Chlamydial infection is asymptomatic in England as well as Tanzania

EDITOR,—H Grosskurth and colleagues conclude that infection with Chlamydia trachomatis is commonly asymptomatic among rural Tanzanian men.1 In our experience, it is commonly asymptomatic among urban men in Lancashire, England.

During April 1994 to April 1995, 84 male patients were seen in whom C trachomatis infection was diagnosed on culture. Of these, only 43 complained of urethral discharge or dysuria, or both. Forty one had no symptoms of urethritis. It is our policy to trace all sexual contacts of patients infected with C trachomatis. Eighteen of the 84 patients were contacts, but only one was symptomatic. The remaining 66, who were not known contacts, were diagnosed by routine screening.

C trachomatis is a common cause of sexually transmitted diseases world wide and if not treated can lead to severe complications, especially in women.2 Since 1988 it has been our policy to screen all men and women attending our department for C trachomatis infection. Some authors have argued against universal screening of men attending sexually transmitted diseases clinics,3 but, given our experience and that the true cost of any undiagnosed genital chlamydial infection to the community will be high, we will continue our current policy. We believe that the “syndromic approach” to the management of sexually transmitted diseases will not adequately address the impact of asymptomatic diseases and may lead to major gaps in programmes to control sexually transmitted diseases.