- The Washington Times - Monday, February 22, 2010

Of the sexual infections that have emerged in the wake of the sexual revolution, chlamydia is the most common — 1.2 million documented cases in the U.S. in 2008 — and one of the most curable.

However, a recent study provides an important reality check: Screening all girls for chlamydia isn’t enough; boys need to be treated too.

“If our goal is to reduce the prevalence of chlamydia in our young people … we’re going to have to pay attention to finding and treating [their] partners,” said Dr. Byron Batteiger, a professor of medicine at the Indiana University School of Medicine and lead author of the study.

Between 1999 and 2009, Dr. Batteiger and his colleagues followed nearly 400 urban teenage girls for an average of three years.

Every three months, the teens (with parental permission) met with health care professionals and were tested for chlamydia. Any infection was treated promptly.

The girls also kept diaries for six months out of a year so they could discuss their boyfriends, sexual activity and condom use with their health care professionals.

In this most optimal of situations — highly motivated, informed girls undergoing regular screenings and treatment under the care of health care professionals, with parental approval — the chlamydia infection rate should have dwindled to nothing.

Instead, it stayed about the same. At key points in the study, the portion of girls with chlamydia infections ranged from 10.4 percent to 10.9 percent.

The reason for the persistently high prevalence rates was reinfection: Sixty-one girls acquired chlamydia a second time, and another 60 girls were reinfected three to nine times.

This sobering outcome indicates that “frequent testing and treatment of women alone will not suffice” to reduce chlamydia in high-risk populations, Dr. Batteiger and his colleagues concluded in their study, which appeared in the Journal of Infectious Diseases. It is young men, they said, who need far more aggressive screening and treatment.

At every clinic visit in the Indiana study, the girls were asked about their current male sex partners. Over time, 313 young men were brought in for testing. About 26 percent of these young men were found to be infected with chlamydia, “a very high level of infection in this pool,” Dr. Batteiger said.

The girls with chlamydia infections named a total 1,387 male sex partners, so the boyfriends who were tested didn’t represent even a quarter of the potentially infected partners.

Public health policy calls for all young women to be screened regularly for chlamydia, but it recommends that young men seek screening only if they are in “high risk” situations.

This is a huge miscalculation, said two public health officials who work to stem sexually transmitted infection rates in young populations.

“We’re only really treating half the equation,” said Dr. Alwyn Cohall, director of the Harlem Health Promotion Center and consulting physician with the Young Men’s Clinic, a nationally recognized model for men’s health care services.

Young men need more education about sexually transmitted infections, he said. “A lot of guys don’t realize that these [chlamydia] infections are silent and that you can have something [infectious] inside your body and not know about it.”

One myth is that chlamydia screening for men is onerous or invasive, but it’s now just a urine-based test, said Dr. Cohall, who is also a faculty member at Columbia University’s Mailman School of Public Health.

Reducing the chlamydia rate is imperative because it is associated with the spread of HIV, he said, noting that cities such as Philadelphia, New York and Washington are hotbeds for both chlamydia and HIV. Young people often will be tested for a sexually transmitted infection and found to be positive for chlamydia. “Then when we do an HIV test, the HIV test is positive as well,” he said.

“One of the reasons the [Young Men’s Clinic] was developed was because we were seeing such high reinfection rates among young women,” Dr. Cohall said.

The clinic provides an award-winning approach to serving young men, but it shouldn’t be unique, he said. “It should be the rule, rather than the exception.”

Dr. Yolanda Wimberly, who sees teens as part of her work at the Morehouse School of Medicine, said that many youths don’t worry about chlamydia because it is curable with antibiotics. They consider HIV or herpes as more of “the worst things you can have,” she said.

But chlamydia can result in pelvic inflammatory disease, ectopic pregnancies and involuntary infertility, she said.

Public health policy and funding should encourage young men to be screened for chlamydia as regularly as young women, she said.

“It’s common sense,” said Dr. Wimberly. After all, “the girls aren’t having sex with themselves. They’re having sex with the boys.”

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