Screening for genital chlamydial infection

doi:10.1136/bmj.321.7261.629

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Jeanne Pimenta, pilot coordinator (JPimenta@phls.org.uk)a,
Mike Catchpole, consultant epidemiologista,
Muir Gray, directorb,
Jenny Hopwood, pilot coordinatorc,
Sarah Randall, pilot coordinatord

^a Public Health Laboratory Service Communicable Disease Surveillance, London NW9 5EQ
^b National Screening Committee, Institute of Health Sciences, Oxford OX3 7LF
^c Evidence-Based Practice Centre, St Catherine's Hospital, Birkenhead L42 0LQ
^d Ella Gordon Unit, St Mary's Hospital, Portsmouth PO3 6AD

Correspondence to: J Pimenta

Accepted 8 June 2000

Sexual and reproductive health in the United Kingdom urgently needs improving,1 and the government is developing the first integrated national strategy on sexual health. 2 3 Theoretical models describing the main determinants of the incidence of sexually transmitted infections suggest that reducing the mean duration of infectiousness is likely to lead to substantially lower levels of disease.4 One way of achieving such reductions is by the earlier ascertainment of cases through screening for infection. The chief medical officer's expert advisory group on Chlamydia trachomatis has recently evaluated the evidence for chlamydia screening in the United Kingdom.5 In this report we summarise the main evidence addressed by the group and outline how its conclusions have been implemented through a screening pilot in two health authorities in England.

Summary points

Chlamydia trachomatis is the most common curable, bacterial, sexually transmitted disease in the United Kingdom

Detection outside genitourinary clinics is limited because the infection is largely asymptomatic

If untreated, infection can lead to severe reproductive morbidity in women

Screening programmes have produced a reduction in prevalence of infection and pelvic inflammatory disease

A pilot of opportunistic screening in England is described targeting mainly young women in primary and secondary healthcare settings

The problem

C trachomatis infection is the most common curable, bacterial, sexually transmitted infection in England.6 Since 1988, the number of cases seen in genitourinary medicine clinics in England has risen by 46% from 30 349 to 44 196 in 1998. The greatest rise over the past 10 years has been in the younger sexually active population (16-19 year old women and 20–24 year old men), and rates of infection are currently highest in these groups.7 Chlamydial infection is largely asymptomatic and, if untreated, the long term consequences of pelvic inflammatory disease, ectopic pregnancy, and tubal factor infertility are especially …