It's well known that sexually transmitted diseases (STDs) are widespread in the U.S., but do doctors take the initiative to test patients for them?

According to a recent study by researchers at the University of Pittsburgh, too few doctors are stepping up to the challenge. As a case in point, the researchers focused on chlamydia, an STD that can cause reproductive damage. Chlamydia is so common among young adults that the U.S. Centers for Disease Control & Prevention (CDC) recommends chlamydia testing at least once a year for all sexually active women up to age 19, and annual testing for any woman 20 years of age or older who is at risk (has had a new sex partner or multiple partners and does not use a condom).

How many doctors conduct this routine testing? Robert L. Cook, MD, and fellow researchers at the University of Pittsburgh School of Medicine surveyed a representative sample of Pennsylvania doctors, including 1600 internists, pediatricians, family practitioners, and obstetrician/gynecologists. Only a third responded that they routinely screen sexually active young women for chlamydia.

Hiding in plain sight

With an estimated 3 million new cases each year, chlamydia is the most common bacterial STD in the U.S. Just exactly how that 3 million breaks down across the sexes is not known because men are not routinely screened for chlamydia, yet clearly, as with the Tango, it takes two to make an STD. About 50% of infected males and 75% of infected females have no symptoms from their chlamydial infection and, thus, no reason to suspect a problem. They are unlikely to seek testing and unlikely to receive treatment. If untreated, they remain infected and contagious; and if they continue being sexually active, every new partner is exposed to chlamydia.

Here's the problem

Recall that 75% of women infected with chlamydia have no symptoms of infection and probably don't know they are infected or seek medical care for the infection. Some of these women will be identified through routine chlamydia screening, but as the Cook study shows, screening is anything but routine in many doctors' offices.

There are several reasons why this "silent epidemic" is a serious public health problem:

-- Up to 40% of women with untreated chlamydial infections develop pelvic inflammatory disease (PID), and of those who develop PID, 20% become infertile; 18% experience debillitating, chronic pelvic pain; and 9% have a life-threatening ectopic pregnancy.

-- Between 60% and 70% of babies exposed to their mother's chlamydial infection at birth develop chlamydial eye infections or pneumonia.

-- A woman with chlamydia is three to five times more likely to acquire the AIDS virus, if exposed.

-- Recently published research strengthens the association between chlamydial infection and cervical cancer.

-- U.S. healthcare costs attributable to chlamydia and its consequences exceed $2 billion per year; the CDC estimates that every dollar spent on chlamydia testing and treatment saves $12 in complications arising from untreated chlamydia.

Non-screening MDs profiled

Aside from the fact that two-thirds of the doctors in their survey neglected routine chlamydia screening, Cook and colleagues found significant disparity in screening habits, depending on gender, geography, and practice profile: Female MDs were significantly more likely to screen sexually active young women for chlamydia than their male colleagues (43% vs 24%); doctors working in metropolitan settings were significantly more likely to screen for chlamydia than their rural counterparts (46% vs 26%); and physicians in a clinic practice were more likely to screen than those in solo private practice (60% vs 18%).

What to do

In most cases, chlamydia is easily cured. Treatments include a 7-day, twice-daily course of doxycycline or a single dose of azithromycin. The latter is more expensive than doxycycline, but compliance is assured. However, as noted above, if you don't know you have a disease, you're unlikely to seek or receive treatment for it, unless it is discovered by testing. If you are a sexually active young woman, talk to your healthcare provider about chlamydia testing. Find out what his or her policies are on routine screening. Find out if you've ever been tested for chlamydia. The likelihood of infection is too great, the test too easy, the treatment too effective, and the consequences of nontreatment too serious for you (or your healthcare provider) to ignore this important issue.