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With reference to the article by van Valkengoed et al,1 we would like to express our views. We agree with the authors' statement that systematic screening of all women aged 15–40 years for asymptomatic Chlamydia trachomatis infection is not cost effective, especially when the prevalence of infection in Amsterdam is low (2.2%–2.8%). Not all countries have achieved such low levels. Even in England and Wales where the prevalence of the infection is higher it is not cost effective to screen all women. However, computer modelling performed for the chief medical officer's expert advisory group on Chlamydia trachomatis2 in the United Kingdom and other countries3,4 has shown that it is cost effective to screen populations where the prevalence is 3%–6%. The Chlamydia Pilot Study, which was conducted in Wirral and Portsmouth in 1999–2000, detected a prevalence of chlamydial infection of approximately 10% in women aged between 16 and 25.5 There is, therefore, a strong argument for screening this age group in the United Kingdom at the present time and not above 25 years as prevalence above this age is low.
One must be careful when extrapolating data from a different country with a different population. However, it would be wise to consider that in the future in the United Kingdom, when screening is established, the prevalence may fall and the cost effectiveness may be reduced.
Although it is not cost effective to screen men, as there are only minor sequelae to be prevented, one shouldn't forget that they are the major reservoir of infection. We should aim not to reinforce existing inequalities by sparing them their share of responsibility for sexual health. Screening men as well will not only decrease the prevalence but also reduce the psychosocial impact of screening for genital chlamydia in women.
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