Barbara Boughton

May 09, 2012

May 9, 2012 (San Diego, California) — National age-related screening guidelines for Chlamydia trachomatis might miss some at-risk women older than 25 years, according to research presented here at the American Congress of Obstetricians and Gynecologists (ACOG) 60th Annual Clinical Meeting.

"Chlamydia is known to vary by age and race, but also by region. To look at screening just by age is simple and easy, but we also have to look at what's the most cost-effective use for our dollars," said Mark Martens, MD, from the Jersey Shore Medical Center in Neptune, New Jersey.

The researchers, led by Dr. Martens, retrospectively reviewed data on more than 320,000 cervical samples from women tested for chlamydia in 40 states. All were screened for chlamydia with a nucleic acid amplification test or polymerase chain reaction at a single microbiology testing lab in New Jersey (Bio-Reference Laboratories).

Current guidelines from the Centers for Disease Control and Prevention recommend annual testing for chlamydia in symptomatic and asymptomatic women younger than 25 and in women older than 25 with risk factors. The ACOG also advises yearly screening for women older than 25 years if they are at high risk. These recommendations might need another look, Dr. Martens said.

The researchers found that national rates of chlamydia were similar to those used to develop current screening recommendations — about 5% to 6% in women younger than 25 and below 1% in women older than 25 (P < .0001). However, when they analyzed their data by state, they found more variation in the younger and older cohorts than national statistics indicate, Dr. Martens said.

According to data the researchers collected, rates of chlamydia in women younger than 25 in states such as Arkansas, Louisiana, and Mississippi were above 10% — much higher than the national average. Eight states, including Arkansas, Delaware, New Hampshire, and New Mexico, had chlamydia rates of more than 2% in women older than 25 — again, higher than the national average.

Chlamydia rates among non-Hispanic blacks were the highest, Dr. Martens noted, although he provided no statistics.

"Expanding screening to at-risk populations is going to be critical to reducing the disease burden and serious sequelae from chlamydia, which can include chronic abdominal pain, ectopic pregnancy, and infertility," Dr. Martens said.

"Although the chlamydia study has yet to be peer reviewed, it does pose an interesting question: Do we need to take another look at when we offer sexually transmitted infection [STI] screening?" said Alison Edelman, MD, MPH, one of the members of the ACOG scientific program committee for the annual meeting. Dr. Edelman is associate professor of obstetrics and gynecology at the Oregon Health and Science University School of Medicine in Portland.

As more women delay marriage, they are likely to have more exposure to sexual partners over time, and possibly more exposure to STIs such as chlamydia, Dr. Edelman noted.

"The difference in the rates of chlamydia seen in different states in this study may warrant further research; this variation is the main determinant of whether or not screening guidelines need to be changed," Dr. Edelman explained.

"As the population changes, it's good to reevaluate when and who we screen. Chlamydia exposure does create significant morbidity and tubal infertility. Making sure that we maximize who we need to capture for treatment is vitally important," Dr. Edelman added.

Dr. Martens reports being a speaker for Bio-Reference Laboratories. Dr. Edelman has disclosed no relevant financial relationships.

American Congress of Obstetricians and Gynecologists (ACOG) 60th Annual Clinical Meeting. Presented May 8, 2012.


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