Missed connections Unintended consequences of updated cervical cancer screening guidelines on screening rates for sexually transmitted infections

Abstract Objective To examine the effects of the updated 2012 cervical cancer screening guidelineson the rates of sexually transmitted infection (STI) screening in primary care. Design Retrospective chart review. Setting Five academic family practice units at St Michael’s Hospital in Toronto, Ont. Participants Female patients, aged 19 to 25, who had at least 1 visit with a physician at 1 of the 5 academic family practice units during a 12-month period before (May 1, 2011, to April 30, 2012) or after (November 1, 2012, to October 31, 2013) the release of the updated guidelines. Main outcome measures Number of women who received Papanicolaou testsor underwent STI screening; rates of STI screening performed during a Pap testor a periodic health examination; screening rates for HIV, syphilis, and hepatitis C; and the methods used for STI screening before and after the release of the updated guidelines. Results Before the release of the 2012 guidelines, 42 of 100 women had Pap testsand 40 of 100 women underwent STI screening. After the release of the guidelines, 17 of 100 women had Pap testsand 20 of 100 women received STI screening. Female patients were less likely to undergo STI screening under the 2012 guidelinescompared with the 2005 guidelines(odds ratio 0.38, 95% CI 0.19 to 0.74; P = .003). Conclusion Implementation of the 2012 cervical cancer screening guidelineswas associated with lower rates of STI screening in the primary care setting. Primary care physicians should screen at-risk women for STIs at any clinically appropriate encounter and consider using noninvasive self-sampling methods.