General Practice

Genital Chlamydia trachomatis infections in primary care

BMJ 1996; 313 doi: (Published 09 November 1996) Cite this as: BMJ 1996;313:1192
  1. Jonathan D C Ross, senior registrara,
  2. Sheena Sutherland, senior lecturerb,
  3. John Coia, consultant microbiologistc
  1. a Department of Genitourinary Medicine, Edinburgh Royal Infirmary, Edinburgh EH3 9YW
  2. b Department of Medical Microbiology, University of Edinburgh, Edinburgh
  3. c Department of Medical Microbiology, Western General Hospital, Edinburgh
  1. Correspondence to: Dr Ross.
  • Accepted 19 September 1996

Chlamydia trachomatis remains one of the commonest causes of pelvic pain, infertility, and ectopic pregnancy in young women1 2 and is often asymptomatic. Genitourinary medicine clinics in Britain provide information on the prevalence of sexually transmitted disease which is used for monitoring and to set targets for disease control. Increasing recognition of C trachomatis as a genital pathogen is likely to result in patients presenting in other health care settings, including general practice. The resources to ensure resolution of infection or to trace sexual contacts who, if untreated, may reinfect the patient may not be available in the community.

We conducted a study to determine the number of genital C trachomatis infections diagnosed by general practitioners in the Lothian region of Scotland and what proportion of patients were subsequently referred to the genitourinary medicine clinic. Lothian, which includes Edinburgh, has a population of 750 000 and has only one genitourinary medicine clinic. We also assessed variation between practices in the number of patients tested for C trachomatis.

Subjects, methods, and results

We included all patients who had a genital swab taken by their general practitioner to test for chlamydia in 1995, excluding repeat tests. Specimens were analysed by the three microbiology laboratories in Lothian by enzyme linked immunosorbent assay (ELISA) or culture tests. We calculated the average specimen rate per general practitioner for the practices and divided them into high and low specimen rates (above and below the median).

The names and dates of births of patients with a positive test result were cross referenced with the records of the genitourinary medicine to assess the proportion who attended within three months. Those referred and not referred were compared with respect to age, sex, and whether the practice was within the city boundaries.

The 619 general practitioners in Lothian were grouped into 98 practice groups (82 contained a single practice and 16 contained two to six practices). The practice of origin was not known for 13 specimens.

After we excluded repeat negative specimens (n = 201), repeat positive specimens (n = 6), and patients with negative and positive results within the study period (n = 40) the study population consisted of 3943 patients. Eighty one practices sent a genital swab for testing and 57 had at least one positive result. The median number of specimens per general practitioner was 4.5 (range 0–63.6). The specimen rate was similar for practices in Edinburgh (4.4) and those outside (5, P = 0.77).

In all, 141 (3.5%, 95% confidence interval 3.4% to 3.7%) patients had positive results, and 19 subsequently attended the genitourinary medicine clinic. The referral pattern was not affected by the patients' age (median age 22 for those referred v 23 for those not referred, P = 0.96) or sex (odds ratio 2.1, 95% confidence interval 0.3 to 14.9) or by the location of the practice (0.7, 0.3 to 1.7; table).

Table 1

Rate of referral to genitourinary medicine clinic with chlamydial infection among Lothian patients diagnosed in general practice

View this table:


General practitioners in the Lothian region of Scotland screened almost 4000 people in 1995 for genital chlamydial infection. The positivity rate (3.5%) was similar to that reported by genitourinary medicine or family planning clinics, and the absolute number of cases represents an important clinical problem.

Rates of testing varied widely between practices. Although practice demographics vary, it is unlikely that this alone accounts for the difference, and the proximity of the local genitourinary medicine clinic did not influence community testing rates.

Only 13% of patients diagnosed in general practice were referred to the genitourinary medicine clinic. Since general practitioners do not generally have the resources to test for cure, trace sexual contacts, or screen for other sexually transmitted diseases this low referral rate is concerning.3 In addition the medicolegal implications of inadequate management of women with chlamydial infection subsequently presenting with secondary infertility or ectopic pregnancy may be serious.

We thank R Wiseman for supplying laboratory data from St John's Hospital, Livingston, West Lothian.


  • Source of funding None.

  • Conflict of interest None.


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