title: Epidemiology of genital Chlamydia trachomatis infection among young women in Costa Rica.
abstract: OBJECTIVE
  To investigate Chlamydia trachomatis (Ct) epidemiology among 5829 women 18 to 25 years old, in Costa Rica.
  
  
  METHODS
  Data are from a community-based human papillomavirus 16/18 vaccine trial. Before randomization, eligible women who reported previous sexual activity were interviewed and tested for Ct DNA by Hybrid Capture 2 and polymerase chain reaction-based genotyping. Multivariate models were developed.
  
  
  RESULTS
  Overall prevalence was 14.2% (95% confidence interval, 13.3-15.1). Among Ct genotypes, serovar E was the most common (4.3%), followed by serovar F (3.0%), serovar D/Da (2.9%), and serovar I/Ia (2.1%).Ct increased with lifetime sexual partners of the women, and among women with 1 lifetime partner, with sexual partners of the partner. Current intrauterine device users had an increase in Ct detection [odds ratio (OR) 1.6, 1.1-2.5] but hormonal contraceptives or condom users did not. Miscarriages were associated with a reduction in Ct detection (OR 0.7, 0.5-1.0) while current regular smoking increased it (OR 1.7, 1.2-2.5). Vaginal discharge, reactive changes, ASCUS or LSIL and moderate to severe inflammation in the cytology were significantly more common among Ct positive women (P <0.001). Gonorrhea prevalence was 0.8%, and it was, as other STIs, highly correlated with Ct detection.
  
  
  CONCLUSIONS
  This is a high-prevalence population where we confirmed the strong link between Ct and sexual behavior of women and their partners. The establishment of a screening program in the age group included in this study should be considered. More studies are needed in developing countries to further investigate the role of intrauterine devices and the lack of protection by condoms, in addition to the interplay between Ct and other STIs, ectopy, inflammation, and epithelial abnormalities.
authors.affiliation: Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica. cporras@proyectoguanacaste.org
authors.forename: Carolina
authors.initials: C
authors.lastname: Porras
authors.forename: Mahboohbeh
authors.initials: M
authors.lastname: Safaeian
authors.forename: Paula
authors.initials: P
authors.lastname: González
authors.forename: Allan
authors.initials: A
authors.lastname: Hildesheim
authors.forename: Sandra
authors.initials: S
authors.lastname: Silva
authors.forename: Mark
authors.initials: M
authors.lastname: Schiffman
authors.forename: Ana Cecilia
authors.initials: AC
authors.lastname: Rodríguez
authors.forename: Sholom
authors.initials: S
authors.lastname: Wacholder
authors.forename: Enrique
authors.initials: E
authors.lastname: Freer
authors.forename: Koen
authors.initials: K
authors.lastname: Quint
authors.forename: Concepción
authors.initials: C
authors.lastname: Bratti
authors.forename: Albert
authors.initials: A
authors.lastname: Espinoza
authors.forename: Bernal
authors.initials: B
authors.lastname: Cortes
authors.forename: Rolando
authors.initials: R
authors.lastname: Herrero
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002690:Chlamydia Infections / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control* / Q000821:virology; D002692:Chlamydia trachomatis / Q000145:classification* / Q000235:genetics; D003364:Costa Rica / Q000453:epidemiology; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D006801:Humans; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D014626:Vaginal Smears
chemical_list: D004269:DNA, Bacterial