Despite U.S. Centers for Disease Control and Prevention recommendations calling for gonorrhea and chlamydia testing each year in sexually active women younger than age 25 years and universal HIV screening, regardless of sexual risk, beginning at age 13 years, screening rates for adolescents remain abysmally low, according to a study presented at the Pediatric Academic Societies annual meeting (Washington, D.C.; May 4-7). Researchers from University of Pennsylvania School of Medicine (Philadelphia) randomly selected 1,000 routine visits by adolescents treated at a diverse array of 29 primary care practices and analyzed data regarding sexual history documentation and performance of sexually transmitted infection (STI) testing (gonorrhea, chlamydia, and HIV). Overall just over one-fifth (21.2 percent) had a documented sexual history, of which 21.2 percent were currently sexually active. STI and HIV testing was performed in 37.8 percent and 22.2 percent, respectively, of documented sexually active patients. “I didn’t expect the rates to be 100 percent, but it was surprising just how low they were,” author Monika Goyal, M.D., now an assistant professor of pediatrics at Children’s National Medical Center in Washington, D.C., tells DTTR. “The two messages to take away from this study are that sexual risk assessments and screening are not […]
Despite U.S. Centers for Disease Control and Prevention recommendations calling for gonorrhea and chlamydia testing each year in sexually active women younger than age 25 years and universal HIV screening, regardless of sexual risk, beginning at age 13 years, screening rates for adolescents remain abysmally low, according to a study presented at the Pediatric Academic Societies annual meeting (Washington, D.C.; May 4-7).
Researchers from University of Pennsylvania School of Medicine (Philadelphia) randomly selected 1,000 routine visits by adolescents treated at a diverse array of 29 primary care practices and analyzed data regarding sexual history documentation and performance of sexually transmitted infection (STI) testing (gonorrhea, chlamydia, and HIV). Overall just over one-fifth (21.2 percent) had a documented sexual history, of which 21.2 percent were currently sexually active. STI and HIV testing was performed in 37.8 percent and 22.2 percent, respectively, of documented sexually active patients.
“I didn’t expect the rates to be 100 percent, but it was surprising just how low they were,” author Monika Goyal, M.D., now an assistant professor of pediatrics at Children’s National Medical Center in Washington, D.C., tells DTTR. “The two messages to take away from this study are that sexual risk assessments and screening are not being done as well as they could be in a primary care provider’s office and that we are still practicing risk-based screening.”
Sexual history documentation was more likely to occur in patients who were older than 15 years, compared to 13- to 14-year-olds, black, and those with nonprivate insurance. STI testing was more likely to be performed in patients who were male, black, or had nonprivate insurance.
Goyal believes that getting these data out to primary care providers as well as the advent of electronic health record-based alerts may improve adolescent screening.
Screening Strategies
Two other presentations at the meeting assessed the effectiveness of alternative gonorrhea and chlamydia screening strategies—one among high-risk adolescents in a clinic and one among asymptomatic adolescents treated in an urban pediatric emergency department (ED).
Researchers at the University of Louisville School of Medicine in Kentucky studied the impact of targeted screening for gonorrhea and chlamydia versus the screen-all policy implemented in 2010 at their urban clinic. A retrospective review of medical records of 879 adolescents (67 percent female; 91 percent African American) that were tested showed that 12 percent tested positive for either or both chlamydia and gonorrhea. Among 598 high-risk teens 17 percent were positive, while 1.4 percent of non-high-risk teens were positive.
Targeted screening would have detected 96.2 percent of positive teens. Based on the cost of one test ($140.80) the estimated cost of screening non-high-risk teens per additional positive test was $9,856 overall and $13,376 in females, causing the authors to conclude that data support targeted STI screening recommendations in high-risk adolescent populations.
In an additional study, researchers from Newark Beth Israel Medical Center prospectively enrolled asymptomatic patients (aged 14 to 24 years) treated in the ED between January 2011 and September 2012. Included patients were medically stable and did not have genitourinary or abdominal symptoms. Patients reporting recent testing or treatment were excluded.
Out of the 313 patients screened (70.7 percent female) for gonorrhea and chlamydia, 16 percent tested positive for either or both STI. Patients were given specific written follow-up instructions to obtain test results and, if needed, receive free treatment and partner notification and treatment. This follow-up treatment was received by 89 percent of patients with chlamydia and 83 percent with gonorrhea.
“In populations with increased risk for gonorrhea and/or chlamydia infection and high rates of symptomatic disease, ED screening of asymptomatic patients reveals a concomitantly high rate of asymptomatic disease,” write the authors, led by Devra Gutfreund, M.D. “Routine urine screening for asymptomatic gonorrhea and/or chlamydia infection within the ED should be considered and high follow-up rates support this screening.”
