CHLAMYDIA and gonorrhoea testing rates in a large American insurance claims analysis indicated suboptimal screening for the two most commonly reported bacterial sexually transmitted infections, caused by Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG).
Chlamydia and gonorrhoea are among the most commonly diagnosed bacterial sexually transmitted infections. Because infections can occur without obvious symptoms, testing plays an important role in identifying cases that might otherwise go undetected and in guiding appropriate treatment and partner management.
Analysis of 2023 data covering 2 million individuals showed that, among those aged 16-24 years, only 23.7% of females and 6.9% of males were tested. Among young women with at least one outpatient obstetrics and gynaecology visit, the testing rate reached 56% highlighting missed opportunities within routine care pathways.
Age and Sex Gaps in Chlamydia and Gonorrhoea Testing Rates
Chlamydia and gonorrhoea testing rates declined further in older age groups for both sexes, reinforcing a clear age gradient in screening uptake. State-level variation was also evident. The median odds ratio of 1.34 among females aged 16–24 indicates that where a patient lived could influence their chance of being tested, with similar individuals potentially being about 34% more likely to receive testing in one state than another. This indicates a geographical variation in clinical practice and service delivery.
Variation in Diagnostic Co-Ordering Practices
Among symptomatic females tested for CT/NG, additional diagnostic panels were frequently ordered alongside initial testing. Co-ordering included Trichomonas vaginalis in 62% of cases, Mycoplasma genitalium in 6%, and herpes simplex virus in 4%. These patterns varied substantially depending on the reason for testing and provider, suggesting heterogeneous diagnostic approaches rather than standardised pathways for sexually transmitted infection evaluation.
Implications for Screening Policy and Practice
Overall low testing rates compared with estimated sexual activity in females under 25 pointed towards potential gaps in adherence to recommended screening strategies. The wide geographic and inter-provider variability suggests opportunities to standardise testing pathways and strengthen system-level prompts in routine care. While insurance claims data offer a large-scale view of clinical practice, they do not capture the full diagnostic context, and comparisons with sexual activity estimates rely on external survey-based evidence.
Collectively, the findings indicate a need for more consistent implementation of sexually transmitted infection screening approaches to reduce missed detection opportunities in at-risk populations.
Reference
Baron J, Heaney D. Real world patterns of STI testing in the US reveal substantial under testing and wide geographic and inter-provider variation. Sex Transm Dis. 2026;DOI:10.1097/OLQ.0000000000002364.
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