Chlamydia - Women

Chlamydia - Women in United States

United States

The vast majority of reported chlamydia cases in the United States are in women, particularly women of reproductive age. In 2021, approximately two-thirds of all reported chlamydia cases occurred in adolescents and young adults ages 15-24. The rate was more than twice as high among females in this age group compared with males of the same age. 

Chlamydia is one of the most commonly reported sexually transmitted infections (STIs) in the U.S., and has been steadily increasing in prevalence over the last few decades. Although this trend appears to have reversed in 2020, the Centers for Disease Control (CDC) cautions that COVID-19-related decreases in health care utilization and STD screenings likely led to underdiagnosis of chlamydial infections during this period. 

While chlamydial infection usually has no noticeable symptoms, it can cause permanent damage to reproductive organs if left untreated. Among women, untreated chlamydia can lead to pelvic inflammatory disease, infertility, ectopic pregnancy (pregnancy outside the uterus) and chronic pelvic pain. Further, chlamydial infection in pregnant women can result in negative health outcomes for the baby, including premature birth, low birth weight, conjunctivitis (pink eye) and pneumonia.

Because chlamydia is one of the most common STIs, it is also one of the most costly. Direct medical costs for chlamydia totaled $691 million in the U.S. in 2018. Lifetime medical costs of chlamydia are much higher for women, estimated at $262 ($127–$483) per infection, compared to just $46 ($32-$62) for men.

Social conditions such as poverty, low educational attainment and unemployment can present barriers to accessing quality sexual health care and contribute to higher rates of chlamydia. 

Rates of reported cases of chlamydia are higher among:

• Black women, who have a rate nearly 14 times higher than Asian women. American Indian/Alaska Native and Hawaiian/Pacific Islander women also have a high rate, while white, multiracial and Hispanic women also have a low rate.
• Women ages 20-24, followed by women ages 15-19, compared with women ages 25 and older.

While abstinence is the only completely effective prevention strategy, mutual monogamy, reducing the number of sexual partners and proper use of latex condoms and dental dams can reduce transmission. Screening for and discussing STI status with sexual partners are critical to stopping the spread of chlamydia, and screening may prevent complications of chlamydia infection among high-risk women. The CDC recommends regular chlamydia screening for:

• Sexually active women younger than age 25.
• Sexually active women ages 25 and older with a new partner, multiple partners or a partner with a positive STI screening.
• Pregnant women at their first prenatal visit and during the third trimester.

If diagnosed, chlamydia is easily cured with antibiotics combined with abstinence during the antibiotic course. Expedited partner therapy is available in some states and allows providers to prescribe antibiotics for sexual partners of individuals diagnosed with chlamydia, which has been shown to prevent reinfection.

Healthy People 2030 has an objective to increase the proportion of sexually active female adolescents and young women who get screened for chlamydia.

Elflein, John. “Number of Reported Cases of Chlamydia in the United States from 1985 to 2021,” April 20, 2023. https://www.statista.com/statistics/626841/number-of-cases-of-chlamydia-in-the-us/.

Gable, Jennifer, Jennifer Eder, and Cynthia Mollen. “Preventing Chlamydia and Gonorrhea Reinfection through Increased Use of Expedited Partner Therapy.” Evidence to Action Brief. Philadelphia: PolicyLab at CHOP Research Institute, December 2016. https://policylab.chop.edu/sites/default/files/pdf/publications/Preventing_Chlamydia_Gonorrhea_Reinfection_through_Increased_Use_of_EPT.pdf.

Kumar, Sagar, Harrell W. Chesson, Ian H. Spicknall, Kristen M. Kreisel, and Thomas L. Gift. “The Estimated Lifetime Medical Cost of Chlamydia, Gonorrhea, and Trichomoniasis in the United States, 2018.” Sexually Transmitted Diseases 48, no. 4 (April 2021): 238–46. https://doi.org/10.1097/OLQ.0000000000001357.