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Am Fam Physician. 2008;77(1):95

Background: The Institute of Medicine reports that sexually transmitted infections (STIs) are a “hidden epidemic” because the public and health care professionals underestimate the impact of these infections. Young women are particularly at risk of STIs because they tend to have multiple sexual partners, do not recognize long-term effects of STIs, and tend not to seek STI-related health care. The rate of Chlamydia trachomatis infection in women 15 to 24 years of age is more than 2,000 cases per 100,000 women. Studies show that 5 to 30 percent of women in this age group receive screening and are positive for C. trachomatis. The impact of this infection in young women includes increased risk of infertility, chronic pelvic pain, pelvic inflammatory disease, and human immunodeficiency virus (HIV) infection. Niccolai and colleagues assessed the frequency and pattern of C. trachomatis recurrence in young women.

The Study: The cohort study included adolescent women from 10 public health clinics. Patients were included if they were 14 to 19 years of age, sexually active, nulliparous, and HIV negative. Participants were evaluated at baseline and at six, 12, and 18 months. At each evaluation, a urine sample was used to test for C. trachomatis. Data were also collected using structured face-to-face interviews and reviews of medical records and health department reports of C. trachomatis infections. The main outcome measure was the diagnosis of recurrent C. trachomatis infection.

Results: For the 411 participants in the study, the mean age was 17.3 years, and the mean follow-up was 4.7 years per person. The average age of participants at first inter-course was 14.5 years, and the mean number of lifetime partners was 4.0. C. trachomatis infections were diagnosed in 52.6 percent of participants; of these, 56.9 percent were diagnosed with recurrent infections. The rate of recurrent infection was 42.1 per 1,000 person-months, and the median time to recurrent infection was 5.2 months.

Conclusion: The authors conclude that recurrent C. trachomatis infections pose a significant health burden in young women. They add that the recurrence rate in this population may be higher than previously recognized.

editor's note: Some of the increase in C. trachomatis infections is thought to be secondary to better screening.1 However, this study suggests that the increase may be related to recurrent infections. Guidelines from the Centers for Disease Control and Prevention suggest that a test for cure is not necessary (except in pregnant women), but a test for recurrence should be performed at least 60 days after the original diagnosis.1 The CDC recommends screening all women who are sexually active and younger than 25 years1; most women with the infection are asymptomatic.—k.e.m.

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