In 2003, the House of Commons Health Committee report on sexual health¹ provided a stark and honest insight into the deterioration of sexual health services in England. Contained within a range of hard hitting recommendations aimed at improving sexual health services were a number of recommendations directly relevant to chlamydia prevention and control. These included discontinuing the use of lower sensitivity enzyme immunoassay tests for the diagnosis and confirmation of genital chlamydia in favour of the more sensitive nucleic acid amplification tests (NAATs) and the speedy implementation of a national chlamydia screening programme. Since the publication of this report, additional funding to convert all NHS chlamydia diagnostic tests to NAAT technology has been identified and its implementation is in progress. In this issue four major papers^2–5 are presented which inform the development and implementation of the NCSP; we assess their findings and discuss some of the early challenges in implementing this ambitious programme.⁶

HOW DID WE GET HERE?

Genital chlamydia is now the most common sexually transmitted infection diagnosed in GUM clinics in England, with high prevalence being documented among young men and women aged under 25 attending a variety of specialist and general healthcare settings.^7,8 The case for screening for genital chlamydia is now well established, and underpins the implementation of screening and testing initiatives in the United States and a few European countries. Despite uncertainty regarding the natural history of infection—the high disease incidence and prevalence; largely asymptomatic nature of disease; complications and costs of untreated infection; availability of effective simple and relatively cheap diagnostic tests; effective and convenient therapy; and growing empirical and modelling evidence regarding the long term effectiveness of screening programmes^9,10 have all been used to call for the implementation of a national screening …