Analysis

Screening programmes for chlamydial infection: when will we ever learn?

BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39154.378079.BE (Published 05 April 2007) Cite this as: BMJ 2007;334:725
  1. Nicola Low, reader in epidemiology and public health
  1. Department of Social and Preventive Medicine, University of Bern, Bern, CH-3012, Switzerland
  1. Correspondence to: low{at}ispm.unibe.ch
  • Accepted 29 January 2007

With more countries recommending screening programmes for chlamydial infection, Nicola Low argues that such programmes are not underpinned by sound evidence

The notion that a programme of widespread screening1 in Sweden controlled transmission of chlamydial infection and reduced morbidity of the female reproductive tract is commonly cited as fact.2 3 4 Unfortunately, this assertion and similar claims about screening in the United States3 4 5 and Canada6 are not supported by rigorous research or practice. Here, I will show how misinterpretation of what comprises a screening programme led to uncritical acceptance of the effectiveness of chlamydia screening, and the funding of a National Chlamydia Screening Programme in England,3 before the benefits and harms were evaluated.

Summary points

  • Lack of an agreed concise definition of a screening programme has contributed to beliefs about the effectiveness of opportunistic screening for chlamydial infection

  • Opportunistic screening as currently implemented in the National Chlamydia Screening Programme in England has not been evaluated in randomised controlled trials

  • Criteria for assessing the appropriateness for introducing a screening programme have not been rigorously applied to chlamydial infection

  • Countries implementing or contemplating national chlamydia screening should conduct research to determine if such screening programmes do more good than harm at reasonable cost

Screening for chlamydial infection in Sweden

Swedish researchers were key players in demonstrating the importance of sexually transmitted chlamydial infection in the 1970s and 1980s. They were instrumental in developing diagnostic testsw1 and defining the role of C trachomatis in pelvic inflammatory disease and infertility.w2 The first documented “program to identify asymptomatics” started in 1982 and tested women under 30 years seeking contraception, abortion, or antenatal care and male partners of infected women.7 In 1988, a change in the Swedish infectious diseases law required doctors to provide free testing, treatment, and partner notification for anyone with suspected …

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