STI fears under new cervical screening program

Creeping STI rates could be an unintended side effect of the shift to the five-yearly cervical cancer screening

Creeping STI rates could be an unintended side effect of the shift from two-yearly Pap smears to the five-yearly cervical cancer screening under the new national system.

The introduction of Renewal in December will see cervical cancer screening beginning at age 25, reducing one avenue for GPs to opportunistically test for STIs in younger people.

Authors of a new Canadian study sought to understand what impact the 2012 changes to cervical cancer screening had on chlamydia testing, after that country introduced new recommendations to begin testing at 21, and lengthened the time between tests from two years to three.

Using physician billing claims data to identify Pap and chlamydia tests, and surveillance data to track cases across Ontario, they found that in the two years following the guideline change there was reduced chlamydia testing in women.

The drop was largest in the 15- to 19-year-old cohort, who had one in four fewer chlamydia tests compared with under the previous guidelines. There was also a shrink in chlamydia diagnoses in that group and those aged 20 to 24 years, although the male incidence of chlamydia stayed constant, and their testing increased during the same period.

This suggested that “reduced testing for chlamydia in females leads to reduced detection of asymptomatic chlamydia infections,” the authors wrote.

“The public-health implications of reduced chlamydia screening over time include missed opportunities for clinical and public health management of cases and a potentially increased spread of chlamydia infection by asymptomatic individuals.”

Professor Deborah Bateson, medical director of Family Planning NSW, said that it was important for GPs to be alert for new opportunities to test for STIs and have sexual-health discussions under the new scheme.

While this could be done during conversations about oral contraceptives, or at any other appropriate time, Professor Bateson pointed to the shift towards long-acting reversible contraception as another reason GPs might have fewer opportunities to bring up sexual health issues with their patients.

Dr Lara Roeske, chair of the RACGP Sexual Health Medicine network, noted that regardless, chlamydia testing rates for women aged 15 to 24 years were already low in general practice, at around 14%, even under the current system.

Instead, all young, sexually active, asymptomatic women and men, should see their GP annually for a chlamydia test, she said.

However, under the new program, chlamydia testing could be done directly on the liquid-based cytology sample, Dr Roeske, who is the liaison physician to the Victorian Cytology Service, said.

“There will be no need for the GP to take a separate sample for a chlamydia test when undertaking cervical screening in the new program,” Dr Roeske said.

From December, women with symptoms such as abnormal vaginal bleeding, pain and discharge would be eligible for co-testing with both HPV and cytology at any age, she said.

“STI testing, including testing for chlamydia infection, should be considered and undertaken if clinically indicated, in addition to referral for other appropriate investigations.”

Ann Fam Med; 15:329-334