Medical Research: What is the background for this study? What are the main findings?
Dr. Ursu: This study was the result of a trend I noticed in clinical practice when in 2009 ACOG recommended that screening for cervical cancer =not begin until age 21 and it seemed that chlamydia screening could be easily missed. When a PAP test is done for cervical cancer screening it is very easy to send another swab for chlamydia screening. Our main findings are two years after the 2009 guideline change the rates of PAP tests decreased significantly which was appropriate but there was an unintended consequence of a significant decrease in chlamydia screening despite no change to the recommendation of chlamydia screening for females age 16-24.
Medical Research: What should clinicians and patients take away from your report?
Dr. Ursu: For clinicians: after my study several departments at the University of Michigan (Family Medicine, Internal Medicine, OBGYN, Pediatrics and the University Health Service) formed a task force to identify barriers to chlamydia screening and improve our institution’s screening rates. About 1 year ago we implemented an outpatient based protocol to capture all eligible 16-24 year old women that relies on a team based approach and a clinical decision support tool in our EMR. These changes have significantly improved our rates of screening.
For patients: chlamydia is the most common sexually transmitted infection, usually has no symptoms, and can cause serious health problems . It is easily tested for by a urine test and is easily cured with antibiotics.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Ursu: It would be interesting to know if chlamydia screening decreased in women aged 21-24 after the guideline change as they are having less frequent PAP testing. We are currently assessing whether our novel approach to screening will lead to more screening, decreased rates of chlamydia transmission and decreased rates complications from chlamydia like pelvic inflammatory disease.
Allison Ursu, MD (2015). Change in PAP Smear Guidelines Unintentionally Means Fewer Chlamydia Tests