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Tests of reinfection important for young adolescents positive for chlamydia
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Tests of reinfection for adolescents who test positive for chlamydia and combined patient–provider interventions to improve documentation may increase CDC guideline adherence, according to new research presented during the 2013 Society for Adolescent Health and Medicine Meeting.
The CDC has detailed guidelines for screening and management of chlamydia infections: sexually active women aged younger than 25 years and high-risk men should be tested yearly; after 3 months, tests of reinfection should be performed, but within 12 months for positive results; and expedited partner therapy should be available for those unlikely to seek evaluation and treatment.
The retrospective study reviewed 2,298 chlamydia tests from 2008 to 2011 and detailed review of any positive cases (7.7%).
Researchers found that almost all (99.4%) of the participants who tested positive received treatment, 90.9% of whom were treated within 14 days of diagnosis.
Although expedited partner therapy was recommended in 86% of the cases, use was only documented in 39.5%.
“There were high rates of documentation that partner therapy was recommended, but poor documentation of actual expedited partner therapy delivery,” researchers wrote. “The legalization of [expedited partner therapy] for chlamydia in New York State during this period may account for some of this discrepancy, but this is an area for improvement.”
Researchers found that retests were performed in 86.4% of the cases, 83% between 3 weeks and 12 months; 18.3% of retests were positive for chlamydia.
Participants who were not tested by 6 months were retested after 6 months (22%) or never retested (13.6%).
Almost half (42.9%) of participants who were not retested had been seen by a medical provider, 85.1% in primary care, inpatient or ED settings, leading to 41 missed opportunities for retesting.
Researchers found that at retesting, 42.9% of 12- to 14-year-olds had positive chlamydia results compared with 17.1% of 15- to 22-year-olds.
“The high reinfection rate in younger adolescents suggests that interventions targeting this age group may be particularly effective,” researchers wrote.
For more information:
Teplow-Phipps R. Abstract #18. Presented at: Society for Adolescent Health and Medicine 2013; March 13-16, 2013; Atlanta.
Disclosure: The researchers reported no relevant financial disclosures.
Perspective
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Toni Darville, MD
This study drives home several important points about Chlamydia trachomatis genital tract infection. First, it is an infection that needs to be considered in pediatric patients. Patients aged 12 to 14 years were positive for infection and had the highest rates of reinfection. Secondly, there is a high risk of reinfection in all adolescents (12- to 22-year-olds). Reinfection occurs because the immune response that is generated by natural infection frequently does not induce sterilizing immunity, and since partner therapy is often not accomplished (only 39.5% of partners received therapy in this study), repeat exposure is likely to occur.
The higher rate of reinfection determined in 12- to 14-year-olds (42.9%) compared with 15- to 22-year-olds (17.1%) might be due to two factors: 1) lower rates of expedited partner therapy and 2) less preexisting immunity due to more recent sexual debut and reduced prior exposure.
The bottom line is that chlamydial screening can be easily performed on a urine sample from boys or girls or on a vaginal swab from girls, and pediatricians and adolescent physicians should utilize screening in sexually active adolescents to detect and treat infected patients in order to protect the reproductive health of young girls and women.
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