Screening and Genotyping of Genital Chlamydia trachomatis in Urine Specimens From Male and Female Clients of Youth-Health Centers in Stockholm County

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Abstract
The current study was conducted in the context of the current increase in cases of Chlamydia trachomatis infections, the development of new diagnostic strategies, and an outreach to community-based youth center screening sites. The goal was to define the prevalence of genital C trachomatis infection among clients of youth-health clinics and to evaluate the feasibility of implementing genotyping as a tool for epidemiologic studies with use of urine specimens. This was a prospective pilot study at two community-based youth-health clinics for teenagers and adolescents. Enrollment followed a high school educational program and public advertising campaign on the common occurrence of nonsymptomatic or only mildly symptomatic chlamydial infection among sexually active young people. Voluntary, confidential, free screening of first-void urine was provided, and the samples were tested by polymerase chain reaction (PCR). Demographic and behavioral data were obtained. Positive samples were differentiated into genovars by genotyping with restriction fragment length polymorphism analysis of the PCR–amplified omp 1 gene. The prevalence of nonsymptomatic or mildly symptomatic chlamydial infection was 6.0% among women and 9.3% among men. A significant increase in the risk of infection was associated with a history of sexually transmitted disease (STD) (P < 0.01). There was no statistical risk correlating with partner change during the past year, infrequent or inconsistent condom use during the past year, present use of contraceptive pills, smoking habits, or recent alcohol consumption. Genotype E was most common (60%) among both sexes. Genotypes F and K were second most prevalent for men (20%), and genotype D was second most prevalent for women (15%). Genotype K or F was found in 23% of cases. Screening programs targeting sexually active adolescents attending youth-health clinics are important for detection of C trachomatis. Genotyping might become an efficient tool in epidemiologic studies. The impact of educational school- and community-based programs on STD among young people needs further evaluation.