Download Epidemiology of Chlamydia

Review of Chlamydia and its Epidemiology
Lauren Smith
3/27/2014
Sexually transmitted diseases (STD) is an issue very common to young Americans.
According to the Centers for Disease Control and Prevention (CDC), annually Chlamydia is the
most reported STD for those under the age of 25. Researchers believe the high prevalence of
Chlamydia is attributed to risky health behaviors including multiple sex partners and lack of
preventive measures –which are generally associated with this young population. Furthermore,
Chlamydia and other STDs indicate health and racial disparities as cases are frequently reported
in the United States by non-Hispanic African-Americans. Chlamydia remains a national problem
as it affects at least 1.2 million lives each year, if left untreated may cause serious health
complications, and is completely preventable and easily treated.
Chlamydia comes from a family of Chlamydiaceae, which is comprised of three species
responsible for human disease (Cohan, B., April 2008). Chlamydia trachomatis (C. trachomatis),
is the bacteria responsible for conjunctivitis, pneumonia, and lymphogranuloma venereum
(LVG). Mostly, this type of chlamydia species is responsible for infections of the urogenital tract
for men and women (Cohan, B., April 2008). Chlamydia can be difficult to treat and prevent
particularly in situations where an infected person is unaware of and/or involved in careless
sexual behavior. For example, the bacteria of the Chlamydia species Chlamydia pneumoniae (C.
pnuemoniae), which causes bronchitis and pneumonia, can be spread from the host to an
uninfected person genital area through oral and anal sex (Cohan, B., April 2008). Once C.
pnuemoniae is introduced to the genitals it will soon develop into C. trachomatis (Cohan, B.,
April 2008). If left untreated, a harmful cycle of re-infection between partners will occur or be
passed to a new person and so forth.
Chlamydia affects men and women and for most persons, their infection is asymptomatic
(Mishori, R. et al., December 2012). When symptoms are present in women, abnormal vaginal
discharge, vaginal bleeding, and frequent urination are usually reported (Mishori, R. et al.,
December 2012). Symptoms such as penile discharge, frequent urination and an itching sensation
are experienced by some men (Mishori, R. et al., December 2012).
Today many state counties track and report the occurrence of Chlamydia and other STDs.
Healthcare professionals and clinics, especially those affiliated with a Medicaid program, report
new cases of Chlamydia to their local health department (eWashtenaw, n.d.). For example,
Michigan has a disease surveillance system which tracks and reports new cases within the year
(eWashtenaw, n.d.). According to the health assessment, in 2010, Michigan reported a rate of
457 new cases per 100,000 residents. The national rate for 2010 was 407 new cases per 100,000
U.S. residents. The National Academy of Science (NASA) reports communicable diseases are
responsible for nearly 33 percent of all deaths in the U.S. (NASA, 2014). The rate of morbidity
including hospitalizations due to these illnesses are also notably high (eWashtenaw, n.d.).
Mortality caused by Chlamydia itself is very rare, however, Chlamydia can cause
irrevocable health complications when left untreated. Pelvic inflammatory disease, for example,
is a direct result of untreated Chlamydia and many other STDs (Mishor, R. et al., December
2012). The bacteria moves upward along the urinary tract and into the reproductive organs,
causing inflammation, pelvic and abdominal pain, and even infertility by building blockage in
the fallopian tubes (Mishor, R. et al., December 2012). Chlamydia and the ability for bacteria to
travel along the urinary tract poses a significant health risk to pregnant women as well. For
pregnant women, Chlamydia may increase the possibility of an ectopic pregnancy, spontaneous
abortion and infant death (Mishor, R. et al., December 2012).
In 2012, Chlamydia disproportionately affected those between the ages of 15 and 24.
Many healthcare professionals believe this age group is more likely than any other age group to
involve themselves in risky health behavior (Mishori, R. et al., December 2012). Realistically,
the majority of this population are single and more likely to have multiple sex partners. Based on
the chart provided by the CDC website, women are at a greater risk for contracting Chlamydia.
The assumption behind this information is women are more likely to participate in screenings
and seek treatment than men (CDC, 2006).
Figure A
Chlamydia- Rates by age and sex, United States, 2012
The rate of Chlamydia among African-Americans, American Indians/Alaska Natives,
Native Hawaiian and other Pacific Islanders and Hispanics is significantly higher than their
Caucasian and Multiracial counterparts (CDC, 2012). African-Americans are single-handedly the
leaders in Chlamydia infections (see Figure B). Racial disparities regarding health is not a new
phenomenon. Other medical conditions such as heart disease and HIV/AIDS disproportionately
affect African-Americans. Lack of access to health care, education, and poverty all influence the
rising rate of Chlamydia among African-Americans and minority populations in general.
Figure B
Chlamydia- Rates by Race/Ethnicity, United States, 2012
As mentioned, accessibility, education and many other environmental and social factors
seem to attribute in the high occurrence of Chlamydia in minorities and young adults. The CDC
reports in 2011 the majority of the country’s population were considered low income (U.S.
DHHS, 2011). The people between the ages of 19 and 34 were more likely to be uninsured (U.S.
DHHS, 2011). Additionally, nearly 30 percent of Hispanics and 20 percent of AfricanAmericans were uninsured (U.S.DHHS, 2011). Because some infected people do not experience
symptoms and may not have insurance, they are less likely to receive routine screening or know
how and where to access care.
In 2012, metropolitan areas reported the highest rates of new Chlamydia cases (CDC,
2014). Through the media and discussions, these areas are predominantly characterized by
diverse/minority populations, lower socio-economic status, low employment rates, and increased
crime rates. All of these factors may influence how a person regards the importance of health,
willingness to participate in preventive services, and the availability of health care clinics and
transportation to such places.
Overall, Chlamydia seems to be an example of a common source epidemic. Since 1995,
Chlamydia remains one of the top most reported STDs across America (CDC, 2014). From
1995-2011, each year there was an increase in the amount of cases in all regions (CDC, 2014).
During this same period, the rate of women infected increased each year (CDC, 2014). For the
first time, 2012 reported a similar amount of new reported cases as 2011 (CDC, 2014). There are
occasional fluctuations dependent on age, sex or ethnicity. During 2008-2011, young adolescents
(14-19) were responsible for the highest rate of infections. However, the rate declined during
2011-2012 (CDC, 2014).
The distribution of Chlamydia is attributed to social and environment factors including
ethnic origin, level of education and social status, and accessibility to health care. It is also
believed that women are more likely to get screened and seek treatment than men which may
explain the difference in reported cases. Since working at a Medicaid insurance company and
interacting with health care professionals and low-income residents, I have learned quite a bit
regarding STDs and follow up treatment. It is quite possible that many young adults for instance
do not properly treat their infection. Usually a doctor will prescribe an antibiotic for the infection
and if used as prescribed, should clear the infection for most women. There are instances when
an infection is not cleared and the person did not seek follow up testing as recommended. This is
one gap that I have not seen mentioned in any resources used and I believe it is important
because what might be indicated as a new case may actually be an ongoing infection. I would
recommend more focus be placed on defining new cases so rate of occurrence is more accurate. I
also believe more research should be geared towards sexual behavior among those most affected
so healthcare professionals can better provide education and teach preventive methods.
References
CDC. (2006). 2005 sexually transmitted diseases surveillance. Review
http://www.cdc.gov/std/stats05/trends2005.htm
CDC. (2014). Figure 5. chlamydia- rates by age and sex, United States, 2012. Review
http://www.cdc.gov/std/stats12/chlamydia-figs.htm
CDC. (2014). Figure 6. chlamydia- rates by race/ethnicity, United States, 2008-2012. Review
http://www.cdc.gov/std/stats12/chlamydia-figs.htm
CDC. (2014). 2012 sexually transmitted diseases surveillance. Review
http://www.cdc.gov/std/stats12/chlamydia.htm
Cohan, B. (1 April 2008). All about chlamydia. Review
http://www.medicalnewstoday.com/articles/102418.php
eWashtenaw. (n.d.). Community health assessment: infectious disease. Review
http://www.ewashtenaw.org/government/departments/public_health/health-promotion/hip/chachip-landing-page/cha-infectious-disease
Mishori, R. et al. (15 December 2012). Chlamydia trachomatis infections: screening, diagnosis,
and management. Review http://www.aafp.org/afp/2012/1215/p1127.html
National Academy of Sciences. (2014). U.S. health in international perspectives. Review
http://sites.nationalacademies.org/DBASSE/CPOP/US_Health_in_International_Perspective/inde
x.htm
U.S. DHHS. (2011). Overview of the uninsured in the United States: a summary of the 2012
current population survey report. Review
http://aspe.hhs.gov/health/reports/2012/uninsuredintheUS/ib.shtml