Prevalence and determinants of genital Chlamydia trachomatis among school-going, sexually experienced adolescents in urban and rural Indigenous regions of Panama.

Objectives To determine the prevalence and risk factors of genital Chlamydia trachomatis (CT) among school-going sexually experienced male and female adolescents in Panama. Methods We conducted two multisite cross-sectional studies using two-stage cluster sampling to select adolescents aged 14–19 years attending urban public high schools (URB) in Panama City, San Miguelito, Colon and Panama Oeste from 2015 to 2018, and in the rural Indigenous Comarca Ngabe-Bugle (CNB) from July–November 2018. CT testing was performed by real-time PCR on urine samples. Random-effects logistic regression accounting for sample clustering was used to identify risk factors. Results We enrolled 3166 participants (54.3% females), median age 17 years (IQR: 15.9–18.1), with no difference by sex. Sexual experience was reported by 1954 (61.7%) participants. Combined CT prevalence was 15.8% (95% CI: 14.2 to 17.4), with no significant differences by region (URB=16.5%, 95% CI: 14.7% to 18.6%; CNB=13.6%, 95% CI: 10.9% to 16.8%; p=0.12). In an age-and-region-adjusted analysis, CT prevalence was higher among female participants compared with males (21.6% vs 9.1%, adjusted OR (AOR)=2.87, 95% CI: 1.62 to 5.10). Among sexually experienced females, CT prevalence was higher among those who reported ≥3 lifetime sex partners compared with one partner (33.5% vs 15.3%, AOR=2.20, 95% CI: 1.09 to 4.07); and among those reporting at least one pregnancy compared with nulligravidae participants (30.9% vs 13.8%, AOR=1.89, 95% CI: 1.05 to 3.43). In unadjusted analyses among males, CT was associated with older age (11.5% among those aged 18–19 years vs 3.4% among those aged 14–15 years, OR=3.69, 95% CI: 1.10 to 12.33). Conclusions We report high CT prevalence among sexually experienced, school-going adolescents in Panama. Female adolescents, particularly those with multiple sex partners and a history of pregnancy, were at highest risk. Adolescent-targeted CT screening should be implemented in Panama. Additionally, evidence-based comprehensive sexuality education will be imperative.