May 15, 2007 - If doctors came up with a highly effective and painless test that could significantly reduce infertility, premature birth or pelvic inflammatory disease, you'd think everyone would be lining up to get it. But a new study, released last week at the American College of Obstetricians and Gynecologists annual meeting, reveals that significantly fewer than half of the country's sexually active young women are being routinely screened for chlamydia, a sexually transmitted disease (STD) that commonly causes these complications if left untreated. While 976,000 cases are reported a year, researchers estimate that an additional 2 million cases go undiagnosed and untreated annually.

HIV/AIDS and the new vaccine for human papillomavirus (HPV) get most of the headlines, but chlamydia is the most commonly reported STD in the country. While not deadly in itself, chlamydia has the potential to do significant damage. Forty percent of women who have it will eventually develop pelvic inflammatory disease (PID), which in turn, greatly increases the risk of infertility or of having a life-threatening ectopic pregnancy (the embryo develops in a woman's fallopian tube, rather than the uterus). In fact, one in five women who develop PID is eventually diagnosed as infertile.

Why is screening so important? Because unlike STDs that cause bothersome symptoms that make their presence painfully obvious, chlamydia is a quiet scourge. The Centers for Disease Control says that about 75 percent of the women and 50 percent of the men who have chlamydia exhibit no symptoms that would prompt them to seek medical attention or take extra precautions so they don't infect others.

That's why annual screens, whether there are symptoms or not, are so important. The current recommendation is that doctors test all sexually active females under the age of 26 every year. Even young teens often need to be screened, since the group most likely to be infected is adolescent girls between the ages of 15 and 19. Teens tend to have more sex more often with more partners than women in their 20s, and the structure of an adolescent's cervix seems to make them particularly vulnerable to this bacterial infection. One recent study at the Yale School of Public Health found that over the course of five years, half of all sexually active teens became infected with chlamydia at least once.

So what's getting in the way of an effective screening program? A medical version of "don't ask, don't tell." Despite evidence to the contrary, many doctors assume that most of their middle- and upper-middle-class patients are not sexually active, and don't bother to ask about it. Few teens and young women volunteer the information if their doctor doesn't raise the issue. And sometimes, even when doctors do ask, they don't get a straight answer.

"If you looked at our indigent clinic, you'd find that we screen something like 90 percent of our young female patients for chlamydia," said Dr. David Soper, professor of Ob-Gyn at the Medical University of South Carolina in Charleston. "But when we walk across the street to our private practices, we think we 'know' that those patients are not having sex with the kind of people who could give them chlamydia. So we don't ask and we don't screen. This becomes a self-fulfilling prophecy because we never see a positive test for it—because we're not looking for it."

Further complicating the picture is the fact that many middle-class teens continue to see their pediatricians for all their medical needs, and may not see an Ob-Gyn until they're heading off to college. Despite the fact that an increasing number of pediatricians are giving girls the HPV vaccine to protect them against cervical cancer, they don't think to take a private moment and ask if they're sexually active or screen them for other sexually transmitted diseases.

The solution, say the experts, is education. Young women need to know more about this infection—and how easily it spreads through sexual contact. Abstinence and monogamy offer the most protection. Short of that, using condoms during every sexual encounter (including oral sex) can reduce the chance of infection. They also need to be reassured that the test is painless—just a simple urine test. Once diagnosed, chlamydia can be treated with an antibiotic. Because of the high rate of reinfections, a follow-up test is necessary three months later.

Doctors also need to be more willing to bring up the topic, and broach it in ways that ensure they'll get candid responses. For example, Soper says, when examining adolescents, he generally spends time with the parent, but also makes a point of talking to his young patients alone. "As physicians, we need to dispel the stigma and bias that so often surround STDs," he said. "The reality is that STDs are diseases of humanity. Humans become infected doing what humans do."

Parents also have a role. They should foster the kind of open relationship with their children that allows them to know if their child is sexually active, Soper said, and share that information with their child's physician. "If the doctor doesn't bring up the subject of the chlamydia screen, parents can bring it up," he said.

Dr. Laura E. Riley, an expert in infectious diseases and assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School, said since many young women don't have regular physical exams, doctors should consider offering the screen whenever an opportunity presents itself. "If a patient presents with something like vaginitis (infection of the vagina), we should do a chlamydia screen while they're there," she said. "Even if they show up in the emergency room for something else, if a doctor thinks they may be at high risk, they should be screened."

Older teens and young women should also be encouraged to advocate for themselves, adds Riley. If they're not sure their doctor is screening them for chlamydia, they should ask about it. "The bottom line is that young women need to be upfront with their physician about their sexual behavior and proactive during the annual gynecologic exam to make sure that they are tested for chlamydia," she said.

Riley has also become a proponent of routine screens for every pregnant woman, especially since untreated chlamydia can cause premature labor, as well as significantly increase the risk that a newborn develops conjunctivitis (an infection of the lining of the eye) and pneumonia. If everyone who should be screened was screened, experts say, we could prevent 7,500 cases of infertility annually. That's a long-term payoff for early vigilance.

URL: http://www.msnbc.msn.com/id/18681015/site/newsweek/