More Chlamydia Screening Urged for Women

Study finds it would reduce incidence, cost of STD

THURSDAY, Oct. 7, 2004 (HealthDayNews) -- More thorough screening for chlamydia, a sexually transmitted bacterium that is the most commonly reported infectious disease in the United States, would probably reduce the incidence of the disease and be cost-effective as well, researchers say.

Currently, the U.S. Centers for Disease Control and Prevention recommends that all women between the ages of 15 to 25 be screened annually for chlamydia, a largely asymptomatic disease with a nearly 100 percent cure rate if caught early. Last year, the CDC further recommended that women who have had the disease should be screened three or four months after their diagnosis for any reoccurrence.

Researchers at Harvard School of Public Health found in their study that expanding the screening to women under the age of 30, and recommending that any woman who has had chlamydia be tested every six months rather than only once after diagnosis, would increase health-care costs by an average of $107 per woman but would be cost-effective in the long run.

"When you take into account the positive effects of screening -- not only for the women themselves, but also, the benefits from avoiding transmission of the disease to babies or to men -- screening becomes cost-saving," said study author Dr. Delphine Hu, a research fellow at Harvard.

The reason that relatively older women should be tested for chlamydia reflects the fact that women are marrying later in life, and so have a longer period of multiple sex partners, increasing their risk for the disease, Hu said. Meanwhile, screening women every six months after they've had chlamydia makes sense because those who've had it are twice as likely to get it again compared to those who never contract the disease.

The study appears in the Oct. 5 issue of the Annals of Internal Medicine.

Chlamydia is a disease of the lower reproductive tract, affecting the cervix and urethea, Hu said, and if treated early by antibiotics, has a 96 percent cure rate. If untreated, it can spread to the upper reproductive tract, where it becomes pelvic inflammatory disease, infecting the uterus and fallopian tubes. In severe cases, it can cause chronic pelvic pain, ectopic pregnancy and tubal infertility.

According to an editorial accompanying the study, there are approximately 3 million cases of chlamydia among women every year, costing about $2 billion annually in health-care costs.

Men, too, can contract chlamydia, Hu says, but because half the time they are aware of their symptoms -- pain when urinating or discharge from the penis -- they seek treatment earlier. Up to 75 percent of females infected with chlamydia are asymptomatic, and are often unaware anything is wrong until they develop serious complications.

"Still, it's important to treat men as well, because if they are not treated, they will continue to be a reservoir of infection for women," she said.

A study in the October issue of the British journal Sexually Transmitted Diseases bears that out. Researchers looking at the results of the first year of a national chlamydia screening program in England found the rate of chlamydia was higher among young men under the age of 25, at 13.3 percent, than it was for the same-aged women, who had a 10.1 percent rate of infection.

Hu and her colleagues urge women to get tested, reporting that only about 40 percent or less of the women who should be getting screened are doing so.

"The tests are very simple, just a urine sample and no pelvic exam," Hu said. "A lot of teens don't know they don't have to have a pelvic exam, and that prevents them from getting tested."

Dr. Isabel Blumberg, an obstetrician-gynecologist at Mount Sinai Hospital in New York City, said it is more common in private ob-gyn practices for doctors to use a speculum and swab tissue to take samples from their patients rather than relying on a urine sample or self-swabbing for chlamydia screening, but she agrees that screening young, sexually active women is important.

"If you catch it early, you can have strong outcomes on reproductive potential," she said. "The problems caused by untreated chlamydia can cost billions of dollars in health-care costs, not to mention the pain and suffering among women with the disease."

More information

The U.S. Centers for Disease Control and Prevention has a thorough fact sheet on chlamydia.

SOURCES: Delphine Hu, M.D., Ph.D., research fellow, Harvard School of Public Health, Cambridge, Mass.; Isabel Blumberg, M.D., obstetrician-gynecologist, Mount Sinai Hospital, New York City; Oct. 5, 2004, Annals of Internal Medicine; October 2004 Sexually Transmitted Diseases
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