Chlamydia Screening Toolkit
Welcome to the Toolkit
Chlamydia is the most commonly reported notifiable disease in the United States. In 2016, there were over 1.6 million cases of chlamydia reported to the Centers for Disease Control and Prevention (CDC). The highest chlamydia rates are among adolescent (ages 15–19) and young adult (ages 20–24) women. Chlamydia is often asymptomatic. If left untreated, chlamydia infection in women can cause pelvic inflammatory disease (PID), and can result in tubal scarring that can lead to infertility, ectopic pregnancy, and chronic pelvic pain. Chlamydial infection also increases susceptibility to the transmission of HIV. Chlamydia is easily detected and treatable with antibiotics.
Gonorrhea is the second most commonly reported notifiable disease, and can also cause PID, infertility, and ectopic pregnancy. Chlamydia and gonorrhea screening can be conducted using a dual test that detects both infections. While this toolkit focuses on increasing rates of chlamydia screening, screening using a dual test addresses both infections simultaneously. Annual chlamydia and gonorrhea screening is recommended for all sexually active women aged <25 years, and for older women at increased risk for infection (e.g., those aged ≥25 years who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STI).
The goal of this toolkit is to support an increase in Title X grantees’ chlamydia screening rates. This toolkit supports improvement on the HEDIS chlamydia screening measure: the percentage of women 16‐24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year.
The toolkit walks sites through a process to increase chlamydia screening rates, organized around the four best practice recommendations of the Chlamydia Screening Change Package.
- Assess baseline chlamydia rates and practices
- Develop an improvement plan
- Best Practice 1: Include chlamydia screening as a part of routine clinical preventive care
- Best Practice 2: Use normalizing and opt-out language
- Best Practice 3: Use the least invasive, high-quality recommended laboratory technologies
- Best Practice 4: Utilize diverse payment options to reduce cost as a barrier
- Sustain and spread improvements
This toolkit was adapted from a chlamydia screening learning collaborative facilitated by the FPNTC in 2017.
Sites should begin by assessing current chlamydia screening rates using Family Planning Annual Report (FPAR) data, and comparing site-level practices to established best practice recommendations.
A participatory process for developing an improvement plan will ensure that staff have ownership and understand their respective roles in achieving change.
| Action Steps | Supportive Resources |
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Facilitate a discussion with clinic staff about the need for increasing chlamydia screening rates among target populations. |
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Facilitate a discussion with clinic staff to develop a site-level plan for increasing chlamydia screening rates. |
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Chlamydia and gonorrhea screening should be incorporated as a routine part of preventive care for sexually active women 24 years of age and younger, for women over 24 who are at increased risk, and men at increased risk. In addition to preventive health visits, clinic staff should include a consideration for chlamydia screening for women 24 years and younger routinely in all visits, including walk-in visits, pregnancy testing, and emergency contraception counseling.
| Action Steps | Supportive Resources |
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Facilitate a discussion with clinic staff about how to incorporate chlamydia screening as a routine part of preventive care. |
Include Chlamydia Screening as a Part of Routine Clinical Preventive Care (Best Practice 1) Training Guide |
Lack of awareness of chlamydia screening guidelines and the social stigma associated with sexually transmitted diseases (STDs) may prevent clients, particularly adolescent and young women, from seeking chlamydia and gonorrhea screening services. Offering screening with normalizing language makes it a routine part of clinical services and is an effective way to build rapport with clients.
| Action Steps | Supportive Resources |
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Facilitate a discussion with clinic staff about how to use opt-out and normalizing language to promote chlamydia screening among sexually active women 24 years and younger. |
Use Normalizing and Opt-Out Language to Explain Chlamydia Screening (Best Practice 2) Training Guide |
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Facilitate an activity with clinic staff to practice using opt-out and normalizing language to promote chlamydia screening among sexually active women 24 years and younger. |
Using Normalizing and Opt-out Language for Chlamydia and Gonorrhea Screening: Training Activity for Clinic Staff |
According to the 2015 STD Treatment Guidelines from CDC, chlamydia can be diagnosed in women by testing clinician-collected, self-collected vaginal swabs, or urine specimens. Systems should be developed to make all of these options available, and all efforts should be made to use the least invasive, high-quality test that is acceptable to, and convenient for, the client.
| Action Steps | Supportive Resources |
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Facilitate a discussion with clinic staff about how to implement the current recommended laboratory technologies for chlamydia screening (for women and men) and streamline the specimen collection process. |
Use the Least Invasive, High-Quality Recommended Laboratory Technologies for Chlamydia Screening, with Timely Turnaround (Best Practice 3) Training Guide |
The Title X Family Planning Program provides services and information to all clients who want and need them, regardless of ability to pay. It is important to diversify payment options and to identify all available options to reduce the cost burden of chlamydia screening to the site and to clients.
| Action Steps | Supportive Resources |
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Facilitate a discussion with clinic staff about strategies for ensuring that cost is not a barrier for the facility or the client. |
Utilize Diverse Payment Options to Reduce Cost as a Barrier for the Facility and the Patient (Best Practice 4) Training Guide |
Implementation is not a one-time activity and does not end after initial improvement plan changes are made. Using a quality improvement approach, staff should prepare for how changes will be sustained at the site, and, once successful, how to spread them to other sites in the network.
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