Background Preventing infertility through the prevention and control of chlamydia is a priority in the USA. Valid and timely surveillance data on chlamydial infections are needed to estimate disease burden, monitor trends, and inform and evaluate chlamydia prevention strategies.
Methods We assessed the strengths and weaknesses of the US chlamydia surveillance system, including notifiable disease reports, opportunistic data from screening programs, and national surveys.
Results Notifiable disease report data are heavily influenced by changes in screening coverage, empiric treatment, diagnostic test technology, and reporting practices. Although test positivity data from federally-funded screening programs can account for the number of tests conducted, data are affected by changes in clinics participating in the program, differences in screening criteria between clinics, and demographic shifts in clinic populations. National survey data are representative of the general population and estimate point prevalence. However, data are not timely and low national chlamydia prevalence (estimated prevalence in 2009–2010 was 1.7%, 95% CI 1.0% to 2.3%) combined with small survey sample sizes results in unstable estimates limiting the ability to monitor trends in demographic subpopulations.
Discussion The current US chlamydia surveillance system does not provide valid and timely data to estimate disease burden and monitor trends in chlamydial infection. The use of multiple data sources is not sufficient to offset inherent biases in each surveillance method. Consequently, new approaches to monitoring chlamydia morbidity are needed. Sentinel surveillance may provide higher quality data and a more comprehensive understanding of chlamydia trends.