A study in the March issue of the Journal of Adolescent Health examined the proportion of primary care physicians who screen sexually active teenage women for chlamydia to determine demographic factors, practice characteristics, and attitudes associated with chlamydia screening.

Data was collected in 1998 from a random sample of 1,600 physicians in Pennsylvania using a survey questionnaire about STD practices. Of the 1,600 mailed questionnaires, 541 were returned for a response rate of 51%.

Results

Chlamydia Screening Practices

• When asked if they would screen an asymptomatic sexually active teenager for chlamydia:
• 49% of pediatric physicians reported that they would.
• 41% of internal medicine physicians reported that they would.
• 28% of obstetrics/gynecology physicians reported that they would.
• 28% of family medicine physicians reported that they would.
• 43% of female physicians and 24% of male physicians reported that they would.
• Of the physicians who worked in a clinic, 60% said they would screen for chlamydia.
• Of the physicians who worked in a group practice, 32% said they would screen for chlamydia.
• Of the physicians who worked in a solo practice, 18% said they would screen for chlamydia.
• Of physicians who worked in a metropolitan area, 46% said they would screen for chlamydia.
• Of physicians who worked in a town/city, 26% said they would screen for chlamydia.

Attitudes and Beliefs

• When asked if they agree or disagree with the following statement: (Information missing on one or more participants; total may not add to 100%.)
• 42% of physicians agreed and 21% disagreed with the statement, I am responsible for ensuring that young women in my practice receive appropriate STD prevention services.
• 37% of physicians agreed and 13% disagreed with the statement, Testing for chlamydia in asymptomatic women can prevent pelvic inflammatory disease.
• 36% of physicians agreed and 12% disagreed with the statement, At least half of the 18 year olds in my practice are sexually active.
• 10% of physicians agreed and 42% disagreed with the statement, Chlamydia is too uncommon in my patient population to screen asymptomatic teenage women for it.
• 31% of physicians agreed and 34% disagreed with the statement, Time pressures limit my ability to provide effective STD prevention and counseling.
• 34% of physicians agreed and 32% disagreed with the statement, Financial reimbursement difficulties limit my ability to provide effective STD prevention and counseling.
• 29% of physicians agreed and 33% disagreed with the statement, Most women with chlamydia have symptoms.

Factors Associated with Chlamydia Screening

• Physicians who reported that more than 20% of their patients were African-American were more likely to say they would screen an asymptomatic sexually active teenager for chlamydia (54%).
• Physicians who reported that more than 4% of their patients visits involved STDs were more likely to say they would screen an asymptomatic sexually active teenager for chlamydia (40%).

The findings suggest that a physician’s perceived prevalence of chlamydia infection is significantly associated with his/her screening behavior. Physicians were significantly less likely to screen if they believed the majority of their 18-year-old patients were not sexually active or if they believed the prevalence of chlamydia infection too low to make screening useful.

The authors conclude that there is an urgent need to implement and evaluate interventions to improve chlamydia-screening rates among adolescent women so that complications of chlamydia infection can be prevented. Furthermore, the authors recommend that improved physician education may help to correct misconceptions about sexual activity among U.S. teenage women, the prevalence of asymptomatic chlamydia infection, and the clinical and cost benefits of screening even when the prevalence is low.

For more information: R. L. Cook, et al., Barriers to Screening Sexually Active Adolescent Women for Chlamydia: A Survey of Primary Care Physicians, Journal of Adolescent Health, vol. 28 no. 3, pp. 204-10.