Chlamydia Prevention in Adults and Infants
Chlamydia Symptoms

Chlamydia Prevention in Adults and Infants – Screening Programs

Chlamydia Prevention in Adults and Infants – Screening Programs
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Chlamydia Prevention in Adults

Infection with Chlamydia trachomatis is one of the STDs for which screening of high-risk asymptomatic individuals is critical for the success of a control program. The vast majority of chlamydial infections are subclinical, and therefore require active case finding in order to remove infected persons from the  transmitter  pool. The availability of a variety of new Chlamydia antigen detection tests should eventually  reduce the cost of diagnosing chlamydial infection to the point at which large-scale screening becomes a cost-effective approach to the problem.

Chlamydia Prevention: Chlamydia-Screening Programs

Family planning and prenatal clinics are obvious sites for chlamydia-screening programs within the current medical care systems of the United States and Canada. The cost of such screening programs in these settings can be controlled by focusing on subgroups with the highest risk for infection. Sexually active adolescent women should be the first group chosen for screening, and should be screened regardless of the presence or absence of other risk factors. For older women, risk factors that can be used to select those at highest risk for routine screening include black race and marital status.

Chlamydia Prevention: Chlamydia Trachomatis prevalence study

In planning a screening program, an initial Chlamydia trachomatis prevalence study of the target population will provide statistics that can be used to focus available resources. Unfortunately, data are not available for helping to rationally define the appropriate cutoff prevalence rate for screening. Therefore, the lowest possible figure should be used, based on the availability of funds to pay for testing, treatment, and partner notification. By focusing on the highest risk groups, significant numbers of “core transmitters” will hopefully be identified. Treating these women and their partners should result in a significant decrease in the prevalence of Chlamydia trachomatisin the population as a whole.

The success of a community-wide screening program for Chlamydia trachomatis requires that resources be spread between all healthcare providers who care for high-risk patients. Providing resources to one and not to others will not have a large or lasting effect on the prevalence of Chlamydia in the population as a whole.

Chlamydia-screening programs based on active case finding in women depend for their success on the treatment of the male partners of identified cases. If the male partners are not included, prevention programs focused on women are doomed to failure. Therefore, a portion of available resources must be allocated to providing for the treatment of potentially infected male partners.

Ideally, Chlamydia trachomatis infection-control programs should be provided for both males and females soon after the initiation of sexual activity. School-based health clinics providing both STD and contraceptive services to males and females are one approach to achieving this goal. Girls undergoing evaluation for contraceptives in this setting could be screened for STDs, including chlamydial infections.

The detection of leukocytes in urine specimens may prove to be an effective screening method for urethral pathogens in asymptomatic males, and antigen detection tests for Chlamydia in urine specimens will hopefully become available. If so, and if young men can be convinced to undergo urine screening periodically after initiating sexual activity, a great deal can be accomplished toward significantly reducing the incidence of chlamydial infection in the western world.

Chlamydia Prevention in Infants

Recognition of the role of Chlamydia trachomatis in neonatal conjunctivitis has led to significant controversy over the optimal topical medication to be applied at delivery for the prevention of ophthalmia neonatorum. On the basis of a small controlled study, Hammerschlag et al. suggested that erythromycin might be significantly more effective than silver nitrate in preventing chlamydial conjunctivitis.

Subsequently, however, observations by other investigators have cast significant doubt on this. In fact, a randomized study at Charity Hospital in New Orleans, in which drugs were administered by non research nurses on the delivery floor, found that more cases of chlamydial conjunctivitis were associated with erythromycin than with silver nitrate.

One explanation for this observation was the difficulty in applying erythromycin ointment compared to the ease of applying silver nitrate drops. Supporting this concept were the observations of Mooney et al., who noted that inappropriate application of erythromycin may actually increase the rate of nonchlamydial conjunctivitis.

A study by Laga et al. showed that silver nitrate has a significant preventive effect against chlamydial conjunctivitis; these data were more recently confirmed by Hammerschlag et al. In fact, the latter study showed no significant differences in efficacy between silver nitrate drops and erythromycin or tetracycline ointment.

In summary, the available data do not support an advantage for either silver nitrate, erythromycin, or tetracycline in preventing neonatal chlamydial conjunctivitis. Silver nitrate causes chemical conjunctivitis, but there are significant difficulties in administering antibiotic ointments, which may also lead to increased numbers of cases of neonatal conjunctivitis.

Regardless of what medication is used, recent studies have shown that the failure rates in infants exposed to Chlamydia trachomatis are approximately 10% to 20%. Finally, it is clear that topical ocular prophylaxis has no effect on chlamydial pneumonia. It must be concluded that the only reliable approach to preventing neonatal chlamydial infection is the identification of infected mothers and their treatment prior to delivery.

References:

American Academic of Family Physicians (AAFP)-   Diagnosis and Treatment of Chlamydia trachomatis Infection – KARL E. MILLER, M.D., University of Tennessee College of Medicine, Chattanooga, Tennessee.

Originally posted 2017-08-19 10:48:11.