The Effect of Changes in Cervical Cancer Screening Guidelines on Chlamydia Testing

The Article in Brief

The Effect of Changes in Cervical Cancer Screening Guidelines on Chlamydia Testing

Michelle S. Naimer , and colleagues

Background Screening for chlamydia, the most commonly diagnosed bacterial sexually transmitted infection worldwide, is often conducted with cervical cancer screening. Using population-based physician billing claims data and public health surveillance data, researchers in Ontario, Canada assessed the population-level impacts of new cervical cancer screening guidelines that recommend less frequent screening and older age of screening initiation.

What This Study Found The 2012 cervical cancer screening guideline change is associated with reduced testing for cervical cancer and chlamydia and reduced identification of chlamydia cases in young women. Researchers found that Pap testing declined in all age groups following the guideline release, with the greatest relative reductions observed for females aged 15 to 19 years. The guideline change was also followed by a decrease in chlamydia testing in females aged 15 to 29 years. The largest reduction was observed in the 15- to 19-years age-group, in whom cervical cancer screening is no longer recommended, suggesting that reduced chlamydia testing may have been an unintended consequence of the guideline change. Reduced chlamydia testing coincided with a reduction in reported chlamydia incidence in females aged 15 to 19 years and 20 to 24 years. In contrast, there were small increases in chlamydia testing in males aged 20 to 24 years and 25 to 29 years two years after the guideline change. Incidence rates were unchanged for males.

Implications

• The authors call for separating screening recommendations for sexually transmitted infections from recommendations for cervical cancer and highlight the need to promote chlamydia screening strategies for females that can be adopted into routine clinical care.