Shimrit Keddem1,2, Marissa Maier3,4, Carolyn Gardella5,6, Joleen Borgerding5, Elliott Lowy5, Maggie Chartier7, Sally Haskell8,9, Ronald G Hauser8,9, Lauren A Beste5,10. 1. Corporal Michael J. Crescenz Veterans Affairs (VA) Medical Center, VA Center for Health Equity Research and Promotion (CHERP), Philadelphia, PA, USA. shimrit.keddem@va.gov. 2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. shimrit.keddem@va.gov. 3. Division of Infectious Diseases, Department of Medicine, Oregon Health & Science University, Portland, OR, USA. 4. VA Portland Health Care System, Veterans Health Administration (VHA), Portland, OR, USA. 5. VA Puget Sound Health Care System, Veterans Health Administration (VHA), Seattle, WA, USA. 6. Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA. 7. Office of Specialty Care Services, Veterans Health Administration, Washington, DC, USA. 8. Pathology and Laboratory Medicine Department, Veterans Affairs Connecticut Health Care, West Haven, USA. 9. Yale University School of Medicine, New Haven, CT, USA. 10. Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Abstract
BACKGROUND: United States (US) rates of sexually transmitted infection (STI) in women, especially gonorrhea and chlamydia, have increased over the past decade. Women Veterans may be at increased risk for STIs due to high rates of sexual trauma. Despite the availability of effective diagnostic tests and evidence-based guidelines for annual screening among sexually active women under age 25, screening rates for gonorrhea and chlamydia remain low in the US and among Veterans. OBJECTIVE: To examine patient characteristics and health system factors associated with gonorrhea and chlamydia testing and case rates among women Veterans in the Veterans Health Administration (VHA) in 2019. DESIGN: We performed a retrospective cohort study of all women Veterans in VHA care between January 1, 2018, and December 31, 2019. PARTICIPANTS: Women Veteran patients were identified as receiving VHA care if they had at least one inpatient admission or outpatient visit in 2019 or the preceding calendar year. KEY RESULTS: Among women under age 25, 21.3% were tested for gonorrhea or chlamydia in 2019. After adjusting for demographic and other health factors, correlates of testing in women under age 25 included Black race (aOR: 2.11, CI: 1.89, 2.36), rural residence (aOR: 0.84, CI: 0.74, 0.95), and cervical cancer screening (aOR: 5.05, CI: 4.59, 5.56). Women under age 25 had the highest infection rates, with an incidence of chlamydia and gonorrhea of 1,950 and 267 cases/100,000, respectively. Incidence of gonorrhea and chlamydia was higher for women with a history of military sexual trauma (MST) (chlamydia case rate: 265, gonorrhea case rate: 97/100,000) and those with mental health diagnoses (chlamydia case rate: 263, gonorrhea case rate: 72/100,000.) CONCLUSIONS: Gonorrhea and chlamydia testing remains underutilized among women in VHA care, and infection rates are high among younger women. Patient-centered, system-level interventions are urgently needed to address low testing rates.
BACKGROUND: United States (US) rates of sexually transmitted infection (STI) in women, especially gonorrhea and chlamydia, have increased over the past decade. Women Veterans may be at increased risk for STIs due to high rates of sexual trauma. Despite the availability of effective diagnostic tests and evidence-based guidelines for annual screening among sexually active women under age 25, screening rates for gonorrhea and chlamydia remain low in the US and among Veterans. OBJECTIVE: To examine patient characteristics and health system factors associated with gonorrhea and chlamydia testing and case rates among women Veterans in the Veterans Health Administration (VHA) in 2019. DESIGN: We performed a retrospective cohort study of all women Veterans in VHA care between January 1, 2018, and December 31, 2019. PARTICIPANTS: Women Veteran patients were identified as receiving VHA care if they had at least one inpatient admission or outpatient visit in 2019 or the preceding calendar year. KEY RESULTS: Among women under age 25, 21.3% were tested for gonorrhea or chlamydia in 2019. After adjusting for demographic and other health factors, correlates of testing in women under age 25 included Black race (aOR: 2.11, CI: 1.89, 2.36), rural residence (aOR: 0.84, CI: 0.74, 0.95), and cervical cancer screening (aOR: 5.05, CI: 4.59, 5.56). Women under age 25 had the highest infection rates, with an incidence of chlamydia and gonorrhea of 1,950 and 267 cases/100,000, respectively. Incidence of gonorrhea and chlamydia was higher for women with a history of military sexual trauma (MST) (chlamydia case rate: 265, gonorrhea case rate: 97/100,000) and those with mental health diagnoses (chlamydia case rate: 263, gonorrhea case rate: 72/100,000.) CONCLUSIONS: Gonorrhea and chlamydia testing remains underutilized among women in VHA care, and infection rates are high among younger women. Patient-centered, system-level interventions are urgently needed to address low testing rates.
Authors: Anne G Sadler; Michelle A Mengeling; Craig H Syrop; James C Torner; Brenda M Booth Journal: J Womens Health (Larchmt) Date: 2011-08-11 Impact factor: 2.681
Authors: Jodie Katon; Gayle Reiber; Danielle Rose; Bevanne Bean-Mayberry; Laurie Zephyrin; Donna L Washington; Elizabeth M Yano Journal: J Gen Intern Med Date: 2013-07 Impact factor: 5.128