The Impact of the American College of Obstetricians and Gynecologists Guideline Changes in Pap Tests on Annual Chlamydia Test Rates

Abstract

Although chlamydia test rates are increasing among sexually active women aged 15-25 years from 2005 to 2014, the slower growth in chlamydia testing rate after 2009 may relate to the change in the Pap testing guidelines. Our finding that more than half of sexually active women aged 15-25 years did not have chlamydia testing and that the rate of increased chlamydia testing slowed after 2009 suggests that interventions to improve chlamydia testing apart from combining with Pap testing are still needed.

Reported Chlamydia and Gonorrhea Are Decreasing Among Young Black Women: Good News or Bad News? A Narrative Review

“…Screening estimates using HEDIS are designed to measure screening among clinic attendees with continuous enrollment and flagged as sexually active based on claims, not the whole population, which can lead to overestimation or underestimation of screening. 18 Our sentinel populations had higher prevalence rates than did the general population, but eligibility criteria were stable, so trends over time should still be representative. Third, data on source of report were often missing and may not be classified the same way across jurisdictions because of several factors at the jurisdiction's discretion, including interpretation of coding guidance and mapping algorithms to link laboratory reports to a given category.…”

“…The rate of testing for chlamydia increased at a slower rate for 15- to 19-year-old girls after 2010 when the recommended age for initial pap tests was raised to age 21 years. An analysis of US commercial medical billing data found chlamydia screening increased at 1.9% per year between 2005 and 2009, but by only 1.0% per year between 2010 and 2014 18 . After Canada instituted similar changes to cervical cancer screening guidelines in 2012, chlamydia testing by commercial laboratories and STI clinics decreased by 25.5% for 15- to 19-year-old girls and chlamydia case reports decreased by 16.8% 19 .…”

“…An analysis of US commercial medical billing data found chlamydia screening increased at 1.9% per year between 2005 and 2009, but by only 1.0% per year between 2010 and 2014. 18 After Canada instituted similar changes to cervical cancer screening guidelines in 2012, chlamydia testing by commercial laboratories and STI clinics decreased by 25.5% for 15-to 19-year-old girls and chlamydia case reports decreased by 16.8%. 19 Thus, opportunities for chlamydia testing and evaluating sexual health may be diminishing in public and primary care settings.…”

Changes in Sexual Behaviors with Opposite-Sex Partners and Sexually Transmitted Infection Outcomes Among Females and Males Ages 15–44 Years in the USA: National Survey of Family Growth, 2008–2019

“…Previous analyses of national medical claims data suggested that chlamydia testing coverage among sexually active females ages 15-25 increased substantially from the mid-2000s to early 2010s. However, the increase in chlamydia testing slowed after 2009 (Hsieh et al, 2017;Tao et al, 2018), the period included in our analyses.…”

“…One recent analysis found that a composite assessment of behaviors associated with STI transmission remained stable or decreased from 2002 through 2011–15 among adolescent, young adult, Hispanic, and Black heterosexual men and women (Leichliter et al, 2020 ). With respect to testing behaviors, however, national health systems data suggested that chlamydia testing coverage increased among adolescent girls and young women from the mid-2000s to early 2010s (Hsieh et al, 2017 ; Tao et al, 2018 ). Additionally, evidence from national laboratory data and a sentinel surveillance program found that trends in chlamydia and gonorrhea positivity from 2010 to 2017 varied by age, sex, and race/ethnicity but did not reflect the increases in reported diagnoses (Diesel et al, 2021 , 2021b ; Kaufman et al, 2020 ; Learner et al, 2020 ; Niles et al, 2021 ; U.S. Preventive Services Task Force et al, 2021 ).…”