STD Testing Among Women Receiving Care in Private Medical Settings: An Examination of Testing Practices Based on an Analysis of Private Insurance Claims, 2003

Background:
Chlamydia trachomatis (CT) and Neisseria gonorrhoea (GC) infections are frequently asymptomatic in women, and recurrent infection is common. As a result, the Centers for Disease Control and Prevention (CDC) recommends that clinicians retest women who have been diagnosed with CT or GC 3 months after treatment. Other organizations have similar guidelines

Objective:
To describe repeat CT and GC testing practices with commercially-insured women.

Method:
We used the MarketScan database, containing insurance claims for over 7 million persons. We analyzed outpatient claims for 2003 for women 15-25 years of age. We defined CT and GC presumptive cases as women with either an International Classification of Diseases (ICD-9) code indicating CT or GC infection or a Current Procedures Terminology (CPT) code indicating a CT or GC test plus a drug claim for treatment 14 days before or 30 days after the test date. Women with claims for CT or GC testing alone were considered non-cases. We compared subsequent testing rates between presumptive cases and non-cases.

Result:
In 2003, 98,106 women were tested or diagnosed with CT or GC; 23 % were retested within the year (30% of presumptive cases vs. 17% of non-cases, p < 0.01). About 18% of presumptive cases were retested within 2-4 months, but repeat testing within 30 days was more common (32%). Most claims for retesting among non-cases occurred after 120 days (54%). Time to retesting was significantly associated with whether the woman was a case or not (p < 0.001).

Conclusion:
Among commercially-insured women with CT or GC, retesting does not occur often, and when it does it is frequently very soon after treatment.

Implications:
More research needs to be done in this area to explore motivations for retesting among women and health care providers' willingness to adhere to health care recommendations.