Too few young women get tested for chlamydia

How many chlamydia tests were performed on sexually active women ages 15-25 in your clinic last year? If your numbers are similar to a new national analysis, about 38% of sexually active young women ages 15-25 were screened for the sexually transmitted disease (STD).1

The Centers for Disease Control and Prevention (CDC) recommends annual screening for sexually active women ages 25 and under.2 The new analysis examined data from the 2006-2008 cycle of the National Survey of Family Growth, a nationally representative household survey. Results indicate 62%, which is more than nine million young women, were not screened as recommended.1

Testing rates were low across all ages; however, investigators did see slightly more encouraging results, notes lead author Karen Hoover, MD, MPH, a medical epidemiologist in the CDC's Division of STD Prevention. The likelihood of being tested was higher among some of the groups of young women who are at particularly high risk of chlamydial infection, she states.

For example, 47% of women who had two or more sexual partners said they had received the test, as did 55% of African-American women, 50% of women who received public insurance, and 41% of women who were uninsured, Hoover observes. Women who accessed reproductive health care in the past year for such services as contraception, a Pap test, pelvic examination, or pregnancy test, also were more likely to report having been tested (45%) compared to those who did not access reproductive health care (4%).

In 2010, about 1.3 million chlamydia cases were diagnosed in the United States.3 Because people with chlamydia often do not have symptoms, many infections go undetected and untreated, Hoover explains Therefore, CDC estimates that the actual number of infections is more than twice that amount, with approximately 2.8 million new cases of chlamydia occurring in this country every year, she states.

"That is why CDC recommends routine annual chlamydia screening for all sexually active women aged 25 and under, as well as retesting for anyone who has been diagnosed with and treated for chlamydia," says Hoover. (Need a patient handout on chlamydia? Access the CDC fact sheet: http://www.cdc.gov/std/chlamydia/STDFact-Chlamydia.htm.)

Retesting is key

Retesting plays a vital role in preventing serious future health consequences, say public health officials. When should retesting occur? CDC guidance suggests about three months after a patient's initial chlamydia treatment. If retesting at three months is not possible, clinicians should retest whenever patients next present for medical care in the 12 months following initial treatment.4

In a statement accompanying the new chlamydia analysis, Gail Bolan, MD, director of the CDC's Division of STD Prevention, said, "It is critical that healthcare providers are not only aware of the importance of testing sexually active young women every year for chlamydia infections, but also of retesting anyone who is diagnosed. Chlamydia can be easily treated and cured with antibiotics, and retesting plays a vital role in preventing serious future health consequences."

Clinicians are finding innovative, simple ways to boost retesting rates. The University at Buffalo (NY) student health center found that a three-step process, including patient counseling and early reminders to return to the clinic, increased chlamydia retesting rates within four months from 16% to 89%.5 Providers reported their results at the March 2012 National STD Prevention Conference in Minneapolis.

Why the initial low retesting rates? Members of the research team believe that students did not understand the importance of or reasoning for returning for a test of reinfection after treatment, says Gale Burstein, MD, former clinical associate professor in the Department of Pediatrics at the School of Medicine and Biomedical Sciences, University of Buffalo. Also, three months after the original treatment date, students no longer were interested in their chlamydia infection, she notes. Providers saw that systems changes needed to be implemented to overcome these challenges, says Burstein, who now serves as commissioner of the Erie County Department of Health in Buffalo.

Beginning in August 2011, work flow, processes, and staff roles and responsibilities were reengineered under leadership of Susan Mancuso, NP, a nurse practitioner at the student health center, Burstein explains. Students with a positive chlamydia/gonorrhea test had to return to the clinic to receive directly observed therapy, instead of just picking up a prescription. Medications were dispensed at no cost to students on site, and students received counseling on chlamydia and the importance to return for a test of reinfection, says Burstein.

Providers gave students a standard letter and provided face-to-face counseling with information about treatment and follow-up, including test of reinfection. Students were advised that they would be contacted to return for test of reinfection within six weeks.

Students received a computer-generated test of reinfection reminder from the health center and an individual email from Mancuso 4-5 weeks, rather than three months, after treatment, says Burstein. Students who didn't return also received a telephone reminder. Each step was recorded in the electronic medical record for process monitoring, Burstein states.

References

  1. Hoover KW. Self-reported chlamydia testing of women in the United States, 2006-2008. Presented at the 2012 National STD Prevention Conference. Minneapolis; March 2012.
  2. Workowski KA, Berman S; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2010. MMWR 2010; 59(RR-12):44.
  3. Centers for Disease Control and Prevention. Chlamydia -- CDC Fact Sheet. Accessed at http://www.cdc.gov/std/chlamydia/STDFact-Chlamydia.htm.
  4. Workowski KA, Berman S; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2010. MMWR 2010; 59(RR-12):46.
  5. Burstein GR, Mancuso S, Opdyke KM, et al. Increasing chlamydia and gonorrhea retesting rates in a student health center using a quality improvement approach. Presented at the 2012 National STD Prevention Conference. Minneapolis; March 2012.