Philadelphia, November 5, 2026 – Researchers at Children’s Hospital of Philadelphia (CHOP) found that a systematic, electronic health record-enabled quality improvement initiative was associated with a large increase in chlamydia and gonorrhea screening among adolescents and led to the detection of more infections. The findings, published today in the journal Pediatrics , suggest a feasible approach to building screening into routine well visits.
Chlamydia and gonorrhea are common bacterial sexually transmitted infections (STIs). Most infections cause no symptoms, and they are often undetected without screening. Infection rates for both are higher in adolescents and young adults than in other age groups, and people ages 15 to 24 account for about half of new STIs in the United States. Early detection and treatment can prevent complications and further spread.
Pediatricians and other pediatric providers serve as a trusted source for screening and counseling for adolescents. However, many adolescents are not screened for these infections, and fewer than one-third are asked about sexual activity at their well visits.
To increase screening rates, the team introduced changes in stages across 33 CHOP Care Network primary care practices. The effort began with the Adolescent Health Questionnaire , developed and piloted by the Possibilities Project (TPP) at CHOP, which is led by pediatricians, researchers at Clinical Futures , and technology experts. This pre-visit questionnaire prompts discussion of key adolescent health topics and helps identify adolescents who may benefit from further care.
The team paired the questionnaire with electronic health record best practice alerts, pre-populated order sets with built-in next steps depending on the responses to the questionnaire, and financial incentives for physicians who increased screening rates. Pediatricians, nurse practitioners, nurses, medical assistants and front-desk and office staff at all 33 practices redesigned how they cared for adolescents. The final step was universal "opt-out" screening, in which all eligible adolescents are tested unless they decline. The largest gains in screening followed this change.
“This was a team effort, and the real credit belongs to our primary care teams,” said lead study author Brian Jenssen, MD, MSHP , Associate Professor of Pediatrics at the University of Pennsylvania Perelman School of Medicine and a pediatrician at CHOP. “Our pediatricians, nurse practitioners, and staff took on a new workflow in the middle of busy clinic days and made it routine. Every infection we found reflects the importance of their work.”
Between 2021 and 2025, chlamydia and gonorrhea screening rates increased from 25% to 75% among sexually active females and from 20% to 75% among sexually active males. At the beginning of the study, approximately 8 cases of chlamydia among sexually active females were identified per month. By the end of the study, that rate increased to approximately 25 cases a month during the highest volume testing period. During the same period, the monthly number of cases identified during screening increased from 4 a month to 16 a month among sexually active males. These improvements were seen across insurance types and racial and ethnic groups.
“Moving from risk-based to universal opt-out screening appears to have made the biggest difference,” Jenssen said. “This approach worked across a large pediatric network, and it can be adapted by other primary care practices.”
This work was supported, in part, by a grant from Optum.
Jenssen et al, “Increasing Chlamydia/Gonorrhea Screening in Adolescents Across a Multi-Site Primary Care Network.” Pediatrics . Online November 5, 2026. DOI: 10.1542/peds.2026- 076482.
PEDIATRICS
Randomized controlled/clinical trial
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Increasing Chlamydia/Gonorrhea Screening in Adolescents Across a Multi-Site Primary Care Network
5-Nov-2026