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Chlamydia trachomatis Infections Among Women Attending Prenatal Clinics: United States, 2004–2009

Satterwhite, Catherine Lindsey PhD, MSPH, MPH*; Gray, Alyson M. MPH; Berman, Stuart MD, ScM*; Weinstock, Hillard MD, MPH*; Kleinbaum, David MA, PhD; Howards, Penelope P. MS, PhD

Sexually Transmitted Diseases: June 2012 - Volume 39 - Issue 6 - p 416–420
doi: 10.1097/OLQ.0b013e318249cbaa
Original Study

Background: Chlamydia screening practices, positivity, and trends from 2004 to 2009 in publicly funded prenatal clinics have not been described.

Methods: A phone-based survey assessing chlamydia screening practices was conducted among a random sample of clinics providing prenatal services (prenatal, family planning, and integrated clinics: “prenatal clinics”) that reported data to the Infertility Prevention Project (IPP) in 2008. Using existing IPP data, chlamydia positivity and trends were assessed among women aged 15 to 24 years seeking care in any prenatal clinic reporting ≥3 years of data to IPP from 2004 to 2009. Linear trends of the effect of year (a continuous variable) on positivity were evaluated using a correlated modeling approach with a random intercept where the unit of analysis was the individual clinic performing chlamydia tests (clinic-based analysis). Covariates included race, age, test technology, and geography.

Results: Of 210 sampled clinics, 166 (79%) completed the survey. Of these, 163 (98.2%) had documented chlamydia screening criteria. Most clinics screened all women during their first trimester and reported 100% screening coverage. From 2004 to 2009, 267,416 tests among women aged 15 to 24 years were reported to IPP from eligible prenatal clinics. Overall chlamydia positivity was 8.3%. Controlling for all covariates, positivity decreased from 2004 to 2009 (odds ratio: 0.93 per year, 95% confidence interval: 0.92, 0.95, 35% decrease overall).

Conclusions: The substantial burden of chlamydia among young women tested in prenatal clinics reporting data to IPP suggests the continued need for routine screening. Decreasing trends from 2004 to 2009 in the IPP prenatal population correspond to findings of overall decreasing chlamydia prevalence in the United States.

From the *Centers for Disease Prevention and Control, Atlanta, GA; CDC Foundation, Atlanta, GA; and Department of Epidemiology, Emory University, Atlanta, GA

The authors thank Dr. James Buehler at the Centers for Disease Control and Prevention (CDC) for providing valuable insights in the early conceptualization of this analysis, and Rob Nelson at CDC for graphical assistance.

The findings and conclusions in this report have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.

Correspondence: Catherine Lindsey Satterwhite, PhD, MSPH, MPH, Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, 3901 Rainbow Blvd, MS: 1008, Kansas City, KS 66160. E-mail:

Received for publication October 20, 2011, and accepted January 3, 2012.

© Copyright 2012 American Sexually Transmitted Diseases Association