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Even when the scarring is not severe enough to cause sterility, it can prove troublesome. It can cause a fertilized egg, normally implanted in the uterus, to become embedded and begin dividing in a fallopian tube, leading to a potentially life-threatening condition known as tubal or ectopic pregnancy. Since 1967 the incidence of ectopic pregnancy in the U.S. has tripled. According to Dr. King Holmes, chief of medicine at Harborview Medical Center in Seattle, chlamydia may be a factor in at least one-quarter of the cases.
Women who contract chlamydia during a normal pregnancy face yet another serious problem: transmitting the disease to their babies, who are infected while passing through the birth canal. In infants, chlamydia manifests itself in the form of conjunctivitis, an inflammation of the eye, or as pneumonia. There is also some evidence, Holmes says, that chlamydial infection during pregnancy increases the risks of premature and stillborn births.
Because chlamydia is easy to treat once it is diagnosed, the key to preventing its spread--and its sometimes serious consequences--is better detection. That could be provided by two recently developed diagnostic tests that are both inexpensive and rapid. One, called MicroTrak, has been marketed for a year by the Syva Co. of Palo Alto, Calif., and provides a diagnosis in less than half an hour. The other, devised by Abbott Laboratories of North Chicago, Ill., takes from 3 1/2 to four hours but is better suited for testing large numbers of people. It became available nationwide last week.
Chlamydia is so widespread that some doctors have begun administering the appropriate antibiotics to suspect patients even before the results of diagnostic tests are in. For example, because 40% of women and 20% of men with gonorrhea also have chlamydia, the CDC's Cates recommends that anyone with a confirmed case of gonorrhea be treated for chlamydia as well. Schachter suggests the same policy for women with PID. "You can't just sit around and wait for a lab diagnosis," he says. "The patient could wind up sterile."
Alarmed by the spread of the disease, Washington State's King County, which includes Seattle, last December allocated $120,000 for a community-wide chlamydia-screening program. Says the county health department's Dr. Hunter Handsfield, who heads the effort: "The problem nationwide is that chlamydia is an out-of-sight, out-of-mind phenomenon." Only when more public health officials recognize and face up to it, he says, will the silent epidemic be brought under control.