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Sexually Transmitted Infection Testing and Screening in Hospital-Based Primary Care Visits by Women

From the ¹Division of Adolescent Medicine and the ²Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and the ³Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.

Address reprint requests to: Jill S. Huppert, MD, MPH, Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 4000, Cincinnati, OH 45229-3039; e-mail: jill.huppert{at}cchmc.org.

OBJECTIVE: To explore determinants of sexually transmitted infection screening of asymptomatic women and sexually transmitted infection testing of women with genitourinary symptoms, to investigate the effect of specific genitourinary symptoms on sexually transmitted infection testing, and to examine trends in screening.

METHODS: We performed secondary data analysis of nationally representative data from the National Hospital Ambulatory Medical Care Surveys, using 17,458 visits by nonpregnant 15- to 44-year-old women seen in primary care clinics between 1997 and 2000. Point estimates, adjusted odds ratios (ORs) and 95% confidence intervals (CIs) are presented.

RESULTS: Sexually transmitted infection screening was performed in 2.4% of visits by women without genitourinary symptoms and was more likely among visits for preventive care (OR 6.9, CI 3.8–12.5), by nonwhite women (OR 4.3, CI 2.3–7.9), and in gynecology clinic (OR 3.9, CI 2.5–6.1). Sexually transmitted infection testing occurred in 13.2% of visits by women with genitourinary symptoms and was associated with Medicaid (OR 2.3, CI 1.4–3.6), preventive care (OR 2.0, CI 1.2–3.2), patient age less than 25 years (OR 1.7, CI 1.0–2.6), and nonwhite race (OR 1.7, CI 1.0–2.6). Among symptomatic women, vaginal symptoms (OR 4.8, CI 2.6–8.9) and abdominal/pelvic pain (OR 2.5, CI 1.4–4.5) were associated with sexually transmitted infection testing. Between 1997 and 2000, sexually transmitted infection screening rates remained stable.

CONCLUSION: Despite national guidelines, sexually transmitted infection testing outpaces screening. Few visits by asymptomatic women under age 25 result in screening. Strategies to improve screening in primary care should target nongynecology settings and non–preventive care visits.

LEVEL OF EVIDENCE: III

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