Advances in diagnosis and treatment may make screening worthwhile

Screening for asymptomatic Chlamydia trachomatis was first proposed in the early 1980s1 and guidelines for selective screening in the United States were published by the Centers for Disease Control in 1993.2 The condition fulfils many of the criteria for screening.3 Most infections are initially asymptomatic but may subsequently cause considerable long term morbidity.4 5 Treatment is simple and effective. So, is genital chlamydial infection worthy of a national selective screening programme in Britain?

C trachomatis is the most common curable sexually transmitted pathogen in Britain. Despite previous calls for more attention to be paid to the problem,6 no national screening guidelines are in place, although the Department of Health has recently formed an expert advisory group to address questions of control. The epidemiology of genital chlamydial infection has been incompletely studied. Screening, diagnosis, and treatment remain inconsistent. National surveillance of chlamydial infection is limited to returns from genitourinary medicine clinics and voluntary laboratory reporting.

Over 39 000 cases of genital chlamydial infection were treated in genitourinary medicine clinics in England and Wales in 1995, more than three times the number of cases of gonorrhoea reported.7 …