Prevalence and Epidemiologic Correlates of Chlamydia trachomatis in Rural and Urban Populations
Sexually Transmitted Diseases
TC. Incident Chlamydia trachomatis infections among inner-city adolescent females. JAMA. 1998;280:521-526. 2. Howell MR, Quinn TC, Brathwaite W, Gaydos CA. Screening women for Chlamydia trachomatis in family planning clinics. Sex Transm Dis. 1998;25:108-117. In Reply: Choice of treatment regimen, either doxycycline, 100 mg twice daily for 7 days, or a 1-g dose of azithromycin, was based on local clinic policy, which reflects standard treatment in most clinic settings serving adolescents at
... adolescents at risk. We agree that analyzing our data on repeat chlamydia infections by treatment modality or compliance or both may have provided interesting information on efficacy. Although data on treatment regimen were not collected in our study, 2 recent reports compared the efficacy of doxycycline vs azithromycin and found them to be comparable, with treatment failures of less than 5% at 2 to 4 weeks after therapy. 1,2 Therefore, we do not believe differentiation of results by treatment regimen or reported patient compliance would have altered our findings. Although our study population was homogeneous and Baltimore is known to have high sexually transmitted disease rates, we believe sufficient evidence exists supporting our recommendation of chlamydia screening every 6 months for sexually active adolescent females. Chlamydia screening in most adolescent female populations yields prevalences of more than 10%, except in areas with long-standing chlamydia control programs such as the Pacific Northwest. 3-6 Dr Klausner presents recommendations based on prevalence rates calculated with small numbers of patients and does not provide information on frequency of infection or reinfection. Our recommendation is based on incidence rates calculated from prospective data collected over 33 months on 3202 adolescent females. Klausner advocates for screening practices to be dictated by local disease prevalences. We agree in concept. However, the chlamydia burden in other parts of the country has not been well described, and most health care infrastructures currently do not have the resources, technology, or impetus to generate these data. In addition, many chlamydia prevalence rates are determined with less-sensitive tests than were used in our study and may underestimate the disease burden. 3 Wherever we look for chlamydia we find it, especially among adolescents. 3-6 Since chlamydia is mostly an asymptomatic in fection with serious consequences, as Klausner points out, and since the risk of pelvic inflammatory disease and its sequelae increases with the duration of untreated infection, we feel it is cavalier to assume without supporting evidence that chlamydia is not a problem in any given adolescent population. Therefore, we recommend screening all sexually active adolescent females for chlamydia infection, regardless of history or symptoms, until evidence to the contrary is generated. 1. Thorpe EM, Stamm WE, Hook EW, et al. Chlamydial cervicitis and urethritis: a single dose treatment compared with doxycycline for seven days in community based practices. Genitourin Med. 1996;72:93-97. 2. Hillis SD, Coles FB, Litchfield B, et al. Doxycycline and azithromycin for prevention of chlamydial persistence or recurrence one month after treatment in women. Sex Transm Dis. 1998;25:5-11. 3. Schacter J. Chlamydia trachomatis: the more you look, the more you findhow much is there? Sex Transm Dis. 1998;25:229-231.