Communicable_Disease

Communicable Disease Paper Angela Lewis HCS 457 November 1, 2010 Jeffrey Rhoades Communicable Disease Paper Chlamydia is a bacterial infection that affects the genitals and also the urinary tract. It spreads very easily through sexual contact and is a very common communicable sexually transmitted disease in the United States. Chlamydia occurs most frequently in teenagers and young adults. Although chlamydia is easily detected and can be cured with antibiotics, it still continues to cause many cases of infertility in women unaware they have contracted the disease until years later (Deland, 2010). Deland (2010) also states that when chlamydia is left untreated it can lead to several serious complications. The most common is infertility in women. Chlamydial infection can also spread to the fallopian tube, which cause scarring, and prevents future pregnancies. Chlamydia also can be spread to the eyes, in which case it can eventually cause blindness. Babies born to mothers who have chlamydia can become infected when they are born. Chlamydia infection in newborns usually affects the eyes or lungs, where it can lead to blindness or pneumonia. Efforts to Control To successful control the sexually transmitted chlamydia trachomatis infections, short of an effective vaccine; broadly based screening programs would be required. Stamm (1998), states that this conclusion stems from several observations. First, chlamydial infections are highly prevalent, especially among adolescents and young adults, and are more widely distributed throughout all socioeconomic, racial, and ethnic groups than other communicable bacterial sexually transmitted diseases. Second, most chlamydial infections do not cause symptoms in women and in many men. Third, chlamydial infections may persist for months, once acquired, resulting in a long period of potential transmission. Finally, these infections are treatable but if left untreated can cause pelvic inflammatory disease (PID). Environmental Factors Chlamydia is a major cause of infertility, which can be preventable and effective prevention interventions are not being used. Health care providers think that the reason for low screening is lack of information about the disease in their communities; patients do not believe that they are at risk, and providers know that they cannot offer services to adolescents in confidence. Adolescents and young adults do not believe that chlamydia is of medical urgency and it can be treated easily. Programs in the community may have some effect but they probably can do better by increasing awareness, partner treatment, and screening, and reaching disproportionately affected populations (MDwise Hoosier Alliance website, 2009). Risk factors Some risk factors that may contribute to the development of chlamydia is a person who is sexually active. Also if the number of sex partners is greater than the risk of infection is also greater. According to the WebMD website (2009), there are other risk factors that contribute to the development of chlamydia. These risk factors include hygiene – douching will increase the risk of chlamydia; medical history – women or men who have had previous episodes of STDs are more likely to be diagnosed with chlamydia than those without. Also women diagnosed with PID are more likely to contract chlamydia; age - being under age 25 puts women and men at greater risk of developing chlamydia; sexual practices – women or men with multiple sex partners are at a greater risk of contracting chlamydia. Because chlamydia can be transmitted by oral or anal sex, men who have sex with men are also at risk for chlamydia infections. Influence of Lifestyles American Social Health Association website (1999-2010) states that after abstinence, the best protection against any type of sexually transmitted disease is a latex condom. However, it doesn't provide 100% protection against STDs, only abstinence does. If a condom is used it must be used properly. Human error causes more condom failures than manufacturing errors. A new condom should always be used with each sexual act (including oral sex). No test screens for all STDs. Some require a vaginal exam and Pap smear; others a blood or urine test. A negative test does not always ensure that there is not an infection. An individual should still ask a health care provider regularly to test for STDs if the woman or man is sexually active in a non-monogamous relationship. Influence of Socioeconomic status When an individual contacts a chlamydia infection, he or she may feel shame and fear. The stigma associated with STDs may influence whether a patient will disclose his or her sexual behaviors to health care providers. A person might also believe that he or she will be judged or condemned. There might also be a limited knowledge about the causes of infertility in women. Among the 12 to17-year-olds from low-income African American neighborhood, 58% might think that they had no control over fertility problems. There still is also a low perception of risk among adolescent females Influence of Disease Management According to the MDwise Hoosier Alliance website (2009), it states that routine testing for chlamydia should be provided for young women between that ages of 16-24 seeking care. The reasons are 1) she has a history of any sexually transmitted disease, 2) she indirectly indicates that she may have had sexual relations, 3) she is seeking gynecological services, 4) she has indicated that she has been sexually assaulted or abused, 5) she is seeking contraceptive services, or 6) she suspects she is pregnant. Adolescents must be educated in the increased diagnoses of STDs and the need to be safe. Reducing the Threat Based on recommendations from the Centers for Disease Control and Prevention (CDC, 2010), sexually active females who are ages 25 and younger should be tested for chlamydia at least once a year, even if there are no symptoms present. Some health experts recommend an annual screening test for older women with risk factors for chlamydia (a new sex partner or many sex partners). In addition, all pregnant women should have a screening test for chlamydia (National Institutes of Health website, 2008). Also by using latex condoms consistently and correctly during vaginal or rectal sexual activity, the risk of receiving chlamydia and developing complications are reduced. The surest way to avoid transmission of sexually transmitted infections is to abstain from sexual contact or be in a long-term mutually monogamous relationship with a partner who has been tested and is not infected. Gaps and Other Resources The goal should be to have conversations and increase awareness about STD prevention and sexual health among adolescents and young adults. This can be obtained through “How To” segments and videos for mobile phones, public service announcements, tips on ways to generate a conversation about STD testing with sex partners and with health care providers. Recommendations for Community Programs Community programs should be geared toward improving access to clinical preventive services for chlamydia and other STDs. The programs should also increase access to health insurance so that individuals with chlamydia infections can be tested and treated. Also the programs should increase the emphasis on quality of care so an individual do not feel shame when he or she has contracted a STD. Data Findings Chlamydial infections are usually asymptomatic. In women chlamydia may result in PID, which is a major cause of infertility, ectopic pregnancy, and chronic pelvic pain. Data from a randomized controlled trial of chlamydia screening in a managed care setting suggested that screening programs can lead to a reduction in the incidence of PID by as much as 60% (MMWR, 2009). In 2008, 1,210,523 chlamydial infections were reported to CDC from 50 states and the District of Columbia. This case count corresponds to a rate of 401.3 cases per 100,000 population, an increase of 9.2% compared with the rate of 367.5 in 2007. Over the past 20 years, from 1989 through 2008, the rate of reported chlamydial infection increased from 102.5 to 401.3 cases per 100,000 population. Among women, the highest age-specific rates of reported chlamydia in 2008 were among those 15 to 19 (3,275.8 cases per 100,000 females) and 20 to 24 (3,179.9 cases per 100,000 females). Age-specific rates among men, although substantially lower than the rates among women, were highest in the 20- to 24-year-old age group (1,056.1 cases per 100,000 males) (CDC, 2008). Intervention According to Low (2006), strategies to increase screening rates included the use of educational packages targeting primary care physicians and the correction of barriers to screening within clinic systems. The intervention consisted of multiple measures, each of which potentially has influenced screening rates in their own right. These included those aimed at increasing awareness of chlamydia, improving knowledge of screening guidelines and non-invasive testing, improving physicians' communication skills, including sexual history taking, and overcoming barriers within clinic systems. Ensuring Quality Health To ensure quality health, the main goal should be to treat infected women before infection progresses. Also reduce the transmission of chlamydia infection in the population and screen all women for asymptomatic chlamydial infection. By screening all sexually active females under the age of 25 years annually and screening women over age 25 years, if they are at an increased risk, quality health will be obtained. Conclusion According to the American Social Health Association website (1999-2010) in the United States, chlamydia is the most common communicable bacterial sexually transmitted disease (STD), particularly among sexually active adolescents and young adults. In 2006, more than one million cases of chlamydia were reported to the Centers for Disease Control and Prevention (CDC). However, it is estimated that almost three million cases occurred, and as many as one in 10 adolescent females test positive for chlamydia. Chlamydia is sometimes called the "silent disease" because an individual can be diagnosed with an infection without knowing it. In fact, over half of all cases of chlamydia do not manifest any obvious signs of infection. Chlamydia is easily detected and treated, but recommended annual screening remains underutilized. Lack of awareness, social stigma, barriers to finding and treating sex partners of infected women, and difficulties in measuring public health affect all present challenges and opportunities for chlamydia prevention programs (National Institute of Allergy and Infectious Diseases, 2010). Any chlamydia screening program also needs to define the target population and how the program will be implemented. A systematic approach to screening is likely to result in higher coverage with greater health benefits, but at a higher cost, whereas the success of opportunistic screening is dependent on adequate levels of awareness and training by health care providers. . References American Social Health Association. 1999-2010. Retrieved from http://www.ashastd.org Centers for Disease Control and Prevention. Chlamydia screening among sexually active young female enrollees of health plans—United States, 2000-2007. MMWR, 2009; 58 (14): 362-365. CDC. 2008 Sexually Transmitted Diseases Surveillance. Retrieved from www.cdc.gov/std/stats/ Deland, P. 2010. What Is Chlamydia' Retrieved from http://www.ehow.com/about_4570505_what-is-chlamydia.html'ref=Track2&utm_source=ask#ixzz145GDUq4E Low, N. Evaluating novel interventions for chlamydia screening. Sex Transm Infect. 2006; 82:97–8. doi: 10.1136/sti.2005.017889. www.ncbi.nlm.nih.gov/pmc/articles/PMC1896158/ MDwise Hoosier Alliance. 2009. Retrieved from www.hoosieralliance.org/pdf/provider/provcom/quality/chlamydia National Institute of Allergy and Infectious Diseases. 2010. Retrieved from http://www.niaid.nih.gov/publications/std.htm National Institutes of Health website. 2008. Chlamydia. National Institute of Allergy and Infectious Diseases. Retrieved from http://www3.niaid.nih.gov/topics/chlamydia/ Stamm, M.D., W. E. 1998. Expanding Efforts to Prevent Chlamydial Infection. New England Journal of Medicine. 339:768-770. Retrieved from www.nejm.org/doi/full/10.1056/NEJM199809103391111 www.WebMD.com http://www.cdc.gov/std/chlamydia/default.htm