eMJA: No barriers to chlamydia testing in sexually active young women

Christopher K Fairley,* Jane Hocking,^† Jane Gunn,^‡ Marcus Y Chen§

* Professor, ^† Postdoctoral Research Fellow, School of Population Health, ^‡ Associate Professor and Deputy Head, Department of General Practice, § Registrar, Melbourne Sexual Health Centre, University of Melbourne, 580 Swanston Street, Carlton, VIC 3053.

cfairleyATunimelb.edu.au

To the Editor: Each year, Australian general practitioners test only about 7% of women aged 16–24 years for chlamydia (according to Medicare records, 89 132 tests were performed on women in this age group in 2004). This compares with 30% of women aged 20–24 years in Sweden1 or Denmark.2 Why are Australian GPs not testing young women for chlamydia?

Chlamydia screening in sexually active women is cost-effective and significantly reduces complications such as infertility.3 The Australian Government’s commitment to chlamydia control is evidenced by the $12.5 million recently provided for increased awareness, improved surveillance and a pilot testing program for chlamydia.

In 2004, 81% of 15–19-year-old and 89% of 20–24-year-old women attended a GP at least once in Australia (unpublished data from Health Insurance Commission [HIC]), yet chlamydia testing was ordered for only a small fraction of these women.

Possible reasons for the low testing rate include a lack of knowledge about the benefits of testing young women, inadequate support, difficulties in raising chlamydia testing during consultations not related to sexual health, or concern about violating HIC rules on screening.4 However, the Medicare Benefits Schedule does permit testing for chlamydia among young sexually active women. Benefits are payable for:

health screening services . . . by the patient’s own medical practitioner . . . to ensure the patient receives any medical advice or treatment necessary to maintain his/her state of health . . . [B]enefits would be payable for the attendance and such tests which would be considered reasonably necessary according to the circumstances of the patient, such as age, physical condition, past personal and family history.5

If the HIC is concerned that “inappropriate practice” may have occurred, there is a clearly defined process for determining this.6 Part of the definition of “inappropriate practice” is “conduct in connection with rendering or initiating services that would be unacceptable to the general body of members of that profession”. A GP’s professional peers would be members of the Royal Australian College of General Practitioners. The College will soon release the latest edition of its Guidelines for preventive activities in general practice (“The Red Book”),7 which includes activities only if they are relevant to general practice and have a demonstrated benefit. The book now recommends that all sexually active women less than 25 years of age should be tested annually for chlamydia.

Increasing chlamydia testing in young Australian women from the current low rate of 7% would reduce complications and save money in the long run.3

Götz H, Lindbäck J, Ripa T, et al. Is the increase in notifications of Chlamydia trachomatis infections in Sweden the result of changes in prevalence, sampling frequency or diagnostic methods? Scand J Infect Dis 2002; 34: 28-34. <PubMed>
Statens Serum Institut. Chlamydia 2003. EPI-News, No. 45, 2004. Available at: http://www.ssi.dk/sw19521.asp (accessed Oct 2005).
Hocking J, Fairley CK. Need for screening for genital Chlamydia trachomatis infection in Australia. Aust N Z J Public Health 2003; 27: 80-81. <PubMed>
Donovan B, Knight V, McNulty A, et al. Gonorrhoea screening in general practice: perceived barriers and strategies to improve screening rates. Med J Aust 2001; 175: 412-414. <eMJA full text> <PubMed>
Medicare Benefits Schedule book. Canberra: Australian Government Department of Health and Ageing, 2004.
Medicare Australia. Health care providers. Professional Services Review Scheme. Inappropriate practice. Available at: http://www.medicareaustralia.gov.au/providers/program_review_integrity/psr.htm#inappropriate_practice (accessed Oct 2005).
Harris M, Bailey L, Bridges-Webb C, et al, editors. Guidelines for preventive activities in general practice (“The Red Book”). 6th ed. Melbourne: Royal Australian College of General Practitioners, 2005.