Background: The comparative prevalences and predictors of chlamydia and gonorrhea have not been studied in the family planning clinic population.
Goals: To determine the comparative prevalences and predictors of chlamydia and gonorrhea among Colorado family planning clinic patients.
Study design: Cross-sectional study of public and private family planning clinic patients in Colorado tested for both chlamydia and gonorrhea (n = 12,926).
Results: Among women tested for both infections, the chlamydia prevalence rate was 4.5% and the gonorrhea prevalence rate was 0.5%. Multivariate analysis showed that independent predictors of chlamydia were age younger than 25 years, black or Hispanic race-ethnicity, cervical friability, mucopus, exposure to a sex partner with chlamydia, or multiple recent sex partners. Independent predictors of gonorrhea were age younger than 20 years, black or Hispanic race-ethnicity, or exposure to a sex partner with gonorrhea; adjusted odds ratios for exposure to gonorrhea and black race were the highest for either infection.
Conclusions: The gonorrhea prevalence rate was very low compared to that of chlamydia in patients at Colorado family planning clinics. Cost-effective gonorrhea testing strategies are needed for this population.
PIP: In Colorado, state health department laboratory personnel used the DNA probe assay, Gen-Probe, to test specimens from 12,926 women for both Chlamydia trachomatis and Neisseria gonorrhoeae infections and from another 9416 women for Chlamydia alone. All the women had attended public and private family planning clinics state-wide during July 1994 to May 1995. Researchers conducted a comparative analysis to determine the prevalence and the predictors of each sexually transmitted disease (STD) among the family planning clinic population in Colorado. Women tested for both chlamydia and gonorrhea had a higher chlamydia prevalence rate than those tested for only chlamydia (4.5% vs. 3.5%; p 0.001). 64 (0.5%) of the women who were tested for both chlamydia and gonorrhea tested positive for gonorrhea. The gonorrhea prevalence was 9 times lower than that of chlamydia. Among the 64 women with gonorrhea, 25 (39.1%) also tested positive for chlamydia. Among the 577 women with chlamydia, 4.3% also tested positive for gonorrhea. The multivariate analysis revealed that variables independently associated with chlamydia included age under 20 or 20-24 years (odds ratio [OR] = 3.84 and 2.44, respectively), African-American or Hispanic race-ethnicity (OR = 2.41 and 1.65, respectively), cervical friability (OR = 2.26), mucopus (OR = 2.64), exposure to a sex partner with chlamydia (OR = 3.79), and multiple recent sex partners (OR = 1.4). Variables independently associated with gonorrhea included age under 20 years (OR = 3.42), African-American or Hispanic race-ethnicity (OR = 12.71 and 3.07, respectively), and exposure to a sex partner with gonorrhea (OR = 39.29). Cost-effective analyses would help determine appropriate selective screening strategies for gonorrhea. The researchers found that the criteria of urban residency, African-American race, and exposure to a sex partner with gonorrhea would involve the testing of 82% of patients, which would identify 94% of gonorrhea infections.