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Background: The goal of annual chlamydia (CT) and gonorrhea (GC) screening of young women is to detect and treat asymptomatic infection to reduce pelvic inflammatory disease (PID). Administrative datasets have limitations for estimating PID incidence in screening programs, and novel methods are needed to compare PID rates across subgroups and to monitor trends.
Objectives:
Methods: Administrative data for laboratory services in KPNC (1/1/2003-12/31/2007) were analyzed to estimate age-specific female CT/GC prevalence (15-25 years and 26-44 years). PID diagnoses in outpatient clinical data were used to calculate PID cases/1,000 CT tests. CT-positives were linked to PID diagnosis following first CT-positive date to calculate PID cases/1,000 CT-positives and proportion linked ≤ one year of CT-positive date.
Results: Among 538,319 female enrollees, there were 841,662 CT and 755,400 GC tests over the five-year observation period. Females aged 15-25 years (n=295,353) had higher CT and GC positivity (3.9%; 0.6%, respectively), compared with older females (aged 26-44 years, n =242,966) (1.5%; 0.2% respectively). Among young females, 2093 PID cases (4.0 cases/1,000 CT tests) were identified in clinical data, compared with older females (2050 PID cases, or 6.3 cases/1,000 CT tests). A similar proportion of CT-positive young females (14.6/1,000 CT-positives) had subsequent PID ≤one year, compared with older females (14.3/1,000 CT-positives). Sixty-one percent of PID cases were tested for CT/GC at the time of diagnosis, with 11.8% CT-positive and 6.0% GC-positive; younger PID cases had higher CT and GC positivity (17.3 and 8.7 %, respectively), compared with older cases (5.7% and 3.7%, respectively). Conclusions: Compared to older females, younger females had higher CT/GC prevalence, higher rates of PID outcomes among those infected with CT, and higher rates of CT/GC-positive PID. Implications for Programs, Policy, and/or Research: Novel methods for comparing PID by subgroups within screening programs may be helpful for monitoring trends and impact of screening.