Chlamydia Screens Dropped After Cervical Cancer Screening Change

Unlink Chlamydia Screening from Pelvic Exams, Cervical Cancer Tests, Study Suggests

August 10, 2015 03:49 pm Chris Crawford

According to a 2013 fact sheet(www.cdc.gov) from the CDC, an estimated 2.8 million new chlamydia infections occur in the United States each year, and the highest prevalence of these infections is among females ages 15-24.

[Doctor going over test results with distressed female patient]

Those numbers helped prompt researchers to investigate how a 2009 change in an American College of Obstetricians and Gynecologists (ACOG) recommendation on cervical cancer screening might affect the rate of chlamydia screening, given that the two tests had frequently been coadministered. Their findings appear in a study published in the July/August issue(annfammed.org) of Annals of Family Medicine.

Before 2009, ACOG recommended beginning cervical cancer screening three years after first sexual intercourse or by age 21, whichever came first. The new recommendation called for initiating screening at age 21.

The researchers found that there was indeed a significant decrease in chlamydia screening among young women ages 15-21 after the 2009 guideline was released and that this occurred even without a drop in office visits, which some had hypothesized might lead to a decline in screening.

Story highlights
  • In a study published in Annals of Family Medicine, researchers found a significant decrease in chlamydia screening after the American College of Obstetricians and Gynecologists released a guideline in 2009 that recommended beginning cervical cancer screening at age 21.
  • The researchers recommend uncoupling chlamydia screening from both cervical cancer screening and pelvic examinations and pursuing new screening opportunities, as well.
  • Chlamydia screening for women ages 24 and younger can be done with a noninvasive urine test or self-swab instead of by pelvic exam and physician-collected swab.

Accordingly, the researchers are recommending uncoupling chlamydia from both cervical cancer screening and screening pelvic examinations -- which the American College of Physicians last year recommended(annals.org) not be performed in nonpregnant, asymptomatic women -- and pursuing new screening opportunities.

Study co-author Allison Ursu, M.D., a lecturer in the Department of Family Medicine at the University of Michigan, Ann Arbor, told AAFP News that this finding illustrates that chlamydia screening was being done in the past almost exclusively when a Pap smear was ordered.

"It is important for family physicians to consider chlamydia testing even when a Pap is not indicated to reduce the incidence of chlamydia and its sequelae," Ursu emphasized.

Study Breakdown

Researchers used a patient population database from five family medicine ambulatory clinics at the University of Michigan to identify visits by females ages 15-21 and conducted a cross-sectional study comparing women who made visits from Jan. 1, 2008, to Feb. 28, 2009, with women who made visits from Jan. 1, 2011, to Feb. 28, 2012.

Data for chlamydia screens completed during more than 9,800 visits made by about 3,500 female patients ages 15-21 were analyzed. Researchers found that women had higher odds of being screened for chlamydia along with a Pap smear before the guideline changed (about 62 percent) than after (about 11 percent). The same trend held for the odds of receiving a Pap smear alone before the guideline change (about 24 percent) and after (about 4 percent).

According to the authors, study limitations include

  • the research was conducted in a single department at a single academic center;
  • researchers did not have access to patient demographics; and
  • data were drawn only from completed tests, not from every test that was ordered.
AAFP Chlamydia Screening Recommendations

In 2014, the AAFP and the U.S. Preventive Services Task Force(www.uspreventiveservicestaskforce.org) recommended screening for chlamydia and gonorrhea in sexually active women ages 24 and younger and in older women who are at increased risk of infection.

At that time, both organizations found insufficient evidence to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men.

Takeaways for FPs

Ursu said it's important for family physicians to evaluate whether chlamydia screening has decreased in their offices since the cervical cancer screening guideline changed. It's also worth noting, she added, that chlamydia screening can be done with a noninvasive urine test or self-swab instead of by pelvic exam and physician-collected swab.

Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, agreed, telling AAFP News that contrary to a misconception shared by many physicians, there is no need to do a pelvic exam to screen for chlamydia.

"Our next steps are to examine how screening for chlamydia is done and how we can improve our rates of chlamydia screening with an outpatient, team-based approach and a clinical decision support tool embedded in our (electronic medical record system)," Ursu said. "For patients, they should be requesting screening for chlamydia if it is not being offered because the infection can have no symptoms; it is an easy urine test and is easily cured with antibiotics."

Related AAFP News Coverage
New Recommendations for Preventing, Detecting STIs Focus on Age, Risk Behaviors
(9/29/2014)

Screening, Education for Sexual Perpetrators, Targeted Gonorrhea, Chlamydia Screening Discussed at NCSC
(4/30/2013)

More From AAFP
FamilyDoctor.org: Chlamydia(familydoctor.org)


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