Screening programme for Chlamydia moves closer

Britain could be the second country in the world to introduce a national screening programme for Chlamydia, the sexually transmitted infection which can cause infertility.

Dr Adrian Renton, department of social science and medicine, anticipates a national screening programme for Chlamydia

The success of pilot schemes will reveal the extent to which the disease is prevalent within a certain age group. These schemes were set up following the report of the Chief Medical Officer's expert advisory group.

"Professor David Taylor Robinson and I, as research collaborators in the field, advocated hard to get the CMO's committee set up in the late nineties," said Imperial College's Adrian Renton; a member of the committee.

Sexual health in the UK has become a greater priority since the government's first strategy on sexual health was launched in March 1999. An integrated sexual and reproductive health strategy covering all ages and high risk groups is due to be published this year.

"Chlamydia is one of the greatest sexual health threats to young women along with unwanted pregnancies and HIV," said Dr Renton of the department of social science and medicine. "It's a very important problem which people should know about."

Although easily cured if detected, the majority of infected people have no symptoms. Untreated, 20 per cent of women may suffer damage to their fallopian tubes with complications of infertility and pelvic inflammatory disease as well as ectopic pregnancy.

"At present, we probably identify less than 10 per cent of prevalent Chlamydia infections. To control the infection we will need to provide services to screen people who may have been exposed, as well as continuing to promote safer sex," he said.

First reported in the 1960s, Chlamydia trachomatis is a bacterium that resembles a virus as it is dependent on host cells for growth and reproduction. It lives inside human cells and has been difficult to detect using standard diagnostic tests.

The screening pilots in the Wirral and Portsmouth, both funded by the Department of Health, have drawn tremendous public and professional responses, particularly in Portsmouth, where all GPs asked have taken part.

Tests were offered to 16-24 year old women by GPs, family planning clinics and youth centres among others, as well as men attending youth centres and genitourinary medicine clinics: GUMS. Between 300 and 400 people a week offered urine samples for analysis.

"Infections found are likely to be sufficiently high for screening to be cost-effective," added Dr Renton, a member of the Public Health Laboratory Services advisory group on HIV and AIDS and the Chlamydia Infection Programme steering group.

"A screening programme could have a substantial impact on epidemiology and control of the infection.

"It could help significantly to reduce Chlamydia in the sexually active UK population and have an important impact on long term health.

"However we have to be careful not to deliver false positive or negative results. It is vital to pay attention to the detail of how the programme is developed, how staff are trained and whether resources are available; costs and benefits, both financial and human, have to balance."

Systematic screening for Chlamydia was first developed in Sweden where there has always been a strong ethos of sexual health promotion, he added.

Consultant epidemiologist, Dr Mike Catchpole who is coordinating analysis of data from the British projects said: "We've had a phenomenal response from all those screened and a massive influx of specimens as a result.

"There could be in excess of 100,000 cases of Chlamydia in that age group in this country yet only 12,000 will be diagnosed in GUMS clinics which is why setting up a national screening programme is so vital.

"The pilot schemes end in September and a report will be given to the National Screening Committee and Department of Health in 2001. It will inform decision on national policy."