Education And Debate

Sexuality and health: the hidden costs of screening for Chlamydia trachomatis

BMJ 1999; 318 doi: http://dx.doi.org/10.1136/bmj.318.7188.931 (Published 03 April 1999) Cite this as: BMJ 1999;318:931
  1. Barbara Duncan, research associate (Barbara.d@msoc.mrc.gla.ac.uk),
  2. Graham Hart, associate director
  1. MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow G12 8RZ
  1. Correspondence to: Dr Duncan
  • Accepted 18 January 1999

In response to a recent expert advisory group report to the chief medical officer, the government has announced the setting up of two pilot schemes to assess the feasibility of a Chlamydia trachomatis screening programme in the United Kingdom.13 Chlamydia is the most common, curable, sexually transmitted infection in the Western world. Chlamydia infection is largely asymptomatic, but if it is left untreated it can have particularly severe long term consequences for women. These sequelae include pelvic inflammatory disease, ectopic pregnancy, and infertility.4

The expert advisory group has recommended that the following groups be targeted for screening: everyone with symptoms of chlamydia infection, all those attending genitourinary medicine clinics, and women seeking termination of pregnancy.1 There should also be opportunistic screening of young sexually active women under 25 years and of women over 25 with a new sexual partner or two or more sexual partners in the past year. The report identifies family planning clinics and general practice as key sites for screening. It also emphasises the importance of follow up management of infected individuals, which should be carried out in conjunction with genitourinary medicine clinics.

Summary points

  • Screening women—but not men—for chlamydia could have unintended consequences

  • Experience from cervical screening shows that women have feelings of “contamination,” reduced attractiveness, and sexual dysfunction and that a positive test result is associated with promiscuity

  • Screening women for chlamydia minimises further men's responsibility for sexual and reproductive health

  • Professional and public education about chlamydia should address the health needs of men and women and should not foster gender inequalities

Costs and benefits of screening

The rationale behind targeting women for this screening programme is based on health benefits, cost effectiveness, and accessibility. Firstly, and most importantly, the purpose of the programme is to reduce the morbidity associated with pelvic inflammatory disease. Evidence from countries …

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