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Title: Factors related to genital Chlamydia trachomatis and its diagnosis by culture in a sexually transmitted disease clinic.
Author: Magder LS, Harrison HR, Ehret JM, Anderson TS, Judson FN.
Journal: Am J Epidemiol; 1988 Aug; 128(2):298-308. PubMed ID: 3394697.
Abstract:
The authors cultured 2,320 patients who attended the Denver Metro Health Clinic for Sexually Transmitted Diseases from September 1981 to June 1983 to determine clinical and epidemiologic factors associated with genital chlamydial infection. Among consecutive heterosexual men with urethral discharge, 226 of 849 (27%) had positive urethral cultures, with rates significantly lower among those with profuse (18%) or purulent (19%) discharges, and higher (37%) among those with symptoms for more than seven days. In a subgroup of men without gonococci, those who had polymorphonuclear leukocytes on smear had higher isolation rates (33%) than those who did not (3%). Among consecutive female patients, 172 of 1,031 (17%) had positive cervical cultures, with rates significantly lower in those who were white (13%), married (7%), or using a diaphragm (0 of 77), and higher in those who were positive for Neisseria gonorrhoeae (38%). There was a marginally significant increased rate of chlamydial isolation among oral contraceptive users only for women aged 20 years or younger. Younger age was significantly associated with chlamydial isolation in both men and women after controlling for sexual activity and other factors. Various patient characteristics can be combined to define subgroups of men and women, with rates of isolation ranging from under 4% to over 60%. These results can be useful in deciding whom to test and whom to treat presumptively in a public health setting. To increase knowledge of the prevalence of genital chlamydia trachomatis infection and the associated epidemiologic and clinical factors, cultures were obtained from 2320 patients at a Denver clinic for sexually transmitted diseases. Specific subsamples examined included 96 consecutive male clinic attendees with no urethral discharge on examination, 1193 consecutive male attendees with urethral discharge, and 1031 consecutive female attendees. Only 4 (4%) of the men attending the clinic who did not have a discharge on examination were positive for chlamydial infection compared with 275 (23%) of men with a discharge. Of the men with discharge, the isolation rate of chlamydia was 27% among heterosexuals but only 14% among homosexuals and bisexuals. Of the female attendees cultured, 172 (17%) had positive cervical findings. Younger age was associated with chlamydial infection in both men and women even after controlling for sexual activity. In a subgroup of men without gonococci, those who had polymorphonuclear leukocytes on smear had higher isolation rates (33%) than those who did not (3%). Among women, chlamydia rates were significantly lower for whites (13%), married women (7%), and diaphragm users (0%). There was a marginally significant increased rate of chlamydial isolation among oral contraceptive users only for women aged 20 years or below. Significantly fewer (18%) men with profuse discharge were positive for chlamydial infection compared with men with a scant or moderate discharge (27% and 31%, respectively), and those with a purulent discharge were less likely to be positive than men with a clear or white discharge. Stepwise multiple logistic regression suggested the following risk factors for chlamydial infection in men: polymorphonuclear leukocytes, gram-stained smear negative for intracellular diplococci, age under 25 years, history of discharge, discharge for more than 7 days, and no dysuria. Risk factors for women included age less than 25 years, unmarried status, gonorrhea, an abnormal cervix, pelvic inflammatory disease, and no recent antibiotic use.

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