Research In Practice Blog
What is known about chlamydia and gonorrhea in the adolescents:
Rates of sexually transmitted infections (STIs) among adolescents and young adults reached record highs in 2021, and this age group accounted for about half of all new infections. Early detection and treatment are critical because untreated STIs can lead to serious long-term health complications, including pelvic inflammatory disease, infertility, and chronic pain. Pediatricians play a key role in addressing this growing public health concern because they provide most preventive care for adolescents and are trusted sources of health information.
National organizations, including the American Academy of Pediatrics and the Centers for Disease Control and Prevention, recommend STI screening in primary care settings. Yet screening remains uncommon, with fewer than one-third of adolescents reporting they were asked about sexual activity during a recent well visit.
Common barriers include:
- Limited appointment time
- Concerns about patient confidentiality
- Lack of provider training and confidence
Current screening approaches often rely on identifying sexually active adolescents, but these strategies can miss many infections. Some young people may not disclose their sexual activity, may never be asked about it, or may not meet current screening criteria despite being at risk. Universal "opt-out" screening, in which eligible adolescents are screened unless they decline, has emerged as a promising alternative because it can identify infections that might otherwise go undetected. Early quality improvement efforts in pediatric settings have shown this approach can increase screening rates. However, there is still limited evidence on the most effective ways to implement and sustain these programs across large pediatric primary care networks.
How this study was performed:
A multidisciplinary team led by researchers at Clinical Futures, clinicians, and quality improvement experts at Children’s Hospital of Philadelphia (CHOP) identified that gonorrhea and chlamydia screening rates among sexually active adolescents were low and inconsistent across the primary care network. Launched in 2021, the project brought together experts in primary care innovation, value-based care, quality analytics, operations, clinical informatics, and research to improve screening practices and adolescent sexual health care across the network. The findings were published today by the journal Pediatrics.
This project, Increasing Chlamydia/Gonorrhea Screening in Adolescents Across a Multisite Primary Care Network, was led in a collaboration between researchers, primary care clinicians, and the improvement team from the Center for Healthcare Quality Analytics. The study team included Drs. Brian Jenssen, MD, MSHP, Elena Huang, Anthony Luberti, Meera Siddharth, Gregory Lawton, Alexander G. Fiks, MD, MSCE and Stephanie L. Mayne, PhD, MHS, in collaboration with Sarah M. Wood, MD, MSHP, Chief of Adolescent Medicine and Director of the Mount Sinai Adolescent Health Center. Additional team members included Gabrielle DiFiore, MPH; Leigh Foppert, DNP, CRNP; Mary Kate Kelly, MPH; Jennifer Beals, MS; Christina Sweeney, MSN, CRNP; Kimberly Bennett, DNP, CRNP; Angela Rapposelli; and Maura Powell, MPH, MBA. Together, the team spearheaded efforts to improve STI screening and care for adolescents across the CHOP Care Network.
Beginning in 2021, CHOP launched a networkwide effort to increase chlamydia and gonorrhea screening among adolescents. The initiative introduced a confidential adolescent health questionnaire, financial incentives for physicians, electronic health record alerts, and ultimately universal opt-out screening, in which testing is routinely offered unless a patient declines.
The program was first piloted with clinicals and staff in 16 practices before expanding across all 33 CHOP Care Network locations in 2024. Researchers analyzed electronic health record data collected between 2021 and 2025 to evaluate changes in screening rates and infection detection.
The Primary Care Innovation That Made It Work:
These results were achieved in exam rooms across the CHOP Care Network. Pediatricians, nurse practitioners, nurses, medical assistants, and front-desk and office staff at all 33 practices redesigned how they cared for adolescents. They explained screening to teens and their parents in advance of confidential visit time between the teen and their provider. They collected urine samples, followed up on positive results, and made sure young people got treated quickly. Practice champions tested new workflows and shared what worked in learning community meetings. Their feedback shaped each phase of the project.
“This was a team effort, and the real credit belongs to our primary care teams,” said Dr. Jenssen. “Our pediatricians, nurse practitioners, and staff took on a new workflow in the middle of busy clinic days and made it routine. Every infection we found reflects their work.”
What this research adds:
Youth and family advisory groups played a key role in developing patient-facing educational materials. Their feedback helped ensure the materials answered frequently asked questions, addressed concerns about STI screening and confidentiality, and presented information in a way that was accessible to adolescents and their families.
Researchers extracted data from the EHR from 2021-2025. Researchers tracked screening rates, positive test results, and differences across demographic groups to understand how the initiative affected adolescent care. They also monitored patient feedback, provider concerns, and other potential unintended consequences.
After universal opt-out screening was introduced, researchers also analyzed screening rates among females ages 15 and older who did not report being sexually active. Because sexual activity information was not routinely collected in the electronic health record before the AHQ was implemented, baseline screening rates were calculated for all adolescents rather than by sexual activity status.
Additional measures included screening rates among males ages 15 and older, as well as the number and rate of positive CT/GC test results among both male and female patients.
Researchers also examined how screening rates varied across the network's 33 primary care practices to better understand how consistently the program was implemented. To ensure the initiative promoted equitable care, screening rates were tracked by insurance type, race, and ethnicity, building on previous findings that showed disparities in CT/GC screening both nationally and within the network.
Throughout the project, researchers monitored any unintended effects of expanded screening, including patient concerns, billing issues, and provider feedback. They also tracked participation in learning community meetings to understand how engaged practices were during the rollout of the universal opt-out screening program.
Clinical Implications
Using a structured quality improvement approach, the team increased chlamydia and gonorrhea screening rates across a large pediatric primary care network and identified many more infections that otherwise may have gone undetected.
Screening rates among sexually active female adolescents increased from 25% to 75%, tripling over the course of the project and exceeding the team's original goal. While adolescent health questionnaires, financial incentives and clinical decision support tools contributed to improvement, universal opt-out screening appeared to have the greatest impact.
Researchers also found a threefold increase in chlamydia cases identified among females and a fourfold increase among males. Some infections were detected in adolescents who reported they were not sexually active, suggesting that screening based only on reported sexual activity may miss infections.
Screening improvements were seen across all demographic groups. Differences between commercially insured and Medicaid-insured patients, as well as between White and Black patients, narrowed over time, suggesting the approach may help advance more equitable care.
The findings suggest that, with the commitment of pediatricians, nurse practitioners, and staff across the network, universal opt-out screening can be successfully implemented across a large pediatric primary care network and may help improve adolescent sexual health outcomes while reducing barriers to care.
This study was supported, in part, by a grant from Optum to the PI, Brian Jenssen.