Men, Chlamydia and the Cycle of Infection

Chlamydia is the most common sexually transmitted disease among young women in America. And while it doesn't have the scare factor of HIV or herpes, if left untreated, chlamydia has potentially serious health consequences, including infections that could affect a woman's ability to conceive. For over a decade, doctors have recommended that women under 26 get tested for the disease annually, whether they have symptoms or not. Seventy-five percent of women and 50 percent of men with chlamydia have no symptoms, according to the Centers for Disease Control. But asymptomatic men are not normally screened or treated for the disease—a practice that may be contributing to the high rate of repeat infections among some women in their late teens, which was reported in a recent study.

Researchers at the Yale School of Public Health followed 411 young women between the ages of 14 and 19 who sought reproductive health care between 1998 and 2001. During an average follow-up of 4.7 years, researchers found that about half of the sexually active women they studied were diagnosed with the disease. But more alarming, about 57 percent of the women who were infected and treated got at least one other chlamydia infection after an average period of only 5.2 months. The study, which was published in this month's Archives of Pediatrics and Adolescent Medicine (APAM), concluded that these recurrent bouts of chlamydia are "a substantial health burden among young women," and that enhanced efforts to prevent recurrent chlamydia infections in young women are "urgently needed."

Health-care experts are now considering whether those efforts should include screening recommendations for asymptomatic men to prevent them from infecting (or in some cases re-infecting) their partners. "So much work has been done in women because we know the negative long-term effects in women," says Linda Niccolai, assistant professor at the Yale School of Public Health and co-researcher on the APAM study. "But what I think is being overlooked is the fact that for the most part, chlamydia is transmitted in heterosexual relationships. So for every woman that has chlamydia there is a man who is infected too."

According to Niccolai, there is an attitude of nonchalance in the general population toward chlamydia, and health-care professionals need to do a better job of explaining the possibly serious effects of this infection, which, if untreated, can spread into a woman's uterus or fallopian tubes and cause pelvic inflammatory disease. It's estimated that almost two thirds of all chlamydia cases go untreated. As many as 40 percent of women with untreated chlamydia have pelvic inflammatory disease, a condition that can result in permanent damage to the fallopian tubes and uterus, leading to chronic pelvic pain, infertility and a potentially fatal ectopic pregnancy (pregnancy outside the uterus). And although complications among men are rare, they can be serious. Infections can spread to the epididymis (the tube that carries sperm from the testis) causing pain, fever and sometimes, although rarely, sterility.

The number of chlamydia cases diagnosed in men has dramatically increased (diagnosed cases were up 43.5 percent from 2001 to 2005 for men, compared to a 15.6 percent rise in women). This, according to the CDC, likely reflects the expansion of screening efforts and increased use of more sensitive diagnostic tests; however, this trend may also indicate an actual increase in infections. But there is still not enough evidence to warrant recommending annual screening of all sexually active young men, as is the case for women, according to Dr. John Douglas, director of the Division of Sexually Transmitted Disease Prevention at the CDC, who says until screening all men is economically feasible, measures will continue to focus on at-risk male populations only—including those in detention facilities and those who seek sexually transmitted disease (STD) screenings for other diseases. Douglas adds, however, that experts are discussing expedited partner treatment, whereby doctors would give several doses of antibiotics to a woman who tests positive; one for herself and one for her partner(s). "We're very aggressively trying to push other ways of preventing reinfection by doing better treatment in men with girlfriends diagnosed with chlamydia, which I would say is the lowest hanging piece of fruit for now," Douglas says.

But even expedited partner treatment has faced roadblocks in several states, according to Craig Roberts, a physician's assistant and epidemiologist who serves on the American College Health Association STD committee. "Through the medical practices of some states, you can't provide medication to someone you haven't seen," he says. Another problem is the lack of information for sexually active young men. "We don't have any messaging out there for [heterosexual] men at all," Douglas says. "The vast majority of men who don't consider themselves to be gay are not receiving any coordinated package of prevention messages."

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