title: The incidence and correlates of symptomatic and asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae infections in selected populations in five countries.
abstract: BACKGROUND
  Asymptomatic Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhea) infections pose diagnostic and control problems in developing countries.
  
  
  METHODS
  Participants in China, India, Peru, Russia, and Zimbabwe were screened for C. trachomatis and N. gonorrhoeae infections and symptoms.
  
  
  RESULTS
  A total of 18,014 participants were evaluated at baseline, 15,054 at 12 months, and 14,243 at 24 months. The incidence of chlamydia in men was 2.0 per 100 person years both from baseline to 12 months and from 12 to 24 months, and in women, 4.6 from baseline to 12 months and 3.6 from 12 to 24 months; a range of 31.2% to 100% reported no symptoms across the 5 countries. The incidence of gonorrhea in men was 0.3 per 100 person years both from baseline to 12 months and from 12 to 24 months, and in women, 1.4 from baseline to 12 months and 1.1 from 12 to 24 months; a range of 66.7% to 100% reported no symptoms. Being female, aged 18 to 24 years, and having more than 1 partner were associated with both the infections. In addition, being divorced, separated, or widowed was associated with gonorrhea. Being male, having 6+ years of education, and reporting only 1 partner were associated with having no symptoms among those infected with chlamydia. No variables correlated with asymptomatic gonorrhea among those infected.
  
  
  CONCLUSIONS
  A high prevalence and incidence of asymptomatic sexually transmitted infections was identified among men and women in a wide variety of settings. More effective programs are needed to identify and treat chlamydia and gonorrhea infections, especially among women, young adults, those with multiple partners, those repeatedly infected, and particularly those at risk without symptoms. The risk of transmission from persons with no symptoms requires further study.
authors.affiliation: Department of Epidemiology, UCLA School of Public Health, 71–269 CHS, Box 951772, Los Angeles, CA 90095–1772, USA. detels@ucla.edu
authors.forename: Roger
authors.initials: R
authors.lastname: Detels
authors.forename: Annette M
authors.initials: AM
authors.lastname: Green
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klausner
authors.forename: David
authors.initials: D
authors.lastname: Katzenstein
authors.forename: Charlotte
authors.initials: C
authors.lastname: Gaydos
authors.forename: H  Hunter
authors.initials: H
authors.lastname: Handsfield
authors.forename: Willo
authors.initials: W
authors.lastname: Pequegnat
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mayer
authors.forename: Tyler D
authors.initials: TD
authors.lastname: Hartwell
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Quinn
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China / Q000453:epidemiology; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology*; D002692:Chlamydia trachomatis / Q000302:isolation & purification / Q000472:pathogenicity; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology*; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification / Q000472:pathogenicity; D010568:Peru / Q000453:epidemiology; D015995:Prevalence; D012426:Russia / Q000453:epidemiology; D060386:Sex Workers; D014189:Transsexualism; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology