Recommended Citation
Kob M, Brill J. Age-Specific Patterns of Chlamydia Screening and Positivity in the Absence of Electronic Health Record Prompts: Variation by Specialty and Social Vulnerability. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
Chlamydia trachomatis (CT) remains one of the most reported bacterial sexually transmitted infections in the United States, disproportionately affecting young women. National guidelines recommend annual screening of sexually active women under the age of 25 to reduce risks of pelvic inflammatory disease and comparable conditions. However, operationalizing risk-based screening within the Electronic Health Record (EHR) proves challenging when sexual activity is not comprehensively documented. During a period without active EHR prompts in Aurora St. Luke’s integrated health system, baseline CT screening patterns were evaluated to inform future workflow and quality initiatives.
Purpose:
To characterize age-specific CT screening and positivity rates and examine variations of these two rates by provider specialty and social vulnerability.
Methods:
A retrospective analysis of EHR data from April 20, 2022, to April 19, 2023, was conducted. Female patients aged 12 years and older, with at least one provider encounter in the prior 12 months were included. Testing rates, positivity, and population prevalence were calculated by age. Screening at wellness visits was stratified by specialty (pediatrics, family medicine, obstetrics/gynecology). Social Vulnerability Index quartiles were compared to assess socioeconomic gradients in testing and positivity.
Results:
Among 1,971,826 active female patients aged ≥12 years, 106,414 (5.4%) underwent chlamydia testing, with 4,968 positive results (4.7% positivity; population prevalence 0.3%). Testing increased with age, from 0.4% among ages 12–14 to 16.0% among ages 21–24, yet overall results remained below estimated sexual activity prevalence. Test positivity among those screened was high across adolescence (≈13–14% at ages 15–20), declining to 9.0% at ages 21–24. At wellness visits, screening differed by specialty across all ages (p<10⁻2⁰), with higher testing in family medicine and obstetrics/gynecology than pediatrics. Patients from high Social Vulnerability Index neighborhoods had greater testing uptake and higher odds of infection.
Conclusion:
Without EHR prompts, CT screening was below guideline recommendations despite high positivity once testing occurred. Population prevalence increased with age due to greater testing, not rising infection risk. Specialty and social vulnerability influenced screening and disease burden, supporting standardized, opt-out screening to improve equity.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
wf_yes
Document Type
Poster
Open Access
Available to all.
Age-Specific Patterns of Chlamydia Screening and Positivity in the Absence of Electronic Health Record Prompts: Variation by Specialty and Social Vulnerability
Background/Significance:
Chlamydia trachomatis (CT) remains one of the most reported bacterial sexually transmitted infections in the United States, disproportionately affecting young women. National guidelines recommend annual screening of sexually active women under the age of 25 to reduce risks of pelvic inflammatory disease and comparable conditions. However, operationalizing risk-based screening within the Electronic Health Record (EHR) proves challenging when sexual activity is not comprehensively documented. During a period without active EHR prompts in Aurora St. Luke’s integrated health system, baseline CT screening patterns were evaluated to inform future workflow and quality initiatives.
Purpose:
To characterize age-specific CT screening and positivity rates and examine variations of these two rates by provider specialty and social vulnerability.
Methods:
A retrospective analysis of EHR data from April 20, 2022, to April 19, 2023, was conducted. Female patients aged 12 years and older, with at least one provider encounter in the prior 12 months were included. Testing rates, positivity, and population prevalence were calculated by age. Screening at wellness visits was stratified by specialty (pediatrics, family medicine, obstetrics/gynecology). Social Vulnerability Index quartiles were compared to assess socioeconomic gradients in testing and positivity.
Results:
Among 1,971,826 active female patients aged ≥12 years, 106,414 (5.4%) underwent chlamydia testing, with 4,968 positive results (4.7% positivity; population prevalence 0.3%). Testing increased with age, from 0.4% among ages 12–14 to 16.0% among ages 21–24, yet overall results remained below estimated sexual activity prevalence. Test positivity among those screened was high across adolescence (≈13–14% at ages 15–20), declining to 9.0% at ages 21–24. At wellness visits, screening differed by specialty across all ages (p<10⁻2⁰), with higher testing in family medicine and obstetrics/gynecology than pediatrics. Patients from high Social Vulnerability Index neighborhoods had greater testing uptake and higher odds of infection.
Conclusion:
Without EHR prompts, CT screening was below guideline recommendations despite high positivity once testing occurred. Population prevalence increased with age due to greater testing, not rising infection risk. Specialty and social vulnerability influenced screening and disease burden, supporting standardized, opt-out screening to improve equity.
Affiliations
Aurora St. Luke's Medical Center