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Chlamydia trachomatis among patients infected with and treated for Neisseria gonorrhoeae in sexually transmitted disease clinics in the United States.
Annals of Internal Medicine 2003;139(3):178-185.
Lyss SB, Kamb ML, Peterman TA, Moran JS, Newman DR, Bolan G, Douglas
JM Jr, Iatesta M, Malotte CK, Zenilman JM, Ehret J, Gaydos C, Newhall
WJ;
Project RESPECT Study Group.
Abstract
BACKGROUND: For two decades, treatment guidelines for sexually transmitted
diseases (STDs) have recommended empirical co-treatment for chlamydia when
patients are treated for gonorrhea. Because the epidemiology of and diagnostic
testing for STDs have changed over time, co-treatment may no longer be needed
as a clinical or public health strategy. OBJECTIVE: To assess the prevalence
of chlamydia among patients at STD clinics who are infected with and treated
for Neisseria gonorrhoeae and to determine whether co-treatment recommendations
are still justified. DESIGN: Cross-sectional analysis of data from a multisite
study. SETTING: Five public STD clinics (Baltimore, Maryland; Denver, Colorado;
Long Beach, California; Newark, New Jersey; and San Francisco, California),
July 1993 through October 1995. PATIENTS: 3885 heterosexual patients (2184
men and 1701 women) who agreed to participate in a trial of counseling interventions
and had conclusive results from diagnostic tests for gonorrhea and chlamydia
performed routinely as part of the trial. MEASUREMENTS: Infection with Chlamydia
trachomatis as determined by polymerase chain reaction. RESULTS: Chlamydia
trachomatis was detected in 20% (95% CI, 16% to 24%) of 411 men and 42% (CI,
35% to 50%) of 151 women with laboratory-confirmed N. gonorrhoeae. Chlamydia
trachomatis was detected in 19% (CI, 15% to 22%) of 410 men and 35% (CI,
28% to 43%) of 154 women with treatment indications for gonorrhea who would
not otherwise have been treated for chlamydia: chlamydia prevalence among
these patients was significantly higher than among patients without treatment
indications for either gonorrhea or chlamydia: 7% in men and 9% in women
(relative risk, 2.58 [CI, 1.92 to 3.47] and 4.12 [CI, 3.05 to 5.57], respectively).
CONCLUSION: The frequent presence of chlamydia among patients at STD clinics
who received treatment for gonorrhea, including sex partners of gonorrhea-infected
patients, supports continuing current recommendations for co-treatment.