Association between Enhanced STD Screening and Declines in Emergency Department and Hospital Diagnoses of Chlamydia trachomatis and Neisseria gonorrhoeae: Philadelphia, 1995-2006

Background:
Recent publications have questioned the benefits of screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Traditionally, it was believed that detecting and treating CT and GC earlier would reduce the associated sequelae including pelvic inflammatory disease (PID), ectopic pregnancy, and infertility.

Objective:
Describe the association between expanded STD screening activity and the incidence of hospital, including Emergency Department (ED), -diagnosed CT and GC cases.

Method:
Females < 24 years old with a positive CT or GC lab result were included in this analysis if reported by a hospital or ED between 1995 and 2006. Hospital diagnosed cases likely represent infections that were more severe, or complicated by PID or other sequelae. Additional data included the number of screening tests performed in Philadelphia from 2000-2006. Descriptive analyses were used to describe the trend of CT and GC cases reported by hospitals. Regression analyses were used to determine the association between reported cases and total screened from 2000-2006.

Result:
The number of CT and GC cases reported by hospitals in women < 24 years peaked in 2001 when 2,538 cases were reported. Case reports have since declined by an average of 263 cases per year. Preliminary regression analysis showed a negative association between the reported cases and increased screening in females (R²=0.88), but a stronger negative association was found between reported cases and screening in males (R²=0.96)

Conclusion:
The decrease of CT and GC cases reported by hospitals suggests a decline in related sequelae city-wide. Male screening is more closely associated with reduced cases in hospitals compared to female screening.

Implications:
Screening for CT and GC, including in males, can lead to reduced complications of infection in women. Furthermore, screening activity can result in substantial financial savings to the health care system by reducing hospital visits.