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A change in screening guidelines may have unintentionally put people at risk of contracting this sneaky, fertility-damaging infection.

July 11, 2017

A new study found that a change in cervical cancer screening guidelines has had an unfortunate, unintended effect. Not only did the change reduce the number of Pap tests every year as it was supposed to, but it also reduced chlamydia testing rates in young women.

That has doctors concerned, because young, sexually active women are the demographic group most at risk of contracting this sneaky bacterial infection, which is the most commonly reported STD in the United States, according to the Centers for Disease Control. Chlamydia often has few or no symptoms, and if left untreated, it can damage fertility.

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“Complications of untreated chlamydia include pelvic inflammatory disease, ectopic pregnancy, and infertility,” says Dr. Jeff Kwong, MD, senior scientist at the Institute for Clinical Evaluative Sciences in Toronto and a coauthor of the study, published in the Annals of Family Medicine. “Not to mention, infected women can pass the disease to their partners, who can then spread it to others.”

The guideline change took effect in 2012, and it focused on the Pap test, which detects slow-growing cervical cell changes that if left untreated could turn into cervical cancer. In an effort to reduce rates of false positives while still detecting cell changes early on, the United States Preventative Services Task Force (USPST) no longer advised that women get a yearly pap test within three years of becoming sexually active or by age 21.

The new recommendation stated that women should get their first pap test by age 21, and then in most cases be screened again once every three years. (Women over 30 also have the option of getting a Pap test concurrent with an HPV test once every five years, according to the USPST guidelines.)

 

While this made Pap testing more convenient for most women, it also gave them less face time with their ob-gyn. Women often used their Pap test visit as an opportunity to be screened for chlamydia, gonorrhea, and other STDs. But since many women weren't seeing their ob-gyn every year anymore, they missed that chance, the study states.

The study focused on testing rates in Ontario, Canada. In 2012, Canadian health officials also adopted the once-every-three-years Pap test guideline established at the same time in the United States. Researchers found that in Ontario, the new guidelines were associated with reduced chlamydia testing and fewer reported new cases of chlamydia in women.

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The greatest reduction of chlamydia testing was in women between ages 15 and 19, where testing rates dropped by about 25%, according to the study. “Young women who are sexually active are at the greatest risk for STDs," says Dr. Kwong. "They may have multiple sex partners and they may not be using protection consistently or at all."

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This is why CDC guidelines advise that all sexually active women under age 25 be screened for chlamydia and gonorrhea annually, as well as women who are 25 or older who are at increased risk of infection—such as those who have a new sex partner, are not monogamous, or have a partner who already has an STD.

Don't have a regular ob-gyn, and aren't sure where to go to get tested? You actually have lots of options, "such as family physicians, student health services, and STD clinics provided through public health departments,” says Dr. Kwong. Planned Parenthood also offers STD testing. If in doubt, give a general walk-in clinic a call and see if they do as well.