Aggregate Health

Disparity in Sarasota
County, Florida
Prevention of Chlamydia in sexually active females;
ages 15-19

Katherine Koch

What is Chlamydia?
Very common sexually transmitted bacterial disease (CDC, 2014)
Caused by the bacterium Chlamydia trachomatis (Kaplan et al.,
2013)
The most commonly reported notifiable disease in the United
States and it is among the most prevalent of all STDs (CDC, 2010)
Since 1994, chlamydia has comprised the largest proportion of all
STDs reported to CDC (CDC, 2010)

What is Chlamydia?
Found in 2 to 12% of sexually active men and
women worldwide (Kaplan et al., 2013)
Primarily infects the reproductive tract (Kaplan et
al., 2013)
Transmitted through sexual intercourse with
someone infected (CDC, 2014)

Symptoms and Treatment

Symptoms:
Many times asymptomatic (CDC, 2014)
May include urinary discomfort, lower abdominal pain,
abnormal discharge from vagina or urethra (Kaplan et al.,
2013)
Complications may include pelvic inflammatory disease and
infertility (CDC, 2014)
Treatment:
Antibiotics such as doxycycline, azithromycin, erythromycin,
ofloxacin (Kaplan et al., 2013)

Demographics
This project will be focusing on females ages 15-19
years old
This is the main age of high school students
The information will be collected based on females
living in Sarasota county within the above stated
age range at time of diagnosis
This is a critical time in many women's lives where
they are beginning to become sexually active and
are feeling pressured by their peers to partake in
sexual intercourse

Healthy People 2020

Objective:
STD- 1 Reduce the proportion of adolescents and young adults
with Chlamydia trachomatis infections (Healthy People 2020,
2014)
Statistics:
7.4% of females aged 15 - 24 years who attended family
planning clinics tested positive for Chlamydia in 2008 (Healthy
People 2020, 2014)
12.8 % of females aged 24 years and under who enrolled in a
National Job Training Program tested positive for Chlamydia in
2008 (Healthy People 2020, 2014)

Recommendations
U.S. Preventive Services Task Force recommends annual screening of all
sexually active females aged <25 years and screening of older women
CDC recommends that men who report rectal sex should be screened at least
annually
Reinfection is common, in part because of reinfection from an untreated
partner
Infected patients and their sex partners should receive timely treatment to
prevent reinfection
Timely treatment of sex partners might be facilitated by use of patientdelivered partner therapy, recommended by CDC for sexually transmitted
chlamydial infection since 2006
Strategies to increase screening in clinical facilities might include patient and
clinician education and structural interventions at the health care facility,
such as adding prompts to the electronic medical record
(Torrone, et al., 2014)

On a National Level
Prevalence of genital Chlamydia among sexually active
females aged 1439 years, by age group and race/ethnicity
National Health and Nutrition Examination Survey,
United States, 20072012

(Torrone et al., 2014)

Sarasota Population in 2012

Sarasota County population 52,811
Females 26,791

(Florida Charts, 2014)

Sarasota County
In 2012 there were 997 reported cases of chlamydia
in Sarasota County (Florida Health, 2012)
There have been about 657 recorded chlamydia
cases in Sarasota County in females ages 15-19
from 2011-2013 (Florida Charts, 2014)
This can be compared to the state of Florida
reporting 18,162 chlamydia cases in females ages
15-19 in 2012 (Florida Health, 2012)

Specific Health Disparity

Females in Sarasota County ages 15-19
Women suffer more frequent and more serious STD
complications than men do (Healthy People 2020, 2014)
Compared to older adults, sexually active adolescents
ages 15 to 19 and young adults ages 20 to 24 are at
higher risk for getting STDs (Healthy People 2020,
2014)
These women are sexually active and are at risk for
contracting chlamydia and other STDs
Many of these women are not educated about the risks
of chlamydia

Specific Health Disparity

Chlamydia often times has no symptoms and can
go undetected leading to further damage
Untreated chlamydia can lead to pelvic
inflammatory disease and infertility (CDC, 2014)
Chlamydia can be passed along partner to partner
because there are no symptoms (CDC, 2014)
Chlamydia can also be passed to newborns if the
infected woman is not treated (CDC, 2014)

Social, Economic and Behavioral

Factors
STDs disproportionately affect disenfranchised people and
people in social networks where high-risk sexual behavior is
common, and either access to care or health-seeking behavior is
compromised (Healthy People 2020, 2014)
Limited access to healthcare
Substance abuse that may alter sexual behavior
Being sexual with multiple partners, thus giving potential to
spread a sometimes asymptomatic disease to multiple partners
There is a stigma associated with STDs and the general
discomfort of discussing them
(Healthy People 2020, 2014)

Risks
1. Reproductive health problems
-Infertility
-Ectopic pregnancies
2. Unknown spread of chlamydia
3. Chronic pelvic pain

Primary Prevention of
Chlamydia
Primary prevention is a way to educate the population. Using
primary prevention, we can decrease the risk of disease, promote
health, and prevent chlamydial infection.
Suggested primary prevention for this aggregate:
* Promote behavioral change
Promote abstinence, delay age of first intercourse, decrease
number of sexual partners, partner selection, and use of safe sex
(condoms)
* Educate about chlamydia and STDs in middle schools
and high schools
(CDC, 1993)

Secondary Prevention of
Chlamydia
Secondary prevention is understanding the
population who is most at risk. These strategies are
efforts to prevent complications in the individuals
infected with chlamydia.
The most important complication to be prevented is
advanced chlamydia, known as salpingitis, and its
potential of ectopic pregnancy, tubal infertility, and
chronic pelvic pain which can come from it.

Secondary Prevention of
Chlamydia
Suggested secondary prevention for this aggregate include:
*Recognizing clinical conditions then applying or using
appropriate chlamydia diagnostic tests and
treatment, as
appropriate.
*Promoting gynecological exams and screening for sexually
active females to identify and treat
asymptomatic chlamydial
infection
*Educating males the importance of informing their sexual
partner of infection and treating the female
partners of men
with infection

Tertiary Prevention of
Chlamydia
Tertiary prevention is treating the infection and
minimizing its effects.
Suggested tertiary prevention for this aggregate:
* Starting and finishing full course of antibiotics
* Promoting regular follow ups and screening
* Promoting education on other STDs
* Promoting support groups and counseling if
needed

References
CDC. (2014). CDC Fact Sheet: Chlamydia. Retrieved October 10, 2014 from
http://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm
CDC. (1993). Recommendations for the Prevention and Management of
Chlamydia trachomatis Infections. Retrieved Oct 10, 2014 from
http://www.cdc.gov/mmwr/preview/mmwrhtml/00021622.htm
CDC. (2010). 2010 Sexually Transmitted Diseases Surveillance. Retrieved
October 12, 2014 from http://www.cdc.gov/std/stats10/chlamydia.htm
City-Data. (2012). Sarasota county, Florida. Retrieved October 14, 2014
from http://www.city-data.com/city/Sarasota-Florida.html
Florida Charts. (2014). Florida Department of Health; County Health Status
Summary. Retrieved October 13th, 2014 from
http://www.floridacharts.com/charts/OtherIndicators/NonVitalIndNoGrpData
Viewer.aspx?cid=0147

References
Florida Health. (2012). STD Trends and Statistics. Retrieved October 1,
2014 from http://www.floridahealth.gov/diseases-andconditions/sexually-transmitted-diseases/std-statistics/_documents/stdten-chlamydia-county.pdf
Healthy People 2020. (2014). Healthy People 2020 Objectives: Sexually
Transmitted Diseases. Retrieved October 10, 2014 from
http://www.healthypeople.gov/2020/topics-objectives/topic/sexuallytransmitted-diseases
Kaplan, C., & Chang, A. D. (2013). Chlamydia. MagillS Medical Guide
(Online Edition)
Torrone, E., Papp, J., & Weinstock, H. (2014). Prevalence of Chlamydia
trachomatis Genital Infection Among Persons Aged 14-39 Years United States, 2007-2012. MMWR: Morbidity & Mortality Weekly
Report, 63(38), 834-838.