The Gynecologic Health Consequences of Chlamydia trachomatis Infection in Military Servicewomen

Abstract

Chlamydia trachomatis is the most common sexually transmitted bacterial infection in the United States. Within the U.S. military, the age- and race-adjusted chlamydia infection rates among female service members are consistently higher than civilian rates, with a 20% annual acquisition rate among young active-duty women. The sequelae of chlamydia disproportionately impact women in terms of severity and cost. Untreated chlamydia progresses to pelvic inflammatory disease in 40% of cases, and is a leading cause of fallopian tube damage and pelvic adhesive disease resulting in ectopic pregnancy, tubal infertility, and acute and chronic pelvic pain. Tubal infertility is among the leading indications for in vitro fertilization (IVF) nationally and rates among couples undergoing IVF at military treatment centers are double the national average. Collectively, chlamydia infection represents a significant resource burden to the military health care system and, in view of the serious gynecologic health sequelae, a significant threat to the readiness of servicewomen. In this review, we discuss the gynecologic impact of chlamydia infection within the military, the critical gaps for research funding, and opportunities for intervention.

Improving chlamydia risk screening by using the CDC's 5 Ps approach to sexual health history

“…Sexually transmitted infections have increased at an alarming rate in the United States over the past decade. Chlamydia has increased by 19% since 2014 and is the most reported bacterial STI in the United States (Nadeau et al, 2018). Chlamydia is known as a “silent” infection because only 10% of men and 5% to 30% of women with a confirmed chlamydia infection develop symptoms (CDC, 2016).…”

“…If chlamydia goes undiagnosed and untreated, it can cause severe complications such as pelvic inflammatory disease, infertility, pain, and severe arthritis (Ahmad et al, 2018). The medical sequelae of chlamydia affects women more than men (Nadeau et al, 2018). Chlamydia also places a significant resource burden on the military health care system by taking soldiers away from their job and taking precious health care resources from other vital causes (Nadeau et al, 2018).…”

“…The medical sequelae of chlamydia affects women more than men (Nadeau et al, 2018). Chlamydia also places a significant resource burden on the military health care system by taking soldiers away from their job and taking precious health care resources from other vital causes (Nadeau et al, 2018).…”

“…Chlamydia trachomatis is infecting service members (SMs) at a rate of two to three times that of the U.S. population, with over 200,000 cases since 2010 and continuing to rise (Nadeau et al, 2018). Complications of undiagnosed chlamydia pose severe consequences to SMs, such as acute or chronic pain and pelvic inflammatory disease (PID), potentially rendering them unfit for duty (Nadeau et al, 2018). In a community inadequately addressed by the current professional guidelines, identifying at-risk service members is a priority in reducing chlamydia (Hull et al, 2017).…”