Clinics can screen adolescent girls for Chlamydia

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Sexually active adolescent girls can be successfully screened for asymptomatic Chlamydia trachomatis infections during pediatric urgent care visits.

“To address the C. trachomatis epidemic among our adolescent and young adult populations, we need to take advantage of missed opportunities and deliver essential preventive services where these young women interface with the health care system,” Dr. Kathleen P. Tebb from University of California, San Francisco told Reuters Health.

Tebb and her colleagues developed and evaluated an intervention to increase the screening rate for this bacterial infection among sexually active adolescent girls during pediatric urgent care visits. Urogenital infection with C. trachomatis is a common sexually transmitted disease causing urogenital infection that can lead to pelvic inflammatory disease and infertility if untreated.

Adolescent Care Teams at five clinics were tasked with determining the most effective system for identifying sexually active teens, obtaining urine specimens and transporting them to the laboratory, communicating positive results confidentially to the teenager, and setting up a follow-up treatment. The findings are published in the June issue of the Archives of Pediatric and Adolescent Medicine.

After 13 to 15 months, the estimated proportion of adolescent girls screened for C. trachomatis during urgent care rose from 26.26 percent to 42.19 percent at clinics where the intervention was implemented but decreased slightly (from 31.95 percent to 29.82 percent) at sites where the staff received only an informational lecture on C. trachomatis screening.

When one of the five intervention clinics was excluded (because it did not implement the intervention as it was intended), the postintervention screening rate for the remaining intervention clinics was 47.99 percent, the authors report.

“Though I am extremely sensitive to the constraints of delivering a sensitive preventive service in the context of an urgent health visit, this study, with its emphasis on a local team approach to quality improvement, shows that it is possible to do so with minimal impact on clinic staff and provider time,” Tebb said.

The investigators are currently conducting a study funded by HRSA/Maternal and Child Health Bureau using a Spanish/English computer kiosk module, similar to an ATM machine, to facilitate screening for asymptomatic Chlamydia infection in young adult women in emergency care settings, Tebb explained.

“This approach utilizes computer technology to assess the client’s risk and prompt the client and health care professionals for urine specimen collection to screen for Chlamydia.”

In a related editorial, Dr. Diane R. Blake from University of Massachusetts Medical School in Worcester writes, “The more possibilities there are for an adolescent to ‘bump into’ a screening opportunity, the fewer holes there will be in the patchwork of screening options, which will increase the probability of approaching 100 percent C. trachomatis screening of sexually active adolescents. This is a lofty goal, but one well worth pursuing.”

By Will Boggs, MD
SOURCE: Archives of Pediatric and Adolescent Medicine June, 2009.

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