Background: CDC recommends screening all sexually active women aged <26 years and older women with risk factors for Chlamydia trachomatis (CT). Evidence suggests too few women receive age-appropriate CT screening while older women may be overscreened. We evaluated differences in CT screening among women aged >25 years across 10 USPHS regions and assessed the proportion of tests that may reflect overscreening in one region.
Methods: We analyzed all CT tests performed among women attending FP clinics participating in national infertility prevention activities in 2010. We calculated the proportion of CT tests performed by age categories (<26 years, >25 years,) for each region. In Region X (the Pacific Northwest) we assessed the proportion of CT tests in women >25 years that did not have any clinical or behavioral risk factors and may represent overscreening events.
Results: A total of 1,619,275 CT tests were performed in the FP clinics in 2010 with 28.4% performed in women >25 years. Testing in older women ranged from 13.0% (Region VII) to 33.0% (Region IV). In Region X, 20.5% (n=16,257) were performed in women aged >25 years. Of these, 72.3% (n=11,758) had an identified risk factor justifying CT testing; 3.7% (n=2,947) of all Region X CT tests could be defined as overscreening events. CT positivity was 3.6% among women aged >25 years that met risk criteria compared to 2.1% among those over-screened.
In FP clinics, the proportion of CT tests performed in older women varied significantly by region. However, overscreening events may be uncommon as nearly three-quarters of older women screened in Region X had an identified risk factor. Further investigation of testing in older women in other clinical settings is warranted to see if there are high levels of overscreening.