March 11, 2008
Women requesting emergency contraception (EC) at STD clinics are considered to be at high risk for STDs because they typically report recent unprotected sex. Yet new research conducted at the ten STD clinics run by the New York City Department of Health and Mental Hygiene (NYC DOHMH) shows that only about one in four of these women was screened for two of the most common STDs -- chlamydia and gonorrhea -- at the time of their request for EC. Among those who were screened for chlamydia and gonorrhea, more than one in ten was infected, suggesting that EC-related visits present an important opportunity to increase detection and treatment of STDs.
Emergency contraception is requested at one in every 17 visits by women to New York City STD clinics. Although EC is available for over-the-counter sale in New York to women who are 18 and older, the clinics provide EC at no cost and are an important resource for young and low-income women in need of EC.
To assess STD testing rates among women seeking emergency contraception, the researchers analyzed electronic medical records from visits to the city's STD clinics between October 2005 and April 2007. They identified 4,657 visits at which EC was requested. The majority (77%) of these EC-request visits were by young women aged 13-25; the median age was 21 (range: 13-49).
Chlamydia and gonorrhea testing was performed at only 27 percent (1,259/4,657) of all EC-request visits. Among the women who were tested for these STDs, investigators found that 12 percent of patients (149/1,259) tested positive for one or both infections. Specifically, 11 percent tested positive for chlamydia and 2 percent tested positive for gonorrhea. Women aged 25 and younger had much higher combined chlamydia and gonorrhea positivity (14%) than women over age 25 (7%), a finding that is consistent with surveillance data showing that gonorrhea and chlamydia case rates are highest among women under age 25.
As a result of this analysis, in October 2007 the New York City STD clinics began actively encouraging all women who seek emergency contraception to get tested for chlamydia and gonorrhea. Researchers believed this approach would identify many previously undetected STD infections and help young women avert the potentially serious complications of untreated chlamydia and gonorrhea, including pelvic inflammatory disease and infertility. The researchers measured chlamydia and gonorrhea screening at EC-request visits during November 2007 through January 2008, and found that among visits where EC was requested, the proportion at which testing was done increased to 57 percent (419/734). The positivity rate remained high at 10 percent (42/419). This suggests that actively offering chlamydia and gonorrhea screening to women when they come to STD clinics for EC could reach at-risk women who might not otherwise be tested, and improve disease detection and treatment. The researchers plan to continue to evaluate the impact of STD testing at EC visits in the future.
Oral Abstract B9c -- STD Testing at Emergency Contraception Visits, New York City STD Clinics, 2005-2007. In: 2008 National STD Prevention Conference, Chicago, Ill., March 10-13, 2008.