Impact of Pap Guideline Changes on Annual Chlamydia Testing Among Young Women: 2007 to 2014

Background: In 2009, American College of Obstetricians and Gynecologists guidelines changed to recommend the initial Papanicolaou (Pap) test at age 21 years and every 2-3 years afterward. Previous studies have shown that women with Pap testing are more likely to receive chlamydia testing. We assessed the impact of Pap guideline changes on the proportion of women identified as sexually-active, and on chlamydia testing rates among sexually-active women.

Methods: This analysis of insurance claims data from 2007 to 2014 included 1.3 to 2.8 million women aged 15-25 years continuously enrolled in commercial health plans each year. Women with any reproductive health services were identified as sexually active. Pap and chlamydia testing rates were estimated among sexually-active women in ages 15-20 years (adolescents) and 21-25 years (young adults). All slopes of trend were tested using regression models.

Results: The proportion of women identified as sexually active (54% of adolescents; 77% of young adults) remained stable over time. Pap testing rates decreased from 54% to 16% among adolescents and from 74% to 57% among young adults.  Chlamydia testing rates increased from 27% to 37% among adolescents (10% to 32% in adolescents without Pap test vs. 42% to 63% with Pap test) and from 29% to 43% among young adults (12% to 24% without Pap test vs. 35% to 57% with Pap test). All changes were statistically significant (p<.001). Of women with pap and chlamydia testing in a given year, 85% had both tests on the same day.

Conclusions: Our results suggest that the Pap guidance changes did not affect estimates of sexual activity. Pap testing decreased, without a corresponding decrease in chlamydia testing. However, low chlamydia testing rates and high concurrence of chlamydia with Pap testing suggest that interventions to improve chlamydia testing are still needed.