MINNEAPOLIS – Researchers at the National STD Prevention Conference agreed: Not enough women are getting tested for chlamydia, and health care providers are missing valuable opportunities to test them.
Among those lost opportunities is the ability to stem the spread of the disease, as new findings show that women who are diagnosed with chlamydia are likely to provide treatment to their partners.
Women with chlamydia infection are usually asymptomatic, and often consult a clinician for some other sexual health concern. Most of these visits provide a perfect opportunity to add a chlamydia screening test, said Dr. Joan Chow, chief of epidemiology in the STD control branch of the California Department of Public Health.
"Annual chlamydia screening has increased during the past 10 years, but still, about 50% of young women who should be screened aren’t being screened," she said at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.
She and her colleagues examined data from California’s Family PACT program, which provides comprehensive family planning services to low-income women.
More than 1.5 million women are enrolled in the program, which includes more than 2,000 medical providers and uses the services of about 200 labs in the state. Chlamydia testing is part of the PACT program benefits, and is recommended for all sexually active women aged 25 years or younger.
The study period spanned 2008-2010, focusing on women aged 25 or younger who were seen at by Family PACT providers in 2009. Dr. Chow compared the chlamydia testing these women received with any testing they had in the prior 12 months, or in the following 12 months.
During 2009, 219,319 young women accessed PACT services; 74% of those had a chlamydia test in the past 12 months, leaving 25% (55,915) untested at the 2009 visit.
Overall, 89% had urine collected for either a pregnancy test or to evaluate for a urinary tract infection. Of those patients, 43% had other services that included an easy opportunity to test, including a pelvic exam.
Most of these young women (75%) visited a PACT office only once during the study period. Only half (52%) returned to an office in the following 12 months, and of those, only 50% were tested for chlamydia, despite not being tested at the previous visit.
In all, only a quarter of the untested young women were tested in the following 12 months, Dr. Chow said. "Since most had only one visit, opportunities to test were not abundant."
But most patients who are diagnosed do help treat their sexual partners if they have access to the expedited treatment packs some clinics provide.
Meighan Rogers
Typically, the packs contain 1 g of azithromycin, condoms, educational material about chlamydia and other STDs, and contact information for all local STD clinics, said Meighan Rogers of the New York City Department of Health’s STD branch.
She and her colleagues conducted a follow-up study of 671 patients diagnosed with chlamydia during a 12-month period from February 2011 through February 2012. Patients could receive up to three partner packs at the visit, with three additional packs available by prescription. The analysis included only patients from heterosexual couples.
A health department representative called each patient 5 days after treatment to determine if the pack had been given to partners, and if the partners had taken the medication. The survey also asked about any adverse effects of the antibiotic and ascertained the written materials’ clarity.
Most of the patients (74%) were women. Of all those eligible for the patient packs, 52% accepted them. Surveyors were able to contact 174 of these patients; 122 of those reported having a total of 150 partners who were locatable. About 44% of these (66) were successfully contacted.
Most (74%) of the partners reported getting the packs; 94% of those said they took the medication. Two partners reported having medical problems from the medication, although the analysis did not specify what those were.
About a quarter of the partners (23%) said they visited a physician afterward. Of those who did not see a doctor, 100% said they planned to. Women partners were significantly more likely to plan a doctor’s visit than men (46% vs. 13%).
That’s good news, said Ms. Rogers. "It’s very hopeful that almost half of the women were planning to see a physician, since this might translate into a decreased risk of pelvic inflammatory disease and its reproductive sequelae."
As state and federal employees, the presenters had no financial disclosures.