Universal Chlamydia and Gonorrhea Screening in Young Women
Chlamydia and gonorrhea infection rates are the highest ever reported, and young women 15 to 24 years old are at the highest risk of infection.1 Because these infections are often asymptomatic,2 many otherwise healthy women may not know they are infected. Untreated infections can have severe and long-lasting negative health consequences, including infertility.2 Screening for chlamydia and gonorrhea infections in young women is crucial for reducing disease prevalence and facilitating treatment.
Unfortunately, screening rates in young women are low.1,3 The Centers for Disease Control and Prevention (CDC) has suggested that providers consider universal, or “opt-out,” screening for chlamydia and gonorrhea infections in young women (ie, all young women 15 to 24 years old are tested unless they decline/opt out of testing, regardless of reported sexual activity).2
This article will discuss the importance of universal screening for chlamydia and gonorrhea in sexually active females <25 years old, including the effectiveness of opt-out testing. Also discussed are screening guidelines, barriers to screening, and how healthcare providers can better communicate with patients to encourage appropriate screening.
Young women are at high risk of chlamydia and gonorrhea infection and associated complications
In 2019, reported sexually transmitted infections (STIs) in the United States reached an all-time high for the 6th consecutive year: more than 2.5 million cases of chlamydia, gonorrhea, and syphilis were reported.1 Chlamydia was the most common STI, with 1.8 million cases reported (an increase of 19% from 2015); almost two-thirds (61%) of the reported cases were in persons 15 to 24 years of age.1,3,4 Women in this age group accounted for 67% of all female chlamydia cases.3,5 Gonorrhea was the second-most common STI in 2019; approximately 253,000 cases were reported, an increase from the 241,000 cases reported in 2018.3
Chlamydia and gonorrhea infections in women are commonly asymptomatic and are treated with a course of oral antibiotics.2 However, untreated infections can result in pelvic inflammatory disease (PID), chronic pelvic pain, ectopic pregnancy, and infertility; women 15 to 24 years old are at highest risk of these complications.3,6,7 Every year, undiagnosed STIs are estimated to cause infertility in more than 20,000 women.3