CDC Says Far Too Few Young Women Screened for Chlamydia

Chlamydia is a common sexually transmitted disease (STD) named for the Greek word meaning “cloak,” precisely because its symptoms are usually mild or absent and it may linger months or years before being discovered. Men and women alike can be infected, and if left untreated chlamydia can progress to serious reproductive and other health problems. In women, the infection can spread to the uterus and fallopian tubes, leading to infertility or an ectopic pregnancy (a pregnancy that occurs outside of the uterus). Women infected with chlamydia are up to five times more likely to become infected with HIV, if exposed. An infected mother can transfer the infection to her baby, where it can cause pneumonia or an eye infection that could result in blindness. In men, infection can spread to the testicles and prostate and can cause sterility.

To help prevent these serious consequences, the U.S. Preventive Services Task Force, Centers for Disease Control (CDC), and professional organizations such as the American College of Obstetricians and Gynecologists recommend annual chlamydia screening for all sexually active women age 25 years or younger, older women with risk factors for the disease such as a new sex partner or multiple partners, and all pregnant women. And though rates of testing have risen significantly over the past decade, screening is far below where it needs to be.

Researchers at the CDC analyzed data reported to the Healthcare Effectiveness Data and Information Set by commercial insurers and Medicaid plans from 2000 through 2007 and found that fewer than half of vulnerable U.S. women are being screened for chlamydia. The information covered 41 states and included information from at least five health plans. “Nationally, the annual screening rate increased from 25.3 percent in 2000 to 43.6 percent in 2006, and then decreased slightly to 41.6 percent in 2007,” the researchers wrote in the April 17 issue of Morbidity and Mortality Weekly Report.

While all regions of the country showed increases in 2007, the Northeast had the highest screening rates at 45.5 percent and the South had the lowest at 37.3 percent. By state, Hawaii reported the highest screening rate at 57.8 percent, while Utah reported the lowest at 20.8 percent. New Jersey had the largest increase over the study period, from 15.2 percent to 40.6 percent, with Alabama showing the largest decrease, from 31.4 percent to 23.1 percent. In 2007, an estimated 1.1 million cases of chlamydia were reported to the CDC, and more than half of those cases involved females aged 15 to 25 years old.

“The findings demonstrate that despite increases in the first half of the decade, chlamydia screening rates remain substantially lower than other critical women’s health services, such as Pap tests,” the researchers said, noting that 73.9 percent of young women had a Pap test in 2007. “The findings in this report highlight the need for simple and effective interventions to increase access and use of chlamydia screening services,” they said.
Chlamydia can be easily treated and cured with antibiotics. A single dose of azithromycin or a week-long regimen of doxycycline taken twice daily, are the most commonly used treatments. “Because chlamydia is easily diagnosed and treated, many of the severe health consequences of chlamydia are preventable,” said Dr. John M. Douglas, Jr., director of CDC’s Division of STD Prevention. “Health care providers, educators and public health professionals must do much more to let young, sexually active women know how important it is that they be tested for chlamydia every year. It is also imperative that health care providers make screening a routine part of their medical practice.”

In an effort to help health care providers improve the delivery of screening services to women, Partnership for Prevention and the National Chlamydia Coalition, with support from the CDC, has developed a new guide called “Why Screen for Chlamydia? An Implementation Guide for Healthcare Providers.” It includes sections on providing confidential care to adolescents, taking a sexual history with adolescent and adult patients, and provides links to resources and tools that will be helpful for providers. “Too few doctors realize that undetected and untreated STDs can adversely affect fertility and reproductive health in later years,” said Dr. Corinne M. Husten, interim president of Partnership for Prevention. “We want doctors to improve delivery rates of this high-value preventive service, and we want sexually active young women to understand that a simple urine test now may make an important difference in their reproductive health in the future.” The guide can be accessed online at www.prevent.org/NCC.

Chlamydia infection is the most common bacterial STD in the United States, with more than 2.8 million new cases estimated to occur each year. Regular screening not only reduces the health consequences of the disease, but is also cost-effective. If 90 percent of eligible women were screened, 30,000 cases of pelvic inflammatory disease (PID) could be prevented each year, according to the National Commission on Prevention Priorities.