The following chart summarizes some difference between the three countries. Notice that the reported rates of chlamydia are lower than the true rates due to under reporting. In addition, higher rates does not suggest a policy failure, since increased screening rates will results in higher the rates of reported cases. Table 1: Summary of Differences Between the three Countries US UK China Insurance System Multiple public payer system, no universal coverage; reimbursement varies in each state Universal coverage; single public payer system Single public payer system; reimbursement varies in each provinces Mandatory Reporting Yes Yes No Opt-out approach No Yes No Test and Treatment Cost Varies by different providers and insurance benefits Free screening and treatment from government-funded clinics and programs Varies by different providers and insurance benefits Screening Rate About 50% among commercial and Medicaid plans insured population 16% young adults under 25 years old Unknown Reported Rate Greater than 456.7 cases per 100,000 (total) —0.457% Greater than 2,300 per 100,000 among 15 to 24 year Inconsistence data due to lack of surveillance: 6.04% to 13.4% among women Diagnostic Test Recommended: NAAT; also used some EIA and DFA Recommended: NAAT; also use some EIA and DFA Unspecified recommendation; EIA and DFA are the main assays of choice Treatment Doxycycline or Azithromycin and other Doxycycline or Azithromycin and other Doxycycline or Azithromycin and other
Partner Notification Combination of patient and provider referral; Expedited partner treatment allowing notification and treatment of partners without medical consultation in most of the states Only conducted by partner-notification trained healthcare staff Unknown, possibly patient referral Follow-up Suggest TOC 3 month after the treatment. Test pregnant women again in third trimester. TOC generally not recommend, unless the patient is pregnant or suspected to have LGV and poor compliance TOC recommended for patients with previously asymptomatic infection, persisted symptoms, noncompliance, suspected reinfection, or post-erythromycin treatment Health policies and intervention programs that aim to control the spread of chlamydia should be based on the principle of stages of prevention: primary, secondary and tertiary. Primary prevention aims to prevent the onset of the disease through risk reduction, such as preventing exposure to disease risk factors. The primary prevention strategy of chlamydia control is to promote safe sex (using condoms or other barriers). Using condoms during sex intercourse can prevent the exposure to the bacterium Chlamydia trachomatis. This healthy behavior approach not only reduces the risk of being exposed to chlamydia, but also provides protection from other STDs. The secondary prevention of chlamydia infection entails the prevention of pathological changes after infection through screening and early intervention. Early screening and detection of the asymptomatic infection will lead to timely treatment before the onset of pathological changes in the reproductive system that lead to more serious consequences, such as PID and damage to the fallopian tubes.