Self-Reported Chlamydia Testing of Women in the United States, 2006-2008

Background: CDC recommends annual chlamydia screening of all sexually active women aged 25 years and younger.  Although several studies have reported low testing coverage, none have provided a nationally representative, population-based estimate.

Objectives: To estimate the rate of self-reported chlamydia testing of sexually active women aged 15-25 years in the United States, and to study the association of patient characteristics and healthcare services with chlamydia testing.

Methods: We analyzed data from the 2006-2008 National Survey of Family Growth, and defined being sexually active as having at least one partner in the past 12 months.  We performed a multiple logistic regression analysis to assess the association between patient age, race/ethnicity, insurance type, poverty level, geographic location, number of partners, or use of a reproductive healthcare service (Pap test, pelvic examination, pregnancy test, or contraception) and chlamydia testing.

Results: Among 23 million U.S. women aged 15-25 years, 68% were sexually active.  Among sexually active women, 38% reported they had been tested for chlamydia.  Women who had two or more partners, were of black race/ethnicity, and with Medicaid, SCHIP, or no insurance were more likely to be tested, as were women who had a Pap test, pelvic examination, or pregnancy test in the past 12 months.

Conclusions: Overall, the chlamydia testing rate of sexually active women aged 15-25 years was suboptimal.  Testing was more likely in women in at-risk and disadvantaged populations, and who utilized reproductive healthcare services.

Implications for Programs, Policy, and Research: The Affordable Care Act includes provisions requiring insurance plans to cover recommended preventive services such as chamydia screening without patient cost sharing.  As a result, chlamydia testing coverage would likely increase following implementation of these provisions.  It is important to monitor chlamydia testing trends to evaluate the impact of this stipulation and to better understand the relationship between testing rates and chlamydia morbidity reported to the CDC.