Detecting Sexually Transmitted Diseases
Ideally, all sexually active women should be screened regularly for common sexually transmitted diseases (STDs), particularly gonorrhea and Chlamydia trachomatis. Both infections have been on the rise for some years and, if untreated in women, can lead to pelvic inflammatory disease and infertility.
In practice, only about half of those American women who make a family-planning visit to a doctor or clinic receive screening for STDs, but these screenings do appear to be aimed at reaching the groups of women most at risk.
These were findings of the National Survey of Family Growth conducted by researchers with the Centers for Disease Control in Atlanta and the National Center for Health Statistics. Based on a probability sample of 7,699 women ages 15 to 44, interviews were conducted with those 3,086 women who had sought family-planning services from a doctor or clinic within the previous 12 months. The study was published in the current issue of Family Planning Perspectives, a professional journal.
Risk factors for sexually transmitted disease include age, race, marital status, the region of the country, age at first intercourse and number of sex partners. Infection rates are highest among black women, among the unmarried, among residents of the Southeast and among those women who became sexually active at a young age.
Because a great many of the clients of family-planning services are teen-agers and single women--both groups at high risk and to whom future fertility is a concern--visits to family-planning clinics are an appropriate setting for STD testing, the researchers said. Until this study, little was known about how many women receive screening or whether the women most at risk received screening.
In 1979, the most recent figures available from the Centers for Disease Control, young women aged 15 to 24 contracted gonorrhea at a rate of 1.5 cases per 1,000 population--more than double the rate of any other age group. (The rate of reported cases in the general population tripled to an estimated 2 million per year during the previous decade.)
For black women, the risk factor was even greater. Black women 20 to 24 contracted gonorrhea at a rate of 66 per 1,000, eight times the rate of white women their age. These black women, perhaps because of discrimination, poverty and lack of access to medical services, also suffered the devastating effects of infection at higher rates than white women. They were twice as likely to develop pelvic inflammatory disease and 1 1/2 times as likely to become infertile.
Thus, target groups for screening should include young single women and black women, and the study found out that these risk groups are receiving screening at a higher rate than others; 67% of black single women received screening compared to 51% of white single women; 57% of the sexually active young teen-agers received screening, a significantly greater proportion than the 41% of women over 20 who were tested; women in the South, where rates of disease are higher, received screening at a rate about 10% higher than women in other parts of the country (58% compared to 46% in the Northeast, Central and West).
The survey also found that women who went to a clinic for family-planning services were far more likely to receive screening for STDs than women who see private physicians. For example, among all women in the survey, 62% of the ones who chose a clinic received testing compared to 43% of those who saw private doctors.
It is possible that the overall incidence of screening is underestimated in this study since the questionnaire went to the women rather than health-care providers. Some patients may not have recalled having such a test or may not have known if a routine pelvic examination included taking an STD culture. It is also not known what tests were taken. The women were simply asked if they had been given a test for venereal disease.
Because the figures analyzed were gathered in 1982, before widespread public education about the variety of sexually transmitted diseases, it is probable that the women subjects referred to receiving screenings for gonorrhea and syphilis.
Planned Parenthood Federation of America’s guidelines for STD screenings in its affiliate clinics are based on incidence of venereal disease in the local population rather than selecting target groups, although the two factors may often coincide.
Its recommendations are that at clinics where gonorrhea cultures test positively at a rate of more than 4%, all clinic clients should be screened. Where the rate of positive tests is less than 2%, screenings should be done with women who are IUD users, have had multiple sexual partners or a history of gonorrhea or pelvic inflammatory disease as well as for anyone who asks for a test.
