Gonorrhea and chlamydia in the United States among persons 14 to 39 years of age, 1999 to 2002.

BACKGROUND

Nationally representative surveys of chlamydia and gonorrhea are an important measure of disease burden and progress of screening programs.

OBJECTIVE

To measure chlamydia and gonorrhea prevalence in the United States.

DESIGN

Analysis of sexual history information and urine specimens collected in the National Health and Nutrition Examination Survey (NHANES), 1999-2002.

SETTING

U.S. civilian noninstitutionalized population as sampled by NHANES, 1999-2002.

PARTICIPANTS

6632 NHANES respondents.

MEASUREMENTS

Urine specimens were tested for chlamydia and gonorrhea. Results were weighted to represent the U.S. civilian, noninstitutionalized population between 14 and 39 years of age.

RESULTS

Prevalence of gonorrheal infection was 0.24% (95% CI, 0.16% to 0.38%). Prevalence of gonorrheal infection was higher among non-Hispanic black persons (1.2% [CI, 0.7% to 1.9%]) than among non-Hispanic white persons (0.07% [CI, 0.02% to 0.24%]). Among those with gonorrheal infection, 46% also had chlamydial infection. Prevalence of chlamydial infection was 2.2% (CI, 1.8% to 2.8%) and was similar between males (2.0% [CI, 1.6% to 2.5%]) and females (2.5% [CI, 1.8% to 3.4%]). Among females, the highest prevalence was in those age 14 to 19 years, whereas among males, it was highest in those age 14 to 29 years. Prevalence was higher among non-Hispanic black persons (6.4% [CI, 5.4% to 7.5%]) than non-Hispanic white persons (1.5% [CI, 1.0% to 2.4%]). Among females with a history of gonorrhea or chlamydia in the previous 12 months, chlamydia prevalence was 16.7% (CI, 5.5% to 50.7%).

LIMITATIONS

The specificity of urine-based assays for chlamydia and gonorrhea is limited, and the possible misclassification of sexual experience status may have affected the accuracy of some estimates.

CONCLUSIONS

The findings support current recommendations to screen sexually active females age 25 years or younger for chlamydia, to retest infected females for chlamydial infection, and to co-treat individuals with gonorrhea for chlamydia.