Stealth attack: Minnesota’s most common STI often has no symptoms

Candy Hadsall of the Minnesota Department of Health
“We tend to have sex with people in our groups, so [chlamydia] keeps making its way back around and around. We’re kind of missing the big picture.” - Dr. Michelle Van Vraken, doctor at TAMS

Curing chlamydia takes just one dose of an antibiotic, but it’s hard to cure Minnesota’s most common sexually transmitted infection when more than three of four victims don’t know they have it.

“Teenagers and even adults think that if you don’t have symptoms, you must not be sick,” said Candy Hadsall of the Minnesota Department of Health. “You don’t go to the doctor when you don’t have symptoms – you think you are ok. So, people can have chlamydia and not know it, and the longer you have the disease, the more likely you are to develop pelvic inflammatory disease.”

Hadsall is in charge of state efforts to reduce STIs that can cause infertility, including PID, an infection of women’s reproductive organs. More than 20 percent of women who develop PID have serious consequences, including infertility.

Because more than half of the Minnesotans with chlamydia are young women, ages 15 to 24, Hadsall’s efforts focus on them. Of more than 14,000 new cases reported in Minnesota in 2009, 10,000 were among women – 7,490 among women 15 to 19.

Young women are the most susceptible to chlamydia because the cells located on the outside of the cervix are more receptive to the infection. As females age, the cervix cells move up into the opening of the cervix, making it harder for chlamydia bacteria to reach these targeted cells. Researchers are still trying to figure out other reasons why women are more susceptible to the disease than men, according to Hadsall.

The embarrassment caused by having chlamydia prevents many teens from getting tested and treated and telling a sexual partner, according to Emily Scribner-O’pray, health educator for Teen Age Medical Service, a teen medical clinic in Minneapolis. STIs seem to imply a person has been promiscuous, she said.

What can you do to keep from contracting or spreading chlamydia?
  • If you’re sexually active, get tested for STDs at least once a year.
  • Before entering a sexual relationship, make sure to get tested for STDs
  • Use latex condoms
  • If you have chlamydia, get treated right away and be sure your partner is treated.
  • If you have such symptoms as an abnormal vaginal discharge or a burning sensation when urinating, see a doctor.

But chlamydia is so common that every teen has probably known someone with it, said Dr. Michele Van Vranken, a doctor at TAMS.

While the number of teenage pregnancies is decreasing, chlamydia cases rose by 15 percent between 2005 and 2009. It beats other, better-known STDs like HIV, which had 370 new cases reported to the health department last year.
Chlamydia is also on the rise nationally. More than 1.2 million cases were reported in 2008, and Minnesota’s rate – 276 per 100,000 people – is far below the national rate of 401.

The increasing number of cases can be partially attributed to the rising number of patients being screened for chlamydia, Hadsall said. New, more sensitive laboratory tests also find more patients infected with chlamydia.

Van Vranken also said that neglecting to screen and treat partners contributes a lot to the spread of chlamydia. Only 43 percent of sexually active females in Minnesota are being screened for the disease, according to a Center of Disease Control analysis of data reported from commercial and Medicaid health plans.

“We tend to have sex with people in our groups, so [chlamydia] keeps making its way back around and around,” Van Vranken said. “We’re kind of missing the big picture.”

Minnesota allows doctors to give antibiotic treatment to a patient to give to their sexual partner after chlamydia is diagnosed. Van Vranken said the first choice is to have the partner seen by a doctor, but this isn’t required.

Hadsall suggests that lack of comprehensive sexual education means that many U.S. teens aren’t aware of chlamydia. “As a result, many teens are not aware of the consequences of unprotected sexual activity or do not have the right information to take the steps necessary to prevent getting diseases or getting pregnant,” she wrote in an email.

A major difference between HIV and chlamydia is the lack of advocacy groups to increase awareness about chlamydia. Planned Parenthood is increasing its education outreach. “The more that women know and the more awareness they have about [chlamydia], the more likely they are to seek medical care,” said Kathi Di Nicola, media relations director for Planned Parenthood Minnesota, North Dakota, South Dakota.

Public health officials worry that chlamydia rates are far higher in minority communities. In 2009, for example, the rate was 16 times higher among black Minnesotans than among whites, five times higher among Hispanics, four times higher for Native Americans and three times higher among Asians.

Gathering ideas for reducing those rates is one reason Hadsall is organizing an Aug. 3 chlamydia summit. The statewide gathering will include representatives from different communities to learn about chlamydia and brainstorm how to reduce the disease.

With this summit and other efforts, Hadsall is planning to develop workgroups for the Minnesota Chlamydia Partnership that would create a statewide plan to reduce the rising rate of chlamydia. Teenagers, parents, faith communities, educators, health professionals, and business communities are all invited to contribute ideas.

Anyone interested in participating in the Aug. 3 summit can register here.

“It’s a complex problem that needs a comprehensive solution,” Di Nicola said. “It’s about making sure that all women in the state have access to preventive medical care, to education, and to the support they need to make healthier choices.”

Graph in front page slide show provided by STDs in Minnesota: Annual Review.

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