Universal Chlamydia and Gonorrhea Screening in a Primary Care Setting: A Quality Improvement Project

Chlamydia and gonorrhea (GC/CT) are two of the most frequently reported sexually transmitted infections (STIs) in the U.S. Often asymptomatic, they can have serious health consequences for women and most new infections occur among females 24 years old and younger. The purpose of this QI project was to evaluate the effectiveness and sustainability of a universal STI screening protocol in a primary care clinic setting. The primary goal was to align their clinical practice with CDC recommendations for universal screening and enhance chlamydia and gonorrhea screening and detection rates in females ages 24 years and younger. Local Problem: STI data in Utah indicate that rates of CT have increased by 44% since 2010, and GC by 818% since 2011. Clinic 2 providers performed risk-based screening only. Clinic staff reported significant discomfort in collecting sexual health histories as a barrier and therefore missed opportunities to screen asymptomatic patients. Methods: Participants from a similar project were surveyed and interviewed to determine the success and sustainability of a universal CT screening protocol that had been implemented in 2021. Feedback was used to inform revisions to the protocol, including the addition of GC screening. A pre-survey was given to the participating Clinic 2 staff to establish baseline measures of knowledge and comfort. A post-survey was distributed at the end of the project to determine participants' feedback regarding usability, feasibility, and satisfaction with the protocol. Chart audits were conducted to determine screening rates and individual provider adherence to the protocol. Interventions: Education on STI screening and taking sexual health histories was provided to clinic staff before protocol implementation. The use of repeated PDSA cycles addressed barriers and reinforced staff participation. Results: A total of 170 eligible patients were seen by 5 providers during 14 weeks of implementation and 117 (69%) patients were offered GC/CT screening. Only 65 (56%) patients had STI testing completed, and 2 (3%) patients had positive chlamydia results. Clinic staff found the protocol to be feasible within their daily workflow. Staff indicated that having a sexual health history questionnaire reduced their discomfort and bias in discussion of STI testing with patients. Conclusion: The asymptomatic nature of GC/CT infections will continue to allow infections to spread unknowingly and for this reason, the CDC guidelines for universal STI testing should be integrated into any clinic setting wherein patients at highest risk are seen by healthcare providers. Clinical behaviors were changed, and more women were screened for STIs due to the intervention. More research is needed to determine cost versus benefit, not only in financial costs but also in human costs associated with the adverse health consequences of undiagnosed STIs in asymptomatic patients.