Gonorrhea and Chlamydia Rates Among 12- to 24-Year-Old Patients in an Urban Health System

Abstract

Background Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infection rates continue to rise. Screening guidelines have largely focused on sexually active female individuals and men who have sex with men populations. Health care system testing and infection rates, particularly among heterosexual male individuals, are poorly understood. Our aim was to evaluate CT and GC testing and prevalence among 12- to 24-year-old patients in an urban federally qualified health center system. Methods This retrospective study analyzed electronic health record data from 2017 to 2019 in a large system of federally qualified health centers in Denver, CO. Abstracted data included demographics, sexual activity, sexual orientation, and laboratory results. χ2 Tests were used to evaluate differences between groups. Results Of the 44,021 patients included, 37.6% were tested, 15.0% were positive for CT, and 3.4% were positive for GC. Heterosexual male patients had a testing rate of 22.8% and positivity rates of CT and GC at 13.1% and 3.0%, respectively. Among tested patients documented as not sexually active, 7.5% were positive for CT. Multiple or reinfections were detected in 29% of patients. Conclusions This study shows low testing rates and high rates of CT and GC infections among all patients, including heterosexual male patients and those documented as not sexually active. Improved screening of these populations in the primary care setting may be key to combating the sexually transmitted disease epidemic.

Increased Detection of Gonorrhea and Chlamydia After Implementation of a Universal Screening Protocol in a Pediatric Primary Care Clinic

“…23 Preimplementation compared with postimplementation, there was a similarly low proportion of males screened and a fewer cases of GC/CT detected in males. A large recent study suggested that universal screening can improve detection among heterosexual men, 18 perhaps indicating that our study was underpowered to detect differences preintervention and postintervention. Reassessing the prevalence of GC/CT in men after 100% fidelity to a universal screening protocol would provide the clearest evidence on potential benefits in detection rates using universal screening and of whether to expand the current risk-based screening to universally screening all men.…”

Closing the Equity Gap: An Intervention to Improve Chlamydia and Gonorrhea Testing for Adolescents and Young Adults in Primary Care

“… 23 Thus, opt-out testing may be a valuable tool to prevent stigmatization of minority groups that have historically been disproportionately tested for STIs. 4 , 10 , 11 …”

“…2 , 3 Among patients tested at our organization from 2018 to 2019 (Denver Health and Hospital Authority [DHHA]), 15% of women and 12% of men were positive for CT or GC at least once. 4 …”

“… 7 We previously evaluated CT and GC screening rates among over 40 000 primary care patients at DHHA and found that only 20% of males and 48% of women aged 14 to 24 years old were tested in a 2-year period. 4 Additionally, we identified CT and GC cases in patients that were documented as “not sexually active.” These data demonstrated significant inequities in testing rates with disproportionate testing of women who identified as Black or African American compared to those who identified as White. This is concerning because significant social stigma is associated with STI testing.…”

“…2,3 Among patients tested at our organization from 2018 to 2019 (Denver Health and Hospital Authority [DHHA]), 15% of women and 12% of men were positive for CT or GC at least once. 4 Many CT and GC infections are asymptomatic; thus, screening is essential to reduce infection rates and prevent morbidity. Currently the United States Preventative Services Task Force (USPSTF) recommends annual screening of sexually active females under age 25 and selective screening of those deemed to be high risk.…”