Guideline change affects chlamydia screening rate
The revised recommendation on cervical cancer screening issued by the American College of Obstetricians and Gynecologists in 2009 not only resulted in a dramatic decrease in the rate of Pap testing among women aged 15 to 21 years, but it was also followed by an even greater drop in chlamydia screening within this population at high risk for the sexually transmitted infection, reported researchers from the University of Michigan.
The study, recently published in the Annals of Family Medicine, analyzed data from patient visits at the university’s family medicine ambulatory clinics over 14-month periods before and after release of the 2009 guideline that recommended cervical cancer screening be initiated at age 21 instead of according to age of sexual initiation.
After excluding visits where Pap testing and chlamydia testing were likely done for diagnosis rather than screening, the investigators found that the total number of visits by women aged 15 to 21 years as well as the mean number of visits per patient was similar comparing the time periods January 1, 2008 to February 28, 2009 and January 1, 2011 to February 28, 2012. However, the proportion of patients having Pap testing decreased from 24.2% before the guideline change to 3.9% after, and the chlamydia screening rate fell from 30.9% to 2.0%. Results of an adjusted analysis showed that the odds of having a chlamydia screen at a clinic visit were 14-fold higher during the period before versus after the guideline change.
Allison Ursu, MD, lead author of the published paper, notes that a study analyzing data from ob/gyn clinics might yield different findings considering the difference in clinical framework of the visits—patients presenting for gynecological care are more likely to have a pelvic exam or present for a sexual health-related reason. Nevertheless, the data should prompt ob/gyn practitioners to consider whether they are doing fewer Pap tests and pelvic exams in patients aged 21 years and younger and if as an unintended consequence of that, they might be missing opportunities to do chlamydia screening.