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Further Uncovering the "Hidden Epidemic"

Linda M. Niccolai, PhD; Abby L. Hochberg; Kathleen A. Ethier, PhD; Jessica B. Lewis, MFT; Jeannette R. Ickovics, PhD

Arch Pediatr Adolesc Med. 2007;161(3):246-251.

Objective  To determine the frequency and patterns of recurrent Chlamydia trachomatis infections, the most common bacterial sexually transmitted infection in young women.

Design  Cohort study using different data collection methods, including face-to-face interviews, medical record reviews, urine-based screening for C trachomatis infections, and a review of state health department reports of C trachomatis diagnoses.

Setting  Ten community-based health centers that provided reproductive health care from June 1998 to September 2001.

Participants  Eligibility criteria included being nulliparous, between the ages of 14 and 19 years, and human immunodeficiency virus–negative, all at the time of recruitment. This convenience sample (N = 411) was recruited by word of mouth, clinician referrals, and advertisements in the clinics. Prospective follow-up data were available for 93.9% (386/411) of the sample. The exposure of interest was prior chlamydia infection.

Main Outcome Measure  Diagnosis of recurrent C trachomatis infection.

Results  During the follow-up period of 23 318 person-months (mean, 4.7 years per person), 216 participants (52.6%) were diagnosed as having C trachomatis infection, and 123 participants (29.9% of the total sample and 56.9% of those with initial infections) were diagnosed as having recurrent C trachomatis infections. Of 456 C trachomatis diagnoses made during the study period, 241 (52.9%) were recurrent infections. The rate of recurrent infections was 42.1 per 1000 person-months. The median time to recurrent infection was 5.2 months.

Conclusion  Recurrent C trachomatis infections comprise a substantial health burden among young women, possibly higher than previously recognized in this vulnerable population.

Author Affiliations: Department of Epidemiology and Public Health and Center for Interdisciplinary Research on AIDS (Drs Niccolai and Ickovics and Ms Lewis) and School of Medicine (Ms Hochberg), Yale University, New Haven, Conn; and Centers for Disease Control and Prevention, Atlanta, Ga (Dr Ethier).