NUR 350 Module 5 Epidemiology Paper example

More Cases or More Testing? An Epidemiologic Look at Chlamydia Among 15- to 24-Year-Olds in Lakeview County

[Student Name]

Southern New Hampshire University

NUR 350: Community and Population Health

Module Five Epidemiology Paper

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[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

More Cases or More Testing? An Epidemiologic Look at Chlamydia Among 15- to 24-Year-Olds in Lakeview County

Background

Chlamydia trachomatis infection is the most commonly reported bacterial sexually transmitted infection in the United States, and adolescents and young adults carry a large share of the burden. Most infections cause no symptoms, so they are found mainly through screening. Untreated infection in women can lead to pelvic inflammatory disease, ectopic pregnancy, chronic pelvic pain and infertility. Because of these risks, national guidance recommends screening every sexually active woman up to her 25th birthday, and older women at increased risk; evidence was judged insufficient to recommend routine screening of men (US Preventive Services Task Force et al., 2021). Treatment is simple and effective, and treatment of partners reduces reinfection (Workowski et al., 2021).

The Lakeview County health department noted that reported chlamydia cases among residents aged 15 to 24 rose between 2021 and 2023. This paper calculates rates for that age group by sex and year, examines whether the increase reflects more infection or more detection, and recommends actions for the community health nurse.

Data and Methods

Case counts came from the state's notifiable disease surveillance system, which records laboratory-confirmed chlamydia infections by county of residence, age and sex. Test volume came from the two laboratories that process nearly all chlamydia tests from Lakeview County providers, which reported the total number of tests and positive results for residents aged 15 to 24. For denominators, the county's census population estimates were used, which were nearly unchanged between 2021 and 2023: about 9,800 women and 10,200 men aged 15 to 24. Rates were calculated per 100,000 population, the standard approach for comparing groups and years of different size (Stanhope & Lancaster, 2020). In late 2021, a school-based health center opened at the county's largest high school and began offering confidential testing, which the analysis considers as a possible influence on detection.

Results

Table 1 shows case counts, populations and calculated rates.

Table 1

Reported Chlamydia Cases and Rates Among Lakeview County Residents Aged 15 to 24, 2021 and 2023

Note. Composite data written for this paper. Rates are cases divided by population, multiplied by 100,000.

For women, the 2023 rate was 412 divided by 9,800, multiplied by 100,000, or 4,204 per 100,000, an increase of 14.5 percent from 3,673 in 2021. For men, the rate rose from 1,157 to 1,549 per 100,000, an increase of 33.9 percent. The overall rate for the age group rose from 2,390 to 2,850 per 100,000, an increase of 19.2 percent. In both years, the rate among women was substantially higher than among men; the ratio of the female to the male rate was 3.2 in 2021 and 2.7 in 2023.

Test volume changed over the same period. Laboratories processed 5,900 chlamydia tests for residents aged 15 to 24 in 2021 and 7,200 in 2023, an increase of 22.0 percent. The share of tests that were positive, however, was nearly unchanged: 478 of 5,900, or 8.1 percent, in 2021, and 570 of 7,200, or 7.9 percent, in 2023.

Interpreting the Findings

The rise in reported cases appears to reflect more testing rather than more infection. Test volume grew by about 22 percent while the percentage of tests that were positive stayed steady at about 8 percent. If infection had become more common, positivity would be expected to rise; instead, more infections were found because more young people were tested. The timing fits the opening of the school-based health center, which made confidential testing easier for adolescents to obtain. This interpretation is reassuring in one sense, because finding and treating more infections should reduce complications and onward spread. It also means the earlier, lower rate had been hiding undiagnosed infections.

The sex difference also needs careful interpretation. Women's rates are about three times men's, but screening recommendations focus on women, and women are more likely to be tested during reproductive health visits. Men are tested mainly when they have symptoms or a partner has been diagnosed. The higher female rate therefore reflects both true differences and the fact that many infected men are never tested. The faster rise in the male rate, 33.9 percent, may indicate that the school-based center reached young men who previously had no convenient place to be tested.

Recommendations for Community Health Nursing

Four actions follow from the analysis. First, sustain and expand confidential testing where young people already are, including the school-based health center, the community college and youth-serving organizations, since access appears to drive detection. Second, strengthen testing of young men through sports physicals, clinic visits and outreach in settings they use, recognizing that the evidence for routine male screening is limited but that treating infected partners protects women. Third, ensure that every diagnosed patient receives treatment, partner notification or expedited partner therapy where permitted by state law, and retesting about three months after treatment to detect reinfection (Workowski et al., 2021). Fourth, monitor positivity along with case counts in future reports so that changes in testing are not mistaken for changes in infection.

Limitations

This analysis has several limits. Surveillance counts include only diagnosed and reported cases. Test volume came from two laboratories and may miss a small number of tests processed elsewhere. Positivity can change for reasons other than prevalence, such as a shift toward testing lower-risk people. Finally, the analysis examined only two years; a longer series would show whether the pattern persists.

The county's data systems could also be improved. Linking laboratory test counts to surveillance reports every quarter, rather than requesting them once for a special analysis, would let the health department track positivity routinely. Adding the testing site to each case report would show which settings are finding the most infections and which groups are still not being reached.

Conclusion

Reported chlamydia rates among young people in Lakeview County rose between 2021 and 2023, but stable test positivity with a large increase in testing suggests that the rise reflects better detection rather than more infection. The community health nurse can build on that success by expanding testing access, reaching young men, ensuring treatment and partner services, and reporting positivity alongside rates so that the numbers tell the true story.

References

Stanhope, M., & Lancaster, J. (2020). Public health nursing: Population-centered health care in the community (10th ed.). Elsevier.

US Preventive Services Task Force, Davidson, K. W., Barry, M. J., Mangione, C. M., Cabana, M., Caughey, A. B., Davis, E. M., Donahue, K. E., Doubeni, C. A., Krist, A. H., Kubik, M., Li, L., Ogedegbe, G., Pbert, L., Silverstein, M., Simon, M. A., Stevermer, J., Tseng, C.-W., & Wong, J. B. (2021). Screening for chlamydia and gonorrhea: US Preventive Services Task Force recommendation statement. JAMA, 326(10), 949-956. https://doi.org/10.1001/jama.2021.14081

Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021). Sexually transmitted infections treatment guidelines, 2021. MMWR Recommendations and Reports, 70(4), 1-187. https://doi.org/10.15585/mmwr.rr7004a1