Prevention Matters

...antibiotics and STD screening.

This week CDC released its annual sexually transmitted diseases surveillance report, which showed that chlamydia and syphilis rates in the U.S. continued to rise in 2009. However, gonorrhea reached its lowest level in almost 70 years. All three STDs can be easily treated with antibiotics but can have serious consequences, including infertility and organ damage, if left untreated.

According to the report, chlamydia rates increased by 3% last year, with 409 cases per 100,000 people—representing an all-time high for reported chlamydia infections. The rate increased by almost 20% since 2006. On a positive note, CDC believes that the increase is likely attributed to expanded screening, and not an increase in the disease.

Unfortunately, large disparities still exist among racial and ethnic minority groups, with young African Americans baring a large burden of the disease.

STD screening can help detect disease early and, combined with treatment, is an effective way to protect a person’s health and reduce transmission to partners. One of the continuing problems is that less than half of the people who should be screened for STDs, do so. To help improve screening, as well as prevention and treatment of chlamydia, Partnership for Prevention convenes and leads the National Chlamydia Coalition, whose mission is to reduce the rates of Chlamydia and its harmful effects among sexually active adolescent and young adults.

The use of electronic records significantly increasing how fast patients with Chlamydia are treated was named the “Best Prevention Idea of the Week,” while children on Medicaid not receiving all required preventive screening services was named the “Worst Prevention Idea of the Week."

BEST

Chlamydia Treated Sooner When Docs Use E-Records

Switching to electronic medical records can significantly boost how quickly patients with the sexually transmitted disease chlamydia are treated, a new study shows.

Researchers found that an electronic medical record system more than doubled the percentage of patients treated within two weeks of diagnosis. The longer a sexually transmitted infection goes untreated, "the more risk there is of onward transmission and of clinical complications," the authors wrote. "Appropriate use of technology greatly improves our ability to treat patients rapidly, and we should strive to use all available methods for the good of our patients and the betterment of public health."

WORST

Medicaid Children Are Not Receiving All Required Preventive Screening Services

The Department of Health and Human Services’ Office of Inspector General (IG) has just released a new report (OEI-05-08-00520) concluding that “Most children in nine selected States are not fully benefiting from Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) comprehensive screening services.”

For anyone concerned about the importance of expanding coverage for clinical preventive services under health reform, this report is a reminder that coverage alone isn’t enough to assure access.

On May 20th, Partnership for Prevention’s work on the National Chlamydia Coalition (NCC) was showcased as part of the Center for Disease Control and Prevention’s (CDC) monthly Public Health Grand Rounds series. The session, entitled "Chlamydia Prevention: Challenges and Strategies for Reducing Disease Burden," featured presentations from active NCC members Dr. Gail Bolan, State STD Director for California and Dr. Gale Burstein, a pediatrician representing the Society of Adolescent Health and Medicine. Dr. Burstein’s presentation highlighted two of the NCC’s publications and outlined our activities aimed to increase chlamydia screening. The CDC’s Dr. Raul Romaguera’s presentation listed the NCC as one of four key partners working with the CDC to reduce chlamydia rates.

Alana Ward
Program Associate
Partnership for Prevention

As many as one in two sexually active young people will contract an STD before the age of 25 so MTV, Kaiser Family Foundation, CDC, Planned Parenthood, Partnership for Prevention and others are urging young people to GYT: Get Yourself Tested for sexually transmitted infections (STDs). Untreated STDs may result in infertility, increase risk of HIV transmission, or cause cervical cancer.

GYT is the central hub for STD information that includes facts and tips for talking about STDs to partners, health care providers, or parents. On the air, MTV is featuring information about STDs on MTV News and mtvU Dean’s List. The MTV “How To” Show will feature how to talk to your partner about getting tested and how to ask your doctor which tests are right for you. The Health Center/Clinic Toolkit also has fact sheets for patients and other content that can be downloaded for free.

You can also find local options for STD testing or text your zip code to the GYT short code (498669) from a mobile phone to get a text with testing centers close to you.

Partnership for Prevention leads the National Chlamydia Coalition (NCC) which strives to reduce the rates of chlamydia and its harmful effects among sexually active adolescents and young adults through increasing screening rates, public awareness and provider education.

Susan Maloney
Senior Program Officer
Partnership for Prevention

Partnership recently awarded grants to several state and local organziations to improve preventive services.

With funding from the Centers for Disease Control and Prevention, one-year grants were awarded to regional, state and local organizations to implement innovative strategies to increase chlamydia screening and follow-up care. The grants are also designed to encourage collaboration among local affiliates of the National Chlamydia Coalition (NCC). Comprised of 40 member organizations, the NCC was established to address the continued high burden of chlamydia infections, especially among women age 24 and younger.

Grants have been awarded to a variety of organizations, including county and state health departments, school-based health centers, a department of juvenile services, and a university, among others. The projects will address one or more barriers to chlamydia screening and will be designed to reach a variety of audiences. Lessons learned from the projects will be shared widely so that models can be replicated in other communities. For a complete list of grantees and project descriptions, click here.

Partnership also awarded six ACTTION State Grants for the implementation of innovative strategies to increase access to tobacco cessation treatments. Funds are to be used primarily for the development of state alliances/summit meetings and the creation of strategic plans. The projects will range from focusing on employer groups and health care systems to the uninsured and the behavioral health/substance abuse populations. For a complete list of grantees and project descriptions, click here.

With funding from the Pfizer Foundation, Partnership hopes to dramatically increase access to and use of proven tobacco cessation treatments through this grant program. The focus of the ACTTION state grants is system and policy change in tobacco cessation, rather than the delivery of programs or direct services.

A recently published study reports that nearly one in four adolescent girls were found to have had at least one sexually transmitted infection (STI), while the prevalence grew to more than one in three among girls who ackowledged being sexually experienced. "The prevalence of STIs among female adolescents is substantial, and STIs begin to be acquired soon after sexual initiation and with few sex partners," said authors of the study, which was published online in the journal "Pediatrics" on Nov. 23.

Data were analyzed from 838 females who were aged 14 to 19 and participating in the nationally representative National Health and Nutrition Examination Survey 2003–2004. After interview and examination, survey participants provided biological specimens that were tested for five STIs: Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, herpes simplex virus type 2, and human papillomavirus (HPV) (any of 23 high-risk types or type 6 or 11).

Among the conclusions :

• Prevalence of any of the 5 STIs was 24.1% among all female adolescents and 37.7% among those deemed "sexually experienced" (gave a "yes” response to the question, “Have you ever had sex?)
• HPV was the most common STI among all female adolescents (18.3%), followed by C trachomatis infection (3.9%).
• Prevalence of any of the STIs was 25.6% among those whose age was the same or 1 year greater than their age at sexual initiation and 19.7% among those who reported only 1 lifetime sex partner.

"These findings support early and comprehensive sex education, routine HPV vaccination at the age of
11 to 12 years, and C trachomatis screening of sexually active female adolescents," the authors wrote.

This seems like a good place to remind readers that a new Facebook application has been launched to help educate, motivate and mobilize people to prevent the spread of Human Papillomavirus (HPV). “Fact Check: HPV” (http://www.hpvfactcheck.org/) allows users to take an interactive, educational quiz about HPV, find additional resources, and commit to take action, while even allowing concerned friends to anonymously share the application with peers.

I know that an untreated chlamydia infection can result in infertility, but many young women do not know. In today's Wall Street Journal, consumer health writer, Melinda Beck, addresses the facts about chlamydia infections and the challenges to getting young women screened routinely. In developing the article Melinda interviewed several members of the National Chlamydia Coalition (www.prevent.org/NCC) which is convened and operated by Partnership for Prevention, in conjunction with the Centers for Disease Control and Prevention.

Susan Maloney
Senior Program Manager
Partnership for Prevention




URL to link to

Despite strong recommendations that all sexually active young women age 25 and younger receive a screening test each year for chlamydia, many websites offering health information fail to mention the importance of chlamydia screening. Health websites providing information to the public often discuss chlamydia infections, symptoms and treatment. But the vast majority of young women with chlamydia have no symptoms so making screening a routine part of medical care is strongly recommended.

Chlamydia screening is recommended by the US Preventive Services Task Force, Centers for Disease Control and Prevention, and many leading medical associations including the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and the American Medical Association. The consequences of untreated chlamydia infections include pelvic inflammatory disease, which may lead to infertility, chronic pelvic pain, and pregnancy complications. Chlamydia can be detected with a urine test and treated with common antibiotics.

The National Chlamydia Coalition, convened by the Partnership for Prevention and the Centers for Disease Control and Prevention, has begun to reach out to health websites urging them to update their entries on chlamydia to make it clear to sexually active young women that chlamydia screening should be a routine part of their medical care. The coalition is pleased to have worked with the National Women’s Health Resource Center to update its chlamydia information to include screening. The article can be accessed at http://www.healthywomen.org/healthtopics/chlamydia. The National Chlamydia Coalition offers additional resources, including where to locate confidential STD screening services, at www.prevent.org/NCC.

Susan K. Maloney, MHS
Managing Senior Fellow & Senior Program Officer
Partnership for Prevention

The Centers for Disease Control and Prevention recently reported that screening rates for Chlamydia are disturbingly low, even as it has become the nation’s most common reportable sexually transmittable disease. Partnership for Prevention has organized the National Chlamydia Coalition to help increase routine screening for Chlamydia infections. We discuss these concerns with Dr. Yolanda Wimberly, a nationally recognized pediatrician and the medical director for the Center for Excellence in Sexual Health at Morehouse School of Medicine in Atlanta.

Octo-Mom placed the challenges posed by infertility treatments squarely in the public eye, but in this and other discussions of infertility and its treatment, I never remember anyone mentioning that some infertility can actually be prevented.

It turns out that various infections, with chlamydia being the most common especially in young women, can progress to pelvic inflammatory disease which, untreated, can result in infertility and other serious reproductive tract problems. In pregnant women, chlamydia infections may be passed to the newborn. Surprised? I was.

And more alarming, by the time they reach 25, 1 in 2 young people will contract an STD and most will not know it. Chlamydia and other infections can be detected by a simple, non-invasive urine test and treated with an antibiotic. Yet this year, the rates of chlamydia infection continued to climb to record highs according to the CDC.

So why aren’t all sexually active young women routinely receiving this evidence-based preventive medical care? Public awareness is low and some young women incorrectly assume that they are tested for STDs whenever they receive a Pap test. Healthcare providers face barriers from lack of reimbursement for screening tests (as opposed to testing a patient with symptoms), to misperceptions that “my patients” aren’t the type to get this infection, to concerns about being able to confidentially treat a young person whose medical coverage is in a parent’s name.

Partnership for Prevention, working closely with CDC, has convened key groups interested in improving screening rates into the National Chlamydia Coalition and has developed a guide for healthcare providers to make screening a routine part of medical care. Read more at www.prevent.org/NCC.

Chlamydia and gonorrhea are still on the rise, with an estimated 1.4 million cases in the United States. That's according to the Centers for Disease Control and Prevention, which released the 2007 Sexually Transmitted Disease Surveillance data today. It also shows continuing racial disparities, and a heavy burden of disease among women.

The Chlamydia rate in women was found to be three times that of men, and although it is easily diagnosed and treated, it’s often asymptomatic and goes undetected. When left untreated, Chlamydia can cause infertility—affecting a woman’s chance to have children later in life. The US Preventive Services Task Force recommends that all sexually active women age 25 years and younger be screened each year for Chlamydia infection. Screening and treatment with antibiotics can prevent pelvic inflammatory disease, infertility, and other reproductive health problems.

Partnership for Prevention has joined CDC in an effort to prevent these lifelong consequences of untreated STDs. Along with eight other organizations that make up the steering committee, Partnership is leading the recently established National Chlamydia Coalition, whose mission is to reduce the rates of Chlamydia and its harmful effects among sexually active adolescent and young adults.

To join the mailing list for the National Chlamydia Coalition, send an email to cjohnson@prevent.org