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July 2003, Vol 93, No. 7 | American Journal of Public Health 1033-1034
© 2003 American Public Health Association

LETTER

INSURANCE AND NONINVASIVE SCREENING FOR STDS

Mary B. Adam, MD

Correspondence: Requests for reprints should be sent to Mary B. Adam, MD, Informatics and Decision Making Laboratory, University of Arizona College of Medicine, PO Box 245031, Tucson, Arizona 85724 (e-mail: adammb{at}pol.net).

St. Lawrence et al. demonstrate dramatically that physicians in practice do a less than stellar job of screening for sexually transmitted diseases (STDs).1 The need to screen for STDs has been well demonstrated in recent studies from Baltimore, Md, where 7.9% of the population aged 18 through 35 years tested positive for gonorrhea or chlamydia by nucleic acid amplification tests on urine samples.2 Physicians can increase their screening. This has been demonstrated in Kaiser Permanente pediatric clinics in California. Physicians in the intervention clinics increased chlamydia screening of sexually active adolescent girls coming in for routine checkups and saw a concomitant decrease in average chlamydia detection rates.3

In both studies, urine testing was well tolerated by the patients. Unfortunately, urine screening is not always well tolerated by insurance companies. The reference laboratory used by our institution charges $46.36 for a chlamydia DNA probe test that can be done on endocervical specimens but not urine. The cost of the urine nucleic acid amplification test is $111.00. Many insurance companies are reluctant to pay the additional costs. The American Academy of Pediatrics passed a resolution in 1999 calling for funding of noninvasive urine testing for sexually transmitted diseases. Other medical societies and advocates for public health should join together in calling for more screening using noninvasive testing. This should increase the volume of tests being done and allow the cost per test to decrease without putting any undue financial burden on insurance companies or laboratories.

On the other hand, insurance companies could lead the way and encourage noninvasive testing by negotiating with laboratories for lower costs. This could be a win-win situation. Patients would appreciate the noninvasive testing, physicians would do more screening, and the insurance companies wouldn’t lose money on noninvasive testing. Therefore, STD rates would decline and the public health would be better served.

References

1. St. Lawrence JS, Montano DE, Kasprzyk D, Phillips WR, Armstrong K, Leichliter JS. STD screening, testing, case reporting, and clinical and partner notification practices: a national survey of US physicians. Am J Public Health. 2002;92:1784–1788.[Abstract/Free Full Text]

2. Turner CF, Rogers SM, Miller HG, et al. Untreated gonococcal and chlamydial infection in a probability sample of adults. JAMA.2002;287:726–733.[Abstract/Free Full Text]

3. Shafer MA, Tebb KP, Pantell RH, et al. Effect of a clinical practice improvement intervention on chlamydial screening among adolescent girls. JAMA.2002;288:2846–2852.[Abstract/Free Full Text]




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Universal STD Screening Requires Universal Care
William R. Phillips
AJPH Online, 11 Sep 2003 [Full text]
This Article
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