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| |  STD Experts Recommend Strategies for Chlamydia Prevention & Treatment ATLANTA, Nov. 8, 1995 -- The following was issued today by CDB Healthcare for Pfizer Inc.: Chlamydia trachomatis continues to pose significant health risks for women, surpassing gonorrhea as the number one bacterial sexually transmitted disease (STD) in the United States with four million new cases of Chlamydia occurring annually. Almost without a symptom, chlamydial infections can change a woman's life, scarring her fallopian tubes and causing infertility. In addition, individuals with sexually transmitted diseases (STDs), both male and female, are believed to be at a three- to five-fold increased risk of acquiring HIV if exposed to that virus. These startling statistics were presented today at the Centers for Disease Control and Prevention (CDC) during an interactive satellite symposium broadcast nationally to health care providers in STD and family planning clinics. "The frequency, severe complications, and high cost of chlamydial infections, combined with the availability of new diagnostic, therapeutic, and programmatic tools make effective management of Chlamydia one of the most exciting and important opportunities we have ever had to improve the health of women," says Judith N. Wasserheit, MD, MPH, Director of the CDC's Division of STD Prevention. Health care providers can test for the Chlamydia bacteria and now treatment can be as simple as a single dose of antibiotics. In theory, the disease can be stopped early -- before a women's reproductive system is damaged. Unfortunately, because many women experience few if any symptoms, most don't know they are infected until the damage has been done. In addition, because many patients are initially asymptomatic, treatment with a standard seven-day course of antibiotics is all too often discontinued, resulting in treatment failure. In fact, non- compliance with multi-dose regimens for STDs has been reported to be 40% to 70%. "For this reason, the most important recent advance in antichlamydial therapy has been the introduction of azithromycin, given as a single one-gram dose for treatment of uncomplicated chlamydial infections," says David H. Martin, MD, Professor of Medicine and Chief of Infectious Diseases at Louisiana State University Medical School. Chlamydia is known as the "silent epidemic" because 75% of women and 50% of men have no symptoms of disease. People at risk for chlamydial infections include a broad range of the general population: more than 10% of sexually active adolescent girls become infected each year. Up to 40% of untreated chlamydial infections can ascend to the upper genital tract, causing pelvic inflammatory disease (PID), and 20% of women with PID become infertile. In addition, almost 10% of women who have had PID will experience a potentially fatal ectopic pregnancy as their first, post-PID pregnancy. And 60% to 70% of infants born to women with untreated cervical infection will develop conjunctivitis, neonatal pneumonia, or both. Men with chlamydial urethritis also are at risk for complications, such as epididymitis, a painful inflammation of part of the reproductive system located near the testicles where sperm are stored and mature. Consequently, chlamydial infections and their sequelae have a significant financial impact on the nation. Direct and indirect costs associated with these infections have climbed from $1.4 billion in 1987 to over $2.2 billion in 1994. Prevention and management of sexually transmitted diseases has assumed increased importance on the global health care agenda following the emergence of the new lethal STD, HIV/AIDS. Evidence increasingly suggests that sexually acquired lesions and inflammation can facilitate HIV transmission. "On a policy level, countries that hope to minimize the impact of the HIV/AIDS epidemic must recognize that STDs are one of the most readily modifiable risk factors for spread of HIV within a community," says Dr. Wasserheit. "They must, therefore, make STD control a major health priority." Although Chlamydia has been difficult to detect in the laboratory, new non-culture tests are now available to diagnose chlamydial infections in asymptomatic individuals. These cost-effective screening tools include: direct fluorescent antibody staining, antigen detection, and DNA probe tests. DNA amplification methodology, involving urine- based screening, may be especially promising, especially for high-risk adolescent populations. In its STD Treatment Guidelines, the CDC recommends two first-line regimens for the treatment of Chlamydia: azithromycin (1 g) orally in a single dose for patients who appear unlikely to comply with multi-dose therapy, such as adolescents, substance abusers, or the homeless, or doxycycline (100 mg) orally twice a day for seven days for uncomplicated chlamydial infections. "The major advantages of doxycycline include its low cost and high efficacy for treating Chlamydia when a full course of therapy is taken," says Dr. Martin. "The disadvantage of this drug is the requirement that it be taken twice daily for a week, and noncompliance with multi-dose drug regimens is common. Conversely, azithromycin costs more for a course of treatment, but since it can be administered by a health care provider in the clinic, compliance rates of 100% can be achieved." Beyond treatment, patient education is the best way to minimize the "silent epidemic" of Chlamydia and the infertility associated with it, says Susan Wysocki, RNC, NP, President of the National Association of Nurse Practitioners in Reproductive Health. "Abstinence is the best prevention, especially among teenagers," she says. "However, if this message does not work, it's important to tell women who are not in mutually faithful relationships to use condoms to help prevent STDs and HIV infections." Likewise, risk of infection is further minimized if sex partners are few in number. When a patient is treated for Chlamydia, the CDC recommends also notifying and treating any sex partners to help prevent reinfection of the patient and reduce additional spread of Chlamydia. "The take-home message should be that screening and prompt treatment of chlamydial infections can reduce infertility and other complications," says the CDC's Dr. Wasserheit. "We, as clinicians, can make a difference and must reduce the spread of Chlamydia infections throughout the United States." The satellite symposium, presented by the Centers for Disease Control and Prevention in cooperation with the American Social Health Association and the National Association of Nurse Practitioners in Reproductive Health, was made possible by an educational grant from the U.S. Pharmaceuticals Group of Pfizer Inc. (NYSE: PFE).
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