Evaluation of Predictive Factors for Chlamydia Trachomatis Infection in Female Family Planning Clients Over Age 25

Background: The U.S. Centers for Disease Control and Prevention recommends that females age 25 and under should be screened for chlamydia annually, and that women over age 25 should be tested as medically indicated. However, the factors predicting chlamydial infection in women over age 25 are not well understood. Identification of factors associated with chlamydia in women over 25 would allow clinicians to target screening towards women at increased risk of infection.

Objectives: To identify factors associated with chlamydial infection in female family planning clients over age 25.

Methods: A retroactive analysis was performed using patient charts of 487 female family planning clients between the ages of 26 and 42, who were tested for chlamydia at five family planning clinics in the Philadelphia area during 2006-2008. Self-reported data and clinical data were examined; association of current infection status with prior infections, behavioral risk factors, and reproductive history was analyzed in clients lacking other medical indicators for testing.

Results: Of 487 clients, 303 (62.2%) had signs/symptoms of infection or were STD testing clients only. In the remaining clients (n=184), prior chlamydial infection was found to be strongly associated with current infection (p=.0002); the association held for infections occurring up to three years prior to the current visit. The association between prior bacterial vaginosis and current chlamydial infection neared statistical significance (p=.061). Other prior infections, behavioral factors, and reproductive factors were found to have no association with infection status.

Conclusions: Chlamydial infection within the past 3 years was found to be associated with current chlamydial infection in female family planning clients over age 25 with no other medical indicators.

Implications for Programs, Policy, and/or Research:Clinicians might consider chlamydial infection within the past 3 years as an indicator for diagnostic testing for females over 25.