Provider willingness to screen all sexually active adolescents for chlamydia

Sexual and Reproductive Health Care Receipt Among Young Males Aged 15-24

PURPOSE

This study aimed to describe young men's sexual and reproductive health care (SRHC) receipt by sexual behavior and factors associated with greater SRHC receipt.

METHODS

There were 427 male patients aged 15-24 who were recruited from 3 primary care and 2 sexually transmitted disease (STD) clinics in 1 urban city. Immediately after the visit, the survey assessed receipt of 18 recommended SRHC services across four domains: screening history (sexual health, STD/HIV test, family planning); laboratories (STDs/HIV); condom products (condoms/lubrication); and counseling (STD/HIV risk reduction, family planning, condoms); in addition, demographic, sexual behavior, and visit characteristics were examined. Multivariable Poisson regressions examined factors associated with each SRHC subdomain adjusting for participant clustering within clinics.

RESULTS

Of the participants, 90% were non-Hispanic black, 61% were aged 20-24, 90% were sexually active, 71% had female partners (FPs), and 20% had male or male and female partners (M/MFPs). Among sexually active males, 1 in 10 received all services. Half or more were asked about sexual health and STD/HIV tests, tested for STDs/HIV, and were counseled on STD/HIV risk reduction and correct condom use. Fewer were asked about family planning (23%), were provided condom products (32%), and were counseled about family planning (35%). Overall and for each subdomain, never sexually active males reported fewer services than sexually active males. Factors consistently associated with greater SRHC receipt across subdomains included having M/MFPs versus FPs, routine versus non-STD-acute visit, time alone with provider without parent, and seen at STD versus primary care clinic. Males having FPs versus M/MFPs reported greater family planning counseling.

CONCLUSIONS

Findings have implications for improving young men's SRHC delivery beyond the narrow scope of STD/HIV care.

Sexually Transmitted Diseases and Managed Care: An Inquiry and Review of Issues Affecting Service Delivery

To understand the potential role of managed care organizations (MCOs) in prevention and control of sexually transmitted diseases (STDs), we conducted a systematic review of articles on STDs and managed care and sought qualitative information from MCOs on STD-related activities. The review focused on prevention, risk assessment, patient education, counseling, screening, and costs of care, but revealed relatively few published articles. Barriers to STD service delivery included competing priorities, lack of time or supporting organizational structures, and differing mandates of health departments and MCOs. Facilitators included collaboration between health departments and MCOs, regulatory and performance incentives, buy-in from key stakeholders, availability of infrastructure to support data collection, and inclusion of chlamydia screening in the Health Employer Data and Information Set to monitor plan performance. Because of the shift of STD service delivery from the public to private sector, incentives need to maximize interest and cooperation of patients, clinicians, and MCOs in STD prevention.

Chlamydia screening practices among physicians and community nurses in Yukon, Canada

BACKGROUND

Yukon, a territory in northern Canada, has one of the highest reported sexually transmitted chlamydia infection rates in the country.

OBJECTIVE

We examined screening practices among physicians and community nurses to elucidate factors that may be contributing to the high rates.

DESIGN

Cross-sectional survey.

METHODS

A questionnaire was distributed to all physicians in Yukon and all community nurses in Yukon's communities. We surveyed sexual health assessment frequency, chlamydia testing frequency and barriers to screening. Comparison of physician testing practices was performed to another Canadian jurisdiction, which previously undertook a similar survey. Survey results were compared to the available laboratory data in Yukon.

RESULTS

Eligible physicians and nurses, 79% and 77%, respectively, participated in the survey. Physicians tested 15 to 24-year-old females more frequently than 15 to 24-year-old males for chlamydia (p = 0.007). Physicians who asked sexual health assessment questions were more likely to test for chlamydia in both females (p < 0.001) and males (p = 0.032). More physicians screened females based on risk factors compared to males. General practice physicians in Yukon were more likely to test females for chlamydia than general practice physicians in Toronto, Canada (p < 0.001). Community nurses had different testing patterns than physicians, with a lower overall frequency of testing, equal frequency of testing males and females, and in applying risk factor-based screening to both males and females. Barriers to screening included testing causing patient discomfort, patients reluctant to discuss screening, health provider uncomfortable conducting sexually transmitted infection tests and sexual health assessments, among others. Laboratory data in Yukon appear to confirm provider screening patterns.

CONCLUSIONS

This survey provides valuable information on health provider screening patterns. We have some evidence which suggests that chlamydia testing rates may be higher among patients seen by physicians in Yukon in comparison to another Canadian jurisdiction. However, more consistent application of optimal screening methods with support to "start the conversation" around sexual health may assist in overcoming barriers to screening and in addressing Yukon's high rate of chlamydia.

Exploring attitudes and practices of General Practice staff towards offers of opportunistic screening for chlamydia: a UK survey

AIM

This study applied a theory-based questionnaire to examine the behaviours and beliefs of all practice staff who may be involved in offering chlamydia screens to young people aged 15-25 years old. We aimed to identify potential influencing factors and examine the organisational constraints, which may be amenable to change.

BACKGROUND

The National Chlamydia Screening Programme offers opportunistic screening to men and women between 15 and 25 years old who have ever had sexual intercourse and primary care is the second largest source of screens. In England 15.9% of the target group were screened against a target of 17% in 2008. Interventions to improve the frequency of offers have shown effects with volunteer practices.

METHODS

A survey of 85 General Practices was completed by 55 doctors, nurses and receptionists. Interviews were conducted with 12 staff from three practices.

FINDINGS

Respondents were unable to identify the national screening target. Only half record if a patient is sexually active. Half the sample had some recollection of the frequency of offers they made, with a mean of 4 per month. These were predominantly in consultations concerning sexual health. Perceived social norms are favourable to screening and respondents have strong perceived control over offering screens, including to those under 16 who are sexually active. Attitudes towards screening were positive but disadvantages and barriers related to increased pressure on practice resources for longer consultations and contact tracing. There were no differences in beliefs and practice behaviours between medical and nursing staff.

CONCLUSIONS

Future interventions should be targeted at increasing the range of consultations in which offers are made, demonstrating how to make offers without increasing consultation time, providing more complete records of sexual activity, screens and results, and encouraging audit and review within the practice to promote practice wide approaches to increasing opportunistic screening.

Cervicitis in adolescents: do clinicians understand diagnosis and treatment?

BACKGROUND

Cervicitis is widespread, but no studies have examined cervicitis in accordance with established guidelines for diagnosis and treatment. Study objectives were to describe adherence to Centers for Disease Control and Prevention guidelines for diagnosis and treatment of cervicitis within an adolescent population and to compare factors associated with adherence to guidelines in a primary care setting and the Emergency Department.

METHODS

Data were collected as part of a retrospective chart review of evaluation, diagnosis, and treatment of STI in adolescent women in an outpatient setting. Participant charts were eligible for review if they were 12-21 years of age and were given an ICD-9 and chart diagnosis of cervicitis. Two primary outcome variables: meeting cervicitis guidelines and correct treatment among those meeting cervicitis guidelines (no/yes) were utilized; the study controlled for age, race, venue, past infection with chlamydia or gonorrhea.

RESULTS

Subjects (n = 365) were examined for the primary outcome variables and 75.1% (274/365) met at least one criterion for cervicitis. Of these, 166 (60.9%: 166/274) subjects were found to meet criteria for cervicitis alone, versus subjects meeting criteria for both cervicitis and pelvic inflammatory disease (PID) (39.4%: 108/274). The majority, 89.3%, (326/365) were treated for both chlamydia and gonorrhea, but only 64.7% (211/326) were treated correctly for both infections.

CONCLUSIONS

Our findings suggest that knowledge deficits exist in diagnosis and treatment of cervicitis in adolescent patients and in differentiating between cervicitis and PID. Educational tools, simulated patient exercises, and order sets may be warranted for quality improvement to allow for improved care of this at risk sexually active population.

Overcoming the barriers to chlamydia screening in general practice--a qualitative study

BACKGROUND

There is low uptake of chlamydia screening in general practices registered with the English National Chlamydia Screening Programme (NCSP). Aims. To explore staff's attitudes and behaviour around chlamydia screening and how screening could be optimized in general practice.

METHODS

A qualitative study with focus groups and interviews, in general practices in seven NCSP areas. Twenty-five focus groups and 12 interviews undertaken with a purposively selected diverse group of high and low chlamydia-screening practices in 2006-08. Data were collected and analysed using a framework analytical approach.

RESULTS

Higher screening practices had more staff with greater belief in patient and population benefits of screening and, as screening was a subjective norm, it was part of every day practice. Many staff in the majority of other practices were uncomfortable raising chlamydia opportunistically and time pressures meant that any extra public health issues covered within a consultation were determined by Quality Outcomes Framework (QOF) targets. All practices would value more training and feedback about their screening rates and results. Practices suggested that use of computer prompts, simplified request forms and more accessible kits could increase screening.

CONCLUSION

Practice staff need more evidence of the value of opportunistic chlamydia screening in men and women; staff development to reduce the barriers to broaching sexual health; simpler request forms and easily accessible kits to increase their ability to offer it within the time pressures of general practice. Increased awareness of chlamydia could be attained through practice meetings, computer templates and reminders, targets and incentives or QOF points with feedback.

Promoting chlamydia screening with posters and leaflets in general practice--a qualitative study

Background

General practice staff are reluctant to discuss sexual health opportunistically in all consultations. Health promotion materials may help alleviate this barrier. Chlamydia screening promotion posters and leaflets, produced by the English National Chlamydia Screening Programme (NCSP), have been available to general practices, through local chlamydia screening offices, since its launch. In this study we explored the attitudes of general practice staff to these screening promotional materials, how they used them, and explored other promotional strategies to encourage chlamydia screening.

Methods

Twenty-five general practices with a range of screening rates, were purposively selected from six NCSP areas in England. In focus groups doctors, nurses, administrative staff and receptionists were encouraged to discuss candidly their experiences about their use and opinions of posters, leaflets and advertising to promote chlamydia screening. Researchers observed whether posters and leaflets were on display in reception and/or waiting areas. Data were collected and analysed concurrently using a stepwise framework analytical approach.

Results

Although two-thirds of screening practices reported that they displayed posters and leaflets, they were not prominently displayed in most practices. Only a minority of practices reported actively using screening promotional materials on an ongoing basis. Most staff in all practices were not following up the advertising in posters and leaflets by routinely offering opportunistic screening to their target population. Some staff in many practices thought posters and leaflets would cause offence or embarrassment to their patients. Distribution of chlamydia leaflets by receptionists was thought to be inappropriate by some practices, as they thought patients would be offended when being offered a leaflet in a public area. Practice staff suggested the development of pocket-sized leaflets.

Conclusion

The NCSP should consider developing a range of more discrete but eye catching posters and small leaflets specifically to promote chlamydia screening in different scenarios within general practice; coordinators should audit their use. Practice staff need to discuss, with their screening co-ordinator, how different practice staff can promote chlamydia screening most effectively using the NCSP promotional materials, and change them regularly so that they do not loose their impact. Education to change all practice staff's attitudes towards sexual health is needed to reduce their worries about displaying the chlamydia materials, and how they may follow up the advertising up with a verbal offer of screening opportunistically to 15-24 year olds whenever they visit the practice.

Opportunistic screening for Chlamydia: a pilot study into male perspectives on provision of Chlamydia screening in a UK university

BACKGROUND

Since 2003, the University of Leeds has been a pilot site for the National Chlamydia Screening Programme (NCSP), which offers opportunistic screening to asymptomatic people under the age of 25. Uptake among men is low. The purpose of this study is to explore perceptions and acceptability of the provision of Chlamydia screening in the University of Leeds among 18-25-year-old male students.

METHODS

Using a purposive sample of 15 male students aged between 19 and 24, two focus group sessions were conducted within university grounds.

RESULTS

Thematic analysis of the data revealed that male attitudes about Chlamydia screening were affected by: (1) lack of knowledge about Chlamydia and screening; (2) social embarrassment about Chlamydia; (3) reluctance to seek medical help; (4) perception that Chlamydia was a 'woman's disease' and (5) indifference about health promotion campaigns.

CONCLUSION

To encourage the uptake of opportunistic screening of Chlamydia, men under 25 years should be made aware of their responsibility for their own sexual health. Emphasis can also be placed on the non-invasiveness, ease and privacy of the test.

Strategies used to increase chlamydia screening in general practice: a qualitative study

OBJECTIVES

To explore strategies used by chlamydia screening co-ordinators and practice staff to implement genital chlamydia screening within general practices.

METHODS

Qualitative phenomenological study using individual semi-structured telephone interviews. Screening co-ordinators were selected purposively in Phase 1 and 2 areas of the Department of Health National Chlamydia Screening Programme in England, where there was significant screening in general practice. Open questions were asked about: the factors that determined high chlamydia screening rates; maintaining motivation for screening; and strategies to increase screening in general practices.

RESULTS

Co-ordinators reported that successful screening practices had a champion who drove the screening process forward. These practices had normalized screening, so all at-risk patients were offered opportunistic screening whenever they attended. This was facilitated by a variety of time-saving methods including computer prompts, test kits in the reception area, youth clinics and receptionist involvement. Chlamydia screening was sustained through frequent reminders, newsletters containing chlamydia screening rates, and advertising to the 'at-risk' population from the screening team. Co-ordinators' enthusiasm and project management skills were as important as sexual health experience. Co-ordinators reported that to facilitate chlamydia screening across all practices, screening could be included in the General Medical Services (GMS) contract, and a higher national profile was needed amongst health professionals and the public.

CONCLUSIONS

All practice staff need to be encouraged to become champions of the chlamydia screening programme through education, especially aimed at older clinicians and receptionists. The National Health Service should consider including chlamydia screening in the GMS contract. Increased public awareness will allow screening to be undertaken more quickly and by non-medical staff.

Providers' perceived barriers to sexually transmitted disease care in 2 large health maintenance organizations

GOAL

To identify providers' perceived barriers to sexually transmitted disease (STD) care in 2 health plans and plan-, clinician-, and patient-level factors that were associated with these barriers in order to inform quality improvement interventions.

STUDY DESIGN

Surveys were mailed to a stratified sample of 1000 physicians, physician assistants, and nurse practitioners at 2 large health plans in 1999-2000. Of the 743 (82%) providers who received questionnaires and responded, data were analyzed from 699 with complete specialty information.

RESULTS

Ninety-five percent of providers identified at least 1 barrier to STD care. The most commonly cited barriers in both plans related to insufficient time and staff to address STDs, to counsel patients or manage sex partners, to keep current with managing high-risk patients, and to monitor patient adherence to recommendations to abstain from sex or use condoms during treatment. Nurse practitioners and specialists in obstetrics and gynecology were more likely to cite these barriers. Providers in staff models were more likely to cite the most common patient-level barriers. Few cited barriers related to diagnostic and treatment services.

CONCLUSIONS

Interventions in health plans are necessary to address constraints related to time and staff performing STD related care, keeping current with managing high-risk patients, and supporting patient adherence to provider recommendations.

Chlamydia trachomatis reinfection rates among female adolescents seeking rescreening in school-based health centers

BACKGROUND

Chlamydia trachomatis (CT) infections are common among adolescents attending high and middle schools. The study objective was to determine the reinfection rates of CT for females attending school-based health centers.

METHODS

Adolescents attending school-based health centers who reported they were sexually active were screened for CT using nucleic acid amplification tests on cervical or urine samples. Between 1996 and 2003, 10,609 female students were tested. The overall annual prevalence for unduplicated students in a calendar year ranged from 15.1% to 19.5%. Reinfection was defined as a positive test result occurring between 30 and 365 days after an initial positive result.

RESULTS

There were 897 female students who tested positive for CT and returned for at least 1 subsequent test between 30 and 365 days later. Of these, 236 had 1 or more subsequent positive tests for a cumulative incidence of reinfection in 1 year of 26.3% (95% confidence interval = 23.4-29.2%). Young age at first infection was significantly associated with increased risk of subsequent infection (P <0.01). Across sites, the cumulative incidence of reinfection in these female students ranged from 14.3% to 38.9%.

CONCLUSIONS

The chlamydia cumulative incidence of reinfection in these female adolescents attending high and middle schools was high and supports the Centers for Disease Control and Prevention recommendation to screen adolescents frequently, especially those with a history of a previous chlamydia infection.

Partner age not associated with recurrent Chlamydia trachomatis infection, condom use, or partner treatment and referral among adolescent women

PURPOSE

Among adolescent women, having older sexual partners has been associated with initial Chlamydia trachomatis (Ct) infection and high-risk behaviors. This study evaluates the role of older partners in the risk of three outcomes: recurrent Ct, lack of condom use, and nonadherence with partner management (PM) strategies.

METHODS

Female participants aged 14 to 18 years enrolled in a randomized clinical trial of patient-delivered partner treatment (PDPT) with at least one follow-up visit were included in this secondary analysis. Patient- and partner-level data were collected at baseline, one, and four months follow-up. Generalized estimating equations (GEE) and logistic regression were used to examine unadjusted and adjusted associations.

RESULTS

The majority of the 496 women were African-American (63.3%), aged 16 to 18 years (62.3%), and asymptomatic for Ct (66.7%). At baseline, all of the women had laboratory-demonstrated Ct and were treated; they had 622 partners during the last 60 days, 21.4% reported having more than one partner with a mean (SD) of 1.5 (.78) partners per woman, and 46.3% of the partners were at least three years older than the woman. Over follow-up, 16.1% of the women experienced Ct recurrence, in 41.9% of the partnerships a condom was not used at last sex, and 80.6% of women reported giving PM. After adjusting for confounders, having a partner at least three years older was not associated with increased risk of Ct recurrence, lack of condom use, or nonadherence to PM strategies.

CONCLUSIONS

Risk of Ct recurrence, lack of condom use, and nonadherence to PM strategies was not higher among adolescent women with older partners.

Willingness to offer chlamydia testing in general practice in New South Wales

OBJECTIVES

To assess willingness of general practitioners (GPs) to offer chlamydia testing to patients, and to identify demographic and practice correlates associated with willingness to offer chlamydia testing.

METHODS

A postal survey of practising GPs in New South Wales was undertaken in 2002 to assess management of STIs in general practice. A 15% (n = 1,020) stratified random sample, based on sex and area of practice, was selected. The overall response rate was 45.4% (n = 409).

RESULTS

More than four out of five study participants reported that chlamydia testing should usually be offered to patients who had recently changed sexual partners or inconsistently used barrier methods such as condoms. While 76% of GPs would like to offer testing to young women, 65% were in favour of testing young men. Just over half (56%) felt that chlamydia testing should usually be offered to patients at the time of a Pap smear. Multivariate analyses revealed that female GPs were more likely to offer testing to young patients and to female patients at the time of a Pap smear. GPs who had postgraduate training in STls had double the odds of offering testing to young men and to female patients at the time of a Pap smear.

CONCLUSIONS AND IMPLICATIONS

This paper reveals variations in GPs' willingness to offer chlamydia testing to patients. Special education programs highlighting the adverse health effects of chlamydial infection have the potential to improve GP involvement in chlamydia screening.

Preventive care for children in the United States: quality and barriers

Our objective was to examine the academic literature covering quality of childhood preventive care in the United States and to identify barriers that contribute to poor or disparate quality. We systematically reviewed articles related to childhood preventive care published from 1994 through 2003, focusing on 58 large observational studies and interventions addressing well-child visit frequency, developmental and psychosocial surveillance, disease screening, and anticipatory guidance. Although many children attend recommended well-child visits and receive comprehensive preventive care at those visits, many do not attend such visits. Estimates of children who attend all recommended visits range widely (from 37%-81%). In most studies, less than half is the proportion of children who receive developmental or psychosocial surveillance, adolescents who are asked about various health risks, children at risk for lead exposure who are screened, adolescents at risk for Chlamydia who are tested, or children and adolescents who receive anticipatory guidance on various topics. Major barriers include lack of insurance, lack of continuity with a clinician or place of care, lack of privacy for adolescents, lack of clinician awareness or skill, racial/ethnic barriers, language-related barriers, clinician and patient gender-related barriers, and lack of time. In summary, childhood preventive care quality is mixed, with large disparities among populations. Recent research has identified barriers that might be overcome through practice and policy interventions.

Sexually Transmitted Disease Care in Managed Care Organizations

Most STD cases in the United States are managed in health sectors dominated by commercial and Medicaid MCOs. To sustain the recent declines in bacterial STD incidence in the United States and to control expansion of the prevalent viral STD, MCOs will need to contribute substantially to control efforts. Applied researchers and quality improvement specialists must work with clinicians, patients, and health systems to develop and scale-up interventions to improve STD prevention and control.

Review of Clinical Trials Testing the Effectiveness of Clinician Intervention Approaches to Prevent Sexually Transmitted Diseases in Adolescent Outpatients

OBJECTIVE

Identify approaches for improving clinician provision of sexually transmitted diseases (STDs) prevention services among outpatient adolescents.

METHODS

Reviewed all peer-reviewed, published clinical trials identified through computerized searches (MEDLINE, PsychINFO) evaluating STD prevention services to outpatient adolescents by clinicians.

RESULTS

Five trials were identified examining changes in clinician provision of STD prevention services. Two of these trials resulted in adolescent self-reported risk reduction but neither of these trials effectively demonstrated reductions in objectively measured STD incidence. Nine clinical trials were identified that compared clinician with non-clinician provision of STD prevention services. Four of these trials resulted in adolescent self-reported risk reduction, and one of these trials demonstrated a reduction in objectively measured STD incidence.

CONCLUSIONS

Trials indicate that improvement in outpatient adolescent STD incidence is possible with non-clinicians as interventionists, and perhaps clinicians as interventionists if clinicians are supported by other educational resources. Opportunities for personalized, interactive adolescent education appears key to intervention success. The clinician role that is tested in most trials is confined to a single brief encounter with little attention to: development of clinician skills, quality of psychosexual risk assessment and tailoring to meet individual adolescent need, systems-level resources and supports, the parental role, or the impact of incorporating prevention into an ongoing adolescent-clinician relationship.

Implementation of a pilot programme for screening for chlamydial infection in general practice

OBJECTIVES

To determine whether opportunistic screening for Chlamydia trachomatis, based on a selective screening, algorithm, is possible in general practice in Belgium; to assess feasibility of the screening strategy with respect to workload, acceptability, and organisational aspects.

METHODS

Implementation of a pilot screening programme by 37 GPs for a period of 15 weeks. GPs' screening practices were registered and compared with the guidelines they had received. Outcome measures were: the number of patients included in the risk assessment, uptake of screening by eligible patients, prevalence of previously unidentified infection, and uptake of treatment. After the study period GPs evaluated a number of feasibility issues on a scoring form.

RESULTS

326 women underwent the risk assessment and 214 were tested by an amplification assay on a urine sample. Prevalence in woman at risk was 6.4%. Overall effective screening rate was 77.6%; 9 of 11 positives took up treatment. Participating GPs found the strategy feasible and perceived that it was well accepted by their patients.

DISCUSSION

The screening strategy was easily implemented by most GPs but some of them dropped out. The guidelines were followed relatively well and there were no major logistic problems. The uptake of treatment wat suboptimal. Efforts must be made to stimulate and educate more GPs to perform screening; laboratory and storage conditions should be optimised; refunding criteria should be revised; and overscreening must be avoided.

Sexually Transmitted Infection Testing and Screening in Hospital-Based Primary Care Visits by Women

OBJECTIVE

To explore determinants of sexually transmitted infection screening of asymptomatic women and sexually transmitted infection testing of women with genitourinary symptoms, to investigate the effect of specific genitourinary symptoms on sexually transmitted infection testing, and to examine trends in screening.

METHODS

We performed secondary data analysis of nationally representative data from the National Hospital Ambulatory Medical Care Surveys, using 17,458 visits by nonpregnant 15- to 44-year-old women seen in primary care clinics between 1997 and 2000. Point estimates, adjusted odds ratios (ORs) and 95% confidence intervals (CIs) are presented.

RESULTS

Sexually transmitted infection screening was performed in 2.4% of visits by women without genitourinary symptoms and was more likely among visits for preventive care (OR 6.9, CI 3.8-12.5), by nonwhite women (OR 4.3, CI 2.3-7.9), and in gynecology clinic (OR 3.9, CI 2.5-6.1). Sexually transmitted infection testing occurred in 13.2% of visits by women with genitourinary symptoms and was associated with Medicaid (OR 2.3, CI 1.4-3.6), preventive care (OR 2.0, CI 1.2-3.2), patient age less than 25 years (OR 1.7, CI 1.0-2.6), and nonwhite race (OR 1.7, CI 1.0-2.6). Among symptomatic women, vaginal symptoms (OR 4.8, CI 2.6-8.9) and abdominal/pelvic pain (OR 2.5, CI 1.4-4.5) were associated with sexually transmitted infection testing. Between 1997 and 2000, sexually transmitted infection screening rates remained stable.

CONCLUSION

Despite national guidelines, sexually transmitted infection testing outpaces screening. Few visits by asymptomatic women under age 25 result in screening. Strategies to improve screening in primary care should target nongynecology settings and non-preventive care visits.

LEVEL OF EVIDENCE

III.

Chlamydia and gonorrhea screening in asymptomatic young women

BACKGROUND

Adolescent and young adult minority women are at high risk for chlamydia (CT) and gonorrhea (NGC) cervical infections, which are significant causes of pelvic inflammatory disease, impaired fertility, ectopic pregnancy and chronic pain. The purpose of this article is to review among young women in the United States: (1) the epidemiology of CT and NGC cervical infection and their medical complications; (2) current public health recommendations to promote asymptomatic CT and NGC screening; (3) current screening practices and challenges of implementing public health recommendations; (4) testing and cost issues; and (5) future directions in promoting asymptomatic CT and NGC screening.

METHODS

We conducted a MEDLINE search for articles published over the last two decades relating to CT and NGC screening in young women and then systematically reviewed all relevant articles.

RESULTS

The data indicate that CT and NGC infection are geographically widespread in the U.S. and asymptomatic infection is highly prevalent among economically disadvantaged young females. Public health recommendations promoting CT and NGC screening in asymptomatic young women are directed to both health care providers and clients. However, strategies to promote screening efforts have been primarily directed toward health care providers; there are no published studies on client-initiated screening strategies. Challenges of implementing public health recommendations and future directions for CT and NGC screening are discussed.

CONCLUSIONS

Young sexually active women continue to be at high risk for CT and NGC infection. The data indicate that implementation of health provider-based and client-initiated screening in private and public health care settings is a challenge. However, there is a great need to develop strategies to understand and promote client-initiated screening.