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  • Title: Assessing the number of genital chlamydial infections in the United States.
    Author: Judson FN.
    Journal: J Reprod Med; 1985 Mar; 30(3 Suppl):269-72. PubMed ID: 4020783.
    Abstract:
    The prevalence and incidence of genital infections with Chlamydia trachomatis have not yet been determined for broadly based populations within the United States. Largely on the basis of results of prevalence studies from sexually transmitted disease clinics, it has been estimated that C. trachomatis infections are the most common of all sexually transmitted infections and may number 3-5 million cases annually. C. trachomatis isolation rates range from 50% to 80% in certain diseases known to be caused by Chlamydia and from 10% to 30% in sexually active female adolescents and approximately 5% in college women. Cheaper, more-sensitive and widely available diagnostic tests are necessary to adequately define the epidemiology of genital Chlamydia infections in the U.S. Newer diagnostic tests and regulations making chlamydial infections reportable will be needed if accurate national incidence rates are to be obtained from broadly based populations within the US. It has been estimated, largely on the basis of studies in sexually transmitted disease (STD) clinics, that genital chlamydial infections are the most common of all STDs, with 3-5 million new cases annually. There are almost no data on possible changes in chlamydial infection rates in defined populations over the past decade. Current classification of the genus Chlamydia provides for 2 species, of which only trachomatis strains infect primarily humans, most often by close physcial contact. Human strains can be divided by immunofluorescent test into 15 immunotypes, of which genital immunotypes D-K are very common and at sites of initial exposure cause nongonococcal urethritis (NGU), postgonococcal urethritis, procititis, conjunctivitis and subclinical infections in men; cervicitis, urethritis, conjunctivitis, and subclinical infections in women; and conjunctivitis and pharyngeal carriage in neonates. Secondary spread can lead to a variety of complications, but rates of epididymitis, pelvic inflammatory disease, ectopic pregnancy, and neonatal pneumonitis are not precise indicators of genital infection rates. Because 30-60% of NGU is believed caused by C. trachomatis, the number of NGU cases can indirectly measure underlying infection rates in men. Reported C. trachomatis isolation rates have ranged from 50-80% in some diseases known to be caused by chlamydia, 20-35% in unselected STD patients, 10-30% in sexually active adolescents, and 5-25% in pregnant women. Numerous factors may affect the true and apparent incidence and prevalence rates. Rates tend to be highest in persons aged 20-24 years and to be quite low for women over 30. Adequately controlled studies have usually shown higher rates in blacks. Homosexuals have higher prevalence of C. trachomatis antibodies than heterosexual men, despite a lower rate of positive cultures. Prevalence rates are lower among more advantaged socioeconomic strata and among users of condoms and diaphragms, especially if nonoxynol 9 is also used. The inadequacy of existing diagnostic techniques has hindered epidemiologic study of chlamydia infections. True prevalence rates of endocervical chlamydial infection for example are probably 20-25% higher than culture results indicate.
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