groups. In the Controlcontrol group, the staff was given a one hour teaching session about chlamydia, including risks of infection, testing procedures, the specific vulnerability of the adolescent and young adult population, and the need for more widespread screening. The test clinics were asked to develop a system to identify teens at risk, provide screening, and develop a follow up and treatment system, and to communicate and follow confidentiality rules. They were asked to meet monthly to review their progress toward increasing the screening rate of adolescent females who presented with non-gynecologic complaints, and to continually refine their system as they learned from experience. Since chlamydia can be tested with a urine specimen, the screening did not involve a pelvic or gynecologic examination. If a female returned for screening within three days of her urgent care visit, she was counted in the pool of successfully screened patients.
Parents who[se] ... teenagers are sexually active should be aware of the high prevalence and serious complications of chlamydia infections.
Parents who are aware that their teenagers are sexually active should be aware of the high prevalence and serious complications of chlamydia infections. In addition to talking with their sons and daughters about birth control, they should encourage them to use safe sex practices such as condoms, to decrease their risk of acquiring an infection with lifelong consequences. If parents are uncomfortable with their knowledge or ability to discuss such issues, they should arrange for an appointment with the teen's doctor, or at an adolescent clinic or a family planning clinic.
If a chlamydia test is positive, both patients and doctors should consider the high risk of other sexually transmitted diseases and do appropriate tests and follow up.
Doctors who staff urgent visit sites, or primary care doctors whose teen and young adult patients only show up when they are sick, should consider adopting a practice of providing written information for their patients and making chlamydia screening easily and confidentially available. If the urgent care site does not provide chlamydia screening, doctors should provide referral sources to the patient to have the testing done accurately and confidentially. Similarly, patients who are seeing their doctors for other problems should feel comfortable asking their doctors for resources for chlamydia testing.
Any patient who is screened should be sure to obtain the results and to comply with full treatment recommendations. This includes letting their partners know of their infection so they can be treated as well. If a chlamydia test is positive, both patients and doctors should consider the high risk of other sexually transmitted diseases and do appropriate tests and follow up.
Currently, routine testing for chlamydia in teen and young adult males is recommended in the Guidelines of Adolescent and Preventive Services but not by other medical groups. The authors of this study propose that annual screening should be adopted for males as well as females. Young adult men who are sexually active may want to ask their doctors about screening, and parents who are aware that their teenage sons are sexually active may want to provide their sons with accurate information and encourage a medical visit to assess their sons' risk and need for testing.
Download chlamydia information sheet here