Uptake of Regular Chlamydia Testing by U.S. Women

A Longitudinal Study


      Routine chlamydia screening is a recommended preventive intervention for sexually active women aged ≤25 years in the U.S. but rates of regular uptake are not known.


      This study aimed to examine rates of annual chlamydia testing and factors associated with repeat testing in a population of U.S. women.


      Women aged 15–25 years at any time from January 1, 2002, to December 31, 2006 who were enrolled in 130 commercial health plans were included. Data relating to chlamydia tests were analyzed in 2009. Chlamydia testing rates (per 100 woman-years) by age and rates of repeated annual testing were estimated. Poisson regression was used to examine the effects of age and previous testing on further chlamydia testing within the observation period.


      In total, 2,632,365 women were included. The chlamydia testing rate over the whole study period was 13.6 per 100 woman years after adjusting for age-specific sexual activity; 8.5 (95% CI=6.0, 12.3) per 100 woman-years in those aged 15 years; and 17.7 (95% CI=17.1, 18.9) in those aged 25 years. Among women enrolled for the entire 5-year study period, 25.9% had at least one test but only 0.1% had a chlamydia test every year. Women tested more than once and older women were more likely to be tested again in the observation period.


      The low rates of regular annual chlamydia testing do not comply with national recommendations and would not be expected to have a major impact on the control of chlamydia infection at the population level.
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        • CDC
        Sexually transmitted diseases treatment guidelines, 2006.
        MMWR Recomm Rep. 2006; 55: 1-94
        • Royal Australian College of General Practitioners
        Guidelines for Preventive Activities in General Practice.
        6th ed. Royal Australian College of General Practitioners, Melbourne, Australia2007
        • Department of Health
        National Chlamydia Screening Programme (NCSP) in England: programme overview; core requirements; data collection.
        2nd ed. Department of Health, London, UK2004
        • U.S. Preventive Services Task Force
        Screening for chlamydial infection: U.S. Preventive Services Task Force recommendation statement.
        Ann Intern Med. 2007; 147: 128-134
        • CDC
        Summary of notifiable diseases—U.S., 2007.
        MMWR Morb Mortal Wkly Rep. 2009; 56: 1-94
        • Miller W.C.
        • Ford C.A.
        • Morris M.
        • et al.
        Prevalence of chlamydial and gonococcal infections among young adults in the U.S..
        JAMA. 2004; 291: 2229-2236
        • Molano M.
        • Meijer C.J.
        • Weiderpass E.
        • et al.
        The natural course of Chlamydia trachomatis infection in asymptomatic Colombian women: a 5-year follow-up study.
        J Infect Dis. 2005; 191: 907-916
        • Mosher W.D.
        • Chandra A.
        • Jones J.
        Sexual behavior and selected health measures: men and women 15–44 years of age, U.S., 2002.
        Adv Data. 2005; : 1-55
        • Cates Jr, W.
        • Wasserheit J.N.
        Genital chlamydial infections: epidemiology and reproductive sequelae.
        Am J Obstet Gynecol. 1991; 164: 1771-1781
        • Hu D.
        • Hook III, E.W.
        • Goldie S.J.
        Screening for Chlamydia trachomatis in women 15 to 29 years of age: a cost-effectiveness analysis.
        Ann Intern Med. 2004; 141: 501-513
        • Kretzschmar M.
        • van Duynhoven Y.T.
        • Severijnen A.J.
        Modeling prevention strategies for gonorrhea and Chlamydia using stochastic network simulations.
        Am J Epidemiol. 1996; 144: 306-317
        • Kretzschmar M.
        • Welte R.
        • van den H.A.
        • et al.
        Comparative model-based analysis of screening programs for Chlamydia trachomatis infections.
        Am J Epidemiol. 2001; 153: 90-101
        • Low N.
        • McCarthy A.
        • Macleod J.
        • et al.
        Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection.
        Health Technol Assess. 2007; 11 (iii–iv, ix–xii): 1-165
        • Regan D.G.
        • Wilson D.P.
        • Hocking J.S.
        Coverage is the key for effective screening of Chlamydia trachomatis in Australia.
        J Infect Dis. 2008; 198: 349-358
        • Turner K.M.
        • Adams E.J.
        • Lamontagne D.S.
        • et al.
        Modelling the effectiveness of chlamydia screening in England.
        Sex Transm Infect. 2006; 82: 496-502
        • Solberg L.I.
        • Nordin J.D.
        • Bryant T.L.
        • et al.
        Clinical preventive services for adolescents.
        Am J Prev Med. 2009; 37: 445-454
      1. Chlamydia screening among sexually active young female enrollees of health plans—U.S., 2000–2007.
        MMWR Morb Mortal Wkly Rep. 2009; 58: 362-365
        • Vogt T.M.
        • Feldstein A.C.
        • Aickin M.
        • et al.
        Electronic medical records and prevention quality: the prevention index.
        Am J Prev Med. 2007; 33: 291-296
        • Groves R.M.
        • Benson G.
        • Mosher W.D.
        • et al.
        Plan and operation of Cycle 6 of the National Survey of Family Growth.
        Vital Health Stat 1. 2005; 42: 1-86
        • Clayton D.
        • Hills M.
        Statistical models in epidemiology.
        Oxford University Press, Oxford1993
        • White H.A.
        A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity.
        Econometrica. 1980; 48: 817-838
        • White H.A.
        Maximum likelihood estimation of misspecified models.
        Econometrica. 1982; 50: 1-26
        • Tao G.
        • Tian L.H.
        • Peterman T.A.
        Estimating Chlamydia screening rates by using reported sexually transmitted disease tests for sexually active women aged 16 to 25 years in the U.S..
        Sex Transm Dis. 2007; 34: 180-182
        • Nguyen T.Q.
        • Ford C.A.
        • Kaufman J.S.
        • et al.
        Infrequent chlamydial testing among young adults: financial and regional differences.
        Sex Transm Dis. 2008; 35: 725-730
        • Pourat N.
        • Tao G.A.
        • Walsh C.M.
        Association of insurance coverage with chlamydia screening.
        Am J Manag Care. 2008; 14: 197-204
        • Tao G.
        • Walsh C.M.
        • Anderson L.A.
        • et al.
        Understanding sexual activity defined in the HEDIS measure of screening young women for Chlamydia trachomatis.
        J Qual Improv. 2002; 28: 435-440
        • Grunbaum J.A.
        • Kann L.
        • Kinchen S.
        • et al.
        Youth risk behavior surveillance—U.S., 2003.
        MMWR Surveill Summ. 2004; 53: 1-96
        • CDC
        Sexually transmitted disease surveillance 2006 supplement, chlamydia prevalence monitoring project.
        in: USDHHS, CDC, Atlanta GA2007
        • Datta S.D.
        • Sternberg M.
        • Johnson R.E.
        • et al.
        Gonorrhea and chlamydia in the U.S. among persons 14 to 39 years of age, 1999 to 2002.
        Ann Intern Med. 2007; 147: 89-96
        • Scott LaMontagne D.
        • Baster K.
        • Emmett L.
        • et al.
        Incidence and reinfection rates of genital chlamydial infection among women aged 16–24 years attending general practice, family planning and genitourinary medicine clinics in England: a prospective cohort study by the Chlamydia Recall Study Advisory Group.
        Sex Transm Infect. 2007; 83: 292-303
        • Kretzschmar M.
        • Turner K.M.
        • Barton P.M.
        • et al.
        Predicting the population impact of chlamydia screening programmes: comparative mathematical modelling study.
        Sex Transm Infect. 2009; 85: 359-366
        • Christiansen-Lindquist L.
        • Tao G.
        • Hoover K.
        • et al.
        Chlamydia screening of young sexually active, medicaid-insured women by race and ethnicity, 2002–2005.
        Sex Transm Dis. 2009; 36: 642-646
      2. Riha J, Soldan K, French C, et al. Who is being tested by the English National Chlamydia Screening Programme? A comparison of those tested in 2007/8 to a population-based survey [abstract]. Presented at the 18th International Society for STD Research Conference; 2009 June 28–July 1; London, UK.