Clinical Review Evidence based case report

Chlamydia infection in general practice

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7186.790 (Published 20 March 1999) Cite this as: BMJ 1999;318:790
  1. N R Hicks (nicholas.hicks@dphpc.ox.ac.uk), consultanta,
  2. M Dawes, general practitionerb,
  3. M Fleminger, general practitionerb,
  4. D Goldman, general practitionerb,
  5. J Hamling, general practitionerb,
  6. L J Hicks, general practitionerb
  1. aDirectorate of Public Health and Health Policy, Oxfordshire Health Authority, Oxford OX3 7LG
  2. bHollow Way Medical Centre, Oxford OX4 2NJ
  1. Correspondence to: Dr N R Hicks
  • Accepted 2 September 1998

How common is chlamydia infection, and who should be investigated and treated for it? Is the net benefit of investigation worth the cost? At a recent discussion in our general practice it soon became apparent that our views and practices varied widely. Was there any evidence to help us reach a consensus? We resolved to try and find out.

Summary points

  • Chlamydia infection is the commonest treatable sexually transmitted disease in the United Kingdom; it is most common in sexually active women aged under 20

  • Serological studies suggest that chlamydial infection may account for a large proportion of cases of tubal infertility and ectopic pregnancy

  • 60-80% of genital chlamydia infections in women may be asymptomatic

  • In one randomised trial, screening high risk women and treating those found to be infected reduced the incidence of pelvic inflammatory disease by about half in 12 months

  • Access to the internet allows valid, relevant information to be identified and retrieved quickly—but appraising the evidence and deciding how best to reflect it in practice takes considerably longer

Case report

Ms A, a 20 year old secretary, was worried because she had had vaginal discharge and irritation for three days. The discharge was slight, clear, watery, and non-offensive, and she had no abnormal vaginal bleeding. Ms A had changed her sexual partner two months previously. Soon after this she had contracted genital thrush, which responded to topical clotrimazole. She uses a combined contraceptive pill and does not use condoms. Ms A has no other sexual partners, and thinks it unlikely her partner has. However, she has little knowledge of his previous sexual history.

The only noteworthy finding at vaginal examination was that Ms A's cervix bled easily when swabbed. A high vaginal swab was taken from the posterior fornix, and two swabs were taken from the endocervix and the urethra—a …

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