Unintended Consequences: The Impact of Cervical Cancer Screening Guidelines on Rates of STI Screening in Primary Care

Abstract

Objective: In 2012, cervical cancer screening guidelines in Ontario shifted from recommending yearly Pap testing to recommending Pap tests every 3 years. We sought to investigate how these changes have impacted rates of sexually transmitted infection (STI) screening in young women.

Methods: We conducted a retrospective cohort study of 600 patients aged 19-25 years who presented to 1 of 2 community family health teams from May 1, 2009 to April 30, 2012 (the annual Pap test group) or from Nov 1, 2012 to Oct 31, 2015 (the triennial Pap test group). The primary outcome was the number of visits at which STI screening was performed. Secondary outcomes were presence/absence of STI screening over a 3-year period and method of screening used.

Results: A significant decrease was observed in the number of visits at which STI screening was performed, with the annual group averaging 1.21 visits/patient compared with 0.82 visits/patient for the triennial group (P = 0.001). A decrease in the proportion of patients screened over 3 years was also observed (66.8% vs. 52.8%, P = 0.007). A significant decrease in the use of endocervical culture (1.06 vs. 0.57 tests/patient, P <0.001), and a non-significant increase in urine NAAT (0.09 vs. 0.17, P = 0.07) and serum STI screening (0.37 vs. 0.47, P = 0.16) was observed.

Conclusions: The 2012 Ontario cervical cancer screening guidelines were associated with a decrease in STI screening among women aged 19-25 years in the primary care setting. This unintended effect of guideline changes highlights a need for STI screening practices that are independent of routine pelvic examinations.

Keywords: Pap smear; cervical cancer; chlamydia; gonorrhea; sexually transmitted infections.