STD Quarterly: Raise the radar on chlamydia screening
STD Quarterly
Raise the radar on chlamydia screening
In reviewing patient files from the last month, how many chlamydia tests were performed at your facility, and how many yielded positive results? If your clinic is seeing an increase in screens, as well as a higher incidence of infection, you are part of a larger nationwide trend.
According to new data released by the Centers for Disease Control and Prevention (CDC), chlamydia was the most common infectious disease in the United States in 2004, with 929,462 cases reported to the CDC.1 The national rate increased 5.9%, rising from 301.7 cases per 100,000 in 2003 to 319.6 in 2004.
The increase in reported cases may be due to screening and identification rather than an actual increase in infection rates, say CDC officials; however, they caution that most chlamydia cases remain undiagnosed.
At the July 2005 biennial meeting of the International Society for Sexually Transmitted Diseases Research in Amsterdam, the Netherlands, CDC researchers presented data that underscore the heavy burden of chlamydia, particularly in young women. In looking at responses from participants in the National Health and Nutrition Examination Survey from 1999 to 2002, who ranged in age from 14 to 39, scientists found a chlamydia prevalence of 2.2% with no significant differences between women and men overall. Nearly one in 20 women between the ages of 14 and 19 were infected, which is the highest proportion of any age group.2
Screening is key
What are some of the steps that CDC is taking to address the burden of chlamydia, especially among women ages 14-19? The CDC and several major medical professional organizations recommend regular chlamydia screening for young sexually active women.
Increased screening efforts are critical to preventing the spread of chlamydia in U.S. youth, says John Douglas, MD, director of the Division of STD in the CDC’s National Centers for HIV, STD, and TB Prevention. In addition to recommending that all sexually active women younger than 26 receive annual screening, CDC funds programs such as the Infertility Prevention Program, which provides chlamydia screening at public clinics and in nontraditional sites such as detention centers and school-based clinics.
About 40% of women with untreated chlamydia infections develop pelvic inflammatory disease (PID) and 20% of those become infertile, according to the CDC.
"CDC works to increase screening in the private sector by educating physicians about chlamydia infection rates in their populations and by encouraging health benefit plans to cover chlamydia testing," says Douglas. "CDC also collaborates with professional associations such as the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics to promote increased screening in young people and with the U.S. Preventive Services Task Force to ensure that chlamydia screening guidelines are consistent."
Add screening to list
Interest in chlamydia screening has increased since its 2000 inclusion in the HEDIS (Health Plan Employer Data and Information Set) managed care guidelines developed by the National Committee for Quality Assurance (NCQA). NCQA is a nationwide organization charged with measuring and reporting on managed care quality.
Such screening pays off. After the obstetrics and gynecology department at Kaiser Permanente of the Mid-Atlantic States introduced a systems-level change in response to the HEDIS measure, the proportion of females who were tested for chlamydia and the number of newly diagnosed females increased.3
Kaiser Permanente worked with the CDC to evaluate its chlamydia screening policies, testing practices, and the proportion of 15-year-old to 26-year-old female patients screened in their mid-Atlantic region before and after the measure was implemented.
10% jump in diagnoses
Screening rates increased by almost a third from 1998 to 2001. As a result of increased testing, a 10% increase in the number of new chlamydia diagnoses was recorded.3
The proportion of the patient populations testing positive remained at 8% in 1998-1999 and 7% in 2000-2001, which demonstrates the high burden of chlamydia in this commercially insured population.
Despite national recommendations encouraging annual chlamydia screening for young sexually active women, far too many women with chlamydia go undiagnosed every year, says Gale Burstein, MD, MPH, the lead CDC researcher on the study.
"A relatively simple systems-level change like the one implemented by Kaiser Permanente’s OB/GYN department could help protect the reproductive health of women across the country," Burstein says.
References
- Centers for Disease Control and Prevention. Trends in Reportable Sexually Transmitted Diseases in the United States, 2004. Atlanta; 2005.
- Datta SD, Sternberg M, Johnson R, et al. Prevalence of chlamydia and gonorrhea in the United States among persons aged 14-39 years, 1999-2002. Presented at the 16th biennial meeting of the International Society for Sexually Transmitted Diseases Research. Amsterdam, the Netherlands; July 2005.
- Burstein GR, Snyder MH, Conley D, et al. Chlamydia screening in a Health Plan before and after a national performance measure introduction. Obstet Gynecol 2005; 106: 327-334.
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