Real World Patterns of Sexually Transmitted Infection Testing in the US Reveal Substantial Under Testing and Wide Geographic and Inter-Provider Variation.

Abstract

Background: Testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) is indicated for diagnostic purposes in symptomatic individuals and for screening purposes in certain populations including sexually active females younger than 25 and partners of individuals who test positive.

Methods: Using 2023 insurance claims data from 2 million US individuals in the Marketscan database with commercial insurance or with Medicaid, we quantified rates of CT/NG testing and patterns of co-ordering of tests for additional infections. We assessed variation in testing rates and patterns using mixed effects logistic regression models.

Results: The overall testing rate for CT/NG in 2023 was 23.7% (23.4-24.0%, 95% CI) in females 16 to 24 and 6.9% (6.7-7.1%) in males 16 to 24; rates were lower in older males and older females. Among females 16 to 24 with at least 1 outpatient obstetrician-gynecology visit, the testing rate was only 56%. Testing rates varied by US state with a median odds ratio of 1.34 in females 16 to 24. Symptomatic females tested for CT/NG were also tested for Trichomonas vaginalis , Mycoplasma genitalium and HSV in 62%, 6%, and 4% of cases, respectively. Patterns of test co-ordering varied widely by reason for testing and specific provider.

Conclusions: CT/NG testing rates were low. Differences between rates of testing and sexual activity in females under 25 suggest guideline nonadherence (sexual activity estimated based on our analysis of NHANES survey data and prior literature including Halpern, 2012 and Rimsza, 2005). Wide geographic and interprovider variation in testing patterns argues for improved testing systems and practice.