Increasing Chlamydia/Gonorrhea Screening in Adolescents Across a Multisite Primary Care Network

To increase chlamydia and gonorrhea (CT/GC) screening among sexually active female adolescents in a large pediatric primary care network using a multifaceted quality improvement (QI) intervention, with secondary aims to increase male screening and case detection.

From 2021 to 2025, we implemented a sequential QI intervention including Adolescent Health Questionnaire implementation, financial incentives, electronic health record (EHR) best practice advisories, and universal screening protocols across 33 practices. The primary outcome was CT/GC screening rates for sexually active female patients aged at least 15 years at well visits. Secondary outcomes included male screening rates and case detection rates. We evaluated outcomes using statistical process control and run charts.

During the study period, 136 241 adolescents aged 15-19 years received care across the network, with monthly well care visits increasing over time (average 1472-1681 visits/month). CT/GC screening rates for sexually active female patients increased from approximately 25% to 75%, with the most substantial improvements following universal opt-out protocols. Male testing rates similarly increased from approximately 20% to 75%. Monthly chlamydia case counts for female patients increased from approximately 8 cases/month to a peak of approximately 25 cases/month during the highest-volume testing period. For male patients, cases increased from approximately 4 to 16 monthly. Improvements occurred across demographic groups regardless of insurance type, race, or ethnicity.

A systematic, EHR-enabled QI intervention significantly improved adolescent CT/GC screening rates while increasing case detection. Universal opt-out screening protocols proved most effective in achieving comprehensive screening and identifying previously undiagnosed infections, demonstrating the clinical value of systematic CT/GC screening in pediatric primary care.