Presented by Catherine L. Satterwhite, MSPH, MPH, Epidemiologist, Division of STD Prevention, CDC at the 2010 National Chlamydia Coalition meeting

1. Catherine Satterwhite, MSPH, MPH
Epidemiologist
National Chlamydia Coalition
October 29, 2010
CDC Epidemiology Update
Division of STD Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention

2. Outline
 May 2010: CDC’s Public Health Grand Rounds
 Chlamydia Trends
 Chlamydia Prevention Strategies: Results from a
Modeling Collaboration
 Chlamydia Immunology Consultation and JID
Supplement
 2010 Treatment Guidelines

3. CHLAMYDIA PREVENTION:
CHALLENGES AND STRATEGIES FOR
REDUCING DISEASE BURDEN
Public Health Grand Rounds

5. Number of External Viewers
Chlamydia Public Health Grand Rounds Viewership

6. Number of Downloads/Page Views
Chlamydia Public Health Grand Rounds
Viewership: Downloads and Page Views

7. Archives
 http://www.cdc.gov/about/grand-rounds/archives/2010/05-
 http://www.youtube.com/watch?v=iGgsfppw6Ds

8. CHLAMYDIA TRENDS
How are we doing?

9. Prevalence,%
Chlamydia Prevalence in Sexually Active Females
Aged 14-24 in the United States
NHANES, National Health and Nutrition Examination Survey, 1999-2008
Sexual activity =“yes” response to “Have you ever had sex?”
Sex = vaginal, anal, or oral sex

10. Chlamydia Case Rates: United States, 1989–2008
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2008. Atlanta, GA: U.S.
Department of Health and Human Services; November 2009

11. Datta et al. Presented at4 8th Annual ICAAC/IDSA 46th Annual Meeting, Washington, D.C., 10/25-28/2008.
*Ages 14-39 years
0
1
2
3
4
5
1999-2000 2001-2002 2003-2004 2005-2006
Prevalence(%)
2-Year Interval
Women
Men
11
National Health and Nutrition Examination Survey
(NHANES): Chlamydia Prevalence by Sex*, 1999-2006

12. Chlamydia Prevalence is Not Increasing
 NHANES (stable/decreasing)
 IPP (stable)
 Chlamydia positivity rates have not changed from 2004 to 2008
• OR: 1.00 (0.99, 1.00)
 National Job Training Program (decreasing)
 Among both women (19%) and men (8%), chlamydia prevalence
declined significantly from 2003-2007
• CT case rates increased by 22.7% from 2003-2007

13. EFFECTS OF SCREENING AND PARTNER
NOTIFICATION ON CHLAMYDIA PREVALENCE
IN THE U.S.: A MODELING STUDY
Mirjam Kretzschmar, Catherine Satterwhite, Jami Leichliter, Stuart Berman

14. Use Modeling to Analyze Effects of Prevention
Strategies on Chlamydia Prevalence
 Impact of increasing chlamydia screening coverage
 Impact of increasing partner notification/treatment
 Individual-based stochastic model
 Describes formation and dissolution of heterosexual partnerships,
sexual networks

15. Effect of Prevention Strategies on Chlamydia
Prevalence After 20 Years of Screening
 Three different strategies each resulted in a 22.5%
prevalence reduction
 Increasing screening of sexually active women ≤25 years from 20%
to 65% (25% partner notification/treatment)
 Increasing partner notification/treatment from 25% to 55% (20%
screening coverage)
 Increasing screening coverage from 20% to 35% and partner
notification/treatment from 25% to 40%
 Combined approach may be more effective
 Best use of resources: Partner services?
 Adding male screening had marginal impact, but would
require substantial additional resources

16. CHLAMYDIA IMMUNOLOGY
CONSULTATION FINDINGS
JID Supplement ,15 June 2010 (Volume 201, Suppl 2):

17. * JID 2010;201 (Suppl 2): S134
 % of untreated chlamydia progressing to PID (high-risk
populations) in 2 week interval between testing and
treatment: 2-5%
 % of untreated chlamydia progressing to PID (1 year,
POPI trial): 10%
 % of PID progressing to infertility: up to 18%
 Not specifically chlamydia-associated PID

18. * JID 2010;201 (Suppl 2): S156
 Two large RCTs: ~50% reduction in PID (Scholes,
Ostergaard)
 Major methodological limitations
 Army (Clark): no benefit
 POPI: no benefit
 Study underpowered: Results suggest possible benefit

19.  16/26 (62%) of women with PID were CT positive at PID
diagnosis
 CT may be a major contributor to clinically-diagnosed PID
 10/16 women who were CT positive at PID diagnosis
were CT negative at enrollment (when screening would
have hypothetically occurred)
 6/16 cases of PID might have been prevented (38%) by screening
* BMJ 2010 340:c1642.

20. * JID 2010;201 (Suppl 2): S190

21. 2010 STD TREATMENT GUIDELINES
Up and coming (preliminary language only—final language pending):

22. Chlamydia Screening Among Young Women:
Changes from 2006
 Age cut-off remains the same: <26 years
 No change to risk factors
 New sex partner, multiple sex partners
 Addresses USPSTF age change (<25 years)
 USPSTF found epidemiology of chlamydial infection in the U.S. has
not changed
 Added language: Among women, the primary focus of
chlamydia screening efforts should be to detect
chlamydia and prevent complications, whereas
targeted chlamydia screening in men should only be
considered when resources permit and do not hinder
chlamydia screening efforts in women.

23. Chlamydia Screening Among Men
 2010
 Insufficient evidence to recommend routine chlamydia screening
in young men because of several factors (feasibility, efficacy, cost)
 Screening of young men should be considered in clinical settings
with a high prevalence of chlamydia (e.g., adolescent clinics,
correctional facilities, STD clinics).
 Changes from 2006: Expansion to allow for venue-
based male screening

24. Chlamydia Retesting in Women and Men
 2010
 Chlamydia-infected women and men should be retested
approximately 3 months after treatment
 If retesting at 3 months is not possible, clinicians should retest
whenever persons next present for medical care in the 12 months
following initial treatment.
 Changed from 2006: Strengthened language, added
men

25. Screening Among Pregnant Women: Chlamydia
 2010: All pregnant women should be routinely
screened for chlamydia during the first prenatal visit.
 Retest during 3rd
trimester: Women aged ≤25 years and those at
increased risk
 If diagnosed with chlamydia in 1st
trimester, retest within 3-6
months (preferably 3rd
trimester)
 Changes from 2006: Strengthened and clarified
retesting language

26. Chlamydia Screening Coverage* Trends
(Women Aged 15-24, HEDIS)
*Among women enrolled in commercial or Medicaid plans who had a visit where they were determined to be sexually active
The State of Healthcare Quality, 2010:
http://www.ncqa.org/portals/0/state%20of%20health%20care/2010/SOHC%202010%20-%20Full2.pdf

27. For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
Thanks!
National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention
Division of STD Prevention