Background Screening and case-finding for Chlamydia infection among all sexually active men and women under the age of 25, annually or during presentation to a health care provider were introduced in Canada and US in 2001. This strategy was aimed to reduce new Chlamydia infections and its long term adverse reproductive complications. The objective of this study is to explore the temporal trends of Chlamydia infections and test uptake in the targeted population of Manitoba.

Method We used Manitoba Cadham Provincial Laboratory (CPL) Chlamydia test data (1992 to 2008). CPL captured almost all sexually transmitted disease testing data of Manitoba. Descriptive statistics and logistic regression were used to describe the trend of Chlamydia infections and tests uptake over time.

Results Overall Chlamydia infection showed an initial flat trend in 1992–2001 and followed by a steady increasing in 2002–2008 trend in all women and men. Using Rural South as reference, the increasing infection rates are most prominent in Rural North rural, OR = 6.12 [CI = 6.06–6.17], Urban Core, OR = 3.52 [CI = 3.49–3.55], Urban non-Core, OR = 3.06 [3.04–3.08], Middle Rural, OR = 1.78 [1.76–1.79], p < 0.0001). Chlamydia test uptake rates showed the same trend and prominent increased test uptakes since 2002 (annual increase 36%, OR = 1.43, CI = 1.42–1.44, p < 0.0001), more in Rural North and Urban Core area in women aged 15–24 years. In younger women (aged 15–19) of Rural North, test positivity rates “outperformed” test uptake rates (annual increase 43% versus 22%).

Conclusions The increasing trends of Chlamydia infection rates cannot be fully explained by the Chlamydia test uptakes in Manitoba young women. The geographic variations flag alarming signals for more effective core group targeted public health intervention.