1. Aetna considers Chlamydia trachomatis screening a medically necessary preventive service according to the recommendations of the U.S. Preventive Services Task Force (USPSTF) and the Centers for Disease Control and Prevention (CDC).  Chlamydia screening is recommended for the following groups:

   1. All pregnant women aged 25 years and younger;
   2. All sexually active women aged 25 years and younger; and

   3. Other women with any of the following risk factors for C. trachomatis infection:

      1. New or multiple sexual partners; or
      2. Having had Chlamydia trachomatis or other sexually transmitted diseases in the past; or

      3. Not using condoms consistently or correctly.

      Aetna considers Chlamydia trachomatis screening experimental and investigational for asymptomatic men, and for women who do not meet these criteria.

2. Aetna considers Chlamydia trachomatis diagnostic testing medically necessary for members with signs or symptoms of C. trachomatis infection.

In its updated recommendations on Chlamydia trachomatis screening, the U.S. Preventive Services Task Force (USPSTF) strongly recommended that clinicians routinely screen all sexually active women aged 24 years and younger, and other asymptomatic women at increased risk for infection, for chlamydial infection (USPSTF, 2007).  Other risk factors for chlamydial infection include a history of chlamydial or other sexually transmitted infection, new or multiple sexual partners, inconsistent condom use, and exchanging sex for money or drugs. The USPSTF also recommended that clinicians routinely screen all asymptomatic pregnant women aged 24 years and younger for chlamydial infection.  The USPSTF made no recommendation for or against routinely screening asymptomatic low-risk women in the general population for chlamydial infection.  The USPSTF found at least fair evidence that screening low-risk women could detect some additional cases of Chlamydia trachomatis, but concluded that the potential benefits of screening low-risk women may be small and may not justify the possible harms.

The USPSTF made no recommendation for or against routine screening of asymptomatic, low-risk pregnant women aged 25 years and older for chlamydial infection.  The USPSTF found fair evidence that the benefits of screening low-risk pregnant women are small and may not justify the possible harms.

The USPSTF concluded that the evidence is insufficient to recommend for or against routinely screening asymptomatic men for chlamydial infection.  The USPSTF found no direct evidence to determine whether screening asymptomatic men for chlamydial infection is effective for reducing the incidence of new infections in women.

Chlamydia screening among young women under the age of 26 is a measure that has been adopted by the National Committee for Quality Assurance (NCQA) for inclusion in the Health Plan Employer Data and Information Set (HEDIS). C. trachomatis infection is the most common sexually transmitted disease (STD) in the United States affecting an estimated 4 million people. Prevalence is highest in sexually active females under the age of 25 years.

Most C. trachomatis infections cause no symptoms. Left untreated, C. trachomatis infection can lead to complications such as pelvic inflammatory disease in the female, which has emerged as a major cause of tubal factor infertility and ectopic pregnancy in women of childbearing age. Chlamydia infection can be passed to the newborn during delivery through the birth canal with a manifestation of neonatal eye infection or pneumonia. These sequelae are unfortunate because C. trachomatis infection is effectively treated with antibiotics.

Diagnosis is based on the detection of the microorganism itself, its antigens, or genetic material collected from the lower genital tract, or in some instances, a urine sample. The sensitivity of tissue culture ranges from 65 to 80%. More available non-culture tests, such as the DFA and the EIA, which detect chlamydial antigens in clinical specimens have specificities from 96-99%. However, these tests with high specificity yield a large number of false positives in a population with a low disease prevalence. DNA amplified hybridization tests are both highly specific and sensitive and are proving to be the best tests in large scale screening. Additionally, the LCR and the PCR can be performed on urine specimens. New DNA amplified hybridization techniques such as transcription mediated amplification (TMA), Q-B replicase amplified hybridization, and nucleic acid sequence-based amplification (NASBA) are currently being investigated and appear to be very promising.

Appendix

The following tests are considered medically necessary for screening or diagnosis of C. trachomatis infection:

1. Cell culture
2. Enzyme immunoassay (EIA)
3. Direct fluorescent antibody (DFA)
4. DNA hybridization (DNA probe)

5. DNA amplified hybridization (nucleic acid amplification) - which includes any of the following: