Article

Chlamydia Positivity in American Indian/Alaska Native Women Screened in Family Planning Clinics, 1997–2004

Division of Allergy and Infectious Diseases, University of Washington, Washington, USA.
Sex Transm Dis (Impact Factor: 2.84). 05/2008; 35(8):753-7. DOI: 10.1097/OLQ.0b013e31816d1f7d
Source: PubMed

ABSTRACT

Previous studies demonstrated high levels of Chlamydia trachomatis (CT) infections within American Indian/Alaskan Native (AI/AN) populations but there are few analyses of CT prevalence in these populations over time.
We analyzed data from 7374 visits at which diagnostic tests for CT were collected in AI/AN women aged 15 to 24 years seen at family planning clinics associated with the Region X Infertility Prevention Project. Trends in population characteristics and test positivity were examined and compared with non-AI/AN women tested in the same setting and time period. Chlamydia positivity was adjusted for changes in diagnostic test type. Multivariable logistic regression was used to identify characteristics associated with infection.
Adjusted CT positivity in AI/AN women rose from 7.8% to 11.0%, which was 1.5 to 2.2 times the non-AI/AN population levels over the study period (absolute difference 2.8%-6.6%). Differences persisted after correction for test type and age. Temporal changes in positivity among AI/AN women were associated with a rise in reported risk behaviors and decline in age of the population being tested. Risk factors associated with positivity among AI/AN women were younger age, > or =1 behavioral risks, > or =1 clinical findings, partner with chlamydia, chlamydia in past year, and pregnancy related visit.
AI/AN women had consistently higher levels of chlamydia positivity than non-Native women, even after adjustment for age and diagnostic test. Further investigation of risks for chlamydia, related outcomes, access to screening, sexual networks, and enhanced surveillance would be beneficial for improving health in this vulnerable population.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Chlamydia trachomatis is an obligate intracellular Gram negative bacterium, which infects mucosal epithelial cells (Schachter and Stephens 2008). Chlamydia display a unique two-stage life cycle consisting of an infectious stage and a replicative stage. During the infectious stage the organism assumes a metabolically inactive form, the elementary body , which can survive in the host extracellular environment. Upon entry into a host cell the elementary body transforms within a host cell vacuole into a metabolically active, replicating form, the reticulate body. Over a period of approximately 36–72 hours of growth and replication, the reticulate bodies transform into infectious elementary bodies, which are extruded from the cell and repeat the cycle by infecting additional cells of the same or a second host.
    No preview · Chapter · Dec 2009
  • [Show abstract] [Hide abstract]
    ABSTRACT: Sex steroids are central to regulation of the dual roles of the female reproductive tract: support of reproduction and protection against deleterious pathogen invasion. The mechanisms by which sex steroids orchestrate the balance between reproduction and protection against pathogenic microorganisms, however, are complex and poorly understood. Epidemiologic studies have revealed associations between sex steroids and diagnosis, shedding, transmission of sexually transmitted diseases and their clinical sequelae, as well as disruptions to the normal vaginal flora. Experimental approaches, including animal models, have provided some insight into the mechanism of these associations, though often with contradictory results. Inherent limitations in traditional approaches to understanding the physiology of sex steroid regulation of immunity in the female genital tract will require significant interdisciplinary collaboration.
    No preview · Chapter · Jan 2010
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We conducted an analysis of rates, geographic distribution, and time to treatment of chlamydia, gonorrhea, and early syphilis (ES) among Arizona American Indians (AIs) to address racial disparities affecting this group. We used the Arizona Department of Health Services' sexually transmitted disease (STD) surveillance database to identify STD cases and calculate rates among AIs in Arizona from 2003 to 2007. We mapped AI ES cases reported during that time frame by reported resident ZIP code, calculated days elapsed from specimen collection to initial treatment, and compared rates and time to treatment for AIs with those of non-Hispanic white (NHW) individuals. Annual Arizona AI STD rates for chlamydia, gonorrhea, and ES from 2003 to 2007 ranged from 2.7 to 7.8 times those of NHW people. During the same time period, the annual rates for all three STDs among adolescents aged 15 to 19 years were also higher among AIs and ranged from 2.0 to 14.8 times those of NHW individuals. The majority of cases for ES reported ZIP codes located in the northeastern and southern central portions of the state. The median time to treatment in AI populations was significantly longer than in NHW populations for chlamydia and gonorrhea, but not for ES. High rates of STDs have been identified among AIs in certain regions of Arizona. Additionally, there are significant delays in treatment for gonorrhea and chlamydia. STD prevention and education programs that prioritize this health disparity and promote expeditious screening, diagnosis, and treatment are needed.
    Full-text · Article · Jul 2010 · Public Health Reports
Show more