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

Gorgos, Linda MD, MSc*; Fine, David PhD; Marrazzo, Jeanne MD, MPH*

Sexually Transmitted Diseases: August 2008 - Volume 35 - Issue 8 - p 753-757
doi: 10.1097/OLQ.0b013e31816d1f7d

Background: 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.

Methods: 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.

Results: 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, ≥1 behavioral risks, ≥1 clinical findings, partner with chlamydia, chlamydia in past year, and pregnancy related visit.

Conclusions: 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.

A study of American Indian/Alaska Native women aged 15 to 24 screened for chlamydia in family planning clinics in the Northwestern United States from 1997 to 2004 found elevated levels of chlamydia positivity compared with non-American Indian/Alaska Native women.

From the *Division of Allergy and Infectious Diseases, University of Washington; and †Center for Health Training, Seattle, Washington

Supported by US Public Health Service Training Grant AI-07140 (to L.G.); Region X Infertility Prevention Project.

Correspondence: Linda Gorgos, MD, MSc, Harborview Medical Center, Center for AIDS and STD, Mailbox 359931, 325 Ninth Avenue, Seattle, WA 98104. E-mail:

Received for publication November 19, 2007, and accepted February 11, 2008.

© Copyright 2008 American Sexually Transmitted Diseases Association