Is Gonorrhea Add-On to Chlamydia Test of Benefit?


JACKSONVILLE, FLA. — A majority of privately insured women tested for chlamydia are also checked for gonorrhea, which may be unnecessary given its significantly lower incidence, according to a study presented at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

“Gonorrhea is much more rare. Chlamydia incidence is 5%–7% versus less than 1% for gonorrhea,” Thomas L. Gift, Ph.D., said in an interview at his poster presentation.

Screening of all sexually active adolescents and females 25 years or younger for chlamydia is recommended by the CDC. However, screening for gonorrhea is only recommended for those at high risk of sexually transmitted diseases.

Dr. Gift and his associate Michele K. Bohm identified 61,183 females aged 15–65 years who were tested for chlamydia, gonorrhea, or both in 2001. They searched outpatient claims in the Medstat Marketscan Database of approximately 4 million privately insured patients. They looked for current procedures terminology codes specific to chlamydia testing or gonorrhea testing. DNA direct or amplified dual-assay codes were also included in the study.

Patients were tested for chlamydia on 66,070 occasions and for gonorrhea on 58,163 occasions. They were tested for both chlamydia and gonorrhea on 56,371 of these occasions, suggesting frequent use of dual testing assays. “Eighty-five percent of the time we found a gonorrhea test on the same day on the chart as the chlamydia test,” said Dr. Gift, an economist in the division of STD prevention at the CDC.

“There are a lot of people being tested for gonorrhea when they shouldn't be,” Dr. Gift said.

The costs can be more than economic—there are false-positive concerns with sexually transmitted infections (STIs), Dr. Gift said. “There is such a host of undefinable costs—for example, an STD diagnosis in a monogamous relationship. The prudent thing is to treat just in case, but there is wreckage strewn around by suggesting someone has an STI.”

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