Gonorrhea and Chlamydia Testing and Case Rates Among Women Veterans in the Veterans Health Administration

Area of Science:

• Public Health
• Infectious Diseases
• Women's Health

Background:

• Sexually transmitted infections (STIs), including gonorrhea and chlamydia, are rising in the US, with women Veterans potentially at higher risk due to sexual trauma.
• Despite established guidelines for screening sexually active women under 25, testing rates for these STIs remain suboptimal among women in the US and the Veterans Health Administration (VHA).

Purpose of the Study:

• To investigate patient characteristics and health system factors associated with gonorrhea and chlamydia testing and incidence among women Veterans within the VHA in 2019.

Main Methods:

• A retrospective cohort study was conducted, analyzing data from all women Veterans receiving VHA care between January 1, 2018, and December 31, 2019.
• Women Veterans were identified by at least one inpatient admission or outpatient visit during 2019 or the preceding year.

Main Results:

• In 2019, only 21.3% of women Veterans under age 25 were tested for gonorrhea or chlamydia.
• Correlates of testing in younger women included Black race, cervical cancer screening, and rural residence.
• Women under 25 exhibited the highest infection rates (chlamydia: 1,950/100,000; gonorrhea: 267/100,000).
• Higher incidence rates for both infections were noted in women with a history of military sexual trauma (MST) and mental health diagnoses.

Conclusions:

• Gonorrhea and chlamydia testing is underutilized among women Veterans in the VHA.
• Infection rates are notably high in younger women Veterans.
• There is an urgent need for patient-centered, system-level interventions to enhance STI screening rates and outcomes.