Impact of Cervical Cancer Screening Guidelines on Screening for Chlamydia

Allison Ursu, MD; Ananda Sen, PhD; Mack Ruffin, MD, MPH


Ann Fam Med. 2015;13(4):361-363. 

In This Article

Abstract and Introduction


The highest prevalence of chlamydia infection in the United States is among people aged 15 to 24 years. We assessed the impact of not doing routine cervical cancer screening on the rates of chlamydia screening in women aged 15 to 21 years. We classified visits to family medicine ambulatory clinics according to their timing relative to the 2009 guideline change that led to more restrictive cervical cancer screening. Women had higher odds of being screened for chlamydia before vs after the guideline change (odds ratio = 13.97; 95% CI, 9.17–21.29; P <.001). Chlamydia and cervical cancer screening need to be uncoupled and new screening opportunities should be identified.


There are an estimated 2.8 million new chlamydia infections annually in the United States.[1] The highest rates of infection are among females aged 15 to 24 years.[1] The US Preventive Services Task Force recommends chlamydia screening for sexually active women aged younger than 24 years.[2] According to data from the Healthcare Effectiveness Data and Information Set, the national chlamydia screening rate in 2008 was 44.7%.[3] Clinicians who are comfortable discussing sexually transmitted infections, female, younger, and obstetrician-gynecologists are more likely to order sexually transmitted infection screening.[4]

In 2009, the American College of Obstetricians and Gynecologists recommended beginning cervical cancer screening at age 21.[5] Previously, they had recommended beginning screening 3 years after first sexual intercourse or by age 21, whichever occurred first.[6] Before 2009, chlamydia screening was more likely to be ordered if a Papanicolaou test was being done,[7] but no published data exist after that year. We assessed whether the change in cervical cancer screening guidelines altered rates of chlamydia screening among young women in primary care clinics.