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Incidence of Chlamydia, Gonorrhea, and Azithromycin Resistant Chlamydia in an Adolescent Population

Authors:
Greg Marchand at Marchand Institute for Minimally Invasive Surgery
Greg Marchand
  • Marchand Institute for Minimally Invasive Surgery
Katelyn Sainz at Washington University of Health and Science
Katelyn Sainz
  • Washington University of Health and Science
Kelly Ware at Marchand OB/GYN
Kelly Ware
  • Marchand OB/GYN
Alexa King
Alexa King
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Abstract

We performed a randomized retrospective chart review of 42 pediatric patients seen at our offices. All of these patients received gonorrhea and chlamydia testing one at least one occasion in our offices. We then matched this group with an equal number of adult patients that were seen in our offices during the same time period, for similar symptomology, (or lack thereof.) We compared gonorrhea and chlamydia rates in the two populations and the difference in rates of drug resistance in those with positive tests. RESULTS: We found a slightly decreased rate of infection with gonorrhea and chlamydia in our test population of pediatric patients (2% vs. 4%). We also found a zero percent rate of resistance to antibiotics in our pediatric population, compared to a low, but statistically significant higher rate in our matched adult cohort group.
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INTRODUCTION: Our practice sees women of all ages. In this
retrospective analysis, we looked at our population of
adolescents, including ages 12-17. All patients received
gonorrhea and chlamydia testing on at least one occasion. In a
retrospective chart review we reviewed 25 charts of children in
this age group and compared the incidence, demographics and
frequency of Azithromycin resistant chlamydia in a randomized
matched subset of "control" adult charts.
PURPOSE: We set out to see if adolescent women in our
practice were at higher risk of contracting gonorrhea and
chlamydia, and when they do contract these disease, we sought
out to see if they would be at higher risk than our adult
population of acquiring strains that were resistant to common
treatments, most notably azithromycin.
MATERIALS AND METHODS: We performed a randomized
retrospective chart review of 42 pediatric patients seen at our
offices. All of these patients received gonorrhea and chlamydia
testing one at least one occasion in our offices. We then
matched this group with an equal number of adult patients that
were seen in our offices during the same time period, for similar
symptomology, (or lack thereof.) We compared gonorrhea and
chlamydia rates in the two populations and the difference in
rates of drug resistance in those with positive tests.
RESULTS: We found a slightly decreased rate of infection with
gonorrhea and chlamydia in our test population of pediatric
patients (2% vs. 4%). We also found a zero percent rate of
resistance to antibiotics in our pediatric population, compared
to a low, but statistically significant higher rate in our matched
adult cohort group.
From the Department of Surgery, Marchand OBGYN PLLC, Mesa,
Arizona, USA
Accepted for presentation at the European Council on Excellence in
Pediatrics, Annual Meeting, December 6th 2018, Prague, Czech Republic.
Corresponding author: Greg J. Marchand, MD, FACS, FICS, FACOG,
Accredited Master Surgeron, Marchand Institute for Mnimally
Invasive Surgery, 1520 South Dobson, Mesa, Arizona, USA
85202-4708; email: gm@gregmarchandmd.com
Financial Disclosure:
The authors did not report any potential conflicts of interest.
© 2018 by Marchand OBGYN PLLC. Published by Marchand OBGYN
PLLC. All rights reserved.
Published Ahead of Presentation, JULY 2018
Marchand OBGYN PLLC 1
CONCLUSION: Our data sample is small, but initial evidence
suggests that the infection rate of adolescents with gonorrhea
and chlamydia may be lower than the adult population when
presenting to an urban Obgyn practice with similar
symptomology. When they are positive, there may also be a
lower rate of drug resistant strains. Logically, this follows that
fewer and less virulent strains may be associated with the
adolescent population as opposed to the adult population. This
data in no way compromises the value of sexual education
counseling provided to pediatric populations, but useful when
counseling young women who may be concerned that
adolescent experimentation may have affected their fertility.
We plan to continue our analysis with a prospective cohort
study to achieve higher quality data on the subject.
G
onorrhea and Chlamydia remain the most commonly
diagnosed sexually transmitted infections of adolescence,
however, to the knowledge of the authors there has been
very little data as to differences in the characteristics of
these infections in the pediatric population versus the
adult population. With a small population of pediatric and
adult female patients in an urban Arizona city, we set out to see
if any differences would come to light in our retrospective
analysis.
DOI:10.13140/RG.2.2.34919.96168/2
1. Forhan SE, Gottlieb SL, Sternberg MR, et al. Prevalence of
sexually transmitted infections among female adolescents aged
14 to 19 in the United States. Pediatrics 2009; 124:1505.
2. Fortenberry JD, Brizendine EJ, Katz BP, et al. Subsequent
sexually transmitted infections among adolescent women with
genital infection due to Chlamydia trachomatis, Neisseria
gonorrhoeae, or Trichomonas vaginalis. Sex Transm Dis 1999;
26:26.
3. Tu W, Batteiger BE, Wiehe S, et al. Time from first
intercourse to first sexually transmitted infection diagnosis
among adolescent women. Arch Pediatr Adolesc Med
2009; 163:1106.
4. Newbern EC, Anschuetz GL, Eberhart MG, et al. Adolescent
sexually transmitted infections and risk for subsequent HIV.
Am J Public Health 2013; 103:1874.
5. Burstein GR, Gaydos CA, Diener-West M, et al. Incident
Chlamydia trachomatis infections among inner-city adolescent
females. JAMA 1998; 280:521.
OriginalResearch
Incidence of Chlamydia, Gonorrhea, and Azithromycin
Resistant Chlamydia in an Adolescent Population
Greg J. Marchand, MD1,4, FACS, FICS, FACOG, Katelyn Sainz1,2, MS4, Alexa King1, MS1, Kelly Ware1,3, MS1
1. Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA 2. Washington University of Heath and Science, San Pedro, Belize
3. University of Science, Arts and Technology, Monserrat, West Indies 4. St. Luke's Medical Center, Tempe, AZ USA
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To determine the time between first intercourse and first sexually transmitted infection (STI) with Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis and time between repeated infections. Observational study. Three adolescent medicine clinics. A cohort of 386 urban young women aged 14 to 17 years at enrollment. Age at first intercourse; organism-specific interval between first intercourse and first STI diagnosis; interval between repeated infections; and age at first STI test prior to study participation. Participants had first intercourse at a young age (first, second, and third quartiles were 13, 14, and 15 years of age, respectively). By age 15 years, 25% of the women acquired their first STI, most often C trachomatis. Median interval between first intercourse and first STI diagnosis was 2 years. Within 1 year of first intercourse, 25% had their first C trachomatis infection. Repeated infections were common; within 3.6, 6, and 4.8 months, 25% of the women with prior C trachomatis, N gonorrhoeae, and T vaginalis infection were reinfected with the respective organisms. Considerable delay in STI testing was found for those who began sex at a younger age. The median interval between first sex and first test were 4.9, 3.5, 2.1, 1.8, and 1.2 years for those who had first sex at ages 10, 11, 12, 13, and 14 years, respectively. Timely screening and treatment are important for prevention of STI sequelae. For urban adolescent women, STI screening (especially for C trachomatis) should begin within a year after first intercourse and infected individuals should be retested every 3 to 4 months.
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Prevalence of Sexually Transmitted Infections Among Female Adolescents Aged 14 to 19 in the United States
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Full-text available
Most young women initiate sexual activity during adolescence; risk for sexually transmitted infections (STIs) accompanies this initiation. In this study we estimated the prevalence of the most common STIs among a representative sample of female adolescents in the United States. Data were analyzed from 838 females who were aged 14 to 19 and participating in the nationally representative National Health and Nutrition Examination Survey 2003-2004. After interview and examination, survey participants provided biological specimens for laboratory testing. The main outcome was weighted prevalence of at least 1 of 5 STIs: Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, herpes simplex virus type 2, and human papillomavirus (HPV) (any of 23 high-risk types or type 6 or 11). Prevalence of any of the 5 STIs was 24.1% among all and 37.7% among sexually experienced female adolescents. HPV (23 high-risk types or type 6 or 11) was the most common STI among all female adolescents (prevalence: 18.3%), followed by C trachomatis infection (prevalence: 3.9%). Prevalence of any of the STIs was 25.6% among those whose age was the same or 1 year greater than their age at sexual initiation and 19.7% among those who reported only 1 lifetime sex partner. The prevalence of STIs among female adolescents is substantial, and STIs begin to be acquired soon after sexual initiation and with few sex partners. These findings support early and comprehensive sex education, routine HPV vaccination at the age of 11 to 12 years, and C trachomatis screening of sexually active female adolescents.
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