Gonorrhea and Chlamydia in the United States among Persons 14 to 39 Years of Age, 1999 to 2002

17 July 2007 | Volume 147 Issue 2 | Pages 89-96

Background: Nationally representative surveys of chlamydia and gonorrhea are an important measure of disease burden and progress of screening programs.

Objective: To measure chlamydia and gonorrhea prevalence in the United States.

Design: Analysis of sexual history information and urine specimens collected in the National Health and Nutrition Examination Survey (NHANES), 1999–2002.

Setting: U.S. civilian noninstitutionalized population as sampled by NHANES, 1999–2002.

Participants: 6632 NHANES respondents.

Measurements: Urine specimens were tested for chlamydia and gonorrhea. Results were weighted to represent the U.S. civilian, noninstitutionalized population between 14 and 39 years of age.

Results: Prevalence of gonorrheal infection was 0.24% (95% CI, 0.16% to 0.38%). Prevalence of gonorrheal infection was higher among non-Hispanic black persons (1.2% [CI, 0.7% to 1.9%]) than among non-Hispanic white persons (0.07% [CI, 0.02% to 0.24%]). Among those with gonorrheal infection, 46% also had chlamydial infection. Prevalence of chlamydial infection was 2.2% (CI, 1.8% to 2.8%) and was similar between males (2.0% [CI, 1.6% to 2.5%]) and females (2.5% [CI, 1.8% to 3.4%]). Among females, the highest prevalence was in those age 14 to 19 years, whereas among males, it was highest in those age 14 to 29 years. Prevalence was higher among non-Hispanic black persons (6.4% [CI, 5.4% to 7.5%]) than non-Hispanic white persons (1.5% [CI, 1.0% to 2.4%]). Among females with a history of gonorrhea or chlamydia in the previous 12 months, chlamydia prevalence was 16.7% (CI, 5.5% to 50.7%).

Limitations: The specificity of urine-based assays for chlamydia and gonorrhea is limited, and the possible misclassification of sexual experience status may have affected the accuracy of some estimates.

Conclusions: The findings support current recommendations to screen sexually active females age 25 years or younger for chlamydia, to retest infected females for chlamydial infection, and to co-treat individuals with gonorrhea for chlamydia.

Editors' Notes Context Accurate information about the prevalence of sexually transmitted diseases is essential to the development of screening programs that effectively reduce disease burden. Contribution These data from the 1999–2002 National Health and Nutrition Examination Survey estimate the prevalence of gonorrhea and chlamydia among the U.S. population age 14 to 39 years to be 0.24% and 2.2%, respectively. Chlamydia prevalence was highest among younger women and persons with a history of gonorrhea or chlamydia infection. Cautions Although these are the most recently available data, they are more than 5 years old and did not permit estimation of prevalence by geographic region. Implication These data support current screening and treatment recommendations for chlamydia. —The Editors

 

Author and Article Information

From the Centers for Disease Control and Prevention, Atlanta, Georgia.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Acknowledgments: The authors thank Drs. Kevin Fenton and Tom Peterman for their critical review of the manuscript.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: S. Deblina Datta, MD, Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-02, Atlanta, GA 30333; e-mail, ddatta{at}cdc.gov.

Current Author Addresses: Drs. Datta, Sternberg, Johnson, Berman, Papp, and Weinstock: Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-02, Atlanta, GA 30333.

Dr. McQuillan: National Center for Health Statistics, Centers for Disease Control and Prevention, HYAT Building IV, Room 4204, MS P08, Hyattsville, MD 20782.

Author Contributions: Conception and design: R.E. Johnson, J.R. Papp, G. McQuillan.

Analysis and interpretation of the data: S.D. Datta, M. Sternberg, R.E. Johnson, S. Berman, J.R. Papp, G. McQuillan, H. Weinstock.

Drafting of the article: S.D. Datta, M. Sternberg, J.R. Papp, G. McQuillan.

Critical revision of the article for important intellectual content: S.D. Datta, M. Sternberg, R.E. Johnson, S. Berman, J.R. Papp, G. McQuillan, H. Weinstock.

Final approval of the article: S.D. Datta, M. Sternberg, R.E. Johnson, S. Berman, J.R. Papp, G. McQuillan, H. Weinstock.

Provision of study materials or patients: G. McQuillan.

Statistical expertise: M. Sternberg, G. McQuillan.

Obtaining of funding: H. Weinstock.

Administrative, technical, or logistic support: G. McQuillan.

Collection and assembly of data: G. McQuillan.