Teen screening for chlamydia could lower infertility

SAN FRANCISCO -- Changing physicians' behavior so they give sexually active teenage girls a simple urine test during a routine doctor's visit is an effective way of identifying chlamydia and ultimately helping prevent infertility problems later in life, a study found.

Researchers from the University of California, San Francisco worked with physicians at 10 Kaiser Permanente managed care pediatric clinics in Northern California from April 2000 and March 2002. They found that an average of 5.8 percent of sexually active girls ages 14 to 18 tested positive for chlamydia in routine screening -- patients who otherwise would not have been tested.

That rate is on track with the national infection rate of 6 percent to 9 percent found during routine screening, according to the Centers for Disease Control and Prevention.

But the new and promising finding was that pediatricians were receptive to changing their behavior regarding the sensitive topic of sexual health, according to lead author Dr. Mary-Ann Shafer, the university's associate director of adolescent medicine.

Chlamydia is the most common bacterial sexually transmitted disease in America, with about 3 million new cases each year. If detected, it is easily treatable with antibiotics.

Girls more susceptible

Teenage girls are six times more likely to contract it than adult women, according to the study in the Dec. 11 issue of the Journal of the American Medical Association.

Girls are more susceptible than boys because they often have sexual relationships with older men. About one in every 73 girls ages 15-19 gets chlamydia, compared to one out of every 279 boys of the same age.

Symptoms typically include vaginal or penal discharge, painful urination and abdominal pain. But because more than 75 percent of infections do not have any symptoms, Shafer said many teenagers do not discover they have the disease until they try to get pregnant years later.

"We know that if chlamydia is left untreated, 10 percent to 15 percent go on to pelvic inflammatory disease, and most of the tubal infertility in adult women is due to chlamydia," she said. "It's not rocket science here."

Last year, the U.S. Preventive Services Task Force urged doctors to screen all sexually active women 25 and younger, and the CDC has since issued similar guidelines. However, nationally only about 20 percent of women ages 15 to 25 that belong to managed care organizations are screened, the study found.

The study was an effort to prove that by changing doctors' behavior and making chlamydia screening a regular part of visits, infections that would have gone undetected can be caught and treated, Shafer said.

Reluctant teens

But change isn't easy.

The reasons are linked to physicians not asking adolescent patients about their sexual histories and teenagers being reluctant to undergo pelvic exams coupled with fears that the results will not be kept confidential.

"I think this is an important study because it showed it's possible to change physicians' behaviors in an area that's difficult for most practitioners," said Dr. Donald Orr, director of adolescent medicine at Indiana University School of Medicine who's studied chlamydia for 20 years. "Many pediatricians, and probably many physicians who aren't trained in adolescent medicine, really aren't comfortable asking about sexual activity in adolescents. What they've done is amazing."

HMOs currently pay for the test, and many are now administered free at public health departments in the form of simple urine tests.

However, many providers may not view the screening as cost effective, especially if the patients are teenage girls who will most likely switch to another doctor later in life, said Dr. Kathleen Irwin, chief of the health services research division of STD prevention at the CDC.

Irwin said Shafer's study was a great example of what could be accomplished.