Task force calls for chlamydia screening
More providers are joining the battle against the silent spread of chlamydia infection with the recommendation from the third U.S. Preventive Services Task Force that primary care clinicians screen all sexually active women ages 25 and younger, as well as older women at risk, as part of regular health care visits.
The task force, a panel of independent, private-sector experts in prevention and primary care, made its recommendation after concluding that there is good scientific evidence that routine screening and treatment could reduce serious consequences of chlamydia in women. The task force, which is sponsored by the Rockville, MD-based Agency for Healthcare Research and Quality, systematically reviews the evidence of effectiveness of a wide range of clinical preventive services to develop recommendations for preventive care in the primary care setting.
The task force recommends that primary care clinicians routinely screen all women, whether they are pregnant, if they:
• are sexually active and age 25 or younger;
• have more than one sexual partner, regardless of age;
• have had a sexually transmitted disease (STD) in the past, regardless of age;
• do not use condoms consistently and correctly, regardless of age.
The task force made no recommendation for or against screening women older than age 26 who are not otherwise at risk. There was not enough evidence to recommend screening men who have no symptoms, members concluded.
Data indicate that many women are not being screened for the STD. According to a recent physician survey, only 32% said they would screen an asymptomatic sexually active teen-age girl for chlamydia as part of a routine gynecologic examination.1 A 1997 study of four major U.S. health plans indicated that only 2%-42% of sexually active females ages 15-25 had been screened for chlamydia.2
Most show no symptoms
Each year, an estimated three million women and men contract chlamydia, states Janet Allan, PhD, RN, CS, dean and professor in the School of Nursing at the University of Texas Health Science Center at San Antonio and vice chair of the task force. Chlamydia often is a silent disease; most women show no symptoms for six months or longer, she states.
"If it goes untreated, chlamydia can cause serious health problems such as pelvic inflammatory disease [PID], infertility; and if you are pregnant, it may cause preterm delivery," states Allan. "Babies born to women with chlamydia can develop eye infections and pneumonia; chlamydia can also cause tubal pregnancies, which can be fatal to the pregnant woman."
Chlamydia can be treated with antibiotics and treatment is 100% effective, Allan observes. Identified by a culture or a urine test, screening costs range from $30-$100, depending on whether a pelvic examination is included, with insurance usually covering screening and treatment, she says.
Allan urges women at risk for the disease to be proactive in screening. Chlamydia now is the most common bacterial STD in the United States, according to the Atlanta-based Centers for Disease Control and Prevention. "Early detection of this disease is the most effective way to prevent serious health problems," she advises.
Chlamydia screening of sexually active young women ages 15-25 now is one of the performance measures included in the Washington, DC-based National Committee for Quality Assurance’s Health Plan Employer Data and Information Set (HEDIS). HEDIS is the most widely used system for assessing managed care performance. The performance measure was added in 2000. (Contracep-tive Technology Update reported on the addition of the performance measure in its February 2000 issue, p. 17.)
According to the organization’s 2000 report, baseline results for the screening measure indicate room for improvement: Chlamydia screening rates for women ages 16-20 and 21-26 averaged 19% and 16%, respectively.3
Routine chlamydia screening of sexually active women 15-25 years of age has health and cost benefits, according to research supported by the Agency for Healthcare Research and Quality.4 The review revealed that screening 100% of sexually active women ages 18-24 would prevent an estimated 140,113 cases of PID each year and result in a savings of $45 for every woman screened.
With the advent of nucleic acid amplification tests, screening for chlamydia now is easier to perform because tests can be performed on urine samples, says Rita Mangione-Smith, MD, MPH, assistant professor of pediatrics at University of California Los Angeles. (See the cover story in the February 2001 STD Quarterly supplement inserted in CTU for an up-to-date review of nucleic acid amplification tests.)
"The technology still is not widely available, but it is becoming much more so now that it is a [HEDIS] performance measure that health plans are going to be measured on," observes Mangione-Smith. "The health plans will make sure that they have the technology in place to do it."
References
1. Cook RL, Wiesenfeld HC, Ashton MR, et al. Barriers to screening sexually active adolescent women for chlamydia: A survey of primary care physicians. J Adolesc Health 2001; 28:204-210.
2. Mangione-Smith R, McGlynn EA, Hiatt L. Screening for chlamydia in adolescents and young women. Arch Pediatr Adolesc Med 2000; 154:1,108-1,113.
3. National Committee for Quality Assurance. NCQA Releases State of Managed Care Quality 2000 Report; Publicly Reporting Plans Make Largest Gains. Washington, DC; Sept. 6, 2000.
4. Mangione-Smith R, O’Leary J, McGlynn EA. Health and cost benefits of chlamydia screening in young women. Sex Transm Dis 1999; 26:309-316.
For more information on chlamydia screening, contact:
• Rita Mangione-Smith, MD, MPH, Assistant Professor of Pediatrics, University of California Los Angeles. E-mail: [email protected].
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