The findings and conclusions in these presentations have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.

Tuesday, May 9, 2006
132

Trends in the Use of STD Diagnostic Technologies in California, 1996-2003

Katherine Ahrens1, K. Jayne Bradbury2, Heidi M. Bauer2, Michael C. Samuel3, Gail Gould2, Chandra Higgins4, Giannina Donatoni5, Peter Kerndt6, and Gail Bolan2. (1) STD Prevention and Control Services, San Francisco Department of Public Health, 1360 Mission St, Suite 401, San Francisco, CA, USA, (2) STD Control Branch, California Department of Health Services, 850 Marina Bay Parkway, Building P, 2nd floor, Richmond, CA, USA, (3) STD Control Branch, California Department of Public Health, 850 Marina Bay Parkway, Building P, 2nd Floor, Richmond, CA, USA, (4) Sexually Transmitted Disease Program, Los Angeles County Department of Health Services, 2614 S. Grand Ave #500, Los Angeles, CA, USA, (5) Maternal, Child, and Adolescent Health Programs, Los Angeles County Department of Health Services, Research Evaluation and Planning Unit, 600 S. Commonwealth Avenue, Suite 800, Los Angeles, CA, USA, (6) Sexually Transmitted Disease Program, Los Angeles County Department of Public Health, 2615 S. Grand Avenue, Room 500, Los Angeles, CA, USA


Background:
Clinical laboratories are an essential component of sexually transmitted disease (STD) control programs.

Objective:
To describe trends in STD diagnostic tests performed by California clinical laboratories.

Method:
A self-administered survey was mailed to all licensed clinical laboratories in California in 1996 and to newly licensed laboratories and those known to perform STD tests from the 1996 survey in subsequent survey years. Data were collected on volume and test type for chlamydia, gonorrhea, syphilis, chancroid, HIV, hepatitis B, herpes simplex virus (HSV), and human papillomavirus (HPV) diagnostic testing. Test volume by disease was analyzed for trends.

Result:
Response rates ranged from 76.5% to 98.5%. Total number of STD tests increased from 10.8 to 16.0 million from 1996 to 2003. The proportion of chlamydia and gonorrhea tests performed using nucleic acid amplification testing (NAATs) increased from 5% to 66% and from 1% to 59%, respectively. Gonorrhea culture testing decreased from 42% to 10% of all gonorrhea tests. HIV testing volume increased from 2.4 to 3.1 million tests. Testing for syphilis and hepatitis B accounted for approximately 40% of all tests throughout the survey period. Newer technology tests for HSV and HPV were less common but increased in use. Private laboratories conducted over 90% of all STD testing.

Conclusion:
Findings from the California annual laboratory survey demonstrated that STD testing, particularly chlamydia, gonorrhea, and HIV, increased from 1996 to 2003; laboratories shifted away from culture and non-amplified tests in favor of NAATs for chlamydia and gonorrhea; and private laboratories conducted the majority of STD testing.

Implications:
Increased use of more sensitive tests for chlamydia and gonorrhea may partly explain observed increases in incidence. Health departments should promote the use of recommended diagnostic technologies. To have the greatest impact, collaborations with private laboratories are essential.

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