• screening
• chlamydial infection
• urine testing
• healthcare settings

It is now 6 years since the randomised controlled trial by Scholes et al demonstrated that a significant reduction in the incidence of pelvic inflammatory disease could be achieved through active case finding¹ and management of genital chlamydial infection among women. It is 4 years since the publication of the report of the chief medical officer of England’s expert advisory group on Chlamydia trachomatis,² which concluded that “the evidence supports opportunistic screening of sexually active women aged under 25 years, especially teenagers,” and over 2 years since the Scottish Intercollegiate Guidelines Network recommended that “opportunistic testing could be considered for women younger than 25 years and sexually active.”³ Expert opinion in the United States is also in favour of screening for genital chlamydial infection, with a recommendation in the 2002 sexually transmitted diseases treatment guidelines that “Sexually active adolescent women should be screened for chlamydial infection at least annually, even if symptoms are not present. Annual screening of all sexually active women aged 20–25 years is also recommended, as is screening of older women with risk factors.”⁴

In the United States the CDC guidelines have been translated into action, with screening for genital chlamydial infection implemented across all states, with well documented evidence of the effectiveness of large scale screening programmes in reducing chlamydia prevalence in areas where this intervention has been in place for several years.⁵ Similarly, a national programme of active case finding, or screening, for genital chlamydial infection in Sweden has been associated with dramatic reductions in the incidence of that infection and its sequelae.⁶

Against this background the first pilot of opportunistic screening of sexually active young women in the United Kingdom (published in this issue of STI),^7, …