Detroit’s chlamydia problem

At the Detroit Department of Health and Wellness's sexually transmitted disease clinic, Dr. Jambunathan Ramanathan and his staff know they have to work a little differently with the teenagers who have chlamydia.

Teens are more likely to have chlamydia, the most common sexually transmitted disease, are less knowledgeable about how they got it and can be more likely to have multiple sex partners than adults, he says.

The antibiotic treatments are the same for teenagers, but Dr. Ramanathan says, "We have to counsel them more for a longer time."

Detroit's chlamydia rate is the highest among the nation's cities, according to the latest federal data; state statistics show about 42 percent of Detroit's 2005 cases in people 19 years old or younger.

And while those facts concern Mark Miller, manager of Michigan's STD program at the Department of Community Health, he also says it means more people are getting tested — and treated — with better detection methods at more sites.

"If you look for disease, you're going to find it," he says. "Even if they're high numbers, they're cases that are treated which is a good thing."

Chlamydia is the most commonly reported STD with more than 900,000 cases nationally in 2004. The bacteria that live in vaginal fluid and semen are transmitted sexually; symptoms, which appear one to three weeks after infection, can include genital discharge. But about 70 percent of infections have no symptoms, according to the National Institute of Allergy and Infectious Diseases.

Long-term effects are more serious for females than for males. Up to 40 percent of women with untreated chlamydia develop pelvic inflammatory disease, according to the Centers for Disease Control, and 20 percent of those may become infertile. Chlamydia also has been linked to a greater risk of ectopic pregnancy. Complications for men are rare, the CDC says.

Having chlamydia and other STDs also makes females more likely to contract the AIDS virus, Dr. Ramanathan says, because of the bacteria's ability to weaken immune systems.

Statewide in 2005, 38,729 cases of chlamydia were reported to the Michigan Department of Community Health, says Katie Macomber, an STD epidemiologist with the department. Some 13,425 of those — more than one-third — were in Detroit.

Women in all age groups are more likely than men to have reported cases of chlamydia, but the disparity is greatest in the teen groups. Nationally, the 15 to 19 age range is also where the most chlamydia cases are detected, according to the CDC. In Detroit in 2005, the chlamydia rate for young women ages 15 to 19 was 7.4 times what it was for their male counterparts.

Among the top nine Michigan counties, only Saginaw had a greater disparity between female and male cases than Detroit. In Saginaw County, there were 8.7 times as many female cases as male. (Alcona County, incidentally, had no reported cases in 2005.)

"For every girl who has chlamydia, there's a boy who gave it to her," Macomber says.

But Macomber explains that one reason for the higher rate among females is that they are tested more. As part of the state Department of Community Health's STD program, females in Michigan were tested at three times the rate of males — 79,813 compared to 24,597 — in 2005, according to data from Health Care Education and Training (HCET), a nonprofit group based in Carmel, Ind., that collects testing data from Michigan and five other Midwestern states.

The reason? Politics and the fact females tend to have more contact with health care providers through gynecological exams and family planning.

"Boys go to doctors when they're sick. Girls have more opportunity to interact with people in medicine," Macomber says.

And federal funding for STD testing mandates that providers target females, Miller says, in a program called the Infertility Prevention Project.

"Politically, it probably sounds better than a VD or STD screening program," he says. "It does prevent infertility, and that's one of the main complications of untreated gonorrhea or chlamydia."

The project provides funds for tests and lab work to the state Department of Community Health. State funds and family planning monies also help the department provide the tests to local clinics, schools, juvenile correctional facilities and school-based centers.

In tests that were part of the Infertility Prevention Project, most of Michigan's chlamydia cases — as in other Midwestern states — were detected in STD clinics and family planning centers. But that's also where the most people were tested. Of the 104,456 tests in Michigan in 2005, 92,637 were administered at those kinds of sites, according to HCET records. Ten percent of all the prevention project tests were positive.

Kristine Judd, the STD administrative program manager with the Michigan Department of Community Health, says the testing strategy increases the number of teens tested — and the number of reported chlamydia cases in that population.

"They're adolescent venues," she says. "We're screening more in sites that are likely to yield more positives."

The test being used also increases the number of cases because it's better than past methods, Ramanathan says. The past test would indicate about 75 percent of chlamydia infections, he says, while the new test detects close to 100 percent.

But along with better testing, Ramanathan says, is better treatment. That treatment, especially for teens, includes education: how chlamydia and other sexually transmitted diseases can be prevented (abstinence, condoms and sex with uninfected partners); how often people should be tested (annually or more often if people have more than one sex partner); and the possible long-term effects of undetected STDs (infertility, greater likelihood of contracting the AIDS virus, and, in the case of syphilis, cardiovascular, nerve and organ damage.)

"There is still a lack of knowledge base on this issue," Ramanathan says. "A lot of people don't understand the complications and that if they are asymptomatic, they still need to get tested."

Judd predicts a drop in chlamydia cases this year by as much as 40 percent because the disease has been "targeted" for testing and treatment, just as syphilis was a few years ago.

Five years ago, 1,175 cases of syphilis were reported in Michigan. That fell to 488 last year after the state promoted targeted screenings, Judd says.

"It finally had an effect," she says. "You pay attention to it and the numbers go down."