Prenatal Screening for Chlamydia and Gonorrhea and the Association with Papanicolaou Testing Among Medicaid-Insured Women — United States, 2009–2010

Background:  CDC recommends universal chlamydia (CT) screening of all pregnant women and gonorrhea (GC) screening of at-risk pregnant women.  Prenatal CT/GC screening is often done concurrently with cervical cancer screening by Papanicolaou (Pap) testing.  In 2012, the USPSTF issued revised cervical cancer screening guidelines and no longer recommends screening in women < 21 years and recommends an increased interval for testing in women ≥21 years.  We estimated CT/GC screening rates among pregnant women and determined whether screening was more likely to occur during Pap testing.

Methods:  Procedural and diagnostic codes from a large Medicaid claims database were used to identify chlamydia, gonorrhea, and Pap testing among pregnant women aged 15–24 during 2009–2010 who were enrolled in Medicaid ≥210 days prior to their date of delivery. Strengths of association between chlamydia and gonorrhea screening and Pap testing were measured using a Chi square test of independence.

Results:  Among 63,332 pregnant women with a live birth, 79% (50,102) had a CT test, 72% (45,318) had a GC test, and 74% (46,966) had Pap testing.  Of the 46,966 women who had Pap testing, 89% (41,695) had a CT test and 80% (37,423) had a GC test; among the 16,366 who did not have Pap testing, 51% (8,407) had a CT test and 48% (7,895) had a GC test.  Women who had Pap testing were significantly more likely to have a CT or GC test (P < .001). Among all pregnant women, 13% (7,959) had neither Pap testing nor a CT or GC test.  

Conclusions:  Prenatal screening rates for CT/GC were suboptimal.  Pregnant women who did not have Pap testing were much less likely to have CT/GC screening.  These findings indicate that CT/GC screening rates could decline in the future if providers continue to tie CT/GC screening to Pap tests.