Chlamydia trachomatis (CT) testing practices in a commercially insured population.

Abstract

Objective: Little data is available on the prevalence of CT in commercially insured female populations. However, it is assumed that the infection is significantly underdiagnosed in this group. A major factor in the underdiagnosis of infection is inadequate behavioral and sexual risk factor ascertainment by clinicians and, possibly, the failure to test patients considered to be high-risk for infection. The purpose of this study is to examine the prevalence of CT testing in a commercially insured female population and to examine factors that may be associated with testing. Design: A retrospective chart review. Materials/Methods: Medical records of 600 commercially insured women ages 15–25 presenting for ambulatory obstetrical and gynecological care to a suburban private practice were reviewed. Information on demographic, reproductive, sexual, and contraceptive practices, as well as risk status for STDs was collected. Patients considered at high-risk for CT infection were those with any of the following characteristics: sexually active women <20 years of age, new or multiple sexual partners in the past 12 months, past history or treatment of a STD, past or current partner with a history of a STD, non-use of condoms, or presenting complaint suggestive of pelvic infection. These risk factors are part of the screening guidelines of the Centers for Disease Control and Prevention (CDC) or the American College of Obstetricians and Gynecologists (ACOG). Univariate and multivariate logistic regression analysis, and chi-square tests were performed to summarize data. Results: The overall rate of testing was 82 of 600 patients (13.6%). Risk factors for CT infection were documented in 165 patients (27.5%), of whom 51 (30.9%) were tested. High-risk women were more likely to be tested than women without documented risk factors (OR = 5.8, p < .0001). Specific risk factors associated with CT testing were: male gender of physician (OR = 2.7, p = .0005), problem-related visit type as compared to routine/annual examinations (OR = 2.8, p = .002), prior pregnancy (OR = 2.3, p = .0007), presenting complaints suggestive of pelvic infection (OR = 9.9, p < .0001), sexual activity in the past 12 months (OR = 12.3, p = <.0001), new sexual partner in past 12 months (OR = 8.8, p = .006), history of STD in past 12 months (OR = 4.1, p = .0007), and sexual activity in women <20 years of age (OR = 4.8, p < .0001). Thirty-six percent of sexually active women <20 years of age were tested as compared to 22% of the entire sexually active study group. The estimated prevalence of infection was 4.9% (4 out of 82 patients) in the study population. Among the 4 patients with positive tests, all had at least one established risk factor for CT. Conclusions: The overall rate of CT testing among commercially insured women is low (13.6%). Although the rate of testing is higher among patients with identified risk factors (31%), testing practices fail to conform to established screening guidelines. The underlying reasons for the failure to test patients identified as high-risk requires further investigation. Supported by: Texas Department of Health.