Ramifications of pelvic exam guidelines
The 2009 change in cervical cancer screening guidelines may have had an unintended consequence: fewer young women are receiving the annual chlamydia screening recommended by the Centers for Disease Control and Prevention (CDC), according to a new study.
University of Michigan researchers used a patient population database to identify visits by women aged 15 to 21 years at 5 different family medicine ambulatory clinics at the university. They performed a repeated cross-sectional study comparing women who made visits between January 2009 and February 2009, which was before the guidelines changed, and those who had visits between January 2011 and February 2012, which was after the guideline change. Visits with Pap and chlamydia testing that were likely diagnostic instead of screening were excluded.
The analyses covered 3472 women aged 15 to 21 years for a total of 9852 visits. Overall significantly more patients underwent Pap testing before the guideline change, roughly 24%, than after the guideline change, only 3.9%. Even after adjusting for clinic site, clinician type, and age, the odds of receiving the test were far more significant before the guideline change (odds ratio = 7.13; 95% CI, 5.38–9.43; P <.001). There was a similar trend with undergoing chlamydia screening before the change versus after the change (odds ratio = 13.97; 95% CI, 9.17–21.29; P <.001). After the change, only 10.8% of chlamydia screens were performed with Pap testing; before the change nearly 62% of chlamydia screens occurred at the same visit as Pap testing.
The investigators concluded that chlamydia screening should be unlinked from pelvic exams and cervical cancer screenings, as the study suggests that they do not serve as opportunities for screening. They also believe that the recent recommendation from the American College of Physicians, which suggested that non-pregnant, asymptomatic women don’t need pelvic exams, could impact chlamydia screening in a similar fashion.
They did note some limitations to their study, including that it covered a single department at a single academic center. The researchers did not have access to demographic information for the patients and the data only showed what tests were completed, not all tests ordered.