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The CMO’s expert advisory group on Chlamydia trachomatis1 and the Health Protection Agency (HPA)2 both state that rates of chlamydial infection are highest among 16–19 year old females and 20–24 year old males. Staff based in the genitourinary medicine (GUM) department in Edinburgh have set up a number of community based initiatives, including a postal testing service, to improve access to chlamydia diagnosis for young people aged less than 25. Many of these initiatives have been targeted specifically at young men, with testing having been made available in a variety of novel settings such as young people’s sexual health and drop-in clinics, further education (FE) colleges, community pharmacies, sports centres, and a high street shop selling CDs. The work forms part of a demonstration project called Healthy Respect that is funded by the Scottish Executive with the aim of helping young people in Lothian develop a positive attitude to their own sexuality and that of others. The long term goal of the project is to reduce teenage pregnancies and sexually transmitted infections.
Between February 2002 and December 2003, as part of the Healthy Respect project, we carried out 4838 chlamydia tests including 2321 from postal testing kits. The overall prevalence of chlamydial infection was 9.5% (10.4% in men, 9.0% in women). Somewhat to our surprise, the 15–19 year old age group showed peak prevalence in men as well as in women.
We compared this with the prevalence by age in men attending Edinburgh GUM (see table 1), anticipating this would be highest in the 20–24 year old age group. Although this was the case for 2002, in 2003 the peak prevalence was in 15–19 year olds, with the proportion of all positive tests in men as a result of the under 20s increasing significantly from 10.1% (51/504) in 2002 to 14.8% (74/500) in 2003 (χ2 5.05; p = 0.025).
There is no doubt that in men, the age group 20–24 accounts for the highest number of cases diagnosed, but our data raise the possibility that either there has been underdiagnosis of cases in younger men or that there is a trend towards younger transmission. Although we only report on 2 years’ data, it will be essential to monitor ensuing trends by concentrating efforts to include teenage men in chlamydia testing programmes.
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