Managing genital chlamydia trachomatis infection in Scotland: targeted opportunistic testing or a screening programme?

Abstract

Objective: To compare two models of testing for genital chlamydia trachomatis infection: opportunistic testing for genital chlamydia trachomatis at sexual health related consultations, as advocated in the SIGN guideline on Chlamydia trachomatis, or the introduction of a screening programme.

Design: Calculation of estimates of numbers of cases found in one Health Board Area using the two different approaches. Review of the literature on chlamydia with reference to the UK National Screening Committee criteria for appraisal of a screening programme.

Setting: Lothian Health Board Area.

Results: The evidence suggests that a screening programme for chlamydia has population benefits and is cost effective compared to a no-screening approach. However, current understanding of the natural history of chlamydial infection and the effect of treatment is inadequate to fully inform individual women regarding the benefit of testing. Full implementation of the SIGN guideline on Chlamydia trachomatis in Lothian would detect at least 600 new cases of chlamydia whereas a screening programme would detect over 2000 new cases in the first year.

Conclusion: Opportunistic testing at sexual health related consultations does not equate with a screening programme. Although a screening programme would detect more cases of chlamydia trachomatis its cost effectiveness compared to opportunistic testing is unproven. Introducing a screening programme has individual psychological and broader social and ethical implications and must not occur by default.