Of all the countries in the industrialized world, the U.S. has the highest rate of sexually transmitted disease (STD) infection.
The North Carolina-based American Social Health Association (ASHA) estimates that 19 million new STD cases occur annually in the nation. That number rises steadily each year.
Among the most common STDs in America is chlamydia. Caused by the bacterium Chlamydia trachomatis, the disease is contracted during oral, vaginal or anal sex with an infected person through vaginal fluid and semen. Men and women can contract chlamydia, and serious complications can arise in either sex, often before symptoms of the disease are noticed.
Chlamydia infections have been on the rise for the last 10 years. According to the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, there were 929,462 reported cases of the disease in 2004, an increase of almost 6 percent compared to 2003. Between 2000 and 2004, the chlamydia infection rate increased by almost 48 percent among men and by 22 percent among women.
For women, the highest infection rates occur among African-Americans, who are more than seven times as likely to report chlamydia than whites, and among those ages 15 to 24. Men ages 20 to 24 are most likely to report the disease. African-American men are 11 times more likely to report infection than white men.
But health authorities say those numbers are misleading. In fact, chlamydia is far more prevalent than reports would suggest. Reported cases represent just a fraction of the total, as many people have no idea that they have the disease. The CDC estimates some 3 million Americans are infected with chlamydia each year.
The numbers are further clouded by the fact that improved screening methods and more sensitive tests may explain the reported infection rate increase. Because complications from chlamydia can be worse in women, health experts recommend that all sexually active women undergo annual screenings for chlamydia. Pregnant women, too, should be screened.
Up to 75 percent of women and 50 percent of men with chlamydia show no symptoms of the disease. When symptoms do occur, they typically show up within one to three weeks of infection. One of the most obvious signs is a mucus or pus discharge from the penis or vagina. Pain during urination is also common.
In women, if the disease is left untreated, it can infect the cervix, fallopian tubes and urethra, and result in pelvic inflammatory disease (PID). This serious infection of the reproductive organs can lead to scarring and blockage of the fallopian tubes and result in infertility, ectopic pregnancy and chronic pelvic pain. Furthermore, pregnant women may pass the infection to their newborns, which become susceptible to both conjunctivitis (eye inflammation) and pneumonia.
In men, untreated chlamydia may lead to fever, swelling and a painful penile discharge - all signs of epididymitis, an inflammatory condition in the region around the testicles that can cause sterility. An estimated 250,000 men under the age of 35 develop acute cases of epididymitis each year.
Men and women are also susceptible to chlamydia infection of the throat or rectum via oral or anal sexual contact.
According to the ASHA, chlamydia also increases a person's risk of HIV infection by up to five times. "It is especially important for our young people to understand that having a sexually transmitted infection such as herpes or chlamydia significantly increases the risk of acquiring HIV infection if they are exposed to it," says ASHA president James Allen, M.D., M.P.H. "Most people do not understand or appreciate the ability of one infection to increase the risk of acquiring another infection - in this case, one that is much more serious."
Nancy Merrill, a member of myDNA's Medical Advisory Board, said everyone who is sexually active should get tested for chlamydia on a regular basis.
"Since there are usually no symptoms that one has chlamydia, most sexually active persons do not have a clue that they are infected."
"Since chlamydia is currently the leading cause of infertility in the United States, all sexually active persons (especially teenagers) should request that the test be done every 6 to 12 months," Merrill said.
Fortunately, screening for the disease is easy and effective. All it requires is a simple swab collection of fluid from the vagina or penis. The fluid is then sent to a lab for testing for the chlamydia bacteria. Tests also may be conducted on urine samples.
In a study published in The Journal of the American Medical Association, The Johns Hopkins University School of Medicine researchers recommend that teenage girls especially be screened for the disease. The study of 3,202 sexually active females ages 12 to 19 found that age alone puts this group in danger.
"We couldn't predict which females in our study would be at increased risk for chlamydia just because they didn't use condoms consistently, or because they had a new sexual partner, or even because they previously had a sexually transmitted disease," says Johns Hopkins adolescent medicine specialist and study author Gale Burstein, M.D., M.P.H. "The only risk factor we found for chlamydia infection was being a teenager."
Burstein and colleagues say their results indicate that screening twice per year by a family doctor may be the best way to prevent serious complications from the disease. "Current guidelines for adolescent primary care call for yearly screenings, but that's not enough," Burstein says. "These sexually active teenagers need more frequent testing."
A positive test for chlamydia does not spell doom for the patient. The disease is curable with antibiotics. The doctor will typically prescribe one of four drugs: azithromycin, doxycycline, erythromycin or ofloxacin.
If you know you have chlamydia, it's important to tell your sexual partners, so they can also be tested and treated, as well as to abstain from intercourse until you no longer have the disease. The best way to prevent the disease is through abstinence, but use of a female or latex condom is also effective.
