Assessing Age-Related Risk for Gonococcal and Chlamydial Infections Among Females in Hawaii, 2001: A Comparison of Morbidity Rates With Screening Test Positivity

Abstract

Objective.-National and state public health officials generally present sexually transmitted disease (STD) surveillance information in terms of overall cases and population-based rates. Because many adolescents (especially in the younger ages) are not sexually active, the use of population-based denominators leads to the calculation of low age-specific STD rates. This study compared morbidity rates with screening test positivity for gonorrhea and chlamydia to better define age-related STD risk among females in Hawaii.Methods.-All female gonorrhea and chlamydia cases reported to the Hawaii State Department of Health (HDOH) during 2001 were grouped by age. Population estimates were used to calculate age-specific morbidity rates. Age-specific screening test positivity was calculated by dividing the number of positive tests identified through the HDOH STD screening programs by the number of screening tests performed in each age category (ϫ100).Results.-Although morbidity rates for both chlamydia and gonorrhea were low among 10-14 year olds, this group had the highest screening test positivity. Screening test positivity decreased incrementally with increasing age.Conclusions.-Screening test positivity may provide a more accurate estimate of STD risk for sexually active adolescents than population-based rates. Physicians should obtain sexual histories from their adolescent patients and provide STD prevention counseling and screening to those found to be sexually active. In addition, expanded STD screening and treatment services should be made available and accessible to young, sexually active adolescents because they appear to be at greatest risk.

Epidemiology of chlamydial infection: are we losing ground?

“…In 2001, the results of 20 222 Chlamydia screening tests showed a highly significant association between test positivity and young age (p<0.0001 for linear trend) 19. In that same year, the US Youth Risk Behavioral Survey results for Hawaii showed an increasing trend of sexual activity with age from 20% of ninth graders to 50% of high school seniors 19. Such studies when considered together demonstrate increasing age to be associated with increasing sexual activity but decreasing Chlamydia infection rates.…”

“…This is illustrated in a study from Hawaii where free and confidential Chlamydia screening and treatment are available at multiple public and private sites for anyone 14 years of age or older without parental consent or notification. In 2001, the results of 20 222 Chlamydia screening tests showed a highly significant association between test positivity and young age (p<0.0001 for linear trend) 19. In that same year, the US Youth Risk Behavioral Survey results for Hawaii showed an increasing trend of sexual activity with age from 20% of ninth graders to 50% of high school seniors 19.…”