The highest prevalence of chlamydia infection in the United States is among people aged 15 to 24 years. We assessed the impact of not doing routine cervical cancer screening on the rates of chlamydia screening in women aged 15 to 21 years. We classified visits to family medicine ambulatory clinics according to their timing relative to the 2009 guideline change that led to more restrictive cervical cancer screening. Women had higher odds of being screened for chlamydia before vs after the guideline change (odds ratio = 13.97; 95% CI, 9.17-21.29; P <.001). Chlamydia and cervical cancer screening need to be uncoupled and new screening opportunities should be identified. 3 Clinicians who are comfortable discussing sexually transmitted infections, female, younger, and obstetrician-gynecologists are more likely to order sexually transmitted infection screening.
4In 2009, the American College of Obstetricians and Gynecologists recommended beginning cervical cancer screening at age 21.5 Previously, they had recommended beginning screening 3 years after first sexual intercourse or by age 21, whichever occurred first.6 Before 2009, chlamydia screening was more likely to be ordered if a Papanicolaou test was being done, 7 but no published data exist after that year. We assessed whether the change in cervical cancer screening guidelines altered rates of chlamydia screening among young women in primary care clinics.
METHODSA patient population database was used to identify visits by females aged 15 to 21 years to 5 family medicine ambulatory clinics at the University of Michigan. We conducted a repeated cross-sectional study comparing women who made visits between January 1, 2008, and February 28, 2009 (ie, before the guideline change) with women who made visits between January 1, 2011, and February 28, 2012 (ie, after the guideline change). We excluded visits where Papanicolaou and chlamydia testing were likely diagnostic rather than screening, based on the billing diagnosis.Our primary outcome was completed chlamydia screening. We measured patient age, clinic site, number of visits per patient during the time period, clinician type, and Papanicolaou test completion. Clinician type refers to resident or faculty status; fellows were considered faculty.We used logistic regression analysis to estimate the odds ratio associ-
RESULTSAnalyses were based on 3,472 female patients aged 15 to 21 who made a total of 9,852 visits. Their characteristics, as well as their total number of Papanicolaou and chlamydia tests, are shown in Table 1.The unadjusted proportion of patients having a Papanicolaou test was significantly higher (P <.001) before the guideline change (394/1,626 = 24.2%) than after (73/1,846 = 3.9%). Adjusting for age, clinician type, and clinic site, the odds of having this test remained sharply higher before the guideline change (odds ratio = 7.13; 95% CI, 5.38-9.43; P <.001). Similarly, the odds of having a chlamydia screen were significantly higher before vs after the guideline change (odds ratio = 13.97; 9...