Sheryl B. Lyss, MD; Mary L. Kamb, MD, MPH; Thomas A. Peterman, MD, MSc; John S. Moran, MD, MPH; Daniel R. Newman, MA; Gail Bolan, MD; John M. Douglas Jr., MD; Michael Iatesta, MA; C Kevin Malotte, DrPH; Jonathan M. Zenilman, MD; Josephine Ehret, BS; Charlotte Gaydos, MS, MPH, DrPH; Wilbert J. Newhall, PhD; for the Project RESPECT Study Group*
Acknowledgments: The authors thank Carol Metcalf, MBChB, MPH, and Catherine Lindsey, MPH, for providing the data and conducting the analyses of chlamydial co-infection among gonorrhea-infected patients in RESPECT-2 (Denver, Colorado; Long Beach, California; and Newark, New Jersey, 19992000).
Grant Support: Project RESPECT was supported by CDC cooperative agreements.
Potential Financial Conflicts of Interest:Honoraria: J.M. Zenilman (Pfizer, Inc.); Stock ownership or options (other than mutual funds): J.M. Douglas (Pfizer, Inc.).
Requests for Single Reprints: Reprint Services, Office of Communications, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop E-07, Atlanta, GA 30333.
Current Author Addresses: Dr. Lyss and Mr. Newman: Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-46, Atlanta, GA 30333.
Dr. Kamb: Global AIDS Program, Centers for Disease Control and Prevention, U.S. Embassy, Hanoi, 7 Lang Ha, Hanoi, Vietnam.
Drs. Peterman, Douglas, and Newhall: Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-02, Atlanta, GA 30333.
Dr. Moran: Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-61, Atlanta, GA 30333.
Dr. Bolan: STD Control Branch, 1947 Center Street, Suite 201, Berkeley, CA 94704.
Ms. Ehret: Denver Public Health, 605 Bannock Street, Denver, CO 80204.
Mr. Iatesta: Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-04, Atlanta, GA 30333.
Dr. Malotte: California State University, Long Beach, 5500 Atherton Street, Suite 400, Long Beach, CA 90815.
Drs. Zenilman and Gaydos: Johns Hopkins University School of Medicine, Ross Research Building, Room 1165, 720 Rutland Avenue, Baltimore, MD 21205.
Author Contributions: Conception and design: S.B. Lyss, M.L. Kamb, T.A. Peterman, D.R. Newman, G. Bolan, J.M. Zenilman, J. Ehret, W.J. Newhall.
Analysis and interpretation of the data: S.B. Lyss, M.L. Kamb, T.A. Peterman, J.S. Moran, D.R. Newman, G. Bolan, J.M. Douglas, C.K. Malotte, C. Gaydos.
Drafting of the article: S.B. Lyss, M.L. Kamb, C. Gaydos.
Critical revision of the article for important intellectual content: S.B. Lyss, M.L. Kamb, T.A. Peterman, J.S. Moran, J.M. Douglas, M. Iatesta, C.K. Malotte, J.M. Zenilman, J. Ehret, C. Gaydos, W.J. Newhall.
Final approval of the article: S.B. Lyss, M.L. Kamb, T.A. Peterman, J.S. Moran, D.R. Newman, G. Bolan, J.M. Douglas, M. Iatesta, C.K. Malotte, J.M. Zenilman, J. Ehret, C. Gaydos, W.J. Newhall.
Provision of study materials or patients: M.L. Kamb, G. Bolan, J.M. Douglas, M. Iatesta, J.M. Zenilman.
Statistical expertise: M.L. Kamb, D.R. Newman.
Obtaining of funding: M.L. Kamb, G. Bolan, J.M. Zenilman.
Administrative, technical, or logistic support: M.L. Kamb, T.A. Peterman, G. Bolan, J. Ehret, W.J. Newhall.
Collection and assembly of data: M.L. Kamb, G. Bolan, J.M. Douglas, C.K. Malotte.
For two decades, treatment guidelines for sexually transmitted diseases (STDs) have recommended empirical co-treatment for chlamydia when patients are treated for gonorrhea. Because the epidemiology of and diagnostic testing for STDs have changed over time, co-treatment may no longer be needed as a clinical or public health strategy.
To assess the prevalence of chlamydia among patients at STD clinics who are infected with and treated for Neisseria gonorrhoeae and to determine whether co-treatment recommendations are still justified.
Cross-sectional analysis of data from a multisite study.
Five public STD clinics (Baltimore, Maryland; Denver, Colorado; Long Beach, California; Newark, New Jersey; and San Francisco, California), July 1993 through October 1995.
3885 heterosexual patients (2184 men and 1701 women) who agreed to participate in a trial of counseling interventions and had conclusive results from diagnostic tests for gonorrhea and chlamydia performed routinely as part of the trial.
Infection with Chlamydia trachomatis as determined by polymerase chain reaction.
Chlamydia trachomatis was detected in 20% (95% CI, 16% to 24%) of 411 men and 42% (CI, 35% to 50%) of 151 women with laboratory-confirmed N. gonorrhoeae. Chlamydia trachomatis was detected in 19% (CI, 15% to 22%) of 410 men and 35% (CI, 28% to 43%) of 154 women with treatment indications for gonorrhea who would not otherwise have been treated for chlamydia: chlamydia prevalence among these patients was significantly higher than among patients without treatment indications for either gonorrhea or chlamydia: 7% in men and 9% in women (relative risk, 2.58 [CI, 1.92 to 3.47] and 4.12 [CI, 3.05 to 5.57], respectively).
The frequent presence of chlamydia among patients at STD clinics who received treatment for gonorrhea, including sex partners of gonorrhea-infected patients, supports continuing current recommendations for co-treatment.
*For members of the Project RESPECT Study Group, see the Appendix.
On the basis of studies of chlamydia and gonorrhea co-infection in the 1980s, guidelines recommend empirical treatment for chlamydia for patients receiving treatment for gonorrhea. The relevance of these recommendations to current practice is unknown.
These 1995 data suggest that, in U.S. sexually transmitted disease clinics, the prevalence of Chlamydia trachomatis among patients infected with gonorrhea (20% in men, 42% in women) or treated for gonorrhea (19% in men, 35% in women) remains sufficiently high to warrant continued empirical therapy for chlamydia.
These data are nearly a decade old. They may not apply in settings that are not sexually transmitted disease clinics.
Table 1. Laboratory-Confirmed Gonorrhea and Chlamydia, by Sex, Study Site, and Age Group
Table 2. Chlamydia among Patients, by Mutually Exclusive, Hierarchical Treatment Indication
Table 3. Chlamydia among Patients with Treatment Indications for Gonorrhea, by Sex, Study Site, and Age Group
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Sheryl B. Lyss, Mary L. Kamb, Thomas A. Peterman, John S. Moran, Daniel R. Newman, Gail Bolan, et al. Chlamydia trachomatis among Patients Infected with and Treated for Neisseria gonorrhoeae in Sexually Transmitted Disease Clinics in the United States. Ann Intern Med. 2003;139:178–185. doi: 10.7326/0003-4819-139-3-200308050-00007
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Published: Ann Intern Med. 2003;139(3):178-185.
Infectious Disease, Sexually Transmitted Infections.
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