Use of a primary care database to determine trends in genital chlamydia testing, diagnostic episodes and management in UK general practice, 1990 2004 (original) (raw)
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Screening for chlamydia in general practice: a literature review and summary of the evidence
Journal of Public Health, 1997
Genital Chlamydia trachomatis infection is the commonest curable sexually transmitted disease (STD) in England and Wales and is one of the chief causes of pelvic inflammatory disease (PID) in women. Infection in women is complicated by the fact that the majority of women with this infection are asymptomatic. It is feasible for general practitioners (GPs) to test for this infection, and there has been debate as to which is the most appropriate screening strategy. In the absence of any national UK guidelines, the purpose of this systematic literature review is to appraise critically and summarize the evidence for screening for genital chlamydia infection in sexually active women attending UK general practice. The four areas to be reviewed are: prevalence of genital chlamydia infection in women attending UK general practice; evidence for routine screening of women attending general practice; evidence for selective screening of women attending general practice; evidence for screening women requesting termination of pregnancy (TOP) or intrauterine device (IUD) insertion. This review should allow GPs and public health practitioners to become aware of the quality of evidence underlying various screening strategies and inform any local guideline development.
Screening and treatment of Chlamydia trachomatis infections
BMJ, 2010
Chlamydia trachomatis is the most commonly diagnosed bacterial sexually transmitted infection worldwide. 1 2 Numbers of diagnoses have increased over the past 10 years as a result of more sensitive tests and increased testing. Genital infection with C trachomatis is asymptomatic in 50-88% of men and women, w1 and 46% of infections clear spontaneously within a year. 3 Persistent chlamydia infection can lead to pelvic inflammatory disease, ectopic pregnancy, and tubal infertility in women w2 and epididymitis and epididymo-orchitis in men. 2 Here, we describe the diagnosis and management of chlamydia and discuss control strategies. Guidance on the laboratory diagnosis and treatment of chlamydia has a strong evidence base, but evidence on the natural course of infection and optimum control strategies is less robust. How common is chlamydia infection and who gets it? Infection can occur at any age but is most common in people under 25, w3 with rates of diagnosis peaking in women aged 16-19 and men aged 20-24 (fig 1). This may be because people in these age groups change partners frequently and because women clear the infection more quickly with increasing age. 3 Risk factors include age under 25 years, two or more sexual partners in the past year, and recent change of partner. Although the true prevalence of this infection is not known, a systematic review in the United Kingdom estimated that 4-5% of women under 20 in the general population and 8-17% of women under 20 attending sexual health services were infected. Fewer data were available for men, but the review concluded that mean prevalence estimates by setting were similar to those for women. 4 European studies report similar figures for women. w5 SummaRy pointS Chlamydia is most common in people aged 16-25 and is usually asymptomatic Untreated infection can cause pelvic inflammatory disease, ectopic pregnancy, and subfertility Nucleic acid amplification testing is highly sensitive on non-invasive samples such as urine and self taken vaginal swabs Mathematical modelling suggests that screening could reduce the prevalence of infection The English national chlamydia screening programme aims to test sexually active under 25s by offering tests in general practice, pharmacies, sexual and reproductive health services, and other venues they visit Partners and ex partners of test positive patients should be tested and treated
Sexually transmitted infections, 2007
To assess the feasibility and acceptability of opportunistic Chlamydia trachomatis (CT) screening of asymptomatic men attending three different secondary healthcare settings and to investigate CT positivity in these settings. Men attending fracture, fertility and family planning (FP) clinics were invited to be screened by first-void urine and complete a questionnaire which collected demographic, sexual and behavioural characteristics, and their opinion about the screening process. 1290 men were approached, with 80% participating. The number of men approached, number providing a satisfactory urine specimen and CT positivity rate (95% CI) were, respectively, n = 401, n = 206, 14.6% (10.4 to 20.1) for the FP clinic, n = 505, n = 328, 1.2% (0.5 to 3.2) for the fracture clinic and n = 384, n = 319, 0.3% (0.1 to 1.8) for the fertility clinic. The highest rates of CT infection were found in men attending the FP clinics, aged between 20-24 years. Most of the men from all three clinics felt ...
Prevalence of Chlamydia trachomatis in young men in north west London
Sexually Transmitted Infections, 2000
Background: Chlamydia trachomatis is the most common, treatable, bacterial sexually transmitted infection in England and Wales. Among men, chlamydial infection is an important cause of non-gonococcal urethritis, epididymitis, and proctitis. The case for wider screening among women has been accepted by an expert advisory group. In the absence of estimates of the prevalence of infection in men, its potential impact at the population level is diYcult to assess. Objective: To estimate the prevalence of Chlamydia trachomatis in young men in clinic and community based samples in north west London. Method: Cross sectional survey in healthcare centres and general practices in north west London. 1002 males aged 18-35 years, living in north west London, were recruited by staV in occupational health departments, general practices, student health services, and a "well man" clinic and by postal recruitment in four GP practices. The men were tested for C trachomatis using the ligase chain reaction assay on urine samples. The main outcome measure was prevalence of C trachomatis infection in men aged 18-35 years. Results: The overall response rate was 51%. Prevalence of confirmed infection was 1.9% (95% CI: 1.14% to 2.96%) in all men. Best estimated minimum prevalence of infection was 1% (95% CI: 0.58% to 1.50%). Estimated prevalence was highest among men aged over 30 years.
Testing and screening for chlamydia in general practice: a cross-sectional analysis
Australian and New Zealand Journal of Public Health, 2014
Objectives: Chlamydia screening is widely advocated. General practice registrars are an important stage of clinical behaviour development. This study aimed to determine rates of, and factors associated with, registrars' chlamydia testing including asymptomatic screening. Methods: A cross-sectional analysis of data from Registrars Clinical Encounters in Training (ReCEnT), a cohort study of registrars' consultations. Registrars record details of 60 consecutive consultations in each GP-term of training. Outcome factors were chlamydia testing, asymptomatic screening and doctor-initiated screening. Results: Testing occurred in 2.5% of 29,112 consultations (398 registrars) and in 5.8% of patients aged 15-25. Asymptomatic screening comprised 47.5% of chlamydia tests, and 55.6% of screening tests were doctor-initiated. Chlamydia testing was associated with female gender of doctor and patient, younger patient age, and patients new to doctor or practice. Asymptomatic screening was associated with practices where patients incur no fees, and in patients new to doctor or practice. Screening of female patients was more often doctorinitiated. Conclusions: GP registrars screen for chlamydia disproportionately in younger females and new patients. Implications: Our findings highlight potential opportunities to improve uptake of screening for chlamydia, including targeted education and training for registrars, campaigns targeting male patients, and addressing financial barriers to accessing screening services.
Bacterial Empire, 2021
Introduction: Chlamydia is transmitted through sexual contact with the penis, vagina, mouth, or anus of an infected partner. It can be transmitted or acquired even without ejaculation. It can also be transmitted perinatally from an untreated mother to her baby during childbirth, resulting in ophthalmia neonatorum or pneumonia in some exposed infants. Objective: The objective of this study was to screen for and determine the prevalence of Chlamydia trachomatis in asymptomatic sexually active women aged 16-33 years with the aid of a point of care rapid test kits within a resource-limited setting. Methods: In this study endocervical swab of a total of 170 female subjects between the ages of 16 to 33 were screened for Chlamydia trachomatis with two types of rapid test kits (Diaspot and Abon Rapid test kits for chlamydia). The subjects consisted of 140 study subjects and 30 control subjects attending the gynecological unit in Igbinedion University Teaching Hospital (IUTH) for other reasons, all subjects were random, sexually active, asymptomatic females and residents in Okada and its environs. Results: A total of 11 subjects tested positive to chlamydia (7.85 %). The samples that tested positive for Chlamydia were from patients that were unmarried and students. The age groups with the highest prevalence were 22-28 (5.71 %) and 16-21 (2 %). 23.63 % have had a previous history of STD and 26.47 % had awareness of chlamydia infection. The ages group (22-27) had the highest level of awareness. The prevalence of Chlamydia trachomatis was consistent with their sexual lifestyles. Conclusion: Chlamydia screening should be a continuous public health intervention and screening programmes should ensure regular chlamydia screening for a high proportion of the target population. The methods for monitoring and ways to ensure standards are met should be adopted.
The management of Chlamydia trachomatis: combined community and hospital study
Sexually Transmitted Infections, 2000
The management of Chlamydia trachomatis: combined community and hospital study Demographic data The study was performed in family planning clinics (FPC), general practices (GP), and a district general hospital (excluding STI clinic) in rural/semirural area of the United Kingdom. Method A review of the records of all patients diagnosed Chlamydia trachomatis positive by ELISA confirmed with MIF between June 1996 and May 1997 was performed. GP records were reviewed by questionnaires to GPs; hospital and family planning records were reviewed by audit coordinator or gynaecology senior house oYcers. Statistics Data were analysed by using Snap 4 Professional by Mercaptor. The 2 test was performed with Yates's correction when expected cell values were less than 5. Results Of the 3989 chlamydia tests requested (2237 GP, 537 FPC, and 115 hospital), 154 were positive (85 GP, 31 FPC, 38 hospital) giving prevalence rates in those tested of 3.6%, 5.8%, and 3.4% respectively. Data were available for analysis on 127 patients: 68 GP (64 F, 4M), 21 FPC (21F), and 38 hospital (33F, 5M) (see table 1).
BMJ, 2005
Objective To measure the coverage and uptake of systematic postal screening for genital Chlamydia trachomatis and the prevalence of infection in the general population in the United Kingdom. To investigate factors associated with these measures. Design Cross sectional survey of people randomly selected from general practice registers. Invitation to provide a specimen collected at home. Setting England. Participants 19 773 men and women aged 16-39 years invited to participate in screening. Main outcome measures Coverage and uptake of screening; prevalence of chlamydia. Results Coverage of chlamydia screening was 73% and was lower in areas with a higher proportion of non-white residents. Uptake in 16-24 year olds was 31.5% and was lower in men, younger adults, and practices in disadvantaged areas. Overall prevalence of chlamydia was 2.8% (95%confidence interval 2.2% to 3.4%) in men and 3.6% (3.1% to 4.9%) in women, but it was higher in people younger than 25 years (men 5.1%; 4.0% to 6.3%; women 6.2%; 5.2% to 7.8%). Prevalence was higher in the subgroup of younger women who were harder to engage in screening. The strongest determinant of chlamydial infection was having one or more new sexual partners in the past year. Conclusions Postal chlamydia screening was feasible, but coverage was incomplete and uptake was modest. Lower coverage of postal screening in areas with more non-white residents along with poorer uptake in more deprived areas and among women at higher risk of infection could mean that screening leads to wider inequalities in sexual health. Matthias Egger professor of epidemiology and public health Milne Centre, United Bristol Healthcare Trust, Bristol BS21 7LR