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Widespread chlamydia screening among women can get results, as was demonstrated in a recent study supported by NIH. Researchers at Seattle's Group Health Cooperative of Puget Sound and the University of Washington found that symptomless women who were screened and treated for chlamydial infection were almost 60 percent less likely than unscreened women to develop pelvic inflammatory disease.

With such effective tools for screening and treatment, why has it proved so difficult to stop the spread of this microorganism? The answer, experts agree, is that not enough at-risk young people are getting tested.

"There are about a million reasons people don't get tested," Mitchell says. "They might feel uncomfortable, or not have insurance, or just not know they should be tested for chlamydia."

Also, doctors often fail to discuss the issue of sexually transmitted diseases with their young patients, according to Gale Burstein, M.D., a chlamydia researcher at Johns Hopkins University. "Physicians have to make a commitment to ask all of their adolescent patients if they are sexually active. But doctors are sometimes uncomfortable pursuing that line of questioning," Burstein says, adding that "a sexually active adolescent woman is more likely to test positive for chlamydia than for tuberculosis, yet TB tests are done much more routinely."

Beyond encouraging more young people to get routinely screened for chlamydia, experts are searching for other avenues to control this sexually transmitted disease. Recently, researchers at Stanford University and the University of California at San Francisco uncovered new information about the chromosomes of C. trachomatis, providing promising leads for developing new antibiotics and even a vaccine. Hitchcock, whose agency supported the study, says she and other STD experts at NIH are "very excited about the new opportunities for vaccine development."

Until the hope of a vaccine is realized, those who choose to be sexually active should use condoms — for what they're worth. "Condom use clearly prevents HIV infection and gonorrhea, as well as pregnancy," Hitchcock says. "Use a condom, but not with blinders on, either. Don't kid yourself that condoms make sex risk-free."

Condoms and Chlamydia

The only sure-fire way to avoid getting chlamydia and other sexually transmitted diseases is by abstaining from sex or being in a mutually monogamous relationship with an uninfected partner. Having multiple partners increases your risk of getting the disease, according to experts.

Anna Lange was especially surprised when she was diagnosed with chlamydia because, besides not having any symptoms, she had been in a monogamous relationship for six months. "We explained to her that the diagnosis didn't mean that either she or her current boyfriend had been unfaithful," says Peter Leone, M.D., medical director at Anna's STD clinic. "We couldn't tell her when or from whom she'd gotten infected. But she did have a history of unprotected sex for a couple of years previously, and she could have become infected at any time during this period."

While even "protected " sex with a condom can't completely prevent transmission of chlamydia or some other sexually transmitted diseases, experts recommend correct and consistent condom use to reduce the chances of getting chlamydia or other STDs.

Should You Get Tested?

The national Centers for Disease Control and Prevention recommends annual chlamydia screening for all sexually active adolescent girls and for other females who may be at high risk for chlamydial infection, such as those who:

• are less than 25 years old
• don't use barrier contraceptives consistently
• have new or multiple sex partners
• have signs of a possible cervical infection
• have previously had an STD.

"Females who are at risk because of their age and sexual activity need to get screened at least once a year," says researcher Gale Burstein, M.D. She and other chlamydia experts have recently questioned whether that is even enough.

Based on a study they conducted in 1998, Burstein and her colleagues at Johns Hopkins University recently recommended a twice-yearly screening of sexually active female adolescents. In tracking more than 3,000 sexually active Baltimore high school girls for three years, they found that more than a quarter of them tested positive for chlamydia at least once in that time frame.

Routine screening is recommended for pregnant women, also, because of the risk that their babies will become infected with chlamydia at birth.

There are no recommendations for routine screening among males, which Burstein says makes it especially likely that their chlamydial infection will be overlooked. "There is a lot of chlamydia in men that we're missing, and they are a major reservoir of infection. We're really only putting a band-aid on the problem because, even if we're screening the women, some are going back to their partners and getting reinfected."

Another Chlamydia Making Headlines

The Chlamydia trachomatis bacteria that cause the sexually transmitted disease should not be confused with Chlamydia pneumoniae. These other bugs, which can cause colds and pneumonia, have been in the news because investigators are researching their possible link with atherosclerosis, a clogging of the arteries that causes most heart attacks and strokes. Add this type of chlamydia to smoking, a bad diet, and a sedentary lifestyle as possible contributors to heart disease.

Tags: Sexually Transmitted Diseases (STDs)

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