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Gale R. Burstein, MD, MPH; Charlotte A. Gaydos, DrPH; Marie Diener-West, PhD; M. Rene Howell, MA; Jonathan M. Zenilman, MD; Thomas C. Quinn, MD

JAMA. 1998;280:521-526.

Context.— Adolescents are at highest risk for infection with Chlamydia trachomatis, an important preventable cause of pelvic inflammatory disease and subsequent tubal factor infertility in US women. Current guidelines for delivery of adolescent primary care services recommend yearly chlamydia screening for those adolescent females considered to be at risk.

Objectives.— To describe the epidemiology of prevalent and incident chlamydia infection among adolescent females to assess the appropriate interval for chlamydia screening and to define risk factors that would identify adolescent females to target for screening.

Design.— Prospective longitudinal study.

Patients.— A consecutive sample of 3202 sexually active females 12 through 19 years old making 5360 patient visits over a 33-month period, January 1994 through September 1996.

Setting.— Baltimore, Md, family planning, sexually transmitted disease, and school-based clinics.

Intervention.— Testing for C trachomatis by polymerase chain reaction.

Main Outcome Measures.— Prevalence and incidence of C trachomatis infections; predictors of positive test result for C trachomatis.

Results.— Chlamydia infection was found in 771 first visits (24.1%) and 299 repeat visits (13.9%); 933 adolescent females (29.1%) had at least 1 positive test result. Females who were 14 years old had the highest age-specific chlamydia prevalence rate (63 [27.5%] of 229 cases; P=.01). The chlamydia incidence rate was 28.0 cases per 1000 person-months (95% confidence interval, 24.9-31.5 cases). The median time was 7.2 months to a first positive chlamydia test result and 6.3 months to a repeat positive test result among those with repeat visits. Independent predictors of chlamydia infection—reason for clinic visit, clinic type, prior sexually transmitted diseases, multiple or new partners, or inconsistent condom use—failed to identify a subset of adolescent females with the majority of infections.

Conclusions.— A high prevalence and incidence of C trachomatis infection were found among adolescent females. We, therefore, recommend screening all sexually active adolescent females for chlamydia infection every 6 months, regardless of symptoms, prior infections, condom use, or multiple partner risks.

From the Department of Molecular Microbiology and Immunology (Dr Burstein), the Division of Infectious Diseases (Drs Gaydos, Zenilman, and Quinn and Ms Howell), and the Department of Biostatistics (Dr Diener-West), Johns Hopkins University, Baltimore, Md; and the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md (Dr Quinn).

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