Background and objectives: Although chlamydia is a well-studied disease, little is known about the rates of genital chlamydial disease among female Hispanics in urban family planning clinics.
Goals: To determine the prevalence of women with chlamydia in two clinic populations during 1994. We also sought to describe previously identified and novel risk factors for chlamydial disease in this unique population.
Study design: We conducted a retrospective case-control analysis in two community clinics in the Washington Heights section of New York City.
Results: In 1994, 4,190 screening tests were done for Chlamydia trachomatis in these clinics, and the prevalence of positive tests was 5.4% (227/4,190). The mean age of the women screened was 19.2 years and most were of Hispanic origin (76%), students (51%), and received Medicaid (61%). Risk factors found to be associated with C. trachomatis infection included young age; earlier age at first coitus; pregnancy at the time of chlamydia screening; concurrent gonorrheal infection; and the clinical findings of cervical abnormalities, vaginal discharge, and adnexal tenderness. Hormonal contraception appeared to be protective against chlamydial infection (odds ratio, 0.36%; confidence interval, 0.17-0.77).
Conclusion: Sexually transmitted diseases were common in our population because 5.4% of the women screened had chlamydial infection and 1.5% had concurrent gonorrheal infection. Our study confirmed risk factors established in other populations. These data support the need for enhanced screening efforts for chlamydia to decrease the prevalence of disease in our population.
PIP: The prevalence of and risk factors associated with chlamydia infection were investigated retrospectively among 4190 US women under 30 years (mean age, 19.2 years) who were patients at two young adult family planning clinics in New York City, New York. Immigrants from the Dominican Republic comprise the largest segment of the population served by these clinics. 76% of study participants were Hispanic, 61% were Medicaid recipients, and 51% were students. 227 women (5.4%) were positive for Chlamydia trachomatis. 7 women (3.5%) with chlamydia had concurrent gonorrhea. Compared with their counterparts with a negative chlamydia test, women with chlamydia were younger (mean age, 19.4 vs. 18.8 years) and had a lower mean age at first coitus (16 vs. 15 years). Use of barrier methods of contraception alone conferred no more protection against chlamydia than contraceptive nonuse, presumably because of inconsistent or improper use. However, women who used both a barrier and hormonal method were less than half as likely to be infected with chlamydia than those using no protection. 39% of women diagnosed with chlamydia had no cervical or vaginal abnormalities, while 20% of women with a negative chlamydia test had physical examination findings suggestive of genital infection. Regression analysis identified three factors significantly associated with chlamydia infection: positive pregnancy test at the time of the first clinic visit, vaginal discharge on pelvic examination, and self-reported drug use. The positive predictive value of diagnosing an infection increased from 50% using the clinical impressions of the providers to 61% with this model.