Information for Reproductive Health and Sexually Transmitted Disease Practitioners and Program Directors
Region III Infertility Prevention Project
Background
Project Summary
Infertility Prevention Efforts in Region III
Administration of Region III Infertility Prevention Project
For More STD Facts
Region III Infertility Prevention Project Contact
Region III Infertility Prevention Project
The following section describes the work of the Region III Infertility Prevention Project (IPP). It is intended to help health professionals looking for additional information about chlamydia and gonorrhea programming as well as those doing research about current STD-related projects. If you are looking for basic information about chlamydia, gonorrhea and/or sexually transmitted disease (STD)-related services, please click here.
Background
Chlamydia is the most frequently reported bacterial STD in the United States. In fact, it is estimated that 2.8 million Americans are infected with chlamydia each year, and approximately 75% of all chlamydia infections nationwide are found in women aged 24 and younger. Of those women infected, upwards of 80% do not have symptoms. In addition, women are frequently re-infected if their sex partners are not treated (upwards of 50% of men do not have symptoms). Of those women with untreated chlamydia, 40% will develop pelvic inflammatory disease (PID). Twenty percent of women with PID become infertile, 18% experience chronic pelvic pain, and 9% will experience ectopic pregnancy, which is life threatening. In addition, pregnant women infected with chlamydia can infect their babies during delivery. Untreated chlamydia can also cause urethritis in men.
The second most commonly reported bacterial STD in the US is gonorrhea. An estimated 600,000 Americans are newly infected with gonorrhea each year, and upwards of 50% of women infected do not have symptoms. 75% of all gonorrhea infections in women nationwide are found in women age 24 and younger. Gonorrhea, like chlamydia, can also lead to PID and infertility in women as well as urethritis in men. Pregnant women infected with gonorrhea can infect their babies during delivery.
In an effort to prevent long-term health effects of both chlamydia and gonorrhea such as STD-related infertility, the Region III IPP works to promote best practices in chlamydia and gonorrhea screening and prevention programs in 6 states (Delaware (DE), District of Columbia, Maryland (MD), Pennsylvania (PA), Virginia (VA) and West Virginia (WV)).
Project Summary
The overall goal of the Region III IPP is to assess and reduce the prevalence of chlamydia and gonorrhea, and their associated complications, through a program promoting coordinated outreach, education, screening, treatment and follow-up services based on the U.S. Centers for Disease Control and Prevention (CDC) guidelines and other best practices. The Region III IPP is part of a National Infertility Prevention Program coordinated by the CDC in collaboration with the Office of Population Affairs of the Department of Health and Human Services.
Infertility Prevention Efforts in Region III
The Region III IPP, which was initiated in 1993, operates through the collaborative efforts of STD, family planning, and laboratory providers throughout the region. Collaborative work and regional coordination are promoted through the ongoing efforts of a regional IPP advisory committee. The current committee is composed of eleven family planning grantees, eight STD program managers, eight public health laboratory directors, three representatives from key clinical services partners, two regional training center representatives, and two medical consultant. Four subcommittees – Clinical Services, Data, Training, and Laboratory - are charged with exploring issues related to their particular subject, and presenting recommendations to the full Committee for consideration. Projects and initiatives supported and/or expanded through regional IPP advisory committee work focus on the following key elements:
1.Clinical Services (screening, treatment, partner management)
2.Training and Education (of clinicians and laboratorians)
3.Laboratory Services (tests, bulk purchasing, performance, turn-around-time, quality assurance)
4.Surveillance (local, state, regional data collection, management, and analysis).
Examples of Region III IPP projects include:
Strengthening adherence to screening guidelines:
In recent years, the Region III IPP has worked to make sure that chlamydia screening efforts are focused on women at high risk of chlamydia. As part of this effort, the IPP has asked states to emphasize screening in women age 29 and younger, who have high rates of chlamydia, and to reduce screening in women age 30 and over (unless they have other risk factors). Several states have made good progress in targeting screening to younger women, which helps to save dollars while making sure that women at high risk get tested. For example, in 2004, West Virginia’s family planning clinics strengthened efforts to target chlamydia screening to younger women and women with risk factors, and to reduce screening in women 30 and over with no risk factors. As a result, West Virginia’s family planning clinics have been able to test women at risk of chlamydia while saving money that was previously spent on unnecessary testing. In fact, WV can boast a cost savings of $19,880.
Internet Screening:
Johns Hopkins University and both the MD and Baltimore Departments of Health initiated a study in 2004 (with support from the Region III IPP) to see if it is possible to offer self-administered chlamydia tests to women using the Internet. A website (www.iwantthekit.org) was developed. Women could order the kit online or pick it up at drugstores or other locations. Overall, 400 women were tested for chlamydia this way. Forty-one of these 400 women, or more than 1 in 10, tested positive for chlamydia. This means that chlamydia was more common in women requesting kits over the Internet than those getting tested at family planning clinics in Baltimore. Also, out of the women over 25 who requested kits from the Internet, 5.6% tested positive for chlamydia. This is higher than what is found in family planning and STD clinics in Baltimore as well. Thus, it is clear that this study is accessing a group of high risk, “older” women not easily reached by clinic services. Because of the success of the Internet Screening Project focused on women, this project will now expand to men. In addition, through efforts of the Region III IPP, Internet screening may also be available in other states within the region.
Enhancing chlamydia screening in correctional facilities:
People entering correctional facilities typically have poor access to healthcare and are at higher risk of chlamydia than other groups. So that the healthcare needs of this group of people could be effectively met, states and citites in Region III began to implement screening programs in correctional facilities. The Region III IPP supported these screening programs by giving information, funding and technical assistance. DE, MD, VA, WV, PA and Philadelphia all now run screening programs in juvenile detention centers, jails and prison sites. This work has been extremely effective in identifying and treating individuals infected with chlamydia. For example, in 2005, MD screened 236 female inmates and 1370 male inmates between January and June. For women, 21.5% of 15 to 19 year olds were positive for chlamydia and 7.4% of 1o to 14 year olds were positive. For males, 6.6% of 15 to 19 year olds were positive and 1.2% of 10 to 14 year olds were positive. The majority of chlamydia in males was identified in the 20 to 24 year old age group, where 10% of those tested were positive. The findings in MD are similar to those found in other states in the Region, thus showing how important it is for Region III IPP partners to continue and expand this important work.
Administration of the Region III Infertility Prevention Project
The Family Planning Council administers the IPP in Region III, and provides coordination and support to the Advisory Committee and the Project. The CDC provides ongoing guidance and technical assistance in the operation of the project, including the provision of up-to-date information on testing, treatment, surveillance, and other vital components of an IPP.
In order to strengthen administration of this project, the Family Planning Council hosts and administers the Region III IPP website found at www.region3ipp.org. If you are a health professional, public health manager, student and/or researcher interested in learning more about STD service protocols, IPP program management principles, new research related to chlamydia and gonorrhea, cutting-edge laboratory test technology, chlamydia/gonorrhea trends in Region III, and/or would just like to learn more about the activities and history of the Region III IPP, you should visit the Region III IPP website. The National IPP website, http://www.cdc.gov/std/infertility/ipp.htm, may also be helpful.
For More STD Facts...
For more information about chlamydia, gonorrhea, and other STDs, please see the STD fact sheets on this site or visit:
http://www.cdc.gov/std/default.htm
http://www.cdc.gov/std/infertility/default.htm
Region III Infertility Prevention Project Contact
Mark Miller , Region III Infertility Prevention Project Director (215) 985-2609
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