Importance of Screening
Because chlamydia is most common among young women and is usually asymptomatic, CDC recommends annual chlamydia screening for all sexually active women under age 26, as well as older women with risk factors such as new or multiple sex partners.4 Data from one study in a managed care setting suggest that chlamydia screening and treatment can reduce the incidence of pelvic inflammatory disease (PID) by over 50 percent.5 Unfortunately, many sexually active young women are not being tested for chlamydia, in part reflecting a lack of awareness among some providers and limited resources for screening.6 Research has shown that simple changes in clinical procedures, such as coupling chlamydia tests with routine Pap testing, can sharply increase the proportion of women screened.7 Increased screening efforts are critical to preventing the serious health consequences of this infection, particularly infertility. While recent data suggest that chlamydia screening may be increasing, it is estimated that more than half of sexually active women under 26 were not screened within the last year.6
Reducing the impact of this disease among women will also require reducing and treating chlamydia among males. Recent studies have also shown that many young women who have been diagnosed with chlamydia may become re-infected by male partners who have not been diagnosed or treated.8, 9, 10 CDC’s 2006 STD Treatment Guidelines recommend that women be re-tested for chlamydia approximately three months after treatment, and also recommend that where possible, antibiotic therapy be delivered by heterosexual patients to their partners if other strategies for reaching and treating partners are not likely to succeed, an approach known as expedited partner therapy.4
Summary
These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 18–30, 2009. The information in this report updates the 2006 Guidelines for Treatment of Sexually Transmitted Diseases (MMWR2006;55[No. RR–11]). Included in these updated guidelines is new information regarding 1) the expanded diagnostic evaluation for cervicitis and trichomoniasis; 2) new treatment recommendations for bacterial vaginosis and genital warts; 3) the clinical efficacy of azithromycin for chlamydial infections in pregnancy; 4) the role of Mycoplasma genitalium and trichomoniasis in urethritis/cervicitis and treatment-related implications; 5) lymphogranuloma venereum proctocolitis among men who have sex with men; 6) the criteria for spinal fluid examination to evaluate for neurosyphilis; 7) the emergence of azithromycin-resistant Treponema pallidum; 8) the increasing prevalence of antimicrobial-resistant Neisseria gonorrhoeae; 9) the sexual transmission of hepatitis C; 10) diagnostic evaluation after sexual assault; and 11) STD prevention approaches.
i Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2008. Atlanta, GA: U.S. Department of Health and Human Services, November (2009.Accessed June 2, 2011)
4 CDC. Sexually transmitted diseases treatment guidelines, 2006. Morbidity and Mortality Weekly Report 2006;55(RR-11).(.(Accessed May 23, 2011)
5 Scholes D et al. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection.
New England Journal of Medicine 1996;334(21):1362-1366..(Accessed May 23, 2011)
6 National Committee for Quality Assurance. The State of Health Care Quality 2008. Washington, D.C., 2008..(Accessed May 23, 2011)
7 Burstein G et al. Chlamydia screening in a health plan before and after a national performance measure introduction. Obstetrics & Gynecology 2005;106(2):327-334..(Accessed May 23, 2011)
8 Whittington et al. Determinants of persistent and recurrent chlamydia trachomatis infection in young women: results of a multicenter cohort study. Sexually Transmitted Diseases 2001;28(2):117-123..(Accessed May 23, 2011)
9 Reitmeijer CA et al. Incidence and repeat infection rates of chlamydia trachomatis among male and female patients in an STD clinic: implications for screening and rescreening. Sexually Transmitted Diseases 2002; 29(2):65-72..(Accessed May 23, 2011)
10 Anschuetz et al. Determining risk markers for gonorrhea and chlamydial infection and reinfection among adolescents in public high schools. Sexually Transmitted Diseases 2009;36(1):4-8.(Accessed May 23, 2011)