Chlamydia trachomatis among Patients Infected with and Treated for Neisseria gonorrhoeae in Sexually Transmitted Disease Clinics in the United States
- Sheryl B. Lyss, MD;
- Mary L. Kamb, MD, MPH;
- Thomas A. Peterman, MD, MSc;
- John S. Moran, MD, MPH;
- Daniel R. Newman, MA;
- Gail Bolan, MD;
- John M. Douglas, Jr., MD;
- Michael Iatesta, MA;
- C Kevin Malotte, DrPH;
- Jonathan M. Zenilman, MD;
- Josephine Ehret, BS;
- Charlotte Gaydos, MS, MPH, DrPH;
- Wilbert J. Newhall, PhD; and
- for the Project RESPECT Study Group*
- From Centers for Disease Control and Prevention, Atlanta, Georgia; San Francisco Health Department, San Francisco, California; Denver Public Health, Denver, Colorado; New Jersey Department of Health, Newark, New Jersey; California State University, Long Beach, California; and Baltimore City Health Department and Johns Hopkins University, Baltimore, Maryland.
Abstract
Background: For two decades, treatment guidelines for sexually transmitted diseases (STDs) have recommended empirical co-treatment for chlamydia when patients are treated for gonorrhea. Because the epidemiology of and diagnostic testing for STDs have changed over time, co-treatment may no longer be needed as a clinical or public health strategy.
Objective: To assess the prevalence of chlamydia among patients at STD clinics who are infected with and treated for Neisseria gonorrhoeae and to determine whether co-treatment recommendations are still justified.
Design: Cross-sectional analysis of data from a multisite study.
Setting: Five public STD clinics (Baltimore, Maryland; Denver, Colorado; Long Beach, California; Newark, New Jersey; and San Francisco, California), July 1993 through October 1995.
Patients: 3885 heterosexual patients (2184 men and 1701 women) who agreed to participate in a trial of counseling interventions and had conclusive results from diagnostic tests for gonorrhea and chlamydia performed routinely as part of the trial.
Measurements: Infection with Chlamydia trachomatis as determined by polymerase chain reaction.
Results: Chlamydia trachomatis was detected in 20% (95% CI, 16% to 24%) of 411 men and 42% (CI, 35% to 50%) of 151 women with laboratory-confirmed N. gonorrhoeae. Chlamydia trachomatis was detected in 19% (CI, 15% to 22%) of 410 men and 35% (CI, 28% to 43%) of 154 women with treatment indications for gonorrhea who would not otherwise have been treated for chlamydia: chlamydia prevalence among these patients was significantly higher than among patients without treatment indications for either gonorrhea or chlamydia: 7% in men and 9% in women (relative risk, 2.58 [CI, 1.92 to 3.47] and 4.12 [CI, 3.05 to 5.57], respectively).
Conclusion: The frequent presence of chlamydia among patients at STD clinics who received treatment for gonorrhea, including sex partners of gonorrhea-infected patients, supports continuing current recommendations for co-treatment.
*For members of the Project RESPECT Study Group, see the Appendix.
Article and Author Information
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Acknowledgments: The authors thank Carol Metcalf, MBChB, MPH, and Catherine Lindsey, MPH, for providing the data and conducting the analyses of chlamydial co-infection among gonorrhea-infected patients in RESPECT-2 (Denver, Colorado; Long Beach, California; and Newark, New Jersey, 1999–2000).
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Grant Support: Project RESPECT was supported by CDC cooperative agreements.
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Potential Financial Conflicts of Interest:Honoraria: J.M. Zenilman (Pfizer, Inc.); Stock ownership or options (other than mutual funds): J.M. Douglas (Pfizer, Inc.).
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Requests for Single Reprints: Reprint Services, Office of Communications, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop E-07, Atlanta, GA 30333.
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Current Author Addresses: Dr. Lyss and Mr. Newman: Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-46, Atlanta, GA 30333.
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Dr. Kamb: Global AIDS Program, Centers for Disease Control and Prevention, U.S. Embassy, Hanoi, 7 Lang Ha, Hanoi, Vietnam.
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Drs. Peterman, Douglas, and Newhall: Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-02, Atlanta, GA 30333.
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Dr. Moran: Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-61, Atlanta, GA 30333.
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Dr. Bolan: STD Control Branch, 1947 Center Street, Suite 201, Berkeley, CA 94704.
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Ms. Ehret: Denver Public Health, 605 Bannock Street, Denver, CO 80204.
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Mr. Iatesta: Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-04, Atlanta, GA 30333.
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Dr. Malotte: California State University, Long Beach, 5500 Atherton Street, Suite 400, Long Beach, CA 90815.
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Drs. Zenilman and Gaydos: Johns Hopkins University School of Medicine, Ross Research Building, Room 1165, 720 Rutland Avenue, Baltimore, MD 21205.
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Author Contributions: Conception and design: S.B. Lyss, M.L. Kamb, T.A. Peterman, D.R. Newman, G. Bolan, J.M. Zenilman, J. Ehret, W.J. Newhall.
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Analysis and interpretation of the data: S.B. Lyss, M.L. Kamb, T.A. Peterman, J.S. Moran, D.R. Newman, G. Bolan, J.M. Douglas, C.K. Malotte, C. Gaydos.
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Drafting of the article: S.B. Lyss, M.L. Kamb, C. Gaydos.
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Critical revision of the article for important intellectual content: S.B. Lyss, M.L. Kamb, T.A. Peterman, J.S. Moran, J.M. Douglas, M. Iatesta, C.K. Malotte, J.M. Zenilman, J. Ehret, C. Gaydos, W.J. Newhall.
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Final approval of the article: S.B. Lyss, M.L. Kamb, T.A. Peterman, J.S. Moran, D.R. Newman, G. Bolan, J.M. Douglas, M. Iatesta, C.K. Malotte, J.M. Zenilman, J. Ehret, C. Gaydos, W.J. Newhall.
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Provision of study materials or patients: M.L. Kamb, G. Bolan, J.M. Douglas, M. Iatesta, J.M. Zenilman.
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Statistical expertise: M.L. Kamb, D.R. Newman.
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Obtaining of funding: M.L. Kamb, G. Bolan, J.M. Zenilman.
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Administrative, technical, or logistic support: M.L. Kamb, T.A. Peterman, G. Bolan, J. Ehret, W.J. Newhall.
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Collection and assembly of data: M.L. Kamb, G. Bolan, J.M. Douglas, C.K. Malotte.
- Copyright ©2004 by the American College of Physicians
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