PREVENTION AND CONTROL

Until an effective chlamydia vaccine is developed, the prevention and control of chlamydia will rely on a comprehensive approach including STD education, chlamydia screening, timely appropriate treatment of patients and their exposed partners, abstinence until treatment completion, and repeat chlamydia testing at 3 months after treatment. Provider compliance rates with CDC-recommended chlamydia screening in women are very low. The availability of chlamydia NAATs should help to facilitate chlamydial screening, because they can be performed on noninvasively collected specimens. However, many barriers to screening exist and need to be addressed, including patients seeking chlamydia screening, patient access to healthcare providers, and some providers not performing chlamydia testing.



Providers need STD education regarding taking a sexual history, performing STD testing, providing CDC-recommended therapy, and educating patients about STDs. Patients need education about risk factors, barrier prevention methods (condoms are highly effective in preventing chlamydia when used properly), symptoms of STDs, and available STD screening tests and treatments. In order to prevent recurrent chlamydia, patient and partner compliance with treatment and abstinence until treatment is complete should be stressed. In order to help prevent chlamydia complications, efforts should be put into place for prompt notification of chlamydia test results and for expediting treatment. As efforts for providing treatment to sexual partners is not always effective, repeat chlamydia testing at approximately 3 months after treatment completion to rule out re-infection should be stressed.



ADDITIONAL RESOURCES



Centers for Disease Control and Prevention (CDC): Expedited partner therapy in the management of sexually transmitted diseases, Atlanta, 2006, U. S. Department of Health and Human Services. Available at: Www. cdc. gov/std/treatment/EPTFinalReport2006.pdf. This CDC report summarizes the available literature on expedited partner therapy (EPT) for the management of the partners of persons with chlamydia and discusses implementation of EPT.



Centers for Disease Control and Prevention (CDC): Laboratory diagnostic testing for Chlamydia trachomatis and Neisseria gonorrhoeae, Expert Consultation Meeting summary report, January 2009. Available at: Www. aphl. org/aphlprograms/infectious/std/Documents/CTGCLab GuidelinesMeetingReport. pdf. This CDC report provides current recommendations for diagnostic tests and patient sample types to be used for diagnosing chlamydial infections.



Centers for Disease Control and Prevention (CDC): Male chlamydia screening consultation. Available at: Www. cdc. gov/std/chlamydia/



ChlamydiaScreening-males. pdf. This CDC report provides guidance for performing chlamydia screening in men based on available scientific data.



Centers for Disease Control and Prevention (CDC). Sexually Transmitted Disease Surveillance 2009. Atlanta, 2010, U. S. Department of Health and Human Services. Available at: Http://www. cdc. gov/std/stats09/surv2009-Complete. pdf. This CDC report presents statistics and trends for sexually transmitted diseases (STDs), including chlamydia, in the United States through 2009.



Centers for Disease Control and Prevention (CDC), Workowski KA, Berman SM: Sexually Transmitted Diseases Treatment Guidelines, 2010, MMWR Recomm Rep 59(No. RR-12):1-114, 2010; Available at: http:// Www. cdc. gov/std/treatment/2010/default. htm. This CDC report provides evidence-based guidelines for diagnosis and management of STDs, including chlamydial infections.



Johnson RE, Newhall WJ, Papp JR, et al: Screening tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae infections—2002, MMWR Recomm Rep 51:1-40, 2002. Available at: Www. cdc. gov/STD/ LabGuidelines/rr5115.pdf. This article reviews chlamydia diagnostic tests. Miller WC, Ford CA, Morris M, et al: Prevalence of chlamydial and gonococcal infections among young adults in the United States, JAMA 291:2229-2236, 2004. This article reports the prevalence of chlamydial infection and associated racial/ethnic disparities in a nationally representative sample of young adults in the United States.



Schachter J, Moncada J, Liska S, et al: Nucleic acid amplification tests in the diagnosis of chlamydial and gonococcal infections of the oropharynx and rectum in men who have sex with men, Sex Transm Dis 35:637-642, 2008. This article provides evidence that nucleic acid amplification tests perform better than culture for the detection of oropharyngeal and anorectal chlamydial infections.

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