By andy Zieminski
ANNAPOLIS – Reported chlamydia cases in Maryland jumped by 57 percent from 1997 to 2006, and one state health official called it “the tip of the iceberg” for the often symptom-less sexually transmitted disease.
Diagnosed chlamydia cases increased in all but Talbot County and the rate per capita grew in all but Talbot and Worcester counties, according to the Department of Health and Mental Hygiene.
But state and local health officials attribute largely to improved screening methods.
“To me, chlamydia is one of these tip-of-the-iceberg things,” said Barbara Conrad, the state health department’s sexually transmitted disease director. “If there were more testing, I think we would find more of it.”
The number of cases statewide grew from 13,965 in 1997 to 21,859 last year, while the rate grew from 273 cases per 100,000 people to 389 per 100,000 in the same period.
Baltimore City had the state’s highest 2006 rate at 989 per 100,000 population, followed by Somerset, Dorchester, Prince George’s and Wicomico counties. Carroll County had the lowest rate, at 86 per 100,000 people.
“It’s prevalent. It’s probably one of the most frequent STDs we encounter with our patients,” said Dr. Donald Shell, the Prince George’s County health officer.
Shell said reported cases are up primarily because new urine testing methods are less invasive than the other type of screening, a genital swab. It is easier to get people, particularly men, to agree to the voluntary urine test, Shell said.
Prince George’s tests people in sexually transmitted disease clinics and during routine physical exams.
Chlamydia is the most commonly reported bacterial STD in the country, but it remains considerably underreported because three-quarters of infected women and half of infected men show no symptoms, according to the Centers for Disease Control and Prevention.
Health experts estimate that as many as 3 million new cases occur nationwide every year, but only one-third are diagnosed.
Shell declined to estimate the number of undiagnosed cases in Prince George’s, but said a “rule of thumb” is that half of sexually active people become exposed to sexually transmitted diseases.
Fred Wyand of the American Social Health Association described the onset of noticeable chlamydia symptoms in women as a “domino effect.” The infection can spread from the vagina throughout the reproductive tract, causing painful inflammation, abscesses and, if left untreated long enough, infertility.
Pregnant women with chlamydia can pass it to their babies, causing eye disorders and even blindness in newborns.
For men, complications such as pain and eventual sterility are rare. Health officials say it can be challenging to convince men of the need to get tested when they are not exhibiting symptoms.
Last year, less than 2 percent of the 4,670 people tested for chlamydia in Anne Arundel County were men, said Elin Jones, a county health department spokeswoman.
Conrad said it is important for health departments to screen more men because even they have “fewer short-term or long-term health effects, they can serve as a source of infection or a reservoir of infection for females.”
Sexually transmitted disease clinics in Baltimore — which reported one-third of the state’s total chlamydia cases last year — do not test men specifically for the infection, said Dr. Laura Herrera, the city’s chief health officer. Men receive a general screening that can, but does not necessarily, identify chlamydia.
The General Assembly passed a law this year establishing a pilot program in Baltimore aimed at curbing high rates of chlamydia and gonorrhea. Under the program, people diagnosed with these STDs can receive antibiotic treatments for themselves and their sexual partners, as well as educational materials.
Federal health officials recommend sexually active women under age 26 receive annual screenings for chlamydia. Once identified, the STD is easily treated with antibiotics.