The effect of the national demonstration project Healthy Respect on teenage sexual health behaviour

BACKGROUND: As part of the independent evaluation of Healthy Respect (a national demonstration project to improve teenage sexual health in Scotland) this study examined the effect of the school-based sexual health education intervention comprising multiprofessional classroom delivery and alongside drop-in clinics on teenage sexual behaviour outcomes. METHODS: Before-and-after cross-sectional surveys of secondary school pupils (average age 14 years and 6 months) were used in 10 Healthy Respect intervention schools in Lothian region and 5 comparison schools without intervention in Grampian region (2001 and 2003). RESULTS: By 2003, the proportion of pupils in Lothian feeling confident about getting condoms and using condoms properly significantly increased, more Lothian pupils (particularly boys) showed improved knowledge about condoms being protective against sexually transmitted infections. No further evidence of improved knowledge, attitudes, or intentions was evident after the intervention. Pupils in Lothian remained more likely to think using a condom would be embarrassing (especially girls), would reduce sexual enjoyment (especially boys), and intentions about condom use (as closer predictors of actual behaviour change) showed no significant improvement. More Lothian ( approximately 24%) than Grampian ( approximately 19%) pupils report having had sexual intercourse at age <16 years, both before and after the intervention, with no evidence of a significant reduction in Lothian by 2003. Overall differences in attitudes to condom use by gender were noted. Findings remain consistent in both unadjusted and adjusted comparisons. CONCLUSION: These findings demonstrate limited impact on sexual health behaviour outcomes, and raise questions about the likely and achievable sexual health gains for teenagers from school-based interventions.     

Prevalence of hepatitis C among injectors in Scotland 1989-2000: declining trends among young injectors halt in the late 1990s

We previously reported a continual decline in anti-HCV prevalence among young injectors from Glasgow and Lothian between 1990 and 1997. The original study was extended to ascertain if the anti-HCV prevalence among injectors from Glasgow, Lothian, Tayside and Grampian had changed since 1997. Residual sera from injectors who had undergone attributable anti-HIV testing were tested anonymously for anti-HCV. In all four regions, no significant changes in prevalence were found among those aged < 25 years during the late 1990s (Glasgow 1997-9/00: 43%-41%; Lothian 1997-9: 13%-17%; Tayside 1997-9: 45%-35%; Grampian 1996-9: 28%-29%). Among those aged > or = 25 years, significant decreases in prevalence were only observed in Glasgow (1997-9/00: 79%-72%, P = 0.03) and Lothian (1997-9: 54%-45%, P = 0.05). The findings highlight that existing harm reduction measures, acknowledged as having helped to reduce the spread of HCV, are not sufficient to bring this epidemic under control and reduce transmission to sporadic levels.     

A randomized trial of strategies to increase chlamydia screening in young women

OBJECTIVE: Despite the recommendations of numerous clinical practice guidelines, testing of at-risk women for Chlamydia trachomatis infection remains low. We evaluated an intervention to increase guideline-recommended chlamydia screening. METHOD: In a two-by-two factorial design randomized trial conducted in 2001-2002, 23 primary care clinics at Group Health Cooperative in Washington State were randomized to either control (standard) or intervention (enhanced) guideline implementation arms. Clinic-level intervention strategies included use of clinic-based opinion leaders, individual measurement and feedback, and exam room reminders. A second patient-level intervention, a chart prompt to screen for chlamydia, was delivered in a random sample of 3509 women. The outcome measure was post-intervention chlamydia testing rates among sexually active women ages 14-25. RESULTS: The clinic-level intervention did not significantly affect overall chlamydia testing (odds ratio (OR) = 1.08, 95% confidence interval (CI) 0.92-1.26, P = 0.31). However, testing rates increased significantly among women making preventive care visits (OR, Pap test visit = 1.23, 95% CI, 1.01-1.51, P = 0.04; OR, physical exam visit = 1.22, 95% CI 1.06-1.42, P = 0.009, intervention vs. control clinics). The chart prompt intervention had no significant effect (OR = 1.08, 95% CI 0.94-1.23, P = 0.27). CONCLUSIONS: Interventions to improve guideline-recommended chlamydia testing increased testing among women making preventive care visits. Additional organizational change and/or patient activation strategies may improve plan-wide testing, particularly among asymptomatic women.     

GP's management of genital Chlamydia: a survey of reported practice

BACKGROUND: Genital chlamydial infection is the commonest curable sexually transmitted disease in the industrialized world. Little is known about how GPs manage this condition. OBJECTIVES: We aimed to determine current knowledge concerning genital chlamydia among GPs and to establish how patients with this infection are managed in primary care. METHODS: A confidential self-administered postal questionnaire survey was sent to all 494 GPs in one English health district (Leicestershire). RESULTS: Completed questionnaires were returned by 290 GPs (a response rate of 59%). A much higher proportion of GPs had tested and/or treated female patients for chlamydia [70%, 95% confidence interval (CI) 64-75%] as opposed to male patients (20%, CI 15-25%). Female patients (70%, CI 64-75%) were also more likely to be managed in general practice than male patients (56%, CI 50-62%). A majority of GPs (66%, CI 60-72%) routinely used an appropriate method of testing for chlamydia although a high vaginal swab, an inappropriate method of testing, was used by a fifth of GPs (19%, CI 15-24%). A large number of different treatment regimes were used by GPs. The majority of GPs (85%, CI 79-89%) prescribed an appropriate antibiotic although few GPs (19%, CI 14-25%) specified a chlamydia treatment regime in accordance with accepted international guidelines with respect to drug, dosage and duration of therapy. CONCLUSIONS: Female patients with known or suspected genital chlamydial infection are commonly managed in UK general practice. There is scope to improve the management of this infection in general practice.      

Barriers to screening sexually active adolescent women for chlamydia: a survey of primary care physicians.

PURPOSE: To determine the proportion of primary care physicians who screen sexually active teenage women for chlamydia and to determine demographic factors, practice characteristics, and attitudes associated with chlamydia screening. METHODS: We obtained a random sample of 1600 Pennsylvania physicians from the American Medical Association masterfile, stratified to include at least 40% women and equal numbers of family physicians, internists, obstetricians/gynecologists, and pediatricians. In January 1998, physicians received mailed questionnaires; nonrespondents received two follow-up mailings. Physician characteristics associated with chlamydia screening were determined using bivariate and logistic regression analyses. RESULTS: Only one-third of physicians responded that they would screen asymptomatic, sexually active teenage women for chlamydia during a routine gynecologic examination. In multivariate analysis, physicians were significantly (p <.05) more likely to screen if they were female (43% vs. 24%), worked in a clinic versus solo practice (60% vs. 18%), worked in a metropolitan location (46% vs. 26%), or had a patient population > or = 20% African-American (54% vs. 25%). Attitudes associated with screening included the belief that most 18-year-old women in their practice were sexually active (36% vs. 12%), feeling responsible for providing information about the prevention of sexually transmitted diseases to their patients (42% vs. 21%), or knowing that screening for chlamydia prevents pelvic inflammatory disease (37% vs. 13%). Physicians were less likely to screen if they believed that the prevalence of chlamydia was low (10% vs. 41%). CONCLUSIONS: A majority of physicians do not adhere to recommended chlamydia screening practices for teenage women. Interventions to improve chlamydia screening might target physicians who are male, in private practice, or who practice in rural areas, and should focus on increasing awareness of the prevalence of chlamydia and benefits of screening.     

Clinical management of chlamydia in general practice: a survey of reported practice

BACKGROUND: Chlamydia trachomatis is the most common curable sexually transmitted infection (STI) in the UK. Prevalence of the infection in different health care settings has been found to be between 2% and 29% and diagnoses of the infection continue to rise significantly. It is estimated, however, that only 10% of all chlamydial infections are seen and treated in genitourinary medicine (GUM) clinics. Few data exist about the actual practice patterns of primary care providers in the management of chlamydia. The management of patients identified with the infection within this setting warrants attention. AIMS: To determine general practitioners' (GPs') and nurses' reported clinical practice in the management of genital chlamydial infection. To design a needs-based education guideline on the management of chlamydia in rural primary care. DESIGN: An anonymous, confidential, self-administered postal questionnaire was sent to all GPs and cervical cytology practice nurses in 84 practices in Dyfed Powys Health Authority (DPHA) area, Wales, UK. RESULTS: Following two mailings of the survey, responses were obtained from 75/84 practices (response rate 89%). A total of 130/307 GPs (response rate 42%) and 72/152 nurses (response rate 47%) in these practices responded. The data demonstrated that few tests for chlamydia are being carried out in general practice: 42% (55/130) of GPs and 54% (37/72) of nurses reported carrying out between one and four tests a month, and 35% (46/130) of GPs and 29% (21/72) of nurses reported performing less than one test a month. Very few positive results are being obtained. The majority of GPs (72%) and nurses (68%) routinely use the appropriate endocervical swab when testing for chlamydia, however 19% of GPs and 20% of nurses are using either an incorrect wooden-stemmed swab or are taking an inappropriate high vaginal swab. CONCLUSIONS: Few chlamydia tests are being performed in primary care in DPHA, Wales. Health professionals in general practice are in need of, and are in favour of, up-to-date training on all aspects of chlamydial identification and management in primary care. Attention needs to be focused upon resources and the paucity of GUM services and their access within the DPHA area.     

Multicomponent Internet continuing medical education to promote chlamydia screening

BACKGROUND: Low Chlamydia trachomatis screening rates create an opportunity to test innovative continuing medical education (CME) programs. Few studies of Internet-based physician learning have been evaluated with objective data on practice patterns. DESIGN: This randomized controlled trial tested a multicomponent Internet CME (mCME) intervention for increasing chlamydia screening of at-risk women aged 16 to 26 years. SETTING: Eligible physician offices had > or =20 patients at risk for chlamydia as defined by the Health Plan Employer Data and Information Set (HEDIS), had at least one primary care physician (internal medicine, family medicine/general practice, pediatrics) with Internet access, and participated in the study managed care organization. The 191 randomized primary care offices represented 20 states. INTERVENTION: The intervention, available from February to December 2001, consisted of four case-based learning modules, was tailored in real time to each physician based on theory of behavior change, and included office-level feedback of chlamydia screening rates. MAIN OUTCOME MEASURE: HEDIS chlamydia screening rates for the pre-intervention (2000) and post-intervention (2002) periods. RESULTS: Pre-intervention screening rates for the intervention and comparison offices were 18.9% and 16.2% (p =0.135). Post-intervention screening rates for the intervention and comparison offices were 15.5% and 12.4%, respectively (p =0.044, adjusting for baseline performance). CONCLUSIONS: The substantial decline in chlamydia screening rates observed in the comparison offices was significantly attenuated for the intervention offices. The mCME favorably influenced chlamydia screening by primary care physicians.     

Genital Chlamydia trachomatis infection in Australia: epidemiology and clinical implications

Over the last decade, notification rates for genital Chlamydia trachomatis infection in Australia have been rising progressively. While chlamydia is common and possibly increasing in the general population, heterosexual adolescents, indigenous Australians in remote settings, and homosexually active men are at particular risk of infection. Few studies are available on the extent of morbidity from chlamydia-associated diseases. Australia urgently needs a national strategy to control chlamydia, with widespread, selective screening as a key component. As general practitioners have an important role to play, we proffer guidelines for selective testing in primary care.     

Countywide survey of the current practice of chlamydia detection in primary care

BACKGROUND: The Chief Medical Officer's (CMO's) Advisory Group on Chlamydia trachomatis (chlamydia) published its report in 1998 and a national screening programme is anticipated. Meanwhile the Public Health Laboratory Service (PHLS) reports that the number of positive diagnoses of genital chlamydia continued to rise throughout the last decade. OBJECTIVES: To consider the current practice of Gloucestershire general practitioners (GPs) for detecting genital chlamydia infections, and based on the findings to help the development of local guidelines and sexual health service provision. DESIGN: Questionnaire survey. SETTING: Primary care groups within a single English county. METHODS: A questionnaire survey was sent to GPs. Responses were handled anonymously and pooled for analysis. MAIN OUTCOME MEASURES: Response rates from GPs on the types of tests used for detection of chlamydia infection, how frequently they test different patient groups for chlamydia infection and attitudes to contact tracing. RESULTS: In women, opportunistic screening is not routinely performed and the rate of diagnostic testing varies with presentation. The rate of testing is comparatively lower in men and over 50% of GPs refer symptomatic men directly to a genitourinary medicine (GUM) clinic. Fewer than 50% of respondents always or usually forward details to GUM for contact tracing. CONCLUSIONS: Opportunistic screening is performed by a proportion of GPs but there is scope for more screening in higher risk groups. There is scope to increase the number of tests for chlamydia infection in patients presenting with symptoms. A programme of training and education in conjunction with guidelines may have merit in unifying practice and making detection and management of chlamydia more effective. This will have financial and resource implications.     

Is provider continuity associated with chlamydia screening for adolescent and young adult women?

BACKGROUND: Longitudinal patient-provider relationships are a cornerstone of primary care. For many prevention services, better continuity of provider has been associated with better adherence to recommended practice. Our objective was to examine the relationship between continuity of care and chlamydia screening in adolescent and young women, a preventive service where large performance gaps exist. METHODS: The study population included 4117 sexually active women aged 14-25 years continuously enrolled at a large U.S. HMO. Administrative data from 2000 to 2002 were used to document chlamydia testing, provider continuity, and selected covariates. We used logistic regression to examine the relationship between provider continuity and chlamydia testing after controlling for potential confounders. RESULTS: 57.2% of eligible young women received a chlamydia test over the 2-year period. After controlling for utilization and other confounders, we found women in the lowest continuity of care quartile had 41% greater odds of being tested than those in the highest quartile (OR 1.41, 95% CI 1.14-1.76). CONCLUSIONS: For adolescents and young women, the likelihood of testing for chlamydia was reduced when care was concentrated with a usual provider. Potential implications for health service delivery are discussed.     

男男性行为人群生殖道沙眼衣原体自我采样检测及相关因素研究进展

检测是生殖道沙眼衣原体（CT）感染综合防控工作中至关重要的环节,我国MSM的生殖道CT感染率高,检测率低。生殖道CT自我采样检测为MSM提供了一个新的选择,对扩大CT检测在该人群中的覆盖面具有重要作用。本文综述了国内外MSM的CT自我采样检测及相关因素,为CT自我采样检测在该人群中的推广提供依据。     

Sub-standard factors in primary obstetric care

OBJECTIVE: Investigating the frequency and nature of sub-standard care factors in non-complicated pregnancies in primary obstetric care. DESIGN: Retrospective investigation of medical files. METHOD: Data concerning obstetric care in 3 midwifery practices in the Delft area (Pijnacker, Nootdorp, Den Hoorn and Schipluiden), the Netherlands, from 1989-1999 were gathered from the primary National Obstetrics Register. Of the 8362 pregnancy records, 72 were selected at random. Using a checklist containing criteria based on the Obstetrics Indication List, the Cochrane Pregnancy and Childbirth Database, and from an expert panel, the records were analysed for the frequency of occurrence of sub-standard factors in perinatal care. RESULTS: Of the 72 pregnancy records, only 1 was found to contain no sub-standard factors. On average 1.7 sub-standard factors were seen with a maximum of 7. Most frequently found were: too few check-ups during the first trimester (39%), no testing for proteinuria at the first visit (26%) and no administration of prophylactic vitamin K1 (43%). Less frequently found sub-standard care factors were: no ultrasound despite indication (11%), no referral to secondary care in the event of foetal distress (6%), no consultation with secondary care in the event of hypertension (3%), or in the case of membranes ruptured for more than 24 hours (1%). Frequently the circumstances surrounding the departure from the main checklist criteria were found to justify the action. CONCLUSION: Sub-standard care factors were demonstrated in many of the pregnancies investigated. A limited number of these factors gave reason to question whether guidelines for good quality perinatal care are being properly applied.     

Developmental services in primary care for low-income children: Clinicians’ perceptions of the healthy steps for young children program

Difficulties with providing quality primary health care for low-income Americans have been well documented. Few studies have addressed the challenges faced by pediatric clinicians serving low-income families or whether practice-based interventions improve clinicians’ ability to provide quality preventive health services. We investigated if, over time, the Healthy Steps for Young Children program affected the practices and perceptions of clinicians in pediatric primary care practices serving low-income families compared to practices serving more affluent families. Self-administered questionnaires were completed at baseline (N=104) and at 30 months (N=91) by clinicians at 20 pediatric practices participating in the Healthy Steps program. Practices were divided into three groups: those serving families with low, middle, and high incomes. Barriers to providing care, provision of preventive developmental services, and perceptions of care were assessed at baseline and at 30 months after introducing the program. Across all income groups and over time, clinicians were more likely to report the provision of preventive developmental health services. Clinicians in low-income practices reported increased problems with both reimbursement and time barriers; clinicians in high-income practices reported increased problems with reim-bursement. At 30 months, clinicians serving low-income families reported the greatest positive changes in their perceptions about the quality of care provided by their practices. They also were more likely to strongly agree that they gave support to families and to be very satisfied with the ability of their clinical staff to meet the developmental needs of children. We found that Healthy Steps was successful in universally increasing developmental services despite the reported practice barriers for both low- and high-income practices. The Healthy Steps program enabled low-income practices to achieve similar levels of clinician satisfaction as middle- and high-income practices despite having reported lower levels at the beginning months of the program. The Healthy Steps for Young Children Program is a program of the Commonwealth Fund, local funders, and health care providers across the nation. It is cosponsored by the American Academy of Pediatrics. Funding for the Healthy Steps National Evaluation is being provided by the Commonwealth Fund, the Robert Wood Johnson Foundation, the Atlantic Philanthropic Foundation, and local funders. The views presented here are those of the authors and not necessarily those of the funders, their directors, officers, or staff.     

Prevalence and correlates of Chlamydia infection in Canadian street youth.

PURPOSE: To determine the prevalence and correlates of Chlamydia trachomatis in Canadian street youth. METHODS: A cross-sectional study of street youth between the ages of 15-24 years was conducted over a 9-month period in seven large urban centers across Canada. Youth were recruited through "drop-in" centers, outreach work, and mobile vans in each city. Information was collected through a nurse-administered questionnaire. Youth were asked to provide urine to test for chlamydia trachomatis by polymerase chain reaction. Separate logistic regression models were run for males and females controlling for age. RESULTS: The prevalence rate of chlamydia was 8.6% in 1355 youth (95% CI = (7.1%, 10.1%)). Higher prevalence rates were found in females than in males (10.9% vs. 7.3%, respectively) and in Aboriginal youth than in non-Aboriginal youth (13.7% vs. 6.6%, respectively). Four variables were associated with increased risk of chlamydia infection in females: Aboriginal status; self-perceived risk; having no permanent home; and having been in foster care. One predictor of chlamydia for males was having had a social worker. CONCLUSIONS: A high prevalence of chlamydia was found in this vulnerable population in comparison to other Canadian youth. Having been in foster care and having had a social worker were found to have a strong association with chlamydia.     

Poor uptake of self-sample collection kits for Chlamydia testing outside primary care

Objectives: New strategies are needed to reach at‐risk populations for Chlamydia screening. Method: Self‐sample collection kits containing instructions and all items required for testing were developed and piloted in a three‐month trial in primary care. Practice staff offered kits to young people receiving opportunistic Chlamydia screening to pass on to their ‘social contacts.’ Results: The ‘pass it on’ approach failed to reach adequate numbers of youth for testing: of 67 kits distributed, three specimens were sent to the laboratory (4.5%). Conclusions: The method of kit distribution trialled here was not successful in reaching at‐risk youth for testing outside the primary care setting. Implications: Use of self‐sample collection for chlamydia testing outside healthcare settings is likely to be important for increased access to testing. The importance of chlamydia testing needs to be widely promoted and methods for kit distribution to reach at‐risk youth identified.     

Nowhere near the point of diminishing returns: correlations between chlamydia testing and notification rates in New South Wales

OBJECTIVE: To examine the relationship between chlamydia testing and chlamydia detection rates in New South Wales, Australia, from 1999 to 2001. METHODS: Correlations between population-based chlamydia testing and notification rates--stratified by age group, area of residence, and year--were determined by linear regression. RESULTS: Strong positive correlations between chlamydia testing and notification rates were observed for both women (r = 0.91, p < 0.001) and men (r = 0.94, p < 0.001). Between 1999 and 2001, the chlamydia test positivity rate increased from 4.3% to 7.3% for women (p < 0.0001) and from 7.8% to 10.5% for men (p < 0.0001). CONCLUSIONS AND IMPLICATIONS: This study suggests that Australia could benefit from a major chlamydia screening program.     

The accuracy of primary care patients' self-reports of prostate-specific antigen testing.

BACKGROUND: The accuracy of reports made by male primary care patients of previous screening for prostate cancer with the prostate-specific antigen (PSA) assay is important for clinical practice, surveillance, and research. METHODS: As part of a clinical trial that evaluated a decision aid for prostate cancer screening, 133 male primary care patients, aged 45 to 70 years, were contacted 1 year after enrollment and asked whether they had received PSA testing. To corroborate these self-reports, each patient's clinic and hospital medical records were reviewed for evidence of PSA test results. RESULTS: The raw percentage agreement between self-reported PSA testing and the medical records was 74.4% (kappa=0.48). When compared to the findings of the medical record reviews, apparent overreporting by some patients was explained by problems with recalling the test within the 1-year time frame (4.5%) and by having been tested outside of the medical center (5.3%). Uncertainty about having been tested was reported by six (4.5%) patients with PSA test results in their medical records. Misreported testing could not be explained for 11.3% of patients. Patients who had not completed high school were 2.7 times more likely to misreport PSA testing (95% confidence interval, 1.61-3.87). CONCLUSIONS: The accuracy of primary care patients' self-reports of previous PSA testing is questionable. Errors in reporting are due largely to problems with recalling a test within a specific time frame or to testing outside of the primary care setting. Under-reporting is a problem for patients uncertain of previous testing.     

Reporting of laboratory-confirmed chlamydial infection and gonorrhea by providers affiliated with three large managed care organizations--United States, 1995-1 999

Surveillance for sexually transmitted diseases (STDs) depends on health departments receiving reports of positive STD test results from laboratories or of STD cases by clinicians. The completeness and timeliness of reporting can affect prompt sex partner notification and outbreak detection. In 1998, approximately 70% of chlamydia cases and 55% of gonorrhea cases were reported by private clinicians, including many affiliated with managed care organizations (MCOs). However, little is known about the completeness and timeliness of MCOs' STD case reporting practices. Three MCOs, three state health departments, and CDC evaluated reporting practices for chlamydial infection and gonorrhea by three large staff or group model MCOs that used different reporting procedures. The findings indicate that state health departments were notified of 78%-98% of chlamydia cases and of 64%-80% of gonorrhea cases identified in these MCOs; the median interval between specimen collection and state health department receipt of a case report was < or = 19 days. To improve surveillance quality, other MCOs, including network model MCOs, which provide most STD care in the United States, should evaluate surveillance quality and identify interventions for improvement.     

Pursuing equity: contact with primary care and specialist clinicians by demographics, insurance, and health status

PURPOSE Long-term shifts in specialty choice and health workforce policy have raised concern about the future of primary care in the United States. The objective of this study was to examine current use of primary and specialty care across the US population for policy-relevant subgroups, such as disadvantaged populations and persons with chronic illness.METHODS Data from the Medical Expenditure Panel Survey from 2004 were analyzed using a probability sample patients or other participants from the noninstitutionalized US population in 2004 (N = 34,403). The main and secondary outcome measures were the estimates of the proportion of Americans who accessed different types of primary care and specialty physicians and midlevel practitioners, as well as the fraction of ambulatory visits accounted for by the different clinician types. Data were disaggregated by income, health insurance status, race/ethnicity, rural or urban residence, and presence of 5 common chronic diseases.RESULTS Family physicians were the most common clinician type accessed by adults, seniors, and reproductive-age women, and they were second to pediatricians for children. Disadvantaged adults with 3 markers of disadvantage (poverty, disadvantaged minority, uninsured) received 45.6% (95% CI, 40.4%–50.7%) of their ambulatory visits from family physicians vs 30.5% (95% CI, 30.0%–32.1%) for adults with no markers. For children with 3 vs 0 markers of disadvantage, the proportion of visits from family physicians roughly doubled from 16.5% (95% CI, 14.4%–18.6%) to 30.1% (95% CI, 18.8%–41.2%). Family physicians constitute the only clinician group that does not show income disparities in access. Multivariate analyses show that patterns of access to family physicians and nurse-practitioners are more equitable than for other clinician types.CONCLUSIONS: Primary care clinicians, especially family physicians, deliver a disproportionate share of ambulatory care to disadvantaged populations. A diminished primary care workforce will leave considerable gaps in US health care equity. Health care workforce policy should reflect this important population-level function of primary care.     

Association of Chlamydia trachomatis with persistence of high-risk types of human papillomavirus in a cohort of female adolescents

Human papillomavirus (HPV) infection is a necessary but not sufficient cause of cervical cancer. While chlamydia infection has been associated with cervical cancer, the meaning of this association remains unclear. The authors' objective was to investigate this association by evaluating whether concurrent genital tract infections are associated with HPV persistence, a precursor to cervical cancer. Interview data and biologic samples for HPV, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and bacterial vaginosis testing were collected from female adolescents in an Atlanta, Georgia, longitudinal cohort study at 6-month visits (1999-2003). Associations with persistence (detection of the same HPV type at two sequential visits (visit pair)) were assessed among subjects with 2-5 visits and > or =6 months of follow-up. Associations were evaluated by logistic regression using methods for correlated data. Type-specific persistence of high-risk HPV types was detected in 77 of 181 (43%) analyzed visit pairs. Concurrent infection with C. trachomatis was independently associated with persistence of high-risk HPV types (adjusted odds ratio = 2.1, 95% confidence interval: 1.0, 4.1). Infection with more than one HPV type at the initial visit was also associated with high-risk persistence (adjusted odds ratio = 2.8, 95% confidence interval: 1.6, 4.9). The association between chlamydia infection and cervical cancer may be due to an effect of chlamydia infection on persistence of high-risk HPV.