New Pap smear schedule led to fewer chlamydia tests, new study suggests

July 20, 2015, University of Michigan Health System

It's a tale of two tests: one for early signs of cervical cancer, the other for a sexually transmitted disease. But a new study suggests that a change in the recommended schedule for one may have dramatically lowered the chances that young women would get the other.

Results published by a University of Michigan team shows the unintended consequences of changes to national health test guidelines: the potential for doctors to fall behind on ordering other tests that screen for serious health problems.

In this case, the two tests are Pap smears and screens for the most common : . If undiagnosed, chlamydia can leave women in pain, infertile or unable to have a successful pregnancy.

Until six years ago, recommendations for most women under age 25 called for Pap smears earlier and more often, and once they were sexually active. Doctors could take samples during the same pelvic exam. But the Pap smear schedule for young women changed in 2009, removing annual tests before age 21 to reduce the chance of unneeded follow-up tests.

"With the change in screening, we wanted to see if there were other implications, and indeed a decrease in chlamydia screening occurred even though the number of visits by young women was about the same," says U-M Medical School Department of Family Medicine lecturer Allison Ursu, M.D., the lead author of the new paper in Annals of Family Medicine.

She and her colleagues looked at the tests given to sexually active young women aged 16 to 21 years with no chlamydia symptoms who came to U-M's five family medicine clinics in the year before the new Pap test guideline and two years later. Those in the earlier group were nearly 14 times more likely to get a chlamydia test than those seen later, even though there was no drop in clinic visits by such patients.

The five clinics have since added a reminder into their shared computer system to prompt doctors to order a chlamydia test once a year for sexually active, asymptomatic young women. A urine test for chlamydia is also available, so doctors don't need to perform a pelvic exam.

The sharp drop in testing at the U-M clinics suggests that the Pap smear guideline change could have had the same effect elsewhere. The team hopes their findings will prompt other primary care clinics to assess whether they need to pay attention to ensuring is done on time, even if it's not paired with a Pap test.

Their results showed that a U-M family medicine clinics, the two were performed together 60 percent of the time before the guideline change, but only 10 percent of the time two years later.

Says Ursu, "The clinical framework of the visit shifts when we're not doing a pelvic exam, and the things we're thinking about are different."

Need for better attention to chlamydia testing

Annual chlamydia tests are recommended for all sexually active young women under age 25, because the disease can be silent for years and can be transmitted by partners symptoms. Early detection and treatment with antibiotics can prevent long-term effects such as pelvic inflammatory disease that can affect the fallopian tubes and lead to infertility or ectopic pregnancy.

The state of Michigan recently approved expedited partner therapy, which allows doctors to prescribe antibiotics to the partner of a patient who screens positive for chlamydia even if they're not seen in the same clinic.

National data show that only about two of every five nationwide get screened for chlamydia on the recommended schedule.

Guidelines for screening tests are set by national groups for particular medical specialties, based on the latest evidence from research that balances benefit and potential for harm. It can take time for doctors nationwide to begin following guidelines, and some may choose to go against them for other reasons. But insurance companies usually pay for screening tests recommended by major specialty groups.

But new computer systems increasingly in use at clinics can be set to prompt medical assistants, doctors and nurses during a visit for the tests recommended for each patient.

The new reminder in the MiChart system in use across all of the U-M Health System's primary care clinics has greatly increased chlamydia screening for teen and young adult women. Now, more than two-thirds of sexually active patients with no symptoms get screened each year. Further analysis will look at impacts on chlamydia infections, PID cases and ectopic pregnancies seen among UMHS patients.

Senior author and U-M professor of Mack Ruffin, M.D., MPH, says, "Patients are very aware of Pap tests and many still think they need one yearly. There's much less awareness of chlamydia screening. The takeaway from this study is that we have to find other opportunities to screen."

Explore further: Screen women for chlamydia, gonorrhea, experts say

Related Stories

Screen women for chlamydia, gonorrhea, experts say

September 23, 2014
(HealthDay)—All sexually active women should be screened for two of the most common sexually transmitted infections: chlamydia and gonorrhea, according to new recommendations from the U.S. Preventive Services Task Force.

Genital-only screening misses many cases of gonorrhea and chlamydia in women

April 28, 2015
Current public health guidelines recommend that only gay men and people with HIV should be routinely screened for extragenital gonorrhea and chlamydia, given the high burden of these sexually transmitted infections (STIs) ...

Many STDs may go undiagnosed, US report finds

June 10, 2014
(HealthDay)—About 400,000 Americans may have the sexually transmitted disease chlamydia, but not know they have it, new research suggests.

Most women are unaware of new guidelines for pap test frequency, study reveals

May 11, 2015
Women know that Pap tests are a useful screening test for cervical cancer, but according to a new study led by researchers at the Perelman School of Medicine at the University of Pennsylvania, most of those surveyed are unaware ...

Study suggests chlamydia infection rates have changed over time but remains common among young women

August 22, 2013
(Medical Xpress)—A study exploring the frequency of chlamydia antibodies among young women – a marker for current and past infection – found this increased between 1993 and 2002, and then declined from 2007 to 2010. ...

Recommended for you

Non-invasive malaria test wins Africa engineering prize

June 24, 2018
Languishing with fever and frustrated by delays in diagnosing his illness, Brian Gitta came up with a bright idea: a malaria test that would not need blood samples or specialized laboratory technicians.

Study reveals new therapeutic target for slowing the spread of flu virus

June 22, 2018
Influenza A (flu A) hijacks host proteins for viral RNA splicing and blocking these interactions caused replication of the virus to slow, according to new research published in Nature Communications by Kristin W. Lynch, Ph.D., ...

First ancient syphilis genomes decoded

June 21, 2018
An international research team, including scientists from the Max Planck Institute for the Science of Human History, the University of Tübingen, the National School of Anthropology and History in Mexico City, and the University ...

Rhesus macaque model offers route to study Zika brain pathology

June 21, 2018
Rhesus macaque monkeys infected in utero with Zika virus develop similar brain pathology to human infants, according to a report by researchers at the California National Primate Research Center and School of Veterinary Medicine ...

California Aedes mosquitoes capable of spreading Zika

June 21, 2018
Over the last five years, Zika virus has emerged as a significant global human health threat following outbreaks in South and Central America. Now, researchers reporting in PLOS Neglected Tropical Diseases have shown that ...

Breakthrough treatment for crippling jaw disease created

June 20, 2018
A first-ever tissue implant to safely treat a common jaw defect, known as temporomandibular joint dysfunction, has been successfully tested by UCI-led researchers in a large animal model, according to new findings.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.