The American College of Obstretricians and Gynecologists has just published its updated schedule of recommended screenings, tests and immunizations for periodic assessments or “well woman exams”. These annual assessments of women aged 21 and above are a key instrument of primary care in the US. Their free provision is being considered for inclusion in the Obama health care law – i.e. under Mikuski’s amendment which requires all new health insurance plans to cover preventive services for women with no out-of-pocket cost to patients.
As regards sexual health, these assessments are the locus for preventative interventions. What is particularly important about the latest recommendations (which replace those of December 2009) is the inclusion of detailed specifications of sexual health screenings and immunizations recommended for each age group. Annual chlamydia and gonorrhoea tests are routine for those aged 21-25, or younger than 21 where individuals are sexually active; for other age groups testing is recommended for individuals reckoned to be at high risk. Annual HIV tests are routine for ages 21-65; for over 65s, tests are recommended for those known to be at high risk. Human papillomavirus vaccination (one series) is recommended for those aged 26 years or less and not previously tested. For all age groups Hepatitis A and B vaccination and Hepatitis C testing are recommended for individuals known to be at high risk.
The fate of the Obama health care law remains to be determined. Those parts of the law concerned with provision of sexual and reproductive issues remain particularly controversial. But if preventative services for women are included in the provision of insurance plans with no out-of-pocket cost, what impact will this have on levels of STI screening in the US?

Committee Opinion no.483, “Primary and Preventative Care: Periodic Assessments”, Obstetrics and Gynecology 117.4, April 2011