2000-2011 Annual Rate of Chlamydia Per 100,000 Population
Sources: 2011 data is based on 2010 Census population estimates
Chlamydia, caused by the bacteria Chlamydia trachomatis, is the most common sexually transmitted infection (STI) in the United States. There were 1,108,374 infections in 2007 (370.2 cases per 100,000 population) STIs, which used to be referred to as sexually transmitted diseases (STDs), are a major concern because of the ease of transmission and potential serious complications. Potential serious sequelae of these infections include pelvic inflammatory disease (PID), infertility, chronic pelvic pain and ectopic pregnancy. These complications result in unnecessary healthcare expenditures as well as unwanted pain and suffering.
Rates for Chlamydia have increased in Indiana, Kentucky, and Ohio since 2005. Although the rates for Chlamydia for our region are lower than the national rate, the notable exception is Hamilton County. The 2011 rate in Hamilton County (805 per 100,000 population) is almost twice as high as the national average and continued to climb in 2011. In 2011, the City of Cincinnati (2150 per 100,000) had more than four times the state and national average and continued to climb from 2010. The 2011 rates were not yet available from Kentucky or Indiana; however, in 2010, Carroll County in Kentucky had the second highest 2010 Chlamydia case rate at 453 per 100,000 population.
The rates of chlamydia are increasing both nationally and in our own area. In our region, rates are mostly below the national rate. However, in Hamilton County, rates are unacceptably high. Unfortunately, due to continued budget cutting of health departments at the state and local level, there are not enough resources to impact the epidemic. The Cincinnati Health Department does not follow-up on positive test results from hospitals and doctors' offices. Therefore, many patients who were tested as positive do not get appropriate treatment. There is also no contact investigation for those with a positive test. The current situation is similar to that of Tuberculosis (TB) in the late 1980s. Health departments had stopped aggressively following up on positive TB cases. The rates for TB went up rapidly; however, with improved surveillance and intervention, the rates of TB have again dropped.
Another possible reason for chlamydia rates to increase in all areas is the increased use of testing. There are now tests that can be done on urine alone and do not require a pelvic exam. Also, there has been increase education of doctors to test women more frequently. The problem is that most patients with chlamydia, especially women are without symptoms and are unaware of their infection.
Chlamydia is easily treated and usually does not require but one dose of antibiotics. However, many patients are not treated at the time of their evaluation because testing does not return for 1 to 2 days. Private physicians and emergency departments must ensure that patients who test positive are informed of their diagnosis and have received treatment. Simply referring patients to the public health department is inadequate. The estimated annual cost for treatment of chlamydia is in excess of $2 billion dollars. It has also been estimated by the Centers for Disease Control and Prevention (CDC) that for every dollar that is spent on early detection would result in a savings of $12.
Edmond A. Hooker, MD, DrPH
Department of Health Services Administration