Chlamydia screening

Current situation

  • Considerable increase in the incidence of chlamydia has led to a major public health problem in the UK.
  • The NHS spends £50 million a year treating infertility secondary to chlamydial infections.
  • The National Chlamydia Screening Programme has been implemented by the DoH.

What is the evidence?

  • Although opportunistic chlamydia screening is being introduced in England, there is no high-quality evidence of its effectiveness.
  • Postal screening has been shown to be a feasible method for screening; however, coverage and uptake were found to be incomplete (BMJ 2005; 330: 940). Lower coverage of postal screening occurred in areas where women were at a higher risk of infection.
  • One study showed that a combination of opportunistic and systematic (invitation by post) screening should achieve a higher coverage than either strategy alone (BJGP 2006; 56: 99–103).
  • A study has shown that continuous opportunistic screening at high uptake rates could reduce chlamydia prevalence within a few years: by 57 per  cent over five years and by 70 per cent over 10 years in women under 35 years (Sex Transm Infect 2006; 82: 496–502).
  • One paper suggests the cost-effectiveness of chlamydia screening programmes might have been overestimated, because the incidence of severe complications associated with chlamydia was lower than previously expected. For example, the rate of infertility was 4 per cent in women testing negative for chlamydia and 6.7 per cent in those testing positive (Sex Transm Infect 2006; 82: 212–18).
  • Women are more prone to stigmatisation than men (BJGP 2006; 56: 587–93). Screening for chlamydia should therefore include non-stigmatising information.

Implications for practice

  • The DoH will speed up roll-out of a national chlamydia screening programme for women under the age of 25.
  • A DoH initiative to offer those under 25 free chlamydia screens in specified pharmacies has been launched.

Available guidelines

  • National guidelines for screening have been produced by the DoH (Chlamydia screening programme roll-out core requirements; London: DoH, 2003).
  • Nearly 100,000 young people were tested for chlamydia in 2005/6 through the National Chlamydia Screening Programme.
  • One study says men and women treated for chlamydia should be screened again within three months because of high repeat infection rates (Ann Intern Med 2006; 145: 564–72).
  • Useful website: Chlamydia Screening Studies project —www.chlamydia.ac.uk

Dr Louise Newson is a GP in the West Midlands and author of 'Hot Topics for MRCGP and General Practitioners’ Pas Test 2006

Key points

  • Chlamydia is the most prevalent STI in the UK.
  • Highest rates are found in females aged 16–24 years.
  • Most infections are asymptomatic.
  • Training and resources are a problem for screening.
  • Cost-effectiveness of screening is still uncertain.

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