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Chlamydia screening: what about the men?

The recent article by Braun and Provost1 addresses increasing access to health care to improve chlamydia screening. Chlamydia rates are currently estimated at 4.2% among young adults in the general US population, and current recommendations require annual screening for all sexually active females aged 25 years or younger.2 The Healthy People 2010 goals regarding chlamydia are: “To reduce the proportion of adolescents and young adults with Chlamydia trachomatis infections to 3% by 2010,” and “Increase the proportion of sexually active females aged 24 years and under who are screened annually for genital Chlamydia infections.”3 In their article, Braun and Provost explored the effects of broadening access to health care on chlamydia screening rates. 
 
The article successfully draws attention to the issue of access to care for young women, but it also raises an interesting question about current chlamydia screening guidelines among young men. During the study, patient-delivered partner therapy was offered to patients at the discretion of each participating Title X agency. Patient-delivered partner therapy is practiced for the purpose of preventing reinfection. Although this study did not address reinfection, recent research has concluded that patient-delivered partner therapy made no difference in reinfection rates.4 This information, coupled with the Centers for Disease Control and Prevention's report that chlamydia rates from 2008 to 2009 increased by 5% among males aged 15 to 19 years and 6% among males aged 20 to 24 years, begs the question, should guidelines include routine chlamydia screening among males younger than 25 years? 
 
Currently, limited chlamydia screening guidelines for males underestimate its prevalence among young men and the roles young men have in its transmission. We recognize that the long-term sequelae of untreated chlamydia in females is a major concern; however, great consideration should be taken to equalizing the screening criteria to decrease transmission rates. Notwithstanding the larger concerns of increasing access to health care to male adolescents and young adults related to sexual health,5–7 broadening screening guidelines would be a more comprehensive approach. 
 
Braun and Provost's article is an excellent starting point for further discussions on policy that can improve access to sexual health care for both male and female adolescent patients. Further research is needed to investigate health care utilization of adolescent males in school-based health clinics. Most important, future research is needed on chlamydia screening programs directed toward adolescent and young adult males in hopes of generalizing screening guidelines and policies.