Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae Infection in Pediatric Private Practice

Abstract

ABSTRACT. Background. Universal screening of sexually active adolescents for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) has been recommended in settings in which prevalence is 2% or greater. Although believed to be above 2%, the prevalence of CT and GC infection in private practice settings has not been clearly established and may affect screening practices.Objectives. To determine CT and GC infection prevalence in 2 pediatric private practices.Design. Cross-sectional study. Setting. Two pediatric private practices in suburban North Carolina.Patients. Convenience sample of patients aged 15 to 24 years who were seen from August 1998 through June 1999. Main Outcome Measures. Prevalence of CT and GC infection.Results. Of 1114 eligible patients, 803 (72%) completed questionnaires and provided urine specimens tested for CT and GC infection using ligase chain reaction assays. Mean age was 17.1 years (standard deviation: 1.8). Most participants were female (63%), white (87%), and from highly educated families (64% of their mothers graduated from college). Sexual activity was reported by 41%. Prevalence of CT infection in all participants was 0.9% (confidence interval [CI]: 0.4%-1.8%); in sexually active participants, 2.1% (CI: 0.9%-4.3%); in sexually active females, 2.7% (CI: 1.0%-5.7%); and in sexually active males, 0.9% (CI: 0.0%-5.1%). One case of GC infection was found.Conclusions. The prevalence of CT and GC infection in this private practice population was much lower than reported in other settings. Screening recommendations may need to be reassessed if other low prevalence populations are found. Pediatrics 2001;108(6). URL: http://www.pediatrics.org/cgi/content/full/108/6/e103; Chlamydia trachomatis, Neisseria gonorrhoeae, pediatrics, primary health care, diagnosis/screening, practice guidelines, sexually transmitted diseases, adolescence.ABBREVIATIONS. CT, Chlamydia trachomatis; GC, Neisseria gonorrhoeae; STD, sexually transmitted disease; CDC, Centers for Disease Control and Prevention; LCR, ligase chain reaction; CI, confidence interval.C hlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) genital infections cause serious and costly sequelae, such as pelvic inflammatory disease and infertility. 1 In the United States, the strongest demographic predictor of infection with CT and GC is age, with most infections diagnosed in adolescents and young adults under 25 years of age. 1 Most recent US studies have reported the prevalence of CT infection in adolescent patients seen in sexually transmitted disease (STD), family planning, detention center, and school clinics to be in the range of 6% to 10%, 2-7 but prevalences as high as 24% have been reported in some settings. 2,8 GC infections are less prevalent but still cause significant morbidity. 1,9 Both the US Preventive Services Task Force and the Centers for Disease Control and Prevention (CDC) recommend routine screening of sexually active female adolescents and high-risk women for CT infection. 10,11 The CDC also recommends screening sexually...

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