Chlamydia trachomatis Infections in Female Soldiers, Israel Ellen S. Bamberger,* 1 Efraim Siegler,† 1 Einat Makler-Shiran,† Mihir V. Patel,† Jordan M. Steinberg,‡ Rosa Gershtein,* and Isaac Srugo* We examined the prevalence of Chlamydia trachoma- tis infection in Israeli female soldiers. The prevalence was 3.2% among soldiers seeking medical care; rural residence was identified as a significant risk factor. Nevertheless, given the study design, recommending broad-scale screen- ing of Israeli female soldiers may be premature. R ecent studies from the United States and Europe report that the prevalence of Chlamydia trachomatis ranges from 5% to 20% in sexually active persons (1,2). Among women, the consequences of the disease include pelvic inflammatory disease, ectopic pregnancy, and infertility, sequelae often accompanied by a substantial economic impact (3). Most importantly, for up to 80% of infected women, infection is asymptomatic, resulting in failure to seek timely medical care and the exacerbation of such sequelae (4). Consequently, screening programs have been recommended to reduce infection, transmission, and dis- ease consequences (4,5). However, before such programs are universally advocated, since the cost-effectiveness of such control programs is at least partially contingent upon disease prevalence (5), more data are required to assess the extent to which such prevalence rates may indeed be gen- eralizable to other countries and populations. Epidemiologic research indicates that prevalence rates of C. trachomatis vary, with a number of risk factors accounting for a substantial portion of this variance (4). For example, in the landmark study by Gaydos et al., sig- nificant risk factors for the prevalence of this infection among American female military recruits included age (women <25 years of age were at higher risk), vaginal intercourse, lack of condom use, and multiple sexual part- ners (4). Given that sexual practices such as condom use and multiple sex partners are likely to vary from country to country, we designed a study to assess the prevalence of C. trachomatis in a population of Israeli women, namely female soldiers, who, according to previous research, had a heightened risk of having the disease because of their age and sexual activity (4–6). The Study Whereas Gaydos et al. invited all female army recruits undergoing a physical examination at a reception base over the course of 2-year period to participate in their study, our sample consisted of Israeli women actively seeking med- ical care. Specifically, participants in the current study were women serving in the Israel Defense Forces, who, over a 12-month period attended a women’s health clinic for a routine gynecologic examination, treatment of geni- tourinary symptoms, or contraceptive counseling. The clinic was associated with a major tertiary hospital in northern Israel. Of the 800 women we asked, 708 volun- teered to participate, for a response rate of 88.5%. Participants were between the ages of 18 and 45 (median age 19, mean age 20). Most participants (77%) were born in Israel. After signing an informed consent form, participants were asked to complete a short questionnaire (including demographic and sexual history items) and provide a urine specimen. We performed the polymerase chain reaction (PCR) of urine specimens to test for C. trachomatis and Neisseria gonorrhoeae (Roche Amplicor, Branchburg, NJ). The PCR results and questionnaire data were coded as dichotomous variables and examined on the basis of both univariate (chi-square and Fisher exact test) and multivari- ate (logistic regression) analysis. Of the 708 participants, 23 (3.25%) tested positive for C. trachomatis, and 8 (1%) tested positive for N. gonor- rhoeae. These rates are substantially lower than the 9.2% prevalence rate for C. trachomatis reported by Gaydos in the U. S. military study (4). The median and average age of those affected was 20. Most of those testing positive reported 1) having had sex in the past 3 months (86%), 2) having had more than one partner (45%) or having had a partner who had had more than one partner (57%), or 3) never having used a condom (70%) (Table). Nevertheless, none of these factors, identified by Gaydos as significant risk factors in the American sample, was found to be a sig- nificant predictor of C. trachomatis infection in the Israeli soldiers. Similarly, while most of those testing positive were born in Israel (81%), country of origin was not a sig- nificant predictor of infection. Neither were gynecologic symptoms found to significantly distinguish between C. trachomatis–positive and –negative soldiers. Indeed, the only factor that we found to significantly distinguish 1344 Emerging Infectious Diseases  Vol. 9, No. 10, October 2003 DISPATCHES 1 Dr. Bamberger and Dr. Siegler contributed equally. *B’nai Zion Medical Center, Haifa, Israel; †Rambam Medical Center, Haifa, Israel; and ‡Albert Einstein College of Medicine, Bronx Burough of New York, New York, USA