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Teen Chlamydia Alarms Experts

Disease: The epidemic has been smoldering for decades, but it's been recognized only in the last 10 years. Awareness and treatments are being stepped up.


BALTIMORE — For 11 years, school nurse Marcy Amos has bandaged the skinned knees and treated the asthma attacks of sixth-, seventh- and eighth-graders at Harlem Park Middle School. More recently, she and her co-workers have also been grappling with another common problem of adolescence--chlamydia, the country's most frequently reported sexually transmitted disease.

Sex is nothing new among middle-school kids in this tough west Baltimore neighborhood. Drugs and crime are rampant, family supports are often lacking, and children grow up too fast. As part of her job at the school-based health center, the outspoken and motherly Amos tries to sit down with all of the sixth-grade girls at Harlem Park to give them the facts about sex. She strongly encourages abstinence. But Amos and the other clinic nurses know that in the city's public schools, the median age of first sexual intercourse is 13 1/2 for girls, 12 1/2 for boys.

For the school's nurses, asking about sexual activity is a routine part of monitoring students' health. "I talk about it with everybody," said nurse practitioner Sharon Hobson, who works with Amos and sees patients in the school health center's two small examining rooms. "You don't know unless you ask."

Pregnancy or a severe gonorrhea infection in the pelvic organs are always among the possibilities that cross these nurses' minds when a 13-year-old girl comes to the health center with abdominal pain. But in the past few years, they and other health workers who treat sexually active adolescents have begun to worry almost as much about chlamydia, an infection that often causes few or no symptoms in a young woman yet can leave her permanently infertile or can cause premature birth of her infant if she is infected while pregnant.

In the past eight months, a new testing program at the school, being conducted as part of a study by researchers at Johns Hopkins School of Medicine, revealed a disturbingly high rate of chlamydia infection among Harlem Park students, most of whom are 11 to 14 years old. Of 135 urine samples taken from sexually active middle schoolers since November, 24--almost 18%--showed infection with chlamydia. Both girls and boys were infected. High rates of infection have also been found in studies of urban high school students in various cities.

The figures reflect an epidemic of chlamydia among teenagers and young adults around the nation--an epidemic that has been smoldering for decades, causing thousands of cases of female infertility, but one that health officials have recognized only in the past 10 years. Nationally, almost 7% of females 15 to 19 years old who were tested at family planning clinics in 1995 were infected with chlamydia, according to the federal Centers for Disease Control and Prevention in Atlanta. For those 20 to 24 years old, the rate was 4%.

"These are young people at the cusp of their reproductive lives," said James A. MacGregor, a professor of obstetrics and gynecology at the University of Colorado School of Medicine. "We've got to screen and treat" to detect chlamydia and prevent permanent damage to women's reproductive organs.

Chlamydia is a bacterial infection that strikes more than 4 million Americans a year and seems preferentially to target the still developing reproductive systems of teenagers and young adults. Researchers say one reason for this vulnerability is that in adolescent females, the tall, columnar cells that form the inner lining of the cervix are also present on the outer portion of the cervix. Chlamydia bacteria easily invade such cells. As women mature, columnar cells on the outer cervix are replaced by flatter cells that are more difficult for the bacteria to infect.

Just how common the disease is in young people has become apparent only since the mid-1980s, as improved diagnostic tests have led to broader screening for chlamydia in family planning clinics and other settings.

The major risk factors are being young--usually younger than 25--and having sex. Although infection rates are higher in poor urban neighborhoods like Harlem Park, the epidemic of chlamydia is not limited to inner cities, said Judith Wasserheit, chief of the division of sexually transmitted disease prevention at the CDC.

"It's very broadly distributed socioeconomically," she said.

But there are encouraging signs that the epidemic can be slowed. In those regions of the country that have established vigorous treatment programs for sexually transmitted diseases, chlamydia rates have declined--especially in the Pacific Northwest and Alaska, where widespread testing for the disease started in the 1980s.

"Now we can be more aggressive to go after people who don't come to clinics, or to test people who do come to clinics more often," said Julius Schachter, a professor of laboratory medicine at UC San Francisco. "Every sexually active individual below age 25 should be tested automatically."


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