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July 3, 1987, Vol 258, No. 1 >
ARTICLE | July 3, 1987

Unrecognized High Prevalence of Chlamydia trachomatis Cervical Infection in an Isolated Alaskan Eskimo Population FREE

Kathleen E. Toomey, MD, MPH; Michael P. Rafferty, MD; Walter E. Stamm, MD
[+] Author Affiliations

Reprint requests to the Pew Health Policy Program, Institute for Health Policy Studies, Bldg 1, Room 202, San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA 94110 (Dr Toomey).


JAMA. 1987;258(1):53-56. doi:10.1001/jama.1987.03400010057027
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References

Chlamydia trachomatis genital infections often go unrecognized where specific culture diagnosis is not easily accessible. We studied the prevalence and clinical correlates of C trachomatis in a geographically isolated Alaskan Eskimo population with a high rate of gonorrhea but for whom specific chlamydial diagnosis had never been available. Using a direct immunofluorescent stain of endocervical secretions, we screened 493 women (52% of all women of reproductive age) when they presented to regional health facilities during the year-long study period. Chlamydia trachomatis was identified in 23% (114/493), including 39% (31/80) of teenagers, 30% (34/115) of prenatal patients, 47% (7/15) of pregnant teens, and 40% (8/19) of women with pelvic inflammatory disease. Genital symptoms, clinical signs, and the presence of concomitant gonorrhea were ineffective means of identifying chlamydial infection. This study demonstrates the successful use, and public health importance, of nonculture direct testing to document the unrecognized high prevalence of C trachomatis infection where culture diagnosis is not available.

(JAMA 1987;258:53-56)

REFERENCES

1 +
 Chlamydia trachomatis infections—policy guidelines for prevention and control . MMWR 1985;;34( (suppl) ):53S-74S.
2 +
Schachter J:  Chlamydial infections . N Engl J Med 1978;;298:428-435,490-485,540-549.
3 +
Stamm WE, Holmes KK:  Chlamydial infections —What should we do while waiting for a diagnostic test? West J Med 1981;;135:226-229.
4 +
Holmes KK:  The Chlamydia epidemic . JAMA 1981;;245:1718-1723.
5 +
Mardh PA, Ripa T, Svensson L, et al:  Chlamydia trachomatis infection in patients with acute salpingitis . N Engl J Med 1977;;296:1377-1379.
6 +
Bowie WR, Jones H:  Acute pelvic inflammatory disease in outpatients: Association with Chlamydia trachomatis and Neisseria gonorrhoeae . Ann Intern Med 1981;;95:685-688.
7 +
Sweet RL, Schachter J, Robbie MO:  Failure of β-lactam antibiotics to eradicate Chlamydia trachomatis in the endometrium despite apparent clinical cure of acute salpingitis . JAMA 1983;;250: 2641-2645.
8 +
Westrom L:  Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries . Am J Obstet Gynecol 1980;;138:880-892.
9 +
Brunham RC, Maclean IW, Binns B, et al:  Chlamydia trachomatis: Its role in tubal infertility . J Infect Dis 1985;;152:1275-1282.
10 +
Rubin GL, Peterson HB, Dorfman SF, et al:  Ectopic pregnancy in the United States—1970 through 1978 . JAMA 1983;;249:1725-1729.
11 +
Gravett MG, Nelson HP, DeRouen T, et al:  Independent associations of bacterial vaginosis and Chlamydia trachomatis infection with adverse pregnancy outcome . JAMA 1986;;256:1899-1903.
12 +
Sandstrom KI, Bell TA, Chandler JW, et al:  Microbial causes of neonatal conjunctivitis . J Pediatr 1984;;105:706-711.
13 +
Beem MO, Saxon EM:  Respiratory-tract colonization and a distinctive pneumonia syndrome in infants infected with Chlamydia trachomatis . N Engl J Med 1977;;296:306-310.
14 +
Tam MR, Stamm WE, Handsfield HH, et al:  Culture-independent diagnosis of Chlamydia trachomatis using monoclonal antibodies . N Engl J Med 1984;;310:1146-1150.
15 +
Stamm WE, Harrison HR, Alexander ER, et al:  Diagnosis of Chlamydia trachomatis infections by direct immunofluorescence staining of genital secretions . Ann Intern Med 1984;;101:638-641.
16 +
Stamm WE, Holmes KK:  Measures to control Chlamydia trachomatis infections: An assessment of new national policy guidelines . JAMA 1986;;256: 1178-1179.
17 +
Westrom L, Mardh PA:  Pelvic inflammatory disease: Epidemiology, diagnosis, clinical manifestations and sequelae , in Holmes KK, Mardh PA (eds): International Perspectives on Neglected Sexually Transmitted Diseases . New York, McGraw-Hill International Book Co, 1983;, pp 235-250.
18 +
Schachter J, Hanna L, Hill EC, et al:  Are chlamydial infections the most prevalent venereal disease? JAMA 1975;;231:1252-1255.
19 +
Schachter J, Stoner E, Moncada J:  Screening for chlamydial infections in women attending family planning clinics . West J Med 1983;;138:375-379.
20 +
Handsfield HH, Jasman LL, Robert PL, et al:  Criteria for selective screening for Chlamydia trachomatis infection in women attending family planning clinics . JAMA 1986;;255:1730-1734.
21 +
McCormack WM, Rosner B, McComb DE, et al:  Infection with Chlamydia trachomatis in female college students . Am J Epidemiol 1985;;121: 107-115.
22 +
Stamm WE, Wagner KF, Amsel R, et al:  Causes of the acute urethral syndrome in women . N Engl J Med 1980;;303:409-415.
23 +
Schachter J, Grossman M, Sweet RL, et al:  Prospective study of perinatal transmission of Chlamydia trachomatis . JAMA 1986;;255:3374-3377.
24 +
Eagar RM, Beach RK, Davidson AJ, et al:  Epidemiologic and clinical factors of Chlamydia trachomatis in black, Hispanic and white female adolescents . West J Med 1985;;143:37-41.
25 +
Chacko MR, Lovchik JC:  Chlamydia trachomatis infection in sexually active adolescents: Prevalence and risk factors . Pediatrics 1984;;73: 836-840.
26 +
Harrison HR, Boyce WT, Haffner WHJ, et al:  The prevalence of genital Chlamydia trachomatis and mycoplasmal infections during pregnancy in an American Indian population . Sex Transm Dis 1983;; 10:18-20.
27 +
Summary Statistics, Kotzebue Region (Gonorrhea) 1984-1985 . Anchorage, Alaska, Section of Epidemiology, Division of Public Health, US Dept of Health and Human Services, State of Alaska, 1985;.
28 +
Kiviat NB, Wolner-Hanssen P, Peterson M, et al:  Localization of Chlamydia trachomatis infection by direct immunofluorescence and culture in pelvic inflammatory disease . Am J Obstet Gynecol 1986;;154;865-873.
29 +
Washington AE, Sweet RL, Shafer MA:  Pelvic inflammatory disease and its sequelae in adolescents . J Adolesc Health Care 1985;;6:298-310.
30 +
Alexander ER, Harrison HR:  Role of Chlamydia trachomatis in perinatal infection . Rev Infect Dis 1983;;5:713-719.
31 +
Schachter J, Sweet RL, Grossman M, et al:  Experience with the routine use of erythromycin for chlamydial infections in pregnancy . N Engl J Med 1986;;314:276-279.
32 +
 STD treatment guidelines . MMWR 1985;;34 ( (suppl) ):75S-108S.
33 +
Stone KM, Grimes DA, Magder LS:  Primary prevention of sexually transmitted diseases . JAMA 1986;;255:1763-1766.
34 +
Nettleman MD, Jones RB, Roberts SD, et al:  Cost-effectiveness of culturing for Chlamydia trachomatis . Ann Intern Med 1986;;105:189-196.
35 +
Williams T, Maniar AC, Brunham RC, et al:  Identification of Chlamydia trachomatis by direct immunofluorescence applied in specimens originating in remote areas . J Clin Microbiol 1985;;22: 1053-1054.

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1 +
 Chlamydia trachomatis infections—policy guidelines for prevention and control . MMWR 1985;;34( (suppl) ):53S-74S.
2 +
Schachter J:  Chlamydial infections . N Engl J Med 1978;;298:428-435,490-485,540-549.
3 +
Stamm WE, Holmes KK:  Chlamydial infections —What should we do while waiting for a diagnostic test? West J Med 1981;;135:226-229.
4 +
Holmes KK:  The Chlamydia epidemic . JAMA 1981;;245:1718-1723.
5 +
Mardh PA, Ripa T, Svensson L, et al:  Chlamydia trachomatis infection in patients with acute salpingitis . N Engl J Med 1977;;296:1377-1379.
6 +
Bowie WR, Jones H:  Acute pelvic inflammatory disease in outpatients: Association with Chlamydia trachomatis and Neisseria gonorrhoeae . Ann Intern Med 1981;;95:685-688.
7 +
Sweet RL, Schachter J, Robbie MO:  Failure of β-lactam antibiotics to eradicate Chlamydia trachomatis in the endometrium despite apparent clinical cure of acute salpingitis . JAMA 1983;;250: 2641-2645.
8 +
Westrom L:  Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries . Am J Obstet Gynecol 1980;;138:880-892.
9 +
Brunham RC, Maclean IW, Binns B, et al:  Chlamydia trachomatis: Its role in tubal infertility . J Infect Dis 1985;;152:1275-1282.
10 +
Rubin GL, Peterson HB, Dorfman SF, et al:  Ectopic pregnancy in the United States—1970 through 1978 . JAMA 1983;;249:1725-1729.
11 +
Gravett MG, Nelson HP, DeRouen T, et al:  Independent associations of bacterial vaginosis and Chlamydia trachomatis infection with adverse pregnancy outcome . JAMA 1986;;256:1899-1903.
12 +
Sandstrom KI, Bell TA, Chandler JW, et al:  Microbial causes of neonatal conjunctivitis . J Pediatr 1984;;105:706-711.
13 +
Beem MO, Saxon EM:  Respiratory-tract colonization and a distinctive pneumonia syndrome in infants infected with Chlamydia trachomatis . N Engl J Med 1977;;296:306-310.
14 +
Tam MR, Stamm WE, Handsfield HH, et al:  Culture-independent diagnosis of Chlamydia trachomatis using monoclonal antibodies . N Engl J Med 1984;;310:1146-1150.
15 +
Stamm WE, Harrison HR, Alexander ER, et al:  Diagnosis of Chlamydia trachomatis infections by direct immunofluorescence staining of genital secretions . Ann Intern Med 1984;;101:638-641.
16 +
Stamm WE, Holmes KK:  Measures to control Chlamydia trachomatis infections: An assessment of new national policy guidelines . JAMA 1986;;256: 1178-1179.
17 +
Westrom L, Mardh PA:  Pelvic inflammatory disease: Epidemiology, diagnosis, clinical manifestations and sequelae , in Holmes KK, Mardh PA (eds): International Perspectives on Neglected Sexually Transmitted Diseases . New York, McGraw-Hill International Book Co, 1983;, pp 235-250.
18 +
Schachter J, Hanna L, Hill EC, et al:  Are chlamydial infections the most prevalent venereal disease? JAMA 1975;;231:1252-1255.
19 +
Schachter J, Stoner E, Moncada J:  Screening for chlamydial infections in women attending family planning clinics . West J Med 1983;;138:375-379.
20 +
Handsfield HH, Jasman LL, Robert PL, et al:  Criteria for selective screening for Chlamydia trachomatis infection in women attending family planning clinics . JAMA 1986;;255:1730-1734.
21 +
McCormack WM, Rosner B, McComb DE, et al:  Infection with Chlamydia trachomatis in female college students . Am J Epidemiol 1985;;121: 107-115.
22 +
Stamm WE, Wagner KF, Amsel R, et al:  Causes of the acute urethral syndrome in women . N Engl J Med 1980;;303:409-415.
23 +
Schachter J, Grossman M, Sweet RL, et al:  Prospective study of perinatal transmission of Chlamydia trachomatis . JAMA 1986;;255:3374-3377.
24 +
Eagar RM, Beach RK, Davidson AJ, et al:  Epidemiologic and clinical factors of Chlamydia trachomatis in black, Hispanic and white female adolescents . West J Med 1985;;143:37-41.
25 +
Chacko MR, Lovchik JC:  Chlamydia trachomatis infection in sexually active adolescents: Prevalence and risk factors . Pediatrics 1984;;73: 836-840.
26 +
Harrison HR, Boyce WT, Haffner WHJ, et al:  The prevalence of genital Chlamydia trachomatis and mycoplasmal infections during pregnancy in an American Indian population . Sex Transm Dis 1983;; 10:18-20.
27 +
Summary Statistics, Kotzebue Region (Gonorrhea) 1984-1985 . Anchorage, Alaska, Section of Epidemiology, Division of Public Health, US Dept of Health and Human Services, State of Alaska, 1985;.
28 +
Kiviat NB, Wolner-Hanssen P, Peterson M, et al:  Localization of Chlamydia trachomatis infection by direct immunofluorescence and culture in pelvic inflammatory disease . Am J Obstet Gynecol 1986;;154;865-873.
29 +
Washington AE, Sweet RL, Shafer MA:  Pelvic inflammatory disease and its sequelae in adolescents . J Adolesc Health Care 1985;;6:298-310.
30 +
Alexander ER, Harrison HR:  Role of Chlamydia trachomatis in perinatal infection . Rev Infect Dis 1983;;5:713-719.
31 +
Schachter J, Sweet RL, Grossman M, et al:  Experience with the routine use of erythromycin for chlamydial infections in pregnancy . N Engl J Med 1986;;314:276-279.
32 +
 STD treatment guidelines . MMWR 1985;;34 ( (suppl) ):75S-108S.
33 +
Stone KM, Grimes DA, Magder LS:  Primary prevention of sexually transmitted diseases . JAMA 1986;;255:1763-1766.
34 +
Nettleman MD, Jones RB, Roberts SD, et al:  Cost-effectiveness of culturing for Chlamydia trachomatis . Ann Intern Med 1986;;105:189-196.
35 +
Williams T, Maniar AC, Brunham RC, et al:  Identification of Chlamydia trachomatis by direct immunofluorescence applied in specimens originating in remote areas . J Clin Microbiol 1985;;22: 1053-1054.

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