IN PRACTICE

Use of a primary care database to determine trends in genital chlamydia testing, diagnostic episodes and management in UK general practice, 1990–2004

Gwenda Hughes¹, Tim Williams², Ian Simms¹, Catherine Mercer³, Kevin Fenton⁴ and Jackie Cassell⁵

¹ Department of HIV and STIs, Health Protection Agency Centre for Infections, London, UK
² General Practice Research Database, Medicines and Healthcare products Regulatory Agency, London, UK
³ Centre for Sexual Health and HIV Research, University College London, London, UK
⁴ National Center for HIV, STD, and TB Prevention, Centers for Disease Control, Atlanta, Georgia, USA
⁵ Brighton and Sussex Medical School, Falmer, Brighton, UK

Correspondence to:
Correspondence to:
Dr G Hughes
Department of HIV and STIs, Health Protection Agency Centre for Infections, London NW9 5EQ, UK; gwenda.hughes{at}hpa.org.uk

Objective: To determine the extent of testing, diagnostic episodes and management of genital Chlamydia trachomatis (CT) infection in UK primary care using a large primary care database.

Methods: The incidence of CT tests, diagnostic episodes, treatments and referrals was measured for all adult patients in the General Practice Research Database between 1990 and 2004.

Results: Rates of CT testing in those aged 12–64 years in 2004 increased to 1439/100 000 patient years (py) in women but only 74/100 000 py in men. Testing rates were highest among 20–24-year-old women (5.5% tested in 2004), followed by 25–34-year-old women (3.7% tested in 2004). 0.5% of registered 16–24-year-old women were diagnosed as having CT infection in 2004. Three-quarters of patients with a recorded diagnosis of CT had had an appropriate prescription issued in 2004, a proportion that increased from 1990 along with a decrease in referrals to genitourinary medicine. In 2004, general practitioners treated 25.0% of all recorded diagnoses of CT in women and 5.1% of those in men.

Conclusions: Testing for and diagnostic episodes of CT in primary care have increased since 1990. Testing continues disproportionately to target women aged >24 years. Extremely low rates of testing in men, together with high positivity, demonstrate a missed opportunity for diagnosis of CT and contact tracing in general practice.

Abbreviations: CT, Chlamydia trachomatis; GP, general practitioner; GPRD, General Practice Research Database; GUM, genitourinary medicine; NCSP, National Chlamydia Screening Programme; OXMIS, Oxford Medical Information System; STI, sexually transmitted infection

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