{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:56:32Z","timestamp":1789088192176,"version":"build-2803163510"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"S3","license":[{"start":{"date-parts":[[2022,8,30]],"date-time":"2022-08-30T00:00:00Z","timestamp":1661817600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,8,30]],"date-time":"2022-08-30T00:00:00Z","timestamp":1661817600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000738","name":"u.s. department of veterans affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J GEN INTERN MED"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>United States (US) rates of sexually transmitted infection (STI) in women, especially gonorrhea and chlamydia, have increased over the past decade. Women Veterans may be at increased risk for STIs due to high rates of sexual trauma. Despite the availability of effective diagnostic tests and evidence-based guidelines for annual screening among sexually active women under age 25, screening rates for gonorrhea and chlamydia remain low in the US and among Veterans.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>To examine patient characteristics and health system factors associated with gonorrhea and chlamydia testing and case rates among women Veterans in the Veterans Health Administration (VHA) in 2019.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Design<\/jats:title>\n                <jats:p>We performed a retrospective cohort study of all women Veterans in VHA care between January 1, 2018, and December 31, 2019.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Participants<\/jats:title>\n                <jats:p>Women Veteran patients were identified as receiving VHA care if they had at least one inpatient admission or outpatient visit in 2019 or the preceding calendar year.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Key Results<\/jats:title>\n                <jats:p>Among women under age 25, 21.3% were tested for gonorrhea or chlamydia in 2019. After adjusting for demographic and other health factors, correlates of testing in women under age 25 included Black race (aOR: 2.11, CI: 1.89, 2.36), rural residence (aOR: 0.84, CI: 0.74, 0.95), and cervical cancer screening (aOR: 5.05, CI: 4.59, 5.56). Women under age 25 had the highest infection rates, with an incidence of chlamydia and gonorrhea of 1,950 and 267 cases\/100,000, respectively. Incidence of gonorrhea and chlamydia was higher for women with a history of military sexual trauma (MST) (chlamydia case rate: 265, gonorrhea case rate: 97\/100,000) and those with mental health diagnoses (chlamydia case rate: 263, gonorrhea case rate: 72\/100,000.)<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Gonorrhea and chlamydia testing remains underutilized among women in VHA care, and infection rates are high among younger women. Patient-centered, system-level interventions are urgently needed to address low testing rates.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s11606-022-07578-2","type":"journal-article","created":{"date-parts":[[2022,8,31]],"date-time":"2022-08-31T00:04:36Z","timestamp":1661904276000},"page":"706-713","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Gonorrhea and Chlamydia Testing and Case Rates Among Women Veterans in the Veterans Health Administration"],"prefix":"10.1007","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2063-9357","authenticated-orcid":false,"given":"Shimrit","family":"Keddem","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marissa","family":"Maier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn","family":"Gardella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joleen","family":"Borgerding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elliott","family":"Lowy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maggie","family":"Chartier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Haskell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald G.","family":"Hauser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren A.","family":"Beste","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,8,30]]},"reference":[{"key":"7578_CR1","unstructured":"Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2019. https:\/\/www.cdc.gov\/std\/statistics\/2019\/overview.htm#anchor_1606829809494. Accessed 5\/17\/, 2021."},{"issue":"Supplement_2","key":"7578_CR2","doi-asserted-by":"publisher","first-page":"S134","DOI":"10.1086\/652395","volume":"201","author":"CL Haggerty","year":"2010","unstructured":"Haggerty CL, Gottlieb SL, Taylor BD, Low N, Xu F, Ness RB. Risk of sequelae after chlamydia trachomatis genital infection in women. J Infect Dis. 2010;201(Supplement_2):S134-S155.","journal-title":"J Infect Dis"},{"key":"7578_CR3","doi-asserted-by":"crossref","unstructured":"Barrow RY. Recommendations for providing quality sexually transmitted diseases clinical services, 2020. MMWR.Recommendations and Reports. 2020;68.","DOI":"10.15585\/mmwr.rr6805a1"},{"issue":"12","key":"7578_CR4","doi-asserted-by":"publisher","first-page":"902","DOI":"10.7326\/M14-1981","volume":"161","author":"ML LeFevre","year":"2014","unstructured":"LeFevre ML. Screening for chlamydia and gonorrhea: US preventive services task force recommendation statement. Ann Intern Med. 2014;161(12):902-910.","journal-title":"Ann Intern Med."},{"issue":"2","key":"7578_CR5","first-page":"80","volume":"63","author":"KW Hoover","year":"2014","unstructured":"Hoover KW, Leichliter JS, Torrone EA, et al. Chlamydia screening among females aged 15\u201321 years\u2014multiple data sources, united states, 1999\u20132010. MMWR Suppl. 2014;63(2):80-88.","journal-title":"MMWR Suppl."},{"key":"7578_CR6","unstructured":"Centers for Disease Control and Prevention,. Chlamydia screening percentages reported by commercial and medicaid plans by state and year. https:\/\/www.cdc.gov\/std\/chlamydia\/chlamydia-screening-2014.htm. Updated 2017. Accessed 5\/17\/, 2021."},{"key":"7578_CR7","doi-asserted-by":"crossref","unstructured":"Beste LA, Maier MM, Borgerding J, et al. Testing practices and incidence of chlamydial and gonococcal infection in the veterans health administration, 2009-2019. Clinical Infectious Diseases. 2020.","DOI":"10.1093\/cid\/ciaa1454"},{"key":"7578_CR8","doi-asserted-by":"publisher","first-page":"S74","DOI":"10.1016\/j.whi.2019.04.014","volume":"29","author":"JL Combellick","year":"2019","unstructured":"Combellick JL, Dziura J, Portnoy GA, Mattocks KM, Brandt CA, Haskell SG. Trauma and sexual risk: Do men and women veterans differ? Womens Health Issues. 2019;29:S74-S82.","journal-title":"Womens Health Issues."},{"issue":"8","key":"7578_CR9","doi-asserted-by":"publisher","first-page":"723","DOI":"10.7205\/MILMED.171.8.723","volume":"171","author":"JR Schultz","year":"2006","unstructured":"Schultz JR, Bell KM, Naugle AE, Polusny MA. Child sexual abuse and adulthood sexual assault among military veteran and civilian women. Mil Med. 2006;171(8):723-728.","journal-title":"Mil Med."},{"issue":"2","key":"7578_CR10","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1007\/s11606-011-1772-z","volume":"26","author":"DL Washington","year":"2011","unstructured":"Washington DL, Bean-Mayberry B, Riopelle D, Yano EM. Access to care for women veterans: Delayed healthcare and unmet need. Journal of general internal medicine. 2011;26(2):655.","journal-title":"Journal of general internal medicine."},{"issue":"1","key":"7578_CR11","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/1471-2458-4-21","volume":"4","author":"EC Tilson","year":"2004","unstructured":"Tilson EC, Sanchez V, Ford CL, et al. Barriers to asymptomatic screening and other STD services for adolescents and young adults: Focus group discussions. BMC Public Health. 2004;4(1):21.","journal-title":"BMC Public Health."},{"issue":"3","key":"7578_CR12","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1016\/S1054-139X(00)00152-X","volume":"28","author":"RL Cook","year":"2001","unstructured":"Cook RL, Wiesenfeld HC, Ashton MR, Krohn MA, Zamborsky T, Scholle SH. Barriers to screening sexually active adolescent women for chlamydia: A survey of primary care physicians. Journal of Adolescent Health. 2001;28(3):204-210.","journal-title":"Journal of Adolescent Health."},{"issue":"3","key":"7578_CR13","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1093\/fampra\/cmq004","volume":"27","author":"CA McNulty","year":"2010","unstructured":"McNulty CA, Freeman E, Howell-Jones R, et al. Overcoming the barriers to chlamydia screening in general practice\u2014a qualitative study. Fam Pract. 2010;27(3):291-302.","journal-title":"Fam Pract."},{"issue":"1","key":"7578_CR14","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.jpag.2018.10.004","volume":"32","author":"SM Wood","year":"2019","unstructured":"Wood SM, McGeary A, Wilson M, et al. Effectiveness of a quality improvement intervention to improve rates of routine chlamydia trachomatis screening in female adolescents seeking primary preventive care. J Pediatr Adolesc Gynecol. 2019;32(1):32-38.","journal-title":"J Pediatr Adolesc Gynecol."},{"key":"7578_CR15","unstructured":"Veterans health administration. https:\/\/www.va.gov\/health\/#:~:text=The%20Veterans%20Health%20Administration%20is%20America\u2019s%20largest%20integrated%20health%20care,million%20enrolled%20Veterans%20each%20year. Accessed 4\/29\/, 2021."},{"key":"7578_CR16","unstructured":"Veterans health administration: Gender-specific health care services for women veterans, CRS in focus. CRS report. . 2021."},{"issue":"7","key":"7578_CR17","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1377\/hlthaff.2014.0054","volume":"33","author":"SD Fihn","year":"2014","unstructured":"Fihn SD, Francis J, Clancy C, et al. Insights from advanced analytics at the veterans health administration. Health Aff. 2014;33(7):1203-1211.","journal-title":"Health Aff."},{"key":"7578_CR18","volume-title":"Screening for gonorrhea and chlamydia: Systematic review to update the US preventive services task force recommendations","author":"HD Nelson","year":"2014","unstructured":"Nelson HD, Zakher B, Cantor A, Deagas M, Pappas M. Screening for gonorrhea and chlamydia: Systematic review to update the US preventive services task force recommendations. . 2014."},{"issue":"12","key":"7578_CR19","doi-asserted-by":"publisher","first-page":"902","DOI":"10.7326\/M14-1981","volume":"161","author":"ML LeFevre","year":"2014","unstructured":"LeFevre ML. Screening for chlamydia and gonorrhea: US preventive services task force recommendation statement. Ann Intern Med. 2014;161(12):902-910.","journal-title":"Ann Intern Med."},{"issue":"RR-03","key":"7578_CR20","first-page":"1","volume":"64","author":"KA Workowski","year":"2015","unstructured":"Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR.Recommendations and reports: Morbidity and mortality weekly report.Recommendations and reports. 2015;64(RR-03):1.","journal-title":"MMWR.Recommendations and reports: Morbidity and mortality weekly report.Recommendations and reports"},{"issue":"1","key":"7578_CR21","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1089\/jwh.2007.0665","volume":"18","author":"J Alvarez","year":"2009","unstructured":"Alvarez J, Pavao J, Mack KP, Chow JM, Baumrind N, Kimerling R. Lifetime interpersonal violence and self-reported chlamydia trachomatis diagnosis among california women. Journal of Women\u2019s Health. 2009;18(1):57-63.","journal-title":"Journal of Women\u2019s Health."},{"issue":"8","key":"7578_CR22","doi-asserted-by":"publisher","first-page":"723","DOI":"10.7205\/MILMED.171.8.723","volume":"171","author":"JR Schultz","year":"2006","unstructured":"Schultz JR, Bell KM, Naugle AE, Polusny MA. Child sexual abuse and adulthood sexual assault among military veteran and civilian women. Mil Med. 2006;171(8):723-728.","journal-title":"Mil Med."},{"key":"7578_CR23","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1089\/jwh.2010.2399","volume":"20","author":"AG Sadler","year":"2011","unstructured":"Sadler AG, Mengeling MA, Syrop CH, Torner JC, Booth BM. Military service, life span sexual assault exposures, and cervical cytologic abnormalities. J Womens Health (Larchmt). 2011;20:1693-1701.","journal-title":"J Womens Health (Larchmt)."},{"issue":"8","key":"7578_CR24","doi-asserted-by":"publisher","first-page":"888","DOI":"10.1007\/s11606-016-3701-7","volume":"31","author":"R Kimerling","year":"2016","unstructured":"Kimerling R, Iverson KM, Dichter ME, Rodriguez AL, Wong A, Pavao J. Prevalence of intimate partner violence among women veterans who utilize veterans health administration primary care. Journal of General Internal Medicine. 2016;31(8):888-894.","journal-title":"Journal of General Internal Medicine."},{"issue":"5","key":"7578_CR25","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1002\/jts.21733","volume":"25","author":"A Borders","year":"2012","unstructured":"Borders A, McAndrew LM, Quigley KS, Chandler HK. Rumination moderates the associations between PTSD and depressive symptoms and risky behaviors in US veterans. J Trauma Stress. 2012;25(5):583-586.","journal-title":"J Trauma Stress."},{"issue":"4","key":"7578_CR26","doi-asserted-by":"publisher","first-page":"357","DOI":"10.7205\/MILMED-D-13-00241","volume":"179","author":"LM James","year":"2014","unstructured":"James LM, Strom TQ, Leskela J. Risk-taking behaviors and impulsivity among veterans with and without PTSD and mild TBI. Mil Med. 2014;179(4):357-363.","journal-title":"Mil Med."},{"key":"7578_CR27","unstructured":"Centers for Disease Control & Prevention,. National survey of family growth (NSFG). . 2019."},{"issue":"10","key":"7578_CR28","doi-asserted-by":"publisher","first-page":"642","DOI":"10.1097\/OLQ.0b013e3181ab481b","volume":"36","author":"L Christiansen-Lindquist","year":"2009","unstructured":"Christiansen-Lindquist L, Tao G, Hoover K, Frank R, Kent C. Chlamydia screening of young sexually active, medicaid-insured women by race and ethnicity, 2002\u20132005. Sex Transm Dis. 2009;36(10):642-646.","journal-title":"Sex Transm Dis."},{"issue":"3","key":"7578_CR29","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1097\/OLQ.0000000000000405","volume":"43","author":"CG Patel","year":"2016","unstructured":"Patel CG, Chesson HW, Tao G. Racial differences in receipt of chlamydia testing among medicaid-insured women in 2013. Sex Transm Dis. 2016;43(3):147.","journal-title":"Sex Transm Dis."},{"key":"7578_CR30","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1111\/j.1748-0361.2007.00130.x","volume":"23","author":"LW Roberts","year":"2007","unstructured":"Roberts LW, Johnson ME, Brems C, Warner TD. Ethical disparities: Challenges encountered by multidisciplinary providers in fulfilling ethical standards in the care of rural and minority people. The Journal of Rural Health. 2007;23:89-97.","journal-title":"The Journal of Rural Health."},{"issue":"2","key":"7578_CR31","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1007\/s11606-012-2289-9","volume":"28","author":"J Katon","year":"2013","unstructured":"Katon J, Reiber G, Rose D, et al. VA location and structural factors associated with on-site availability of reproductive health services. Journal of general internal medicine. 2013;28(2):591-597.","journal-title":"Journal of general internal medicine."},{"issue":"2","key":"7578_CR32","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1007\/s11606-011-1772-z","volume":"26","author":"DL Washington","year":"2011","unstructured":"Washington DL, Bean-Mayberry B, Riopelle D, Yano EM. Access to care for women veterans: Delayed healthcare and unmet need. Journal of general internal medicine. 2011;26(2):655.","journal-title":"Journal of general internal medicine."},{"key":"7578_CR33","unstructured":"Martin REM. No title. Utilization of a Clinical Decision Support System to Increase Chlamydia Screening Rates in Young Women: a Quality Improvement Project. 2020."},{"issue":"4","key":"7578_CR34","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1370\/afm.2097","volume":"15","author":"MS Naimer","year":"2017","unstructured":"Naimer MS, Kwong JC, Bhatia D, et al. The effect of changes in cervical cancer screening guidelines on chlamydia testing. The Annals of Family Medicine. 2017;15(4):329-334.","journal-title":"The Annals of Family Medicine."},{"issue":"10","key":"7578_CR35","first-page":"e459","volume":"61","author":"T Bogler","year":"2015","unstructured":"Bogler T, Farber A, Stall N, et al. Missed connections: Unintended consequences of updated cervical cancer screening guidelines on screening rates for sexually transmitted infections. Canadian Family Physician. 2015;61(10):e459-e466.","journal-title":"Canadian Family Physician."},{"issue":"12","key":"7578_CR36","first-page":"1924","volume":"98","author":"YH Wimberly","year":"2006","unstructured":"Wimberly YH, Hogben M, Moore-Ruffin J, Moore SE, Fry-Johnson Y. Sexual history-taking among primary care physicians. J Natl Med Assoc. 2006;98(12):1924.","journal-title":"J Natl Med Assoc."},{"issue":"4","key":"7578_CR37","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1097\/00007435-200204000-00011","volume":"29","author":"MR Ashton","year":"2002","unstructured":"Ashton MR, Cook RL, Wiesenfeld HC, et al. Primary care physician attitudes regarding sexually transmitted diseases. Sex Transm Dis. 2002;29(4):246-251.","journal-title":"Sex Transm Dis."}],"container-title":["Journal of General Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11606-022-07578-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11606-022-07578-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11606-022-07578-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,16]],"date-time":"2022-09-16T15:17:51Z","timestamp":1663341471000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11606-022-07578-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,30]]},"references-count":37,"journal-issue":{"issue":"S3","published-print":{"date-parts":[[2022,9]]}},"alternative-id":["7578"],"URL":"https:\/\/doi.org\/10.1007\/s11606-022-07578-2","relation":{},"ISSN":["0884-8734","1525-1497"],"issn-type":[{"value":"0884-8734","type":"print"},{"value":"1525-1497","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,30]]},"assertion":[{"value":"11 June 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 April 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 August 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they do not have a conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}}]}}