Changes in Cervical Cancer Screening Impact Chlamydia Testing

The rates of chlamydia screening have significantly declined as a result of not performing routine cervical cancer screening in young women, according to a study published in the July/August issue of the Annals of Family Medicine. Uncoupling screening for sexually transmitted diseases and cervical cancer screening is necessary, the authors say, to improve rates of chlamydia testing.

The highest prevalence of chlamydia infection in the United States is among young adults aged 15 to 24 years, but cervical cancer screenings became "more restrictive" in women in 2009 following the American College of Obstetricians and Gynecologists' recommendation that cervical cancer screening should begin at age 21 years, rather than screening three years after first sexual intercourse or by age 21, whichever occurred first.

In the current study, females (aged 15 to 21 years) who made visits to five family medicine ambulatory clinics at the University of Michigan were identified. Rates of chlamydia screening were compared between eligible groups of women who made visits between January 1, 2008 and February 28, 2009 (before the guideline change; n= 1,626) and women who made visits between January 1, 2011 and February 28, 2012 (after the guideline change; n=1,846). Based on diagnostic codes, visits were excluded if Papanicolaou (Pap) and chlamydia testing were performed for diagnostic rather than screening purposes.

Based upon 3,472 female patients (9,852 total visits), the researchers found that both the proportion of patients having a Pap test was significantly higher before the guideline change versus after (394 versus 73 tests). Even when adjusting for age, clinician type, and clinic site, the odds of having a Pap test remained more than seven-times higher before the guideline change. Similarly, the odds of having a chlamydia screen were significantly higher (nearly 14 times higher) before versus after the guideline change. Before the guideline change, 61.9 percent of the chlamydia screens were concurrent with Pap testing versus only 10.8 percent after the guideline change.

"This unintended decrease occurred despite recommendations promoting chlamydia screening and access to noninvasive testing," write the authors led by Allison Ursu, M.D., from the University of Michigan, 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.... We need to identify new opportunities for screening and put into place standard workflows that will maximize screening in this population."

Takeaway: In order to improve rates of chlamydia screening among young women, chlamydia and cervical cancer screening need to be uncoupled and new screening opportunities for sexually transmitted diseases need to be identified.