Toward Control of Sexually Transmitted Chlamydial Infections

In 1985, the Centers for Disease Control and Prevention (CDC) published the first edition of guidelines for the prevention and control of Chlamydia trachomatis infections [1]. These guidelines outlined the high prevalence and enormous morbidity associated with chlamydial infection, delineated the specific syndromes in which chlamydia was a major etiologic agent, and recommended empiric treatment of these syndromes. Recently, the CDC published an updated set of guidelines for the prevention and control of Chlamydia trachomatis infections [2]. These 1993 guidelines advocate new approaches to prevention and control of chlamydial infection made possible by scientific advances of the last decade.

Among these advances is a clearer understanding of the high frequency of asymptomatic unrecognized infection, especially in adolescents and young adults [3]. Although the occurrence of asymptomatic chlamydial infections had long been known, the prevalence and epidemiologic significance of such infections was not fully appreciated because research studies initially placed emphasis on the symptomatic syndromes caused by chlamydia, including nongonococcal urethritis, epididymitis, mucopurulent cervicitis, the dysuria-pyuria syndrome, and pelvic inflammatory disease [4]. In actuality, most cervical infections in women can be regarded as asymptomatic, and, more importantly, upper genital tract infection in women may also be asymptomatic in many instances. Approximately 50% of women with infertility attributable to chlamydia-induced distal tubal scarring have no history of overt pelvic inflammatory disease [5]. In addition, asymptomatic chlamydial urethritis in young men appears to be an important and previously underemphasized reservoir of infections that may be transmitted to young women [6].

Taken together, these considerations suggest a twofold approach to the control of chlamydial infections. First, symptomatic infections must be diagnosed and treated; simultaneously, the sexual partners of the index patients, who often have unrecognized infections, should also be tested and treated. Second, we must implement programs to …