University of Pittsburgh researchers find frequency of chlamydia screening in sexually active teenage women inadequate

March 19, 2001

PITTSBURGH, March 20 - Two-thirds of doctors do not perform recommended chlamydia screenings on sexually active young women, according to a study by the University of Pittsburgh Center for Research on Health Care, published in the March issue of the Journal of Adolescent Health. Failure to detect chlamydia can lead to pelvic inflammatory disease, infertility, ectopic pregnancy and chronic pelvic pain.

"Our results show that adherence to recommended screening procedures is alarmingly low. Physicians may need to be educated about the disease and the need for chlamydia screenings in all sexually active young women. If measures aren't taken, many young women's reproductive health could be jeopardized," said Robert L. Cook, M.D., M.P.H., assistant professor of medicine at the University of Pittsburgh School of Medicine.

Chlamydia is the most common bacterial sexually transmitted disease in the United States; almost every major medical association recommends that sexually active young women get tested yearly for the disease. Depending on the setting, anywhere between one percent and 20 percent of sexually active young women have chlamydia, with an average of about three percent; 80 percent show no symptoms. Even if the prevalence is low, screening has been shown to be clinically useful and cost-effective.

Dr. Cook and his colleagues surveyed over 800 primary care physicians in Pennsylvania. Participants were given a case study asking what tests they would conduct during a routine gynecological exam of a sexually active 19-year-old woman, who indicated no symptoms.

Only one-third of the physicians indicated they would test for chlamydia, according to the study. Female physicians, physicians in public clinics and academic settings, physicians in metropolitan areas and physicians with a large proportion of minority patients were more likely to screen for chlamydia.

The study also found that physicians were less likely to screen their patients for chlamydia if they believed that the majority of their 18-year-old patients were not sexually active or if they believed the prevalence of chlamydia is too low to make screening useful.

"It's a startling misconception among some doctors that their young patients aren't sexually active or wouldn't be exposed to the disease. Sixty-five percent of 18-year-old women have had intercourse and chlamydia is frequently detected across all populations."

According to the study, screening for chlamydia prevents pelvic inflammatory disease, lowers the prevalence of chlamydia in a population over time and may reduce the risk of acquiring HIV infection. Current U.S. health care costs attributed to chlamydial infections exceed $2 billion; screening could significantly reduce this amount.

The results indicate an urgent need for improvement in physician adherence to screening guidelines. The researchers believe that physician education will help to correct misconceptions about sexual activity in teenage women, the prevalence of chlamydia and the benefits of screening. They also encourage sexually active young women to be sure they are getting a chlamydia test whenever they have a routine gynecologic examination.
The study was funded by the University of Pittsburgh Center for Research on Health Care, located at UPMC Montefiore. The Center for Research on Health Care is a consortium of clinicians and acamedicians representing many departments and schools within the University of Pittsburgh, the VA Healthcare System and Carnegie Mellon University. The center supports the development of high quality health services research.

Jocelyn Uhl
Frank Raczkiewicz
PHONE: 412-624-2607
FAX: 412-624-3184

University of Pittsburgh Medical Center

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