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Am Fam Physician. 2006;73(10):1822

Adolescents 15 to 19 years of age have an infection rate of Chlamydia trachomatis that is five times the overall rate in the United States. Most of these infections are asymptomatic, but if left untreated they can cause significant morbidity. Various programs have been developed to screen for C. trachomatis in this age group, but the infection rate is still high. The current guidelines for treating persons with C. trachomatis to prevent further disease were published by the Centers for Disease Control and Prevention (CDC). They recommend treating patients with appropriate antibiotics, providing prevention counseling concerning sexually transmitted diseases (STDs), treating the partners, additional screening for other STDs, and retesting for C. trachomatis. Despite these published recommendations, there is little information concerning their implementation.

Hwang and associates evaluated the comprehensive management of C. trachomatis infections in adolescents. The study was a review of the treatment and follow-up care documents for adolescents with C. trachomatis. The participants were adolescents 14 to 19 years of age who attended pediatric clinics in five large health maintenance organizations and were diagnosed with urogenital C. trachomatis. Infection was detected using a nucleic acid amplification test of the first urine specimen in boys and girls or an endocervical sample in girls. The first positive test was considered the index test, and each participant was followed for one year after that test. In addition, the state allowed for patient-delivered partner treatment for individuals who tested positive for C. trachomatis. Main outcome measures included antibiotic treatment, counseling regarding safer sex, treatment of the patient's partner, screening for other STDs, and retesting fo rC. trachomatis.

The study population included 122 adolescents, 96 of whom were girls. Ninety-seven percent of the study population received the appropriate antibiotic treatment based on CDC guidelines. Counseling concerning safer sex was documented in 79 percent of the participants, whereas partner treatment occurred in 52 percent of the participants. Thirty-six percent of the participants were tested for other STDs. Retesting for recurrent C. trachomatis within three to 12 months after the initial positive test, as recommended by the CDC, only occurred in 10 percent of participants. Boys were significantly less likely than girls to receive safer sex counseling and treatment for partners.

The authors conclude that most adolescents with urogenital C. trachomatis infection received appropriate antibiotic therapy. However, a smaller number of patients received the other CDC care recommendations, and there were significant missed opportunities to provide comprehensive care for adolescents with urogenital C. trachomatis. The authors say that the current system needs to be altered to address these gaps.

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