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LETTERS: I Simms, G Hughes, M Catchpole, C Thompson, Harisadhan Maiti, Heather Bower, Jenny Norrie, Margaret Polaneczky, and A A Opaneye Screening for Chlamydia trachomatis BMJ 1998; 317: 680a [Full text]

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Sue Kinn   (9 December 1998)

Untitled 9 December 1998
Sue Kinn Send response to journal: Re: this article	Dear Editor The ‘male factor' is crucial to effectiveness of screening and is in danger of being overlooked There has been much recent correspondence about screening for genital chlamydial infection and the importance of partner notification, which is acknowledged to be optimal in GUM settings1,2. However, we are concerned that two issues have been conspicuously absent from this debate; firstly, the emphasis on women as the target population for screening with no discussion about involving men and, secondly, the absence of discussion about availability of partner notification facilities in general practice (advocated by the advisory committee to the Chief Medical Officer and described by Boag and Kelly3). It seems likely that women have been chosen as the target population for screening because of difficulties in accessing young men in the primary care setting. The ‘male factor' in chlamydial infection is crucially important in fulfilling any hopes of health gain. Selective screening in women, in health care settings without the resources to effect partner notification, may, paradoxically, create more morbidity than doing nothing at all; the male-to-female transmission rate of the infection is over 70% 4 and each repeated episode of re-infection doubles the risk of tubal infertility5. Furthermore, there are perhaps some sociological concerns about focusing our public health efforts concerning chlamydial infection so strongly on women, who were traditionally viewed as the reservoir of venereal diseases in the past. Surely, strategies for optimising sexual health in the 1990s should adopt a more enlightened approach? Successful strategies in Sweden and elsewhere for reduction of morbidity caused by Chlamydia trachomatis have included men in screening programmes. Ignoring the ‘male factor' would seem to be a dangerous course of action and is worthy of more debate. 1 Maiti H, Bower H, Norrie J. Contacts attendance rate is 70% in Hertfordshire. BMJ 1998; 317: 681 [letter] 2 Thompson C. Genitourinary medicine clinics in Scotland give high priority to contact tracing. BMJ 1998;317:681[letter] 3 Boag F, Kelly F. Screening for Chlamydia trachomatis: the case for screening is made, but much detail remains to be worked out. BMJ 1998;306:1474 [editorial]. 4 Lycke E, Lowhagen GB, Halligen G et. al. The risk of transmission of genital Chlamydia trachomatis infection is less than that of genital Neisseria gonorrhoeae infection. Sexually Transmitted Diseases 1980;7:6 -10. 5 Westrom L, Joesoef R, Reynolds G et. al. Pelvic inflammatory disease and infertility: A cohort study of 1844 women with laparosopically verified disease and 657 control women with normal laparosopic results. Sexually Transmitted Diseases 1992; 19: 185-92. Dr Sue Kinn Project Leader Nursing Research Initiative for Scotland Faculty of Health Glasgow Caledonian University Cowcaddens Rd Glasgow G4 0BA Dr Jane Macnaughton Clinical Lecturer Department of General Practice Glasgow University Woodside Health Centre Barr Street Glasgow G20 7LR Dr Anne Scoular Consultant GU Physician Department of Genitourinary Medicine and Sexual Health Glasgow Royal Infirmary University NHS Trust 16 Alexandra Parade Glasgow G31 2ER No conflicts of interest for any authors. JM is a member of a Scottish Intercollegiate Guideline Network (SIGN) group developing a guideline on the management of genital Chlamydia infection.