Experts Reconsider Wisdom of Limiting Chlamydia Screening Only to Women
Authors: Rebecca Voelker
Journal: JAMA (2010)

AS PUBLIC HEALTH EXPERTS GET A better handle on the high incidence of repeated infections with Chlamydia trachomatis among US adolescents, the need for better screening and intervention has become obvious. Now research has revived the notion that inadequate screening among boys and young men has helped push the revolving door of repeated chlamydia infection. Experts have known for years that repeatedchlamydiainfectionsarecommon in young women. But few studies have examinedwhether thesearereinfections ortreatmentfailures,orwhetherrepeated infection is as common in young men as in young women. Studies of adolescents inclinicsandschool-basedscreeningprogramsarebeginningtofill insome of these knowledge gaps. A study published in January examined chlamydia infections in 210 adolescent girls treated in Indianapolis, Ind, primary care clinics. Researchers evaluated clinical samples and documentation of the girls’ sexual activity every 3 months for 3 years. More than half (121) of the girls had subsequent infections after being treated. Based on genotyping of the ompA gene in C trachomatis clinical samples, the researchers reported that 84% of the repeated infections were reinfections, 14% were attributable to antibiotic failure, and 2% were persistent infections without documented treatment (Batteiger BE et al. J Infect Dis. 2010;201[1]:42-51). J. Dennis Fortenberry, MD, one of the study’s authors and professor of pediatrics at the Indiana University School of Medicine, Indianapolis, said the findings trump the common assumption that screening programs will reduce infections. Despite intensive screening and treatment, Fortenberry said, the girls “kept getting chlamydia.” Fortenberry observed that expectations of what screening programs can accomplish may be too high. But he also noted that many current screening programs are not reaching enough highrisk adolescents. “That means we should give better attention to the male partners,” he said. “Part of it has to do with challenging our belief that just by screening young women we’re doing enough.” Epidemiologist Greta Anschuetz, MPH, agreed. “I do believe that men should be screened,” she said. Data that she and her colleagues at the Philadelphia Department of Public Health in Pennsylvania collected from 14 862 local high school students from 2002 to 2006 show that chlamydia and Neisseria gonorrhoeae infection rates were 2.5 times higher in females than males— 6.0 vs 2.4 cases per 100 person-years. The vast majority (90%) of infections were chlamydia (Anschuetz GL et al. Sex Transm Dis. 2009;36[1]:4-8). The reinfection rates in male and female students were perhaps more telling. During the school years studied, the reinfection rate was 19 per 100 personyears in male students compared with 17.7 in female students. So even though females had higher overall infection rates, more of the males were repeatedly infected. The finding has implications for screening recommendations. The US Preventive Services Task Force (USPSTF) has concluded that current evidence does not support screening of boys or young men. However, the Centers for Disease Control and Prevention (CDC) in Atlanta suggests that if programs do screen males, individuals who test positive should be rescreened 3 months later for reinfection. The USPSTF and CDC recommend that only sexually active women younger than age 26 years be screened for chlamydia; the CDC suggests that those who are infected be retested about 3 months after treatment. But the screening rate in young, sexually active women is low— 41.6% in 2007 (Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 2009;58[14]:362-365). The federal government’s Healthy People 2010 objectives set a target goal to screen 62% of sexually active young women. Screening is recommended just for women because untreated chlamydia can leave them with complications such as pelvic inflammatory disease and infertility, but few, if any, complications occur in men.