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Northwest Portland Area Indian Health Board |
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The Northwest Tribal 1997-1998 Year End
Chlamydia Surveillance Report |
Discussion
For the fiscal year October 1997-September 1998, there were 93 new cases of CT reported for the eleven Northwest tribes participating in this project. A large majority (84%) of these cases were reported among women and over half (78%) of all reported cases (male and female patients combined) were either between the 16-19 or 20-24 age groups. These trends are consistent with national rates.
Female Patients
Of the female patients diagnosed with CT, over half (51%) of the diagnoses occurred during a routine medical visit; 23% had medical symptoms and therefore sought medical treatment; and 6% had sexual contact with an individual who had tested positive for an STD. Eight women (10%) were diagnosed with CT during a prenatal evaluation. Just under half (49%) of the symptomatic female patients presented vaginal discharge at the time of the medical visit; 33% presented pelvic pain; 12% presented both pelvic pain and dysuria, and 3% were asymptomatic.
Male Patients
Of the male patients diagnosed with CT, two thirds (67%) had medical symptoms and therefore sought medical treatment; and 33% had sexual contact with an individual who had tested positive for a STD. Just under half (46%) of the symptomatic male patients presented both penile discharge and dysuria at the time of the medical visit; 36% presented only dysuria; and 18% presented only penile discharge.
Treatment
Over half (80%) of the patients diagnosed with CT received a treatment
plan of Azithromycin; and 10% received Doxycycline.
Follow-up Activities
There are several follow-up questions that are asked on the Chlamydia Surveillance Forms, however these questions are often left unanswered by staff who submits the forms.
Gonorrhea
Was patient positive for Gonorrhea?
Of the 95 forms submitted by Northwest Indian health programs for FY
97-98, there were 89 forms that answered the question regarding Gonorrhea.
Of these, there were 2 patients diagnosed with CT who had also been diagnosed
for Gonorrhea.
Pelvic Inflammatory
Disease
If female, was the patient positive for PID?
Of the 95 forms submitted by Northwest Indian health programs for FY
97-98, there were 78 forms that answered the question regarding PID.
Of these, there were eleven (14%) female patients diagnosed with PID.
Sexually Transmitted
Disease (STD) Counseling
Was patient counseled about STDs?
Of the 95 forms submitted by Northwest Indian health programs for FY
97-98, there were 87 forms that answered the question regarding STD counseling.
Of these, there were 78 (90%) patients with CT that received STD counseling.
HIV counseling
and testing
Was patient offered counseling and testing for HIV?
Of the 95 form submitted by Northwest Indian health programs for FY
97-98, there were 43 forms that answered the question regarding HIV counseling
and testing. Of these there were 30 (70%) patients with CT that received
HIV counseling and testing.
State Health
Department
Was the state health department notified?
Of the 95 form submitted by Northwest Indian health programs for FY
97-98, there were 91 forms that answered the question regarding reporting
practices to the state health department. Of these there were 89
(98%) new cases of CT that were reported to the state health department.
Medication
Allocation for Contacts
Were medications given to patient for contact(s)?
Of the 95 form submitted by Northwest Indian health programs for FY
97-98, there were 91 forms that answered the question regarding medication
allocation for contacts. Of these 30 (33%) patients with CT were
given medication for their contact(s).
Partner Referral
Follow-up
Were partners referred for follow-up?
Of the 95 form submitted by Northwest Indian health programs for FY
97-98, there were 90 forms that answered the question regarding partner
referral follow-up. Of these 34 (38%) partners of patients diagnosed
with CT were referred to follow-up services.
Conclusion
Most newly diagnosed cases of CT were among female patients between 16-19 or 20-24 age groups during a routine medical visit. Approximately 14% of the female patients diagnosed with CT were also diagnosed with PID.
There were a few male patients diagnosed with CT at Northwest Indian health programs for FY 97-98. Most of these male patients presented symptoms (i.e., penile discharge and dysuria) that prompted them to seek medical services and treatment. According to published data, approximately 40% of males and 75% of women who are infected with CT are asymptomatic and the majority of CT cases reported nationally are diagnosed during a routine medical visit. Low rates of CT among men suggest that many of the partners of women with CT are not screened or treated for CT.
Therefore, based on this information, there may be significant benefits in screening asymptomatic males for CT. However, because the standardized CT testing approaches require a painful penile swab, males are less likely to undergo screening for CT. Alternatively, the Ligase Chain Reaction (LCR) is an innovative testing instrument that received licensure by the Food and Drug Administration (FDR) in 1995. LCR is a testing instrument that effectively detects CT DNA in urine. Research indicates that LCR has a sensitivity2 of 93-98% and a specificity3 of 99.9% for diagnosing CT. Because LCR is noninvasive, patients may be more likely to undergo testing for CT infection.
In summary, CT is one of the most common STD’s nationwide and is most prevalent among youth between 15-25 years. CT continues to disproportionately impact AI/AN communities. If CT is left untreated, significant health complications may result, including ectopic pregnancy, infertility, and PID. However once detected, CT is easy to treat and cure. Obtaining information about: 1) the magnitude of CT infection; 2) various risk behaviors; and 3) follow-up and treatment plans within Northwest AI/AN communities continues to be an important first step towards development of effective STD prevention programs and improving the overall health of Northwest Indian communities. Knowing this information may serve to optimize the development and design of STD prevention strategies occurring in Northwest AI/AN communities. Finally, identifying CT infection among individuals who do not demonstrate signs of CT infection will enable timely and effective medical treatment that will minimize the potential long-term health complications resulting from untreated CT.
For more information or to receive additional copies of this report,
please contact Francine Romero
at The EpiCenter at (503) 228-4185.
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Last Modified May 1, 2002
By: Jim Fry