Article Text
Abstract
Objectives To determine the prevalence and risk factors of genital Chlamydia trachomatis (CT) among school-going sexually experienced male and female adolescents in Panama.
Methods We conducted two multisite cross-sectional studies using two-stage cluster sampling to select adolescents aged 14–19 years attending urban public high schools (URB) in Panama City, San Miguelito, Colón and Panama Oeste from 2015 to 2018, and in the rural Indigenous Comarca Ngäbe-Buglé (CNB) from July–November 2018. CT testing was performed by real-time PCR on urine samples. Random-effects logistic regression accounting for sample clustering was used to identify risk factors.
Results We enrolled 3166 participants (54.3% females), median age 17 years (IQR: 15.9–18.1), with no difference by sex. Sexual experience was reported by 1954 (61.7%) participants. Combined CT prevalence was 15.8% (95% CI: 14.2 to 17.4), with no significant differences by region (URB=16.5%, 95% CI: 14.7% to 18.6%; CNB=13.6%, 95% CI: 10.9% to 16.8%; p=0.12). In an age-and-region-adjusted analysis, CT prevalence was higher among female participants compared with males (21.6% vs 9.1%, adjusted OR (AOR)=2.87, 95% CI: 1.62 to 5.10). Among sexually experienced females, CT prevalence was higher among those who reported ≥3 lifetime sex partners compared with one partner (33.5% vs 15.3%, AOR=2.20, 95% CI: 1.09 to 4.07); and among those reporting at least one pregnancy compared with nulligravidae participants (30.9% vs 13.8%, AOR=1.89, 95% CI: 1.05 to 3.43). In unadjusted analyses among males, CT was associated with older age (11.5% among those aged 18–19 years vs 3.4% among those aged 14–15 years, OR=3.69, 95% CI: 1.10 to 12.33).
Conclusions We report high CT prevalence among sexually experienced, school-going adolescents in Panama. Female adolescents, particularly those with multiple sex partners and a history of pregnancy, were at highest risk. Adolescent-targeted CT screening should be implemented in Panama. Additionally, evidence-based comprehensive sexuality education will be imperative.
- Chlamydia trachomatis
- adolescent
- Latin America
Data availability statement
Data may be obtained from a third party and are not publicly available. Data include indirect identifiers therefore for ethical reasons, are not in a repository.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
Data may be obtained from a third party and are not publicly available. Data include indirect identifiers therefore for ethical reasons, are not in a repository.
Footnotes
Handling editor Catherine H Mercer
Contributors AG and JMP designed and coordinated the URB study. AG and PM designed the CNB study. AO, JC, OC, AM performed laboratory analysis of chlamydia. AG and PM performed statistical analyses and interpretation. AL, BA, SP and AM aided in data collection. JMP oversaw data collection, analysis and manuscript creation. AG and PM wrote the first draft of the manuscript. All coauthors critically reviewed and approved the final manuscript draft.
Funding Panama's Ministerio de Economia y Finanzas and Panama ́s National STI/HIV/Viral Hepatitis Program.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.