Less frequent pap tests are increasing STI rates, U of T prof says

Changes to health policy which now recommend that women undergo Pap tests for cervical cancer once every three years are having a social side effect: increasing rates of sexually transmitted diseases like chlamydia.

That’s the contention from Dr. Michelle Naimer, associate professor from the University of Toronto’s Faculty of Medicine and clinical director of the Mount Sinai Academic Family Health Team, who says because chlamydia often doesn’t produce noticeable symptoms, the infection may be passed along to sexual partners unwittingly.

“As an unintended consequence of women needing less-frequent Pap tests, thousands of women haven’t been screened for chlamydia, resulting in fewer cases being diagnosed,” Naimer says in a column for the Toronto Star. “And because most women are unaware they are infected, these women miss the opportunity for treatment —and pass the STI along to their partners.”

Since the late 1990s, STIs like chlamydia, gonorrhea and syphilis have been on the rise across North America. Last year, provincial health authorities in Alberta, Manitoba and Ontario all reported significant increases in STIs in recent years. Ontario showed a 30 per cent rise in gonorrhea cases between 2013 and 2015, with 39,022 cases of chlamydia in 2015. Health officials in New York City recently reported a 27 per cent increase in the rate of syphilis, a 13 percent increase in gonorrhea and a six per cent rise in chlamydia, all between 2015 and 2016.

A number of factors are said to be at play. Social media dating sites along with the development of better testing technology to detect infections are both considerations, but experts are also pointing to a more lax approach to using protection by people both young and old.

A study earlier this year from the University of Guelph found that a majority of middle-aged men are not using condoms when they have sex. Younger Canadians, on the other hand, are thought to be less aware of the risks of unprotected sex than previous generations. “Research shows that people often stop using condoms when they start using the birth control pill,” says Dr. Samir Gupta, to Global News, “which would indicate that they’re not thinking about the risk of sexually transmitted infections.”

Add to that a reduction in the frequency of cervical cancer screening and the situation is a cause for concern, says Naimer. “For women, untreated chlamydia can cause serious health problems such as infertility, pelvic inflammatory disease and ectopic pregnancy; in men, health problems include urethritis, epididimitis and infertility,” she says.

Naimer advocates that physicians do their part in encouraging women and men to get tested for STIs by prompting discussion about testing and asking patients if they have questions about STIs.

“Primary care providers like me need to be more proactive and look for other chances to offer screening and discuss safe sex practices,” says Naimer.

Naimer points out that while testing for STIs like chlamydia and gonorrhea used to be a more uncomfortable procedure, involving a swab test inside the vagina for women or the urethra for men, both of these infections can now be tested through a simple urine sample.