Using an improvement program to improve Chlamydia trachomatis testing


Clinicians may still use urine nucleic-acid amplification tests, despite the recommendation to use a more sensitive vaginal swab to test for Chlamydia trachomatis. A report looks at whether a quality improvement program could change that.

For testing for Chlamydia trachomatis in female patients aged <25 years and sexually active, the Centers for Disease Control and Prevention recommends using nucleic-acid amplification tests (NAAT) from a vaginal swab sample. A report examined whether a quality improvement program would increase the number of clinicians using the vaginal swab NAAT instead of the less sensitive urine NAAT.1

The investigators utilized 3 different interventions in 3 pediatric practices over the course of 12 months. The interventions included cross-training, education, and process standardization. The primary outcome for the study was the percentage of urogenital C trachomatis tests performed by vaginal swab.

Over the course of the study, 818 urogenital C trachomatis tests were performed. Two hundred eighty-nine tests were run before the first intervention and 529 were run after the intervention. In the preintervention period, 1.4% of the C trachomatis tests were performed by vaginal swab. Within 6 weeks of the first intervention, investigators had exceeded the aim of 25%. Following the second intervention, they found sustained improvement with an average of 68.3% of the tests being performed by vaginal swabs in the postintervention period. No difference in the overall number of C trachomatis tests run before and after the intervention.

The researchers concluded that the quality improvement program had led to a significant increase in the use of vaginal swabs. They noted that the intervention that standardized processes were linked with more impact than the education intervention.


1. Brigham KS, Peer MJ, Ghoshhajra BB, Co JP. Increasing vaginal Chlamydia Trachomatis testing in adolescent and young adults. Pediatrics. 2020:146(1):e20193028. doi:10.1542/peds.2019-3028

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