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Missed Opportunities for Chlamydia Screening of Young Women in the United States

Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.

OBJECTIVE: To identify missed opportunities for chlamydia screening in ambulatory care offices.

METHODS: We analyzed data from the 2005 National Ambulatory Medical Care Survey to estimate the number of visits to obstetrician–gynecologists and primary care physicians (family and general practitioners, internists, and pediatricians) for preventive care, pelvic examinations, Pap tests, and urinalyses for nonpregnant women aged 15–25 years, and the proportion of these visits at which chlamydia tests were not performed.

RESULTS: Obstetrician–gynecologists provided care for nonpregnant women aged 15–25 years at 6.3 million office visits during 2005, and primary care physicians at 20.9 million visits. Although obstetrician–gynecologists conducted only 23.1% of visits made by young women, they conducted 68.8% of visits with pelvic examinations and 71.1% of visits with Pap tests. Primary care physicians conducted 77.5% of visits with urinalyses. Obstetrician–gynecologists did not perform a chlamydia test at 3.2 of 3.8 million (82.1%) visits with pelvic examinations and at 1.8 of 2.3 million (77.3%) visits with Pap tests. Primary care physicians did not perform a chlamydia test at 2.9 of 3.0 million (99.1%) visits with urinalyses.

CONCLUSION: There are many missed opportunities for chlamydia testing of young women in ambulatory care visits — during pelvic examinations, Pap tests, and urinalyses. Effective and simple interventions are needed to increase targeted chlamydia screening of women by physicians.

LEVEL OF EVIDENCE: III