Sexually Transmitted Diseases In The US: Chlamydia

Sexually Transmitted Diseases have become increasingly prevalent in the United States. The Centers for Disease Control and Prevention (CDC) estimate that nearly 20 million new STIs occur every year in the United States, with over half occurring among young people aged 15–24. Specifically, Chlamydia had been reported as being one of the most commonly noted STI’s in the United States. It is reported as being among the most prevalent of all Sexually Transmitted Diseases (STD’s), and since 1994, has made up the largest percentage of all STDs.

Causes

Chlamydia is caused by the bacteria Chlamydia Trachomatis is the leading cause of the most commonly reported STI’s in the U.S. and worldwide. The disease is transmitted through person to person unprotected sexual contact. There are reported cases where individuals who have contracted Chlamydia and found to have been asymptomatic for an extended length of time. When this occurs, the infected person may not seek treatment right away leaving them susceptible to many complications of the disease such as worsened inflammation in the pelvic region or Pelvic Inflammatory Disease (PID) which may cause reproductive sterility.

Incubation Period

The incubation period for Chlamydia is poorly defined so much so that it has been termed the “silent infection”. The time from initial exposure to the onset of symptoms varies from person to person. Symptoms may appear from one to three weeks after initial contact with the affected individual. Some of the symptoms that an individual might experience is fever, foul malodorous discharge from the anus, vagina, or eyes if the infection starts there, painful urination, painful intercourse, bleeding post-coitus, and or abdominal pain.

Chlamydial bacteria require human hosts to survive and live parasitically in cells without replicating. Chlamydia passes between cells, and between people, in what is known as “elementary bodies”. These structures are spore-like in nature and eventually graduate to what cells that are known as reticulate bodies. These are cells that can replicate once they are transmitted to a new host, they are more sophisticated in this form.

Diagnostics

Chlamydia can be diagnosed in a few ways; for women, a urine sample may be obtained, or a vaginal, cervical, anal or oral swab may be collected. For men, like women, a urine sample may be obtained however, a urethral, anal, or oral swab may also be collected. Serum studies may be done but will only indicate an increased level of white blood cells if the infection has reached colonization that causes the individual’s body to react.

County and State Statistics

For the most recent measurement period (2017), and when compared to other California counties, Riverside County reported a Chlamydia incidence rate of 467.3 cases per 100,000 population. The Strategic Health Alliance Pursuing Equity organization (SHAPE), which is a community-wide effort to coordinate the resources of public health system partners to improve health for all communities in Riverside County reports that this is the second-worst quarter the county has had since 2013 when the value was lower, at 392.2 per 100,000 population.

Statewide, California has a Chlamydia incidence of 552.2 cases per 100,000 Californians which is worse when compared with the infection rate for Riverside County. According to the California Department of Public Health (CDPH), Chlamydia infections have increased statewide approximately 9% over the last few years. Chlamydia rates among females were 60% higher than among males and 54% of cases were among people under age 25.

Federal statistics

In 2017, a total of 1,708,569 chlamydial infections were reported to the CDC in 50 states and the District of Columbia. This case count correlates to a rate of 528.8 cases per 100,000 population. During 2000–2011, the rate of reported chlamydial infections increased from 251.4 to 453.4 cases per 100,000 U.S. residents. Then, during 2011–2013, the rate of reported cases dropped to 443.5 cases per 100,000 population. This was succeeded by an increase of reported cases over each of the next four years, when in 2016–2017 the rate increased 6.9%, from 494.7 to 528.8 cases per 100,000 U.S. residents.

Prevention

Public Health Nurses are responsible to the people and the communities they serve to aid in primary prevention of disease and disability. For primary prevention, it is the goal of the Public Health Nurse to prevent cases of Chlamydia through sex education, and behavior modification strategies i.e. avoid having multiple sexual partners or avoiding unprotected sex. These interventions are listed by the CDC as preventative measures as there are no vaccinations against this STI.

Secondary prevention involves early screening and treatment if disease is diagnosed. The goal of the Public Health Nurse is to prevent transmission of the disease from affected hosts to unaffected hosts. Also, if an individual is diagnosed with Chlamydia, the goal is to avoid any complications of the disease. For example, salpingitis is a complication that can cause ectopic pregnancy, or tubal infertility. Therefore, screening becomes vitally important to avoid such complications especially because there is a risk that an individual may be asymptomatic for the disease and adversely, experience the ravaging effects of the STI on the reproductive system.

Tertiary prevention involves care of the person who affected by a disease or chronic condition. The goal is to maximize quality of life by limiting the effects of the disease or condition on the body, avoiding or minimizing complications, and restoring function to as much as possible. Regrettably, if a person with a chlamydial infection is not treated promptly, the damage that occurs may be permanent. For example, a woman may become infertile as a result of a chlamydial infection so the goal of the Public Nurse, in that case, may be to promote reproductive counseling especially if the woman had not had any children.

Unfortunately, tertiary prevention of acute and chronic chlamydial infections of the upper genital tract has largely failed because irreversible tubal damage has already occurred by the time symptoms develop or the patient presents with infertility or tubal pregnancy.

Conclusion

While Chlamydia continues to be the most commonly reported STI various measures have been identified through continual surveillance to aid in decreasing the incidence and complications of the disease. Some interventions that have been identified are increasing awareness, prevention, and early screening and treatment. There are specific groups and age ranges that have been identified as being most at risk. For example, cases of chlamydial infections were highest among sexually active women aged 16-24. Also, Black or African Americans, followed by American Indian (AI), Alaskan Native (AN), and Native Hawaiian (NH) or Other Pacific Islander (OPI) women were most commonly affected. That said the CDC, has recommended state and local Public Health entities concentrate efforts in the regions where these races are highly populated. Although statistics indicate an increase in chlamydial infections efforts are still encouraged through increasing awareness in schools, community clinics, social sites frequented by adolescents and young adults, and anywhere the message can be relayed. Also, behavioral modification strategies are encouraged by promoting abstinence, encouraging a decrease or avoiding multiple sexual partners, using latex condoms, and early screening. With these interventions continually promoted, the statistical tide may turn in a downward trend once again. However, the statistics are what they currently are, and Public Health Nurses can and should continue to do the great impactful work they do to help individuals and communities at large be educated and prevent this disease from perpetuating.

References

1. California Department of Public Health. Sexually Transmitted Disease Control Branch 2019. Retrieved from: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/STD.aspx
2. Centers for Disease Control and Prevention (CDC). CDC Grand Rounds: Chlamydia prevention: challenges and strategies for reducing disease burden and sequelae. MMWR Morb Mortal Wkly Rep 2011; 60:370- 373.
3. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2015. Atlanta: U.S. Department of Health and Human Services; 2016.
4. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2017. Retrieved from: https://www.cdc.gov/std/stats17/chlamydia.htm
5. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2018. Atlanta, GA: Department of Health and Human Services; September 2018.
6. O'Connell, C. M., & Ferone, M. E. (2016). Chlamydia trachomatis Genital Infections. Microbial cell (Graz, Austria), 3(9), 390–403. doi:10.15698/mic2016.09.525
7. Riverside County 2019. Strategic Health Alliance Pursuing Equity Chlamydia Incidence Rate, 2017. Retrieved from: http://www.shaperivco.org
8. Paavonen J. (1997). Is screening for Chlamydia trachomatis infection cost effective? Genitourinary medicine, 73(2), 103–104. doi:10.1136/sti.73.2.103