UN-SDG CASE STUDY – CHLAMYDIA TRACHOMATIS and GENDER
Amari Carlson, Payton Powell, Dylan Lujan, Ernesto Robles-Rodriguez
College of Southern Nevada (Henderson Campus)
Professor Rudacille
SOC: 101
12/3/2025
Chlamydia is a type of sexually transmitted infection that mostly affects women. It can cause serious problems if it is not treated, so it is important to understand why it affects women the most. In this project, we are looking at different countries to see how they deal with chlamydia and how the infection rates in women are different around the world. By comparing countries, we can get a better idea of why women are more at risk in some places and how different prevention methods can help.
Chlamydia can be serious for women. “In the USA alone, more than 1.7 million cases are reported each year,” (Qu et al., 2021) and “women also face serious risks like infertility, pelvic inflammatory diseases, and ectopic pregnancy” (Qu et al., 2021) if it is not treated. One reason it is worse for women is that the infection can reach parts of the body that cause long term problems and many women do not notice any symptoms at first. This means that infections can go unnoticed and can cause trouble later. Studies have looked at how often women are checked, how the infection spreads, and what methods work best to prevent it in different countries. Studies show that if chlamydia is not being treated, it can have long-term effects on women’s health. “Early screening and proper treatment can help reduce infection rates and prevent serious health outcomes for women,” (Qu et al., 2021) which shows why focusing on women is so important when trying to control this infection worldwide. Looking at different counties also helps us understand which programs are effective and which ones could be improved to protect women the most.
Research on women’s health in Europe shows that young women experience the highest rates of chlamydia trachomatis infection and face the most serious long-term consequences when cases go untreated. Two major studies highlight both the prevalence of infection and the unique reproductive risks women face. In Germany, Gassowski et al. used data from two population-based surveys and a laboratory surveillance system to measure infection rates across age groups. Their findings show that chlamydia is most common among adolescent and young adult women, with 2.8% of girls aged fifteen to seventeen and 2.3% of women aged eighteen to twenty-four testing positive. The study also noted that men are screened far less often, creating undetected infections that contribute to continued transmission among women. The authors emphasized that early screening is essential to prevent long-term harm.
A Dutch study by Hoenderboom et al. followed women who had previously participated in a national screening trial to examine long-term reproductive outcomes. The researchers found clear links between prior chlamydia infection and pelvic inflammatory disease, ectopic pregnancy, and tubal factor infertility. Because these complications primarily affect women and can result in permanent reproductive damage, the study demonstrates how untreated infections disproportionately impact women’s health.
In comparison, the United States shows similar patterns but takes a different approach to detection and treatment. Chinnock et al. studied the effects of rapid nucleic acid amplification testing (NAAT) in emergency departments, comparing a new 90-minute test to the standard 24hour turnaround time. After the rapid test was implemented, incorrect treatment rates for women dropped from 37% to 19, while the control group saw almost no improvement. These results indicate that faster testing significantly improves treatment accuracy for women and reduces missed or delayed care. Across both Europe and the United States, young women remain the most affected group, but countries differ in how they address the issue. Europe through population-level monitoring and the U.S. through faster clinical diagnostics.
In Australia, specifically in Melbourne and Sydney, researchers conducted a study that would follow the women up to fifty-six days “post treatment” and determine whether women contracted chlamydia through reinfection or treatment failure. They used various methods, including comprehensive sexual data collection, the detection of Y chromosome DNA, and high discriminatory chlamydial genotyping (Hocking et al, 2013). Moreover, they would measure the azithromycin antibiotic levels of the women using a “validated liquid chromatography - tandem mass spectrometry” method to determine if low azithromycin absorption could be a cause of treatment failure (TF). Finally, the behavior surrounding chlamydia and the lowest dose of azithromycin given to prevent this infection will be experimented with as well.
After this study, they concluded that “if our hypothesis is correct and 8, rather than 23 fail chlamydia treatment with azithromycin, then nearly 3,000 women in Australia and 70,000 women in the USA were inadequately treated for chlamydia in 2011” (Hocking et al, 2013). Moreover, this treatment failure could lead to persistent infection with longer time of each infection and higher risk of complications. Additionally, they also found that there is “little monitoring of chlamydia antibiotic susceptibility, and the role of antimicrobial resistance in treatment failure is unknown” (Hocking et al, 2013). If this study finds that one gram of Azithromycin is sufficient in treating ct, then this will contribute to making treatment of chlamydia more efficient.
There is also relevant information in China. In one study done from 2006-2020, it focused on “newly diagnosed and reported chlamydia cases in women aged 15-49” (Zhao, et al, 2025). They included all diagnosed cases starting January 1, 2006 to December 31, 2020. They included data from twenty-one provinces in Guangdong Province. They used Quasi-Poisson regression models to examine the relationship between sociodemographic factors and chlamydia incidence. Results were that “from 2006 to 2020, 523,367 new chlamydia cases were reported among women of reproductive age in Guangdong” (Zhao, et al, 2025). They found that from 2006 to 2020, the percentage of chlamydia increased exponentially, from 47.4 in 2006 to 95% in 2020. Also, in older women, “9,045 cases were reported, with a mean reported rate of 4.9 per 100,000, rising significantly from 0.01 in 2006 to 9.6 in 2020” (Zhao et al, 2025).
To add on, another study conducted found 3008 patients with infection in thirteen hospitals in twelve provinces of China, which were performed between May 2017 and November 2018. In total, 2,908 participants were included. “The prevalence rates of chlamydia and gonococcal infections in women with genital tract infections were 6.33% and 0.01% respectively” (Zhang et al, 2023). Equally important, premarital sex, first sexual intercourse before age 20, and bacterial vaginosis were “high-risk factors” in their analysis. To end, they concluded that since most chlamydia cases were asymptomatic and no vaccine was available, strategies to combat the infection should include “behavioral interventions as well as early screening programs” to properly identify chlamydia trachomatis and treat individuals efficiently.
Compared to the U.S., and Europe, Australia is not as developed in their methods in how to combat chlamydia trachomatis. However, they are not far behind. When we look at China, their rates are increasing far more and by greater numbers than both the U.S. and Europe. Moreover, their strategies to treat this infection are less advanced. Overall, in combating ct globally, methods/strategies like the U.S. and Europe are leading the way in research and solutions.
In Kenya, specifically Kisumu, Nairobi, and the coastal region a study was conducted by multiple researchers looking at young HIV-negative cis-gender men, (MSM) who often have intercourse with men and transgender women, (TSW). All 650 participants of the study were given 650 Kenyan shillings (U.S $5.6) for scheduled follow-up visits. At baseline 15.8% of MSM and 27.5% of TSW had chlamydia or gonorrhea, transgender women were also discovered to have higher rates of oropharyngeal CT/NG at around 15.2% compared to cis-gendered men at around 1%, “despite the higher prevalence of infections among TSW there were no differences in CT/ NG prevalence and incidence between TSW and MSM” (Sanders EJ, et al. BMJ Open 2025) ,with both groups getting reinfected at a similar rates even after adjustment, Participants who already had a baseline CT/NG infection were three times more prone to reinfection even well after treatment. Improved contraceptive use, partner notification and newer strategies such as doxycycline post-exposure prophylaxis are needed to help fight the crisis, tests are expensive but important for proper screening and reliable diagnoses especially when dealing with the asymptomatic nature of these infections
This situation highlights a massive unmet need for STI prevention among vulnerable populations who tend to have a lower socioeconomic status.
With all this in mind, it can be concluded that there is still far more research to be done toward combating the prevalence of chlamydia around the world. In countries like the U.S., Europe, and Australia, there seems to be far more research completed already and there are strategies that have been developed and becoming more efficient. In countries like China and Kenya, there still needs to be far more research in developing methods to solve this issue.
Overall, women suffer from this infection far more than men, and in our research, it would be beneficial to include men like women. Sexual behavior and culture do impact the knowledge and ultimately the treatment that women receive, also the time and place they receive it. Women have higher risk for dangerous complications with their pregnancies and overall health when infections go untreated, and developments are underway in combating this. However, we still see that rates are high in women in specific locations, and this is due to socioeconomic status, geographic location, and the efficiency of the nation the women reside in. Despite these disparities, nations are recognizing this as a healthcare problem that needs to be addressed and they are trying to develop better methods, including factors they did not consider before and emphasizing some that they had not, and in doing this they have found success.
References
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Chinnock, B., Ramirez, G., Teran, C., & Kouklis, G. (2025). Implementation of a 90-minute gonorrhea and chlamydia test decreases antibiotic under- and overtreatment in female emergency department patients. The Journal of Emergency Medicine, 75©, 307–318. [Implementation of a 90-minute gonorrhea]
Elisabeth AB, Dirk Luijt, Alewijn Ott, & Janny H Dekker. (2022). High rates of anorectal chlamydia in women: a cross-sectional study in general practice. BJGP Open, 6(3). High rates of anorectal chlamydia in women
Gassowski, M., Poethko-Müller, C., Schlaud, M., Sailer, A., Dehmel, K., Bremer, V., Dudareva, S., & Jansen, K. (2022). Prevalence of Chlamydia trachomatis in the general population in Germany – a triangulation of data from two population-based health surveys and a laboratory sentinel system. BMC Public Health, 22, 1-9. Prevalence of Chlamydia trachomatis in the general population in Germany
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Hocking, J. S., Vodstrcil, L. A., Huston, W. M., Timms, P., Chen, M. Y., Worthington, K., McIver, R., & Tabrizi, S. N. (2013). A cohort study of Chlamydia trachomatis treatment failure in women: a study protocol. BMC Infectious Diseases, 13, 379. A cohort study of Chlamydia trachomatis
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