Table of Contents
Research Proposal on Chlamydia in Comanche County Oklahoma. 3
What is the Etiology of Chlamydia?. 4
What is the Burden (Prevalence and Incidence)?. 5
What are the Risk Factors of Chlamydia?. 7
Research Proposal on Chlamydia in Comanche County Oklahoma
Introduction
This research proposal posits to provide a platform for additional research into the issue of the incidence of Chlamydia in Oklahoma. Chlamydia is ranked as the most regularly reported sexually transmitted diseases (STD) in Oklahoma. Chlamydia is caused by Chlamydia trachomatis bacterium. It is reported as the most widespread STD in Oklahoma. In 2009, Chlamydia accounted for approximately 74% of the reported cases of sexually transmitted diseases in Oklahoma (Janz, 2010).
Boyer, W. The Chlamydia Syndrome. Journal of Medicine, 52, 14.
According to this article, although the symptoms of Chlamydia are typically lacking or mild, severe complications that cause irremediable damage can grow “silently” prior to a patient ever identifying a problem. In women, the disease may cause chronic pain, ectopic pregnancy, infertility and/or pelvic inflammatory disease.
Brandie, T., & Catherine, H. (2011). Management of Chlamydia Trachomatis Genital Tract Infection: Screening and Treatment Challenges. Journal of Infection & Drug Resistance, 19.
According to this article, approximately 70% of women suffering from Chlamydia are asymptomatic. Additionally, a pregnant woman suffering from Chlamydia infection can spread the infection to the infant’s eyes in the course of a vaginal birth. The resultant ophthalmic infection may eventually result in the baby’s blindness. Males suffering from Chlamydia infection may experience penile discharge, whereas approximately 1% to 25% of males infected do not experience any symptoms of the disease.
Beigi, R. (2010). Antimicrobial Resistance Connected with the Treatment of Bacterial Vaginosis. Am J Obstet Gynecol, 91, 24.
According to the article, potential complications of infections in males include epididymitis, reactive arthritis (Reiter Syndrome) and, infertility. In males, receptive anal sexual activity might cause Chlamydial proctitis.
What is the Etiology of Chlamydia?
Workowski, K. & Berman, M. (2006). Centers for Disease Control Prevention. Sexually Transmitted Diseases Treatment Guidelines. MMWR Recomm Rep, 55, 32-33.
According to this article, Chlamydia trachomatis (Ct) refers to a non-motile, gram-negative bacterial pathogen that has a life cycle of two phases. The infectious structure of the organism is known as the elementary body (EB) that connects to and penetrates the host cell. Subsequent to penetrating the host cell, the EBs starts their second life cycle in the form of metabolically dynamic reticulate bodies (RBs). These RBs utilize host-derived ATP to reproduce through binary fission. Approximately some hundred progeny are formed in a large cytoplasmic inclusion. The newly reproduced RBs restructure into the contagious EBs and are freed by the host cell, hence concluding the life cycle.
Marrazzo, H., & Whittinton, W. (2002). Predicting Chlamydia & Gonoccal Cervical Infection: Implications for Management of Cervicitis. Obstet Gynecol, 579-84.
According to this article, in the Chlamydia trachomatis genus, there are numerous serovariants and serovars with etiologic potential for infection pathology. Immunity subsequent to infection is considered as being type specific and simply partly protective; consequently, intermittent infections are frequent. In females, the original site of contagion is typically the endocervical columnar epithelia. In adolescents who have columnar epithelial cells on the ectocervix, as well as, users of oral contraceptive pills are highly vulnerable to infection.
Herieka E. (2009). Chlamydia Trachomatis Reinfection Rate: An Elapsed Feature of Management of Female Genital Chlamydia. Sex Transm Infect Journal, 77, 223.
According to the article, cervical infections can resolve impetuously or persist as a low-grade unceasing infection with nominal symptoms of inflammation. The infections are able to rise through the upper genital tract to engage the fallopian and endometrium tubes. The chronicity and severity of the Chlamydia infections materialize as highly inconsistent. In males, the infections typically remain restricted to the urethra, but are able to multiply to cause prostatitis or epididymitis. The infections can resolve impetuously, except that the natural path of untreated contagion in males is not entirely known.
Background
What is the Burden (Prevalence and Incidence)?
In 1988, Oklahoma mandated the reporting of Chlamydia when 2,714 incidents were documented. Later, in 2009, a sum total of 14,991 incidents were documented. It is essential to mention that the rate of Chlamydia occurrences in Oklahoma rose by 5.5% between the year 2008 and 2009. This follows a development of increase in Chlamydia morbidity in Oklahoma and, by extension the U.S. since the year 1997. Probable reasons for the increase could have been improved reporting, increase in sensitive diagnostic checks, or a real rise in the disease occurrences. In 2009, Oklahoma reported a prevalence rate of 412 in every 100,000 individuals with 74% of the cases reported being female. Females have a greater propensity to visit the doctor than males, owing to the annual exams as well as pregnancy and may account for a portion of the significant gap in the documentation of Chlamydia cases by gender (Terrainia & Martin, 2010).
Whereas Oklahoma had the highest amount of reported Chlamydia incidents, Comanche County reported the highest incidence at 923 in every 100,000 persons, Oklahoma County followed with a rate of 592 in every 100,000 persons, while Tulsa County documented 569 per 100,000 persons. Comanche County reported a 27% rose between the year 2008 and 2009, while Tulsa and Oklahoma counties had rates comparable to 2008. Chlamydia happens in any age, but 15 to 19 years age group reported 2,143 cases in every 100,000 persons, while 20 to 24 years age group reported 2,110 in every 100,000 persons had the greatest rates amongst all age groups.
Pacific/Hawaiian Islanders reported the highest rate amongst all cultural groups of 1,657 in every 100,000 persons, but represented merely 64 incidences in 2009, depicting a 47% rise from 2008. The African/Black American populace reported the second greatest rate with a rate of approximately 1,562 in every 100,000. This depicts 7 times more in comparison to White populace, which reported a rate of 222 in every 100,000 persons. The third greatest was reported among the Native Americans with a rate of 513 in every 100,000 persons. This depicts 2.3 times more than the rate reported among the Whites population. The Hispanics reported a rate of 448 in every 100,000 persons in the year 2009, which depicts a 24% rise from 2008.
The figure below grants a graphical presentation of the concern at hand in Oklahoma from 1998 to 2007.
(Terrainia & Martin, 2010).
What are the Risk Factors of Chlamydia?
Whiteside, A. (2012). Health Structures for HIV Treatment & Care. Sex Transm Infect, 9, 5-10.
According to the article, a number of factors may contribute to the Chlamydia development. For instance an individual who has a danger that is higher-than-average of developing Chlamydia if he is active sexually. It also means that a person, who has numerous sex partners, bears a greater the danger of contagion.
Heidi, B. (2010). Chlamydia Trachomatis Effects on the Female Reproductive Tract of the Macaca Nemestrina, Obstet Gynecol, 8, 26.
According to this article, other features that contribute to Chlamydia development include:
- Age– a person under the age of 25 years bears at greater danger of developing Chlamydia.
- Birth control –Women who use intrauterine device (IUD) bear a greater danger of acquiring Chlamydia than the women who do not. They are also more prone to acquire Chlamydia if they are taking contraceptive pills.
- Gender – The cervix of young women and teenage girls is not entirely developed and is possibly more vulnerable to contagions that are sexually transmitted. These women bear a predominantly higher risk for contagion if sexually active.
- Hygiene– vaginal douching increases the risk of acquiring Chlamydia.
- Medical history – Women or men with earlier incidents of STDs are increasingly prone to be diagnosed with Chlamydia than the persons without. In addition, women who are diagnosed with pelvic inflammatory disease (PID) would be increasingly prone to acquire Chlamydia.
- Sexual practices– persons with numerous sex partners bear a greater risk of acquiring Chlamydia. Persons who practice unprotected sexual intercourse are as well at greater danger of Chlamydia. Since Chlamydia is able to be transmitted through anal or oral sex, homosexuals and lesbians are also at danger of Chlamydia infections.
Llewellyn, C. (2012). What is Unappealing about STI Research? An Experience of Performing Sexual Health Research. Sex Transm Infect Journal, 8, 12.
According to the article, Chlamydia is occasionally referred to as the “silent disease” since a person may be diagnosed with a contagion without realizing it. In reality, over 50% of all Chlamydia cases do not manifest any evident signs of contagion.
Methods
This research proposal proposes to conduct studies prior to April 2012 that estimate the rate of Chlamydia among the inhabitants of Comanche County, Oklahoma. Searches would be limited to several articles published in the English language over the precedent 20 years. A sum total of 10 unduplicated publications would be identified. Of the 10 publications, abstracts will be reviewed for significance to the topic. Explicit study design, geographic region as well as population demographics, percentage of persons tested, diagnostic test type employed, duration of follow-up, will be considered in the exclusion and inclusion criteria. To guarantee high quality data, peer-reviewed publications only will be considered; unpublished data and conference abstracts will be excluded.
The studies will be categorized into tiers on the basis of the study design and follow-up techniques. Tier 1 studies or active cohorts, will be those that involve patient enlistment: randomized controlled tests as well as, potential cohort studies having active follow-up. The tier 2 studies will comprise of passive cohorts, retrospective or prospective cohort studies with passive follow-up that does not necessitate patient enrollment, will not have specific retesting gaps, but which would collect data based on the timing as well as results of successive trials. Tier 3 studies, or disease registry, will include those that report infection rates by use of clinic-based registries or surveillance systems that do not contain data on patients who would test negative. For these studies, infection proportions will be computed by dividing the amount of patients with a later infection by the amount of patients originally infected. Synopsis estimates of the median as well as range of infection rates will be determined for Chlamydia. For studies that report infection rates for sequential tests in the same study sample at diverse time intervals, the infection rate based on the greatest timeframe up to 1 year will be incorporated in the data analysis. For randomized tests in which infection was the consequence of interest and data will be stratified by study arm, the infection rate grounded on the control conditions will be incorporated in the analysis.
Stoner, B. & Buckel, C. (2008). The Psychosocial Weight of Chlamydia Infection: Outcomes of Formative Qualitative Research. Journal of Adolescent Health, 5, 31-32.
According to the article, it would be appropriate to utilize the Mann-Whitney and Kruskal-Wallis statistical tests to contrast median infection rates among the study tiers. To project the optimal timing for retesting the patients treated for Chlamydia, a second degree (quadratic) regression model will be fitted to the data with reinfection rate as the dependent variable and independent variable being time. This model is preferred because it provides the best fit founded on standard model selection criteria. The Model analyses will be performed by use of SAS 9.1 software. PROC REG will be used to compute regression coefficients, and PROC GPLOT will be employed in plotting the data. In order to examine the factors connected with reinfection, summary rates will be stratified by study tier, length of follow-up, percentage of persons retested (Tiers 2 and 1 only), diagnostic test used, sample size, treatment regimen, as well as clinical setting. Additionally, differential rates will be examined among studies that include adequate data on ethnicity, race, age, symptom status, co-infection status, partner management strategy, as well as sexual risk behavior.
Conclusion
Since Chlamydia remains one of the dominant STDs in the U.S, there is need for increased emphasis on additional research in order to mitigate the predicament.
The diagnosis of Chlamydia raises considerable inter-personal social, as well as, psychological concerns among women in reproductive age. Although Chlamydia remains curable, it is highly stigmatizing and it disrupts confidence and trust in sexual partnerships. Upcoming research ought to clarify the correlates and magnitude of the psychosocial weight of a Chlamydia diagnosis.
References
Beigi, R. (2010). Antimicrobial Resistance Connected with the Treatment of Bacterial Vaginosis. Am J Obstet Gynecol, 91, 24.
Boyer, W. The Chlamydia Syndrome. Journal of Medicine, 52, 14.
Brandie, T., & Catherine, H. (2011). Management of Chlamydia trachomatis genital tract infection: screening and treatment challenges. Journal of Infection & Drug Resistance, 19.
Heidi, B. (2010). Chlamydia Trachomatis Effects on the Female Reproductive Tract of the Macaca Nemestrina, Obstet Gynecol, 8, 26.
Herieka E. (2009). Chlamydia Trachomatis Reinfection Rate: An Elapsed Feature of Management of Female Genital Chlamydia. Sex Transm Infect Journal, 77, 223.
Janz, N. (2010). Health Belief Model: Health Education & Health Behavior. San Francisco: Jossey- Bass.
Llewellyn, C. (2012). What is Unappealing about STI Research? An Experience of Performing Sexual Health Research. Sex Transm Infect Journal, 8, 12.
Marrazzo, H., & Whittinton, W. (2002). Predicting Chlamydia & Gonoccal Cervical Infection: Implications for Management of Cervicitis. Obstet Gynecol, 579-84.
Stoner, B. & Buckel, C. (2008). The Psychosocial Weight of Chlamydia Infection: Outcomes of Formative Qualitative Research. Journal of Adolescent Health, 5, 31-32.
Terrainia, H. & Martin, L. (2010). The Oklahoma State Department of Health HIV/STD Epidemiologic Profile. Oklahoma: Oklahoma State Department of Health.
Whiteside, A. (2012). Health Structures for HIV Treatment & Care. Sex Transm Infect, 9, 5-10.
Workowski, K. & Berman, M. (2006). Centers for Disease Control Prevention. Sexually Transmitted Diseases Treatment Guidelines. MMWR Recomm Rep, 55, 32-33.
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