Adolescents and young adults have the highest rates of chlamydia infections compared with other age groups. Early detection of this infection can reduce disease spread and prevent the sequelae of untreated chlamydia infections. Chlamydia infections frequently are asymptomatic, so screening programs have been emphasized. Unfortunately, several obstacles reduce the likelihood that persons in this age group will be screened. These obstacles include lack of health insurance and a regular health care source, fear of the traditional chlamydia testing methods and results of tests for sexually transmitted diseases (STDs), and concern that others might discover that they were tested. To better understand these obstacles, Blake and colleagues studied young people's beliefs and opinions about obstacles and motivation for obtaining STD testing. They also provided recommendations for improving young people's participation in chlamydia screening programs.

The study design incorporated eight focus-group interviews of young adults 15 to 24 years of age. Participants were recruited from Job Corps and Department of Youth Services sites. The groups were divided equally into male and female groups. Each focus group was interviewed using a structured interview guide. Each session was audiotaped and transcribed by an outside agency. The text was evaluated using published content analysis techniques, and major themes were identified.

Participants identified obstacles to testing, including concern that someone would find out they were tested or had tested positive, fear of discovering they had an STD, and fear of testing positive for human immunodeficiency virus infection. Many participants had limited understanding of the physical effects of chlamydia infections, and some thought it was possible to die of this infection. Study participants recommended providing more information about the effects of chlamydia infections, the availability of a simple urine test, and treatment regimens. They said it is necessary to make the STD screening process more confidential. There was overwhelming interest in the possibility of a home test for chlamydia infections.

The authors conclude that to improve youth and young-adult participation in chlamydia screening programs, more information about this infection must be made available, and misconceptions and concerns about screening, including privacy concerns, must be addressed.

editor's note: Because chlamydia infections can be asymptomatic and because of the potential morbidity of this infection, the Centers for Disease Control and Prevention recommends that all adolescent and young adults be screened for it. Despite these recommendations, the rate of screening for chlamydia remains low. Physicians should be aware of the issues addressed by Blake and colleagues and educate young people about chlamydia infection and potential outcomes. In addition, we need to assure confidentiality. If left unaddressed, chlamydia infections will continue to go undetected in this age group.—K.E.M.