Less than one-third of primary care physicians have made screening for chlamydia a part of their routine practice. Seven years ago, an official recommendation was issued that stated all sexually active adolescent girls and young women should be tested form Chlamydia trachomatis genital infection.
According to a soon-to-be published survey from the Centers for Disease Control and Prevention; several factors are to blame for this lack of screening. These include: the cost of routine screening, confidentiality issues, and the asymptomatic nature of the chlamydial infection itself. The most common reason cited for not screening is the feeling by physicians that the infection is not prevalent among their patients and screening is thereby a waste of time, effort and money.
The CDC says it stands by their recommendations. The agency's first update of the original recommendations issued in 1993 are expected to be published this fall, and if anything, the recommendation will become more broad and include screening of certain groups of high-risk men.
Chlamydia is only one type of routine sexually-transmitted disease screening that is recommended by the CDC. The CDC would like to approach an 80-90% screening rate for sexually active women under the age of 20. But, if current trends continue, the CDC will be fighting a loosing battle. The most notable barrier is that some physicians hold firmly to the belief that sexually transmitted diseases are not a problem in his or her particular patient population. According to medical epidemiologists, this reason does not stand up under close scrutiny. Even in areas of the country where chlamydia is considered rare, more than 2% of the women within the age range recommended for screening will have the infection.
Last summer, the battle for chlamydia screening got a boost when it was made one of the 50 quality measures used in the Health Plan Employer Data and Information Set by the National Committee for Quality Assurance. These quality measures are used to assess the performance of most of the country's largest managed care plans. The addition is expected to cause screening rates to go up.
The CDC is putting pressure on Congress to pay for chlamydia screening at public clinics as part of its national infertility prevention program. By the late 1990s, 20-50% of eligible women being treated at the federally funded clinics were being screened. As more funding becomes available this number is expected climb.