Over-screening for chlamydia and gonorrhea among urban women age ≥25 years

Abstract

Objective: The purpose of this study was to determine the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in older women who are at increased risk of sexually transmitted infections (STIs) based on community STI prevalence. Additionally, we explored the associations between STI risk factors and CT/NG to determine the percentage of women who were over-screened.

Study design: We conducted a retrospective chart review of women ≥25 years old who were either tested or screened for CT/NG during a gynecology visit at an urban teaching institution. Pregnancy and HIV infection were exclusion criteria. Descriptive statistics, univariate analyses, and logistic regression were performed.

Results: Of 658 eligible women, the median age of those positive for CT/NG was 30 years (range, 26-41 years). Chlamydia and gonorrhea prevalence was 1.7% (11/658 women) and 0.3% (2/658 women), respectively. All positive results were captured by testing women of any age who reported symptoms or an STI exposure and by screening women who were ≤40 years old. After adjustment of data for age, we found that symptomatic women were 3 times more likely to test positive for CT/NG (adjusted odds ratio, 3.4; 95% confidence interval, 1.1-10.3) and that STI-exposed women were 10 times more likely to test positive for CT/NG (adjusted odds ratio, 10; 95% confidence interval, 1.9-52.5). In asymptomatic non-STI-exposed women, nonmonogamous relationship (P = 1.0), abnormal examination results (P = 1.0), and previous STI (P = .35) were not associated with CT/NG. Over-screening occurred in 21% of women (141/658), all of whom were menopausal, had a hysterectomy, or were >40 years old.

Conclusion: CT/NG prevalence among older women was low, even in a community of high STI prevalence. More than 20% of women could have avoided CT/NG evaluation without impacting the detection of positive results in our clinic cohort. Over-screening occurred among asymptomatic, non-STI-exposed women who were menopausal, had a hysterectomy, and were >40 years old.

Keywords: chlamydia; gonorrhea; older women; screening.