Low Rates of Both Asymptomatic Chlamydia Screening and Diagnostic Testing of Women in U.S. Outpatient Clinics

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Abstract
To estimate demographic characteristics of nonpregnant women who seek health care in hospital outpatient clinics, and the proportion of visits where a chlamydia test was not done in asymptomatic young women at preventive visits and in symptomatic women. We analyzed data from the 2005 National Hospital Ambulatory Medical Care Survey to estimate the number of visits made by nonpregnant women aged 15-25 years and 26-35 years. We estimated the proportion of preventive visits where young women were not screened for chlamydia and the proportion of visits where women with signs or symptoms of chlamydia were not tested. In 2005, 5.2 million visits were made by nonpregnant women aged 15-25 years to outpatient clinics: 21.3% were by black non-Hispanic women, 15.2% by Hispanic women, 41.9% by women with Medicaid/State Children's Health Insurance Program insurance, and 10.8% by women with signs or symptoms of chlamydia. These young women were not screened at 84.0% of 1.2 million asymptomatic preventive visits, and were not tested for chlamydia at 78.3% of 0.6 million visits where they presented with signs or symptoms of chlamydia. Women aged 26-35 years were not tested at 86.3% of 0.4 million visits where they presented with signs or symptoms of chlamydia. While low chlamydia screening coverage has been reported, the low level of diagnostic testing in outpatient clinics was unexpected. Simple and effective interventions are needed to increase both diagnostic testing and screening of young women for Chlamydia in outpatient clinics, a venue that provides care to at-risk populations.