Doubts over chlamydia screening

The chlamydia screening programme, to be rolled out across England by March 2007, might not be cost-effective, according to Swiss researchers.

They found that although a positive chlamydia test raised the risk of reproductive problems in women, this increased risk was much lower than previous studies have suggested.

'The benefits of a screening programme may have been overestimated,' they concluded.

The researchers looked at the number of reproductive complications in a cohort of 43,715 Swedish women who had access to chlamydia screening when aged 15-29 years.

Over 22,000 of the women in the cohort were screened for chlamydia. Of these, 2,626 tested positive for chlamydia at least once, and 19,897 women tested negative.

Women who tested positive were more likely to experience reproductive problems by the age of 35. But their complication rates were lower than expected.

Studies of clinical populations, which current screening recommendations are based on, have suggested that up to 40 per cent of women with chlamydia will go on to develop pelvic inflammatory disease (PID), while 10 per cent will have an ectopic pregnancy or become infertile.

But in this study, just 5.6 per cent of women who tested positive developed PID, 6.7 per cent became infertile, and 2.7 per cent had an ectopic pregnancy.

By comparison, these figures were 4.7 per cent, 4 per cent and 2 per cent respectively in patients who tested negative.

Dr Richard Ma, of the RCGP's sex, drugs and HIV task group and member of the National Chlamydia Screening steering group, said: 'It's disappointing to hear that the benefits of chlamydia screening are not as great as we expected.

'But chlamydia screening still has a role to play. A lot more people are becoming aware of chlamydia infection, and STIs in general, as a result of this screening campaign.'

emma.baines@haynet.com

- Sex Transm Infect 2006; 82: 212-8; Live links at GPonline.com.

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