Tests for sexually transmitted infections fell after Pap smear guidelines changed

There was a decrease in screening for sexually transmitted infections, an unintended consequence of Ontario's changes to cervical cancer screening guidelines, doctors have found.

Researchers at St. Michael's Hospital in Toronto tracked patient charts at five family physician offices in the year before the guidelines changed and the year after.

"In keeping with the new guidelines, which recommend delaying cervical cancer screening to age 21 and screening less frequently, it is not surprising that our study found a 60 per cent decrease in Pap testing," Dr. Tali Bogler, the study's lead researcher and her co-authors said in Thursday's issue of Canadian Family Physician.

"However, we found an unintentional 50 per cent decrease in screening for chlamydiaand gonorrhea subsequent to the the updated guidelines."

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The study's authors say when office visits for Pap tests fell, family physicians might have had fewer chances to screen for sexually transmitted infections in young women. Doctors often performPap tests and STI screening at the same time.

Specifically, the researchers found:

• Pap smear tests reduced by 60 per cent (from 42 to 17 per cent.)
• Screening rates for gonorrhea and chlamydia the two most common STIs in women aged 15 to 24 decreased from 40 to 20 per cent.

"Our findings highlight an unintended and potentially harmful public health consequence of the updated Ontario cervical cancer screening guidelines," the study's authors said.

They said it's critical for family doctors to find new and innovative ways to screen for sexually transmitted infections in sexually active women under age 25. These could include self-administered swabs and urine tests and expanding screening programs beyond the clinic to high schools, universities, shopping malls and street outreach sites.

Cancer Care Ontario released its updated guidelines for Pap screening in May 2012.

Limitations of the research include the lack of a control group, non-randomization and inconsistent documentation of sexual activity in patient charts.

The study also took place at primary care sites caring for an inner-city population and may not apply elsewhere.