Background:
Because of the serious health consequences of genital chlamydial infection in women, the National Job Training Program screens young women for chlamydial infection. Infected women are treated and tests-of-cure are performed 1-2 months after completion of the treatment. Persistent infection may be due to treatment failure or re-infection. Factors associated with treatment failure include antimicrobial resistance, drug non-compliance, poor absorption, and immune response.

Objective:
To assess factors associated with persistent chlamydial infection in disadvantaged women entering the National Job Training Program from 1998 to 2004.

Method:
We described demographic characteristics associated with persistent infection (defined as a positive GenProbe or BDProbeTec test after completion of treatment, mostly with a single dose of azithromycin) from women (aged 16 to 24 years) infected at entrance to the training program.

Result:
A total of 10.9% women tested positive for chlamydia at entrance. Of the 4,882 infected women, 5.5 % had persistent infection after completion of the treatment. Blacks and Asians/Pacific Islanders had a 6.0% rate of persistent infection, Whites 4.8%, Hispanics 4.2%, and American Indians 2.6% (p=0.07). Women had similar rates of persistent infections regardless of age, region they resided (South, Midwest, Northeast, and West), year of test, or type of test. Multivariate logistic regression analyses found similar findings.

Conclusion:
The overall rate of persistent infection is lower compared to other non-controlled studies (11%-15%) and slightly higher compared to randomized controlled trials (3%-4%). Persistent infection in these women may be due to treatment failure and re-infection.

Implications:
The findings of this study underscore the need for retesting regardless of demographic characteristics.