New Directions in Adolescent Risk

What’s Different about Detroit’s School Screening Program? Research Aimed at Explaining Results Showing 5 Consecutive Years of Declines in CT Prevalence
Detroit’s school-based STD screening program is the first such program to be associated with a sustained reduction in chlamydia prevalence. Richard Louis Dunville, MPH, Division of Adolescent and School Health, CDC, describes mathematical modeling and other innovative approaches CDC is taking to explain these results within the context of other school-based screening programs.

Novel Strategies to Improve STI Screening

STD Tracker Reminder System Increases Repeat Testing Following Treatment for Chlamydia or Gonorrhea
A simple STD tracking system designed as a reminder for clinicians resulted in a 26.5% increase in repeat testing of women at three months following chlamydia or gonorrhea. An STD tracker reminder tool is an effective strategy that can be easily adopted in other clinics to increase retesting rates, and may decrease complications related to repeat infections with chlamydia or gonorrhea.

Estimating the Impact and Cost-Effectiveness of Full Implementation of Screening Guidelines for Chlamydia and Gonorrhea in the United States
This analysis estimates that offering annual chlamydia and gonorrhea screening to all eligible women aged 15-44 years would reduce the population prevalence of chlamydia and gonorrhea by 32.1% in women and 10.4% in men compared to no screening. The net cost of the screening program would be $32,825 per QALY gained over no screening. The researchers conclude that fully implementing the USPSTF and CDC chlamydia and gonorrhea screening guidelines could have a beneficial impact on US population health.

Results from a Pilot of Universal Extra-Genital Chlamydia and Gonorrhea Screening Among Men Who Have Sex with Men (MSM) Who Attend Los Angeles County STD Clinics
n February 2015, the Los Angeles County (LAC) Department of Public Health piloted a universal chlamydia (CT)/Gonorrhea (GC) extra-genital screening protocol at 12 municipal STD clinics among all men who have sex with men (MSM) to determine if it resulted in increased morbidity. When followed, a universal extra-genital CT/GC screening protocol for MSM was effective at identifying additional infections, adding to the literature that exposure-based screening for MSM contributes to undiagnosed infection.

Clinical Case Series

A Perfect Storm of Noncompliance: Chlamydia Trachomatis Infection and Progressive Pelvic Inflammatory Disease in an Adolescent Patient
Discussion: (1) Multiple challenges may exist in ensuring an adolescent’s compliance with an outpatient regimen for PID. (2) There is insufficient evidence to guide best practice strategies for PID in this group due to low enrollment of early and middle adolescents in national trials. (3) Alternative PID regimens may be necessary to ensure compliance and successful treatment in this population.

Clinical Controversies in Women’s STD Care

Modeling the Trade-Off Between Azithromycin and Doxycycline for Treatment of Urogenital Chlamydia in Women
Whether to treat urogenital chlamydia with azithromycin or doxycycline is an ongoing debate, because of tradeoffs between each drug’s respective efficacy, adherence, and cost. To add public health perspective to the clinical debate, researchers calculated the total costs of azithromycin and doxycycline treatment in women as a function of reported treatment efficacies across variable levels of adherence to doxycycline, estimating direct medical cost to the health care system as the sum of drug and pelvic inflammatory disease (PID) costs.

Helping Providers Get It Right

Engaging Primary Care Providers in a Quality Improvement (QI) Initiative to Improve Chlamydia (CT) Screening
QI training, on-site technical assistance, tools and data feedback led to provider confidential sexual history documentation improvements and adolescent CT screening increases in each clinic.

Women’s Sexual and Reproductive Health: Opportunities for Intervention

Racial/Ethnic Disparities in Lifetime Risk of Chlamydia Trachomatis (CT) Infection Among Women in King County, Washington
The cumulative risk of CT infection varies dramatically by race/ethnicity, with over 60% of non-Hispanic Black women diagnosed with at least one infection by age 34 in the birth cohorts most affected by CT, a risk almost five times that observed in non-Hispanic Whites. Black-White disparities have declined over time as rates have increased modestly among Hispanics and non-Hispanic Whites while declining 33% among Blacks.

Impact of Pap Guideline Changes on Annual Chlamydia Testing Among Young Women: 2007 to 2014
This analysis of insurance claims data from 2007 to 2014 included 1.3 to 2.8 million women aged 15-25 years continuously enrolled in commercial health plans each year. Women with any reproductive health services were identified as sexually active. Pap and chlamydia testing rates were estimated among sexually-active women in ages 15-20 years (adolescents) and 21-25 years (young adults). All slopes of trend were tested using regression models. Results suggest that the Pap guidance changes did not affect estimates of sexual activity. Pap testing decreased, without a corresponding decrease in chlamydia testing. However, low chlamydia testing rates and high concurrence of chlamydia with Pap testing suggest that interventions to improve chlamydia testing are still needed.