ARLINGTON, Va. — Roughly half of military women who should be tested for the sexually transmitted disease chlamydia might not be getting the required routine exam, and a solution to the problem could still be three years away as health officials await a computer tracking system.
It’s tough to gauge who is getting tested and who isn’t, because the services don’t track that data, in spite of guidelines across the services that direct testing of all female recruits and other women in the at-risk category, said Navy Capt. Katherine Surman, director of women’s health policy for the Pentagon’s Health Affairs office.
Instead, officials rely on independent studies to show where potential problems lie, she said.
Generally, women listed in the “at-risk” category of contracting chlamydia are those 25 years and younger and who are sexually active, particularly those with more than one partner.
One Defense Department study conducted between April 2000 and March 2001, which started before the testing mandate but ended after its implementation, showed that 59 percent of active-duty women slip through the testing cracks.
Published in 2002, the study states that 41 percent of active-duty women were tested over that one-year period. Researchers studied 163,299 sexually active women ages 16 to 26 enrolled in the military health system, which included civilians, active duty and dependents. Women ages 16 to 20 had a 34 percent testing rate, and women ages 21 to 26 had a 28 percent overall testing rate.
Common but stealthy
Chlamydia is a curable disease transmitted during sexual contact with an infected partner. It can cause serious problems in men and women as well as in newborns of infected mothers.
The infection is one of the most widespread bacterial STDs in the United States. The Centers for Disease Control and Prevention estimates more than 3 million new infections each year and roughly one in 10 sexually active women under 25 has the disease, said CDC spokeswoman Karlie Stanton.
About 77 percent of chlamydia cases are asymptomatic, meaning those infected show no obvious symptoms, and thus tend to not know about it and don’t seek medical treatment, said Charlotte Gaydos, an associate professor of medicine at the Johns Hopkins University School of Medicine, Division of Infectious Diseases, and the lead author of yet another study, one that showed one in 10 Army recruits tested positive for the disease.
“The downward side of that is that they don’t go the doctor. It’s not like having a sore throat or a fever, where you know something is wrong …,” she said. The disease is easily detected through a urine test and easily treated with an antibiotic.
Left untreated, in women it can cause pelvic inflammatory disease that can lead to scarring, complicate pregnancies and cause infertility. Left untreated in men, it can cause urethral infection. One study has linked it to male infertility, Gaydos said.
Focus on women
Screening and prevention programs have focused heavily on women for two reasons, Stanton said. The repercussions in untreated cases for women are far more severe, and testing has been simpler.
Yet according to the CDC Web site, “many men with chlamydia are not diagnosed and treated, thus continuing the cycle of infection.”
In the military system, more men can now expect to be tested with a change to urine exams, Surman said.
“More men will be tested because a urine test is so much easier,” Surman said. “It happens to them as well, and they deserve to be treated. This will help push that along."
In the military, Gaydos and four other researchers applied in 1993 for the Army-funded grant to study women’s health issues, and tapped the Army’s Training Center at Fort Jackson, S.C., and soldiers at Fort Bragg, N.C., one of the Army’s largest bases. In November 2001, the researchers broadened the study, and of the 2,245 male recruits tested at Fort Jackson, found a prevalence of 5.3 percent, she said.
The Pentagon Health Affairs office is working on a system to ensure all female patients receive the proper care and is pinning hopes on a new computer tracking system, called Composite Health Care System II, Surman said.
CHCS II is a computerized medical and dental record database system the Pentagon expects to install at all of the department medical facilities beginning in January. It’ll take nearly three years for the process to be completed.
In 2001, all services implemented guidelines to routinely screen women for chlamydia, with the Air Force, Marine Corps and Navy testing all new recruits and the Army testing women upon arrival to their first duty station. The services also adopted the CDC recommendation to test women 25 and younger during routine annual exams.
“We do need to do better job of getting the word out to troops about sexually transmitted diseases and how to protect yourself,” Surman said. “We need to tell them to ‘please come in and please get treated. There is no stigma to any of that. We want to help you get better, to go to work and enjoy your life.’”
