Background Baltimore City ranks in the top half among major US cities for rates of chlamydia infections, 80% of which were from women < 26 years of age. Research has shown that younger women who are at the highest risk for chlamydia are being undertested while older women are being overtested. The purpose of this study was to determine the prevalence of chlamydia and gonorrhoea (CT and GC) infections in women ≥ 26 who are at increased risk of infection and to determine factors associated with a positive test.

Methods We conducted a retrospective chart review of medical records for all Medicaid-insured women aged 26 and older who were seen for a gynaecology visit at an academic medical institution in Baltimore, MD from January 2009 to December 2010 and tested for CT and GC. Pregnant women and those who were HIV positive were excluded from the study.

Results Of the 625 women that were included in the study, the median age of those testing positive for CT or GC was 30 (IQR 28–32). For those who tested negative, the median age was 35 (IQR 30–45). No woman over the age of 45 had a positive test. The prevalence of CT and GC in this population was 1.7% and 0.3%, respectively. By only testing women who were symptomatic, had a history of an STI, who complained of being exposed to an STI, or were 40 years or younger, we captured all positive tests and screened 86.4% of the original 625 patients.

Conclusion There remains a low prevalence of chlamydia and gonorrhoea in older women, regardless of risk factors. We recommend selective screening of high-risk women (STI exposure, symptomatic, or hx of STI). This research demonstrates the need for improved adherence to and rethinking of CT and GC guidelines in older women.