Opt-Out Screening

In the 2021 STI Treatment Guidelines from the Centers for Disease Control and Prevention (CDC), the recommendation on chlamydia screening remains the same—annual screening is recommended for all sexually active women aged <25 years. What is new, however, is a reference to an opt-out screening option.

"Providers might consider opt-out chlamydia and gonorrhea screening (i.e., the patient is notified that testing will be performed unless the patient declines, regardless of reported sexual activity) for adolescent and young adult females during clinical encounters. Cost-effectiveness analyses indicate that opt-out chlamydia screening among adolescent and young adult females might substantially increase screening, be cost-saving, and identify infections among patients who do not disclose sexual behavior."

So how do you implement an opt-out screening strategy at your practice? A central component is normalizing chlamydia testing at your practice. You can reduce missed opportunities for screening by making it part of routine preventive care, using normalizing language to explain the opt-out screening strategy to patients. By emphasizing the practice rather than the patient, you can reassure your patients that testing is routine.

How to Talk with Patients and Parents about Opt-Out Screening

The way you talk to patients about chlamydia screening is key to facilitating an opt-out strategy. The videos below offer examples of language you can use that normalizes testing and makes it a routine part of care. You can watch all of the clinical scenarios in the video below, or watch shorter videos with individual patients.

A patient in to receive a Depo-Provera shot

A patient in for a confirmation pregnancy test

A teen in for a wellness visit with her mother

Printable Material

These documents offer information on screening recommendations, the HEDIS measure on chlamydia, an opt-out strategy, and ways your practice can improve screening rates.

Additional Resources

Improving Chlamydia Rates through Opt-Out Screening
This webinar from the American Sexual Health Association features Ina Park, MD, Associate Professor, University of California San Francisco School of Medicine. It is intended for physicians, physician assistants, registered nurses and nurse practitioners engaged in the engaged in the care of women.

2021 STI Treatment Guidelines
CDC’s Sexually Transmitted Infections (STI) Treatment Guidelines, 2021 provides current evidence-based prevention, diagnostic and treatment recommendations that replace the 2015 guidance.

Why Screen for Chlamydia? A How-To Implementation Guide for Healthcare Providers
Developed by the National Chlamydia Coalition, this short guide for providers offers advice on how to improve delivery of chlamydia screening, take a sexual history and provide confidential care to adolescents.

Chlamydia Screening Change Package
This quality improvement tool was designed to support Title X grantees’ performance improvement on the HEDIS chlamydia screening measure. The package includes a rationale, improvement strategies, and Title X success stories for four best practices.

Implementation of a Learning Collaborative Model Increases Chlamydia Screening at 37 Family Planning Clinics: Lessons Learned From 3 Cohorts
This article from “The Real World of STD Prevention” feature in Sexually Transmitted Diseases demonstrates the effectiveness of using normalizing language and adopting an opt-out screening approach at 37 family planning clinics.