Chlamydia testing can be offered opportunistically during any suitable consultation - discussing contraception easily leads to mentioning sexual health.
Sending invitations to patients to come in for a test has been shown to have a poor uptake and many patients do not want to have an internal examination.
Explaining there is no need for a physical examination and that tests can even be done by the patients themselves often reassures young patients.
Types of test
There are three types of tests and all of them are very sensitive. For men, a urine test is the most convenient - although the patient must not have passed urine in the previous hour.
Self-vaginal swab is a popular method with young women. They can do it in the bathroom or in the examination room behind a screen or curtain.
If a woman is having a speculum examination for any other reason you could offer an endocervical swab for chlamydia testing. It is important to realise that each of these tests suits a certain situation or patient - it does not mean that a urine test is inferior to endocervical testing.
The tests for chlamydia are extremely sensitive (93-100 per cent) with a specificity of above 99 per cent. The reason for this is that the nucleic acid amplification test uses DNA and RNA sequences for identification and only small numbers are needed.
The DNA/RNA can be detected for many days, which means that samples collected from the patient during a Friday afternoon can still be sent for testing on Monday or Tuesday. The sample can be stored safely in the fridge or at room temperature.
Testing is offered to all young people and it is important they do not feel they are targeted because of their sexual behaviour.
Lots of young people worry about confidentiality. You may work in a close-knit community and it is important to stress that anything discussed is between the patient and yourself.
Patients should be offered a test once a year, or when changing sexual partners.
Even with the best intentions, patients are poor at returning samples to the practice. When offering a test to a patient during a consultation, it is important to collect the sample during the same setting. Packs or screening kits handed out to patients are often never seen again.
Involve the practice
Make chlamydia screening everybody's responsibility; healthcare assistants and practice nurses are ideally placed as they often have longer appointments and see more young patients.
Research among young people has shown that they prefer to talk about sexual health in private with a nurse or doctor. They do not appreciate receptionists offering screening to them in front of a full waiting room.
- Dr Kalwij is the National Chlamydia Screening Programme's GP champion and a GP in south London
Alan, 21, comes to visit you because of his ongoing acne problems. You have prescribed him minocycline in the past. Alan is pleased and would like to continue with the antibiotics. While you wait for the script from the printer, you ask him: 'So, how is life?'
'Fine doc. I passed my exams and more importantly, I have got a new girlfriend.' The patient flushes slightly.
'Since you mention being in a new relationship, have you thought of being tested for chlamydia? Our practice is offering this now to everybody who is sexually active and younger than 25. How do you feel about that?'
'What kind of test it is. Do you have to examine me?'
'No, not at all. All we need is a urine test.'
'That doesn't sound too bad'.
'You can do it right now while I fill out your form.'
Alan agrees. His test comes back negative and he feels relieved.
If the patient tests positive
1. Treatment is straightforward: azithromycin 1g stat (unless the patient is pregnant or allergic to azithromycin).
2. Advise that reinfection can occur if the sexual partner is not tested and treated.
3. It is important to emphasise that the patient should abstain from unprotected sexual intercourse for seven days.
4. Contacting and informing present and previous sexual partners is an important step in controlling chlamydia.
5. All patients testing positive should be advised to get tested for other STIs.