Chlamydia Screening Rates Drop Among Young Women

Tara Haelle

July 31, 2015

Young women, who are at the highest risk for chlamydia, are far less likely to get screened for the infection since cervical cancer screening guidelines changed in 2009, according to a cross-sectional study published in the July/August issue of the Annals of Family Medicine. Females between ages 15 and 21 had 14 times greater odds of being screened for chlamydia before the guideline change than after, researchers report.

"This unintended decrease occurred despite recommendations promoting chlamydia screening and access to noninvasive testing," write Allison Ursu, MD, and colleagues at the University of Michigan in Ann Arbor.

"This study suggests that we cannot rely on pelvic examinations or cervical cancer screenings as opportunities for chlamydia screening as has been suggested in the past."

Among the estimated 2.8 million new chlamydia infections that occur annually in the United States, the highest rates occur among females aged 15 to 24 years. Despite chlamydia screening recommendations from the US Preventive Services Task Force for sexually active women younger than 24 years, less than half (44.7%) of these women were screened in 2008.

Meanwhile, the 2009 change in guidelines by the American College of Obstetricians and Gynecologists recommended that women start cervical cancer screenings at age 21 years, in contrast to the previous guidelines that recommended starting at age 21 years or 3 years after first sexual intercourse.

In the current study, the researchers used patient data from five University of Michigan family medicine clinics to compare adolescent and young women's visits from January 1, 2008, through February 28, 2009, with those from January 1, 2011, through February 28, 2012. The researchers excluded visits in which Papanicolaou or chlamydia testing was likely to be diagnostic.

A total of 3472 females aged 15 to 21 years made 9852 visits across both periods. Almost a quarter (24.2%) of the 1626 patients before 2009 had a Pap test compared with 3.9% of the 1846 patients whose visits occurred after the 2009 guidelines change. After accounting for age, clinician type, and clinic site, females had seven times lower odds of a Pap test after the guidelines changed (odds ratio [OR], 7.13; 95% confidence interval [CI], 5.38 - 9.43).

Similarly, the authors found that patients were significantly more likely to undergo chlamydia screening before the guideline change than after (OR, 13.97; 95% CI, 9.17 - 21.29). The absolute rate of screening was 30.8% in the early period and 2.0% in the latter period.

The researcher note that 61.9% of the patients receiving chlamydia screens before the guideline change received it at the same time as a Pap test compared with 10.8% (4 of 37) after the change.

"Chlamydia screening needs to be unlinked from the pelvic examination and cervical cancer screening," the authors write. "The American College of Physicians recently recommended against performing a screening pelvic examination in nonpregnant, asymptomatic women. This recommendation may affect chlamydia screening rates in a way similar to that of the change in cervical cancer guidelines."

The authors have disclosed no relevant financial relationships.

Ann Fam Med. 2015;13:361-363. Full text

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