High prevalence of genital Chlamydia trachomatis infection in women presenting in different clinical settings in Jamaica: implications for control strategies

Objective: To determine the prevalence of genital Chlamydia trachomatis inf ection and risk factors in women attending family planning, gynaecology, an d sexually transmitted disease (STD) clinics in Jamaica. Methods: Endocervical specimens from 645 women including 238 family plannin g 170 gynaecology, and 237 STD clinic attendees were examined for C trachom atis using a direct fluorescence assay (DFA) and culture. Investigations we re carried out for the presence of other STD pathogens and demographic, beh avioural, historical, and clinical dara recorded for each participant. Results: The prevalence of C trachomatis infection was 35%, 47%, and 55% in family planning, gynaecology, and STD clinic clients,respectively. The per formance of the DFA was comparable to that of culture in screening for C tr achomatis. Logistic regression analysis revealed that the independent risk factors for C trachomatis infection were non-barrier: contraceptive methods in family planning clients (OR=2.1; 95% confidence interval (CI)=1,2-3.9; p=0.0110), cervical ectopy in gynaecology clients (OR=3.9; 95% CI=1.4-10.6; p=0.0076) and concomitant Trichomonas vaginalis infection in STD clients ( OR=3.5; 95% CI=1.8-6.8; p=0.003). Age, number of sex partners, and reason f or visit were not identified as risk factors for C trachamatis infection. Conclusions: Consistently high prevalence of C trachomatis infection occurs in Jamaican women. Universal screening or presumptive treatment should be evaluated as prevention and control measures for C trachomatis infection in this population where all women appear to be at risk.