Practice Guideline Information Sheet



Practice Guideline Information Sheet

Guideline Title [Required]

|Chlamydia Screening |

Date Submitted [Required] Approved By: (Dept & Person) [Required]

|July 2005 | |Eric France, MD, Chief, Preventive Medicine |

| | |Women’s Health Task Force |

| | |Regional Prevention Committee |

Contact [Required] person to contact regarding this guideline’s content

|Sue Jane Fox |

|Department |Prevention |

|Phone |303-344-7256 |Email |Sue.J.Fox@ |

| | | | |

Author(s)

|Sue Jane Fox |

|Women’s Health Task Force |

Clinical Category [Required] Choose one (more if needed) from the list below.

| Allergy | Geriatrics | Pharmacy |

| Anesthesiology | Hematology/Oncology | Physiatry/Rehab |

| Cardiology | Infectious Disease | Podiatry |

| Cardiovascular Surgery | Mental Health | Pulmonology |

| Dermatology | Nephrology | Radiation Oncology |

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|Endocrinology |x Obstetrics/Gynecology | Surgery |

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| Gastroenterology |x Pathology/Laboratory Services |XPrimary Care |

| | |xPediatrics |

Keywords To aid in searching for the guideline

|Chlamydia Screening, Well Teen Care, Sexual Health, HEDIS, STD |

Abstract or other summary description of this guideline

|Asymptomatic genito-urinary chlamydia infection is common in sexually active women under the age of 26. Without treatment, this |

|can lead to pelvic inflammatory disease, fallopian tube scarring, ectopic pregnancy, and infertility. Screening and appropriate |

|treatment has been shown to be effective in reducing the morbidity associated with this infection. This guideline provides |

|recommendations for effective screening practice. |

Intended Audience [Required] Click below to change

|xAll Providers |xPhysicians |

|xAll Providers and Staff |xNurses |

|Members |xPhysician Assistants |

| Other: |

Practice Guideline Plan Sheet

What is the intended clinical outcome of implementing this guideline ?

|Chlamydia infections will be identified and effectively treated early. |

What is the implementation plan?

|All sexually active women under age 26 will be screened for genito-urinary chlamydia at least once a year. Symptomatic women will |

|be screened as appropriate. |

|Guideline will also be available on the Permanente Knowledge Connection (pkc.) intranet site. |

What is the plan for evaluating the outcome of implementing this guideline?

|Chlamydia screening rates are a HEDIS measure which is monitored and reported regularly. |

These guidelines are informational only and are not intended or designed to substitute the reasonable exercise of independent clinical judgment by providers in any particular set of circumstances for each patient encounter. The guidelines are flexible and are intended to be used as a resource for integration with a sound exercise of clinical judgment. They can be used to create an approach to care that is unique to the needs of each individual patient. The implementation of this guideline is not intended to conflict with any agreed upon health plan benefits nor is it intended to prevent access to care that the practitioner believes is warranted based on clinical judgement.

Date: July 2005

Title: Screening: Chlamydia

Rationale of Guideline: Assymptomatic genito-urinary chlamydia infection is common in sexually active women under the age of 26 years, with a rate of 5-8% for HMO insured populations reported in the literature. Left untreated, cervical infections can lead to pelvic inflammatory disease (PID), fallopian tube scarring, ectopic pregnancy, and infertility. Screening of sexually active women under age 26, followed by appropriate treatment, has been shown to be effective in reducing the morbidity associated with chlamydia infection (number needed to screen to prevent one case of PID = 200, infertility = 1,000, ectopic pregnancy = 2,200, chronic pelvic pain =1,500, any one sequelae = 150; cost to prevent any 1 sequelae = $1,000).

Guideline: All sexually active women under age 26 years should be screened for genito-urinary chlamydia infection at least once a year. Additional testing for chlamydia is appropriate at any visit where a woman has signs of cervicitis, or at the clinical discretion of the provider.

Additional recommendations: Chlamydia tests may be obtained by either a urine test (available beginning 8/05) or at the time of a routine pelvic exam and Pap smear using an appropriate cervical swab. Women in this age group should begin cervical cancer screening with pap smears 3 years after the onset of sexual activity or age 21 and should continue at least every 2 years.

Starting at adolescence, all women should be asked about sexual activity at all health maintenance (“well teen”) exams and at other visits at the clinical discretion of the provider. Note that this information is confidential beginning at age 12 years according to Colorado statue. Women requesting pregnancy testing or contraception counseling or therapy should be assumed to be sexually active. Women who are not sexually active but are using oral contraceptives for reasons other than contraception, or have pregnancy tests for other reasons (such as prior to Accutane therapy) need not be tested. The indication for the oral contraceptives or pregnancy testing, or that the women is not sexually active (“sexual abstinence”) should be noted in the medical record.

While the USPSTF does not make a clear recommendation regarding the screening of sexually active adolescent males (“I” recommendation based on lack of evidence), the use of urine chlamydia screening in this population may be clinically beneficial in our at-risk population. Therefore, urine screening of sexually active males may be offered per provider discretion with shared decision making and appropriate counseling.

Target Population: Sexually active females age 13-26, sexually active adolescent males

Responsible Party: Sue Jane Fox, Prevention, Sue.J.Fox@, 303-344-7256; Karin Kempe, MD, Prevention, 303-344-7662, Karin.L.Kempe@

Approval: Chief, Preventive Medicine

Review Date: July 2007

Methods for Measuring Effectiveness: HEDIS rates of screening sexually active females age 16-25, 16-20, and 21-25.

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Kaiser Permanente Colorado Region

Screening: Chlamydia

Date: July 20, 2000

Page #1

Preventive Medicine

Approval: Departments of Family Practice, OB/GYN, Pediatrics, Internal Medicine,

Lab Administration, Preventive Medicine.

Review Date: July 2007

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