Screening for chlamydia

Many developed countries offer screening for Chlamydia trachomatis to young people, with the aim of controlling high rates of chlamydia infection and reducing the reproductive health risks associated with such infection.1 In England alone, more than £100m (€111m; $150m) has been spent on delivering screening since 2003.2 However, the benefits of screening are uncertain for many reasons, not least because evidence that screening reduces the incidence of pelvic inflammatory disease, which can lead to chronic pelvic pain, tubal factor infertility, and ectopic pregnancy, has been questioned because of “methodological inadequacies” in the trials carried out to date.3

In the linked study (doi:10.1136/bmj.c1642), the Prevention of Pelvic Infection (POPI) trial, Oakeshott and colleagues’ primary objective was to examine whether screening sexually active young women reduced the incidence of pelvic inflammatory disease.4 They tackled this important question by exploiting a window of opportunity that arose because the English national chlamydia screening programme, established as part of the strategy to improve sexual health in young people, was introduced in some areas before others.5 This enabled them to conduct a randomised controlled trial in parts of London where the screening programme was not yet available. The trial recruited more than 2500 female students and after …