Women need more intensive chlamydia screening, CDC says

Retesting remains low despite the agency’s recommendation to rescreen for the STD three months after initial treatment.

By — Posted March 28, 2012

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Annual chlamydia screening alone is not enough to stem the tide of new infections among the nation’s young, sexually active women each year, according to the Centers for Disease Control and Prevention. The agency recommends that physicians also retest patients 25 and younger three months after treatment for chlamydia to ensure that the person has not been reinfected.

On average, between 10% and 25% of women treated for the disease will be reinfected within three months, said Gail Bolan, MD, director of the CDC’s Division of Sexually Transmitted Disease Prevention.

Young, sexually active women have an increased risk of developing chlamydia, in part, because their cervix is not fully matured and is more susceptible to infections, the CDC said. But physicians often overlook chlamydia screening among these women, according to data released March 13 at the CDC’s National STD Prevention Conference in Minneapolis. The conference focused on advances and challenges in efforts to halt the spread of STDs.

Only 38% of the nation’s nearly 16 million sexually active women ages 15 to 25 were tested for chlamydia in the past year, said a CDC analysis of self-reported data from the 2006-08 National Survey of Family Growth.

“This new research makes it clear that we are missing too many opportunities to protect young women from health consequences that can last a lifetime,” said Kevin Fenton, MD, PhD, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention.

If left untreated, chlamydia can lead to chronic pelvic pain, potentially fatal ectopic pregnancy and infertility, according to the CDC.

The first step to reduce cases of the disease is for physicians to discuss sexual activity with adolescent female patients and determine whether a chlamydia test is necessary, Dr. Bolan said. The CDC recommends annual chlamydia screening for all sexually active women 25 and younger.

Dr. Bolan encourages doctors to talk to patients who test positive for the disease about the importance of their partner getting treated as soon as possible. She also recommends that physicians offer a handout to such patients that includes information on the importance of getting retested within three months.

To ensure patients return for a follow-up screening, doctors can use pop-up reminder options in electronic billing systems that identify when an individual misses her scheduled appointment, said Holly Howard, MPH, project coordinator of the California Dept. of Public Health’s STD Control Branch’s Women’s Health Unit.

Chlamydia infections underreported

Chlamydia is the most commonly reported bacterial STD in the U.S., the CDC said. Though 1.3 million infections were diagnosed in 2010, the CDC estimates that the actual number of new cases that occur each year is 2.8 million. Underreporting is common with chlamydia because a majority of people who are infected do not have symptoms.

Data presented at the STD prevention conference show that retesting rates for chlamydia remain low. Just 21% of women who tested positive between 2007 and 2009 received a follow-up screen within six months, said a study of 63,774 men and women treated at clinics in New York, New Jersey and the U.S. Virgin Islands. The clinics are part of the CDC’s Infertility Prevention Project, which funds chlamydia and gonorrhea screening and treatment for low-income, sexually active women.

“It is critical that health care providers are not only aware of the importance of testing sexually active young women every year for chlamydia infections, but also of retesting anyone who is diagnosed,” Dr. Bolan said. “Retesting plays a vital role in preventing serious future health consequences.”

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