Chlamydia Screening: Expanding the Scope

Genital Chlamydia trachomatis infection remains the most commonly reported infectious disease in the United States, with an estimated annual incidence of at least 3 million cases and annual related costs exceeding $2 billion (1, 2). Most initial infections in women are asymptomatic but may progress to serious sequelae, mainly pelvic inflammatory disease, ectopic pregnancy, infertility, and chronic pelvic pain. Without an effective vaccine, prevention programs have focused primarily on screening and treating young women, the highest-risk group in terms of prevalence and complications (3). Such programs have reduced the occurrence of pelvic inflammatory disease, have reduced the overall prevalence of chlamydia in the screened population, and have been cost-effective (3, 4). Current guidelines from the U.S. Preventive Services Task Force thus recommend annual screening of all sexually active women younger than 25 years of age (5), as well as other women with risk factors.

Several important developments have recently enlarged the potential scope of screening programs and modified thinking about whom and how to screen. First, many studies of young women have drawn attention to the high rate of recurrent infection (15% to 25%) within 6 months of previous treatment (6, 7). Most of these recurrences probably represent reinfection from untreated partners, but a proportion may also represent persistent infection or ineffective treatment (8). Because of the high prevalence of recurrent infection, the Centers for Disease Control and Prevention has recommended retesting 3 to 4 months after an initial infection (9). Second, nucleic acid amplification tests for chlamydia (tests that amplify and detect chlamydia DNA or RNA) are considerably more sensitive than previously available diagnostic tests. Because these tests can be effectively used on first-void urine specimens and on …