Universal Youth Chlamydia Screening Is Up for Debate
September 1, 2025 7 minutes read
By Melinda Young
Studies continue to show that some populations are at an elevated risk of the sexually transmitted infection (STI) Chlamydia trachomatis (CT) genital infection. Once infected, women can develop health problems, including pelvic inflammatory disease (PID) and infertility.1,2
The Centers for Disease Control and Prevention’s (CDC’s) latest data show that CT genital infection among young, sexually active females, ages 14 to 24 years, is 5.8%, and CT prevalence for Black females of that age group is 2.5 times as high as among white, Hispanic, and non-Hispanic/other groups.2 White and non-Hispanic/other females had the highest percentage of health insurance coverage at 89.7%, compared with 75.8% for Hispanic females and 83.8% for Black females. But other factors, such as sex without a condom in the past year, were similar among most groups.2 When asked about the number of sex partners in the past year, 42% of young Black females and 36.2% of white females reported having two or more partners. Hispanic females had the lowest percentage at 26.4%.2
The CDC study concluded that CT prevalence was significantly higher for Black females with or without health insurance, for those with two or more partners in the past year, and among those who reported not using a condom during sex in the past year. White young females who reported not using a condom during sex in the past year had a lower prevalence.2 CDC researchers were unable to comment on the study because of a “pause” in communication with media, but the study’s conclusion states that their findings “reinforce longstanding evidence that factors related to sexual networks may play a more significant role in the racial disparities of STI prevalence than individual-level STI risk factors.”2
Other potential factors are poverty, stigma, and healthcare access, suggests Barbara Van Der Pol, PhD, MPH, a professor of medicine and public health at the University of Alabama at Birmingham. Many people in poor, rural areas do not have a public health clinic or major healthcare facility near them. They may have primary care providers, but these offices could be small and have staff and other patients that a young female knows, she explains. “Everybody knows everybody, and you see the person working, and they know your mother,” she adds. Some smaller doctor offices may not have access to a laboratory for STI testing, so they do not offer this service.
It is about poverty, access to care, transportation, day care, taking time off work, and waiting for hours at a public health center that only takes walk-ins, Van Der Pol says. “There are all kinds of things that can prohibit people from getting services,” she adds.
Decades of research indicate that people who have untreated CT have higher rates of pelvic inflammatory disease and — as a consequence of that — sometimes higher rates of tubal factor infertility, including ectopic pregnancy, Van Der Pol says.1 “In the 1990s, [CT] was added to the CDC’s list of notifiable diseases so they could track the numbers,” she says. “And there was an infertility prevention program that was funded by the CDC.”
The recommendation is to encourage annual screening of all sexually active women between the ages of 15 and 25 years because that is where there are the highest number of CT cases, she adds.
Since Chlamydia trachomatis is asymptomatic up to 70% of the time in women, screening is the main way to identify infection in a population of young women, Van Der Pol notes. The United States has followed that recommendation for about three decades. Other nations have followed the same screening strategy for years, but that is changing in some nations. For example, the United Kingdom had a CT screening program that started in the 1990s. When investigators looked at PID rates, they found they were lower in some groups but not hugely lower, and the positive effects occurred mainly in the first decade, she explains.
“That impact is sort of gone, and it plateaued the impact of screening programs, [which also] sort of plateaued,” Van Der Pol says. “In most countries, you can’t show a relationship between a screening program and its length of duration and reductions in infertility.”
This raises the public health question of whether a costly screening program is worth spending money on when its public health benefits are unclear. “Again, this is not about treating people who have active disease and symptoms,” she adds. “We’re just talking about broad population-level screening of people with no sign of disease, and the problem is they can’t find a population-level benefit.”
All public health programs have limited resources, so some nations, like the Netherlands, stopped requiring CT screening. Other nations, like the United Kingdom and France, are trying to decide whether to stop the program, Van Der Pol says.
The debate has not been a major issue in the United States yet, and the United States — along with European nations — will continue to screen all pregnant people for CT because that has had a proven health benefit in terms of infants’ health, she notes. “It used to be that babies got eye drops that were to treat potential gonorrhea and chlamydia infections because it was before we had good diagnostics. It was safer just to proactively treat the baby,” Van Der Pol explains. “But now we don’t have to do that because we’ve got diagnostics, and we can just say, ‘Oh, for sure, we know this person’s negative.’”
Screening for chlamydia also could be useful as a human immunodeficiency virus (HIV) prevention mechanism because there is a small amount of increased risk of HIV acquisition among women with chlamydia, Van Der Pol notes.3
“Black women in the deep South have some of the highest rates of new HIV cases in the country,” she says. “Screening those women for chlamydia might actually be useful as an HIV prevention mechanism.”
Clinicians working with reproductive-aged women can start a conversation about STIs and chlamydia in particular by asking patients about their pregnancy plans and sexual health. Van Der Pol suggests saying, “Let’s understand where your sexual health is right now.” This can be followed up by offering a chlamydia screening test. For the 95% of people who have a negative result, this is an opportunity to give them good news.
“But for the other 5%, it’s good news, as well,” she says. “Because we found this, we can treat it. Let’s take care of this. Let’s get you started off on a clean slate and move forward from here.”
The goal is to think about sexual health testing from a very positive perspective, she adds. “I think that as providers adopt that attitude more and more often, it’s easier for them to talk about it,” Van Der Pol says.
When it comes to various opinions on routine screening for chlamydia among young females, clinicians should make sure they understand their own clientele/patients and follow guidelines whenever possible, she adds. “Screening in pregnant women is always appropriate,” Van Der Pol says. “They need to make informed decisions based on what they know about their patients.”
Clinicians also can watch for a chlamydia vaccine, which could become a reality in the near future. If a vaccine is approved by the Food and Drug Administration, it will be up to public health officials and sexual and reproductive health clinicians to promote it to young people. “There was some progress being made toward a chlamydia vaccine, and it was interrupted with the COVID epidemic,” she says. “But it’s likely that something might go into trials in the next couple of years.”
The question will be whether parents and young adults would use the vaccine. Vaccination for the human papillomavirus (HPV) has been suboptimal in the United States, although the vaccine has been available since 2006.4 Parents of adolescents have raised concerns about COVID-19 vaccine safety since the pandemic began in 2020, and similar concerns may have had an effect on the use of the HPV vaccine among adolescents.4
It might be even more challenging to convince parents to vaccinate their adolescents against chlamydia because of the stigma of it being a sexually transmitted infection, Van Der Pol notes. For the HPV vaccine, a lot of its marketing has focused on how it prevents cancer, so parents may not think of it as being a prevention solely for an STI, she adds.
“When you get to something like chlamydia, you aren’t going to be able to market it to prevent infertility,” she says, citing the challenge of conducting clinical trials to see whether a chlamydia vaccine can prevent infertility. “So, people are going to say, ‘Well, we hear this, [and] my daughter’s never going to get chlamydia. My daughter is a good girl,’” Van Der Pol explains. “So, the vaccine hesitancy problems are going to be much higher for chlamydia than they’ve been for the HPV vaccine.”
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Van Der Pol B. The evolving debate around screening for Chlamydia trachomatis. Expert Rev Anti Infect Ther. 2025;Jun 27:1-3. doi:10.1080/24787210.2025.2526846;1-3. [Online ahead of print].
2. Copen CE, Spicknall IH, Dittus PJ, Kreisel KM. Prevalence of Chlamydia trachomatis genital infection among sexually experienced females aged 14-24 years by race/ethnicity, United States: 2011-March 2020. Sex Transm Dis. 2025;Apr 3:10.1097/OLQ.0000000000002164. [Online ahead of print].
3. World Health Organization. Chlamydia. Nov. 21, 2024. https://www.who.int/news-room/fact-sheets/detail/chlamydia#:~:text=If%20left%20untreated%2C%20chlamydia%20infection,associated%20with%20adverse%20pregnancy%20outcomes
4. Footman A, Kanney N, Niccolai LM, et al. Parents’ acceptance of COVID-19 compared to human papillomavirus vaccines. J Adolesc Health. 2022;71:673-678.
Studies continue to show that some populations are at an elevated risk of the sexually transmitted infection (STI) Chlamydia trachomatis genital infection. Once infected, women can develop health problems, including pelvic inflammatory disease and infertility.
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