[Risk factors for Clamydia infections of the genital organs in adolescent females].
BACKGROUND
Chlamydia trachomatis (Ct) infections are the most common bacterial sexually transmitted diseases (STDs). The highest age-specific rates for chlamydia are found in adolescents. Female adolescents are more susceptible to STDs than older women because their cervical anatomic development is incomplete and especially sensitive to infection by certain sexually transmitted pathogens, and for some other features that characterize sexual behavior and health care behavior of the young people. The aim of this study was to identify risk factors and risk indicators statistically associated with the presence of Ct genital infection in adolescent females.


METHODS
The study group comprised 300 sexually active 19 years old girls who were attending the Mother and Child Health Care Institute of Serbia in the period from 1995 to 1997. The participants of this study were interviewed about their sexual behavior, health care behavior and their responsibility level in sexual relationships. Physical examination included microbiological and colposcopic findings. Vaginal and cervical microbiological examinations included the analysis of collected specimens for microscopic and culture analyses. Ct infection of the cervix was identified by direct immunofluorescence staining of smears using monoclonal antibodies. Colposcopic findings were divided in two groups: cervical ectopy and other findings. Data were statistically analyzed using step-wise linear regression.


RESULTS
The prevalence of Ct genital infection in the study group was 30.3%. Characteristics in adolescent girls with this infection were mostly as follows: first sexual intercourse was before the age of 17, first sexual partner was older, a great number of sexual partners, (more than 3-25.3% vs 20.1%; more than 4-16.5% vs 10.5%), sexual intercourse during casual contact (44.0% vs 34.4%) and high coital frequency (83.5% vs 72.7%). Among these characteristics, only the coital frequency was significantly associated with the probability of chlamydial genital infection (p < 0.05). Statistical findings about the use of contraceptives among the adolescents indicated that the level of safe sexual practice was low in the majority of girls, despite the presence of chlamydial genital infection. Nevertheless, the girls without Ct genital infection more frequently reported the condom as the method of contraception used for the longest adolescence period (41.6%) in comparison with the adolescent females infected by Ct (17.6%). This difference was statistically significantly associated with the possible manifestation of Ct genital infection (p < 0.05). Healthy adolescent females used condom more frequently at the last intercourse (37.3%) than girls with Ct genital infection (18.2%). Adolescent females often experienced only 0-2 methods of contraception (70.3% of girls infected with Ct and 59.8% of healthy girls). Health care behavior was poor in the examined girls. The suspicion of getting a STD was the reason for their first gynaecological examination in 25.3% of adolescent women with Ct genital infection and in 20.6% of healthy girls. Unwanted pregnancy during adolescence reported 16.5% of girls with Ct cervicitis and 15.8% of healthy girls. The existence of STD previous to examination was noted in 7.9% of infected girls and 7.7% of healthy subjects. Drug abuse reported 23.1% of studied adolescent females with Ct genital infection and 23.0% without it. A large proportion of both the adolescent females and their partners had negative attitudes toward the condom use (54.9% of infected girls and 57.1% of their partners; 32.1% of healthy girls and 35.9% of their partners). The difference between the attitudes toward the condom use among infected and healthy adolescent women and their partners was statistically significant (p < 0.001). Clinical findings of cervical ectopy were more frequent in girls infected with Ct (60.4%) in comparison to healthy girls (15.8%). These differences were also statistically significant (p < 0.001). Associated genital infections (vaginal and/or cervical) were more frequent in adolescent women with Ct cervicitis (56.0%) than in healthy girls (36.8%). The observed differences were statistically significant (p < 0.01).


CONCLUSIONS
Predictors of Ct genital infection in adolescent women, according to the step-wise linear regression analysis, were as follows: the presence of cervical ectopy, negative attitudes of adolescent girls and their partners toward the condom use; associated genital infections; frequent coitus; experience in causal sexual relations and older age of the first sexual partner. However, the possibility that this criterion provides imprecise identification of uninfected adolescent women and separation of only Ct infected women, is limited. Therefore, screening of the presence of Ct genital infections in all sexually active adolescent women is necessary.
Sedlecki
K
K
Dr. Vukan Chupitsh Mother and Child Health Institute of Serbia, Belgrade.
Markovic
M
M
Rajic
G
G
D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis / Q000635:transmission*; D002692:Chlamydia trachomatis; D003268:Contraception Behavior / Q000523:psychology; D005260:Female; D005831:Genital Diseases, Female / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D012307:Risk Factors; D012725:Sexual Behavior; D015231:Sexually Transmitted Diseases, Bacterial / Q000175:diagnosis