chlamydia trends: what we do and don’t know

Chlamydia Trends: What We Do and Don’t Know

Lizzi TorroneEpidemiologist

Division of STD Prevention

National Chlamydia CoalitionJanuary 26, 2012

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Division of STD Prevention

Chlamydia—Rates by Sex, United States, 1990–2010

NOTE: As of January 2000, all 50 states and the District of Columbia have regulations that require the reporting of chlamydia cases.

Rate (per 100,000 population)

Year

0

125

250

375

500

625

750

20102008200620042002200019981996199419921990

Women

Total

Men

Chlamydia—Rates by Age and Sex, United States, 2010

15–19

20–24

25–29

30–34

35–39

40–44

45–54

55–64

65+

Total

Men WomenRate (per 100,000 population)

Age3,700 2,960 2,220 1,480 740 0 0 740 1,480 2,220 2,960 3,700

774.3

1,187.0

598.0

309.0

153.2

91.3

39.3

233.7

2.8

10.9

3,378.2

3,407.9

1,236.1

530.9

220.1

94.7

32.8

610.6

2.1

9.3

Chlamydia—Percentage of Reported Cases by Sex and Selected Reporting Sources,

United States, 2010

*HMO = health maintenance organization; HD = health department.NOTE: These categories represent 72.5% of cases with a known reporting source. Of all cases, 11.6% had a missing or unknown reporting source.

STD Clinic

Private Physician/HMO*

Other HD* Clinic

Family Planning Clinic

Emergency Room

Percentage

Men Women0

5

10

15

20

25

30

35

40

What do chlamydia case report data tell us?

Chlamydia is the most commonly reported nationally notifiable disease.

Chlamydia is most commonly diagnosed among young females.

Many females are diagnosed in private healthcare settings.

What do chlamydia case report data NOT tell us?

The incidence and prevalence of chlamydia. Duration of infection is unknown Doesn’t account for changes in

• Screening coverage• Test technology used• Empiric treatment• Reporting practices

Chlamydia Screening Coverage* Trends (Women Aged 16-20 and 21-24 years, HEDIS)

2001 2002 2003 2004 2005 2006 2007 2008 2009 20100

20

40

60

80

100

Medicaid (21-24 yos)Medicaid (16-20 yos)

*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, 2011: http://www.ncqa.org/LinkClick.aspx?fileticket=FpMqqpADPo8%3d&tabid=836

Percentage

What do chlamydia case report data NOT tell us?

The incidence and prevalence of chlamydia. Duration of infection is unknown Doesn’t account for changes in

• Screening coverage• Test technology used• Empiric treatment• Reporting practices

Percentage of Nucleic Acid Amplification Tests (NAATs) Used Among Women, Infertility

Prevention Project, 2000–2010

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100

20

40

60

80

100

Percentage

What do chlamydia case report data NOT tell us?

The incidence and prevalence of chlamydia. Duration of infection is unknown Doesn’t account for changes in

• Screening coverage• Test technology used• Empiric treatment• Reporting practices

What do we know about trends in Chlamydia?

Case reports are increasing, but… Likely reflects increased screening and use of NAATs

After analyzing data at the clinic level to account for unmeasured factors between

clinics (e.g., screening practices), positivity remained stable from 2004–2008.

Limitation: Can’t account for changes within clinics over time (e,g., demographic shifts in who

goes to the clinic)

Among both women (19%) and men (8%) aged 16-24 years entering the national job

training program, chlamydia prevalence declined significantly from 2003–2007.

Limitation: May not be generalizable and population entering program may change

over time

epub, Dec 2012

In nationally representative surveys from 1999–2008,

prevalence decreased 40% among men and women aged 14–39 years and prevalence

remained stable among women aged 14–25 years.

Limitation: Small sample sizes and low prevalence limit ability to monitor trends in

subgroups

What do we know about trends in chlamydia?

Case reports are increasing, but… Likely reflects increasing screening and use of NAATs

Positivity and prevalence estimates suggest stable or decreasing morbidity, but… Current national data sources have limitations

What don’t we know about trends in chlamydia?

What opportunities do we have?

Increase screening coverage Particularly among adolescents Within the context of a changing healthcare

environment Improve chlamydia surveillance

Limitations of current national data sources Consider different metrics and data sources

Acknowledgements

Jim Braxton LaZetta Grier Rob Nelson Catherine

Satterwhite Hillard Weinstock

Thank you!ETorrone@cdc.gov

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: http://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.

National Center for HIV/AIDS, Viral Hepatitis, STD , and TB Prevention

Division of STD Prevention