Chlamydia Gonorrhea testing rates in a large analysis of US insurance claims indicated suboptimal screening for the most common bacterial sexually transmitted infection caused by Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (to).
Chlamydia and gonorrhea are the most common sexually transmitted bacterial infections. Because infection can occur without obvious symptoms, testing plays an important role in identifying cases that may otherwise go undetected and in directing appropriate treatment and partner management.
An analysis of 2023 data covering two million individuals showed that among those aged 16 to 24, only 23.7% of females and 6.9% of males had been tested. Among young women who had at least one outpatient obstetrics and gynecology visit, the testing rate was 56%, highlighting missed opportunities within routine care pathways.
Age and sex gaps in chlamydia and gonorrhea testing rates
Rates of chlamydia and gonorrhea testing declined most in older age groups for both sexes, reinforcing a clear age gradient in screening uptake. Country-level variation was also evident. The average odds ratio of 1.34 among females ages 16 to 24 suggests that where a patient lives can affect their chance of getting tested, with similar individuals being 34% more likely to receive testing in one state than in another. This indicates geographic variation in clinical practice and service delivery.
Variation in diagnostic co-ordering practices
Among females with symptoms on CT/NG testing, additional diagnostic panels were often ordered alongside the initial tests. Common order included Trichomonas vaginalis In 62% of cases, Mycoplasma genitalium in 6%, and herpes simplex virus in 4%. These patterns varied widely depending on the reason for testing and the provider, suggesting heterogeneous diagnostic approaches rather than standardized pathways for evaluating STIs.
Implications for screening policy and practice
Overall lower rates of testing compared to estimated sexual activity in females under 25 years of age indicated potential gaps in adherence to recommended screening strategies. The wide geographic and interprovider heterogeneity suggests opportunities to standardize testing pathways and enhance system-wide claims in routine care. While insurance claims data provide a broad view of clinical practice, they do not capture the full diagnostic context, and comparisons with estimates of sexual activity rely on external, survey-based evidence.
Collectively, the results suggest a need for more consistent implementation of STI screening approaches to reduce missed opportunities for detection in at-risk populations.
reference
Baron J, Heaney D. Real-world patterns of STD testing in the United States reveal a large amount of testing under testing and wide geographic and among provider variation. Dis sex transfer. 2026;DOI:10.1097/OLQ.0000000000002364.
Featured image: Xenon on Adobe Stock
