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

Abstract

BackgroundYukon, a territory in northern Canada, has one of the highest reported sexually transmitted chlamydia infection rates in the country.ObjectiveWe examined screening practices among physicians and community nurses to elucidate factors that may be contributing to the high rates.DesignCross-sectional survey.MethodsA 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.ResultsEligible 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.ConclusionsThis 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.

High Interest in Syphilis Pre-exposure and Post-exposure Prophylaxis Among Gay, Bisexual and Other Men Who Have Sex With Men in Vancouver and Toronto

“…Higher rates in young women may be due to a greater biological susceptibility to chlamydial infection compared to their male peers due to a higher prevalence of cervical cell configuration (13,14). Additionally, women are more likely than men to be screened for STIs (15,16,17).…”

“…Differences in STI screening behaviours across Canadian provinces and territories may also contribute to the variation in chlamydia rates across geographical locations. For example, there is some evidence that chlamydia screening rates may be higher in Yukon than in some other Canadian jurisdictions, which may contribute to the comparatively high rate of reported cases of chlamydia infection observed in the territory (16).…”

Chlamydia and lymphogranuloma venereum in Canada: 2003-2012 Summary report

“…Younger women are biologically more susceptible to chlamydial infection (18,19). In addition, women are more likely to be screened for STIs (20,21). Trends in LGV infection are difficult to interpret due to gaps in available data, but there is evidence that it is becoming endemic among MSM in Canada.…”

Chlamydia in Canada, 2010–2015

“…Infections in females are frequently asymptomatic, and untreated infections can lead to serious complications and morbidity such as pelvic inflammation, ectopic pregnancies and infertility (21,22). This may explain why chlamydia screening programs and physician practices have traditionally targeted females (23). A higher rate of ascertainment could partly explain the higher rates of chlamydia infection among females.…”