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Who tests whom? A comprehensive overview of Chlamydia trachomatis test practices in a Dutch region among different STI care providers for urogenital, anorectal and oropharyngeal sites in young people: a cross-sectional study
  1. Casper D J den Heijer1,2,
  2. G A F S van Liere1,2,
  3. C J P A Hoebe1,2,
  4. J E A M van Bergen3,4,
  5. J W L Cals5,
  6. F S Stals6,
  7. N H T M Dukers-Muijrers1,2
  1. 1Department of Medical Microbiology, Maastricht University Medical Centre, School of Public Health and Primary Care, Maastricht, The Netherlands
  2. 2Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands
  3. 3Department of General Practice, University of Amsterdam, Amsterdam, The Netherlands
  4. 4Soa Aids Nederland, Amsterdam, The Netherlands
  5. 5Department of General Practice, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
  6. 6Department of Medical Microbiology, Atrium Medical Centre, Heerlen, The Netherlands
  1. Correspondence to Dr Casper D J den Heijer, Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleenbeeklaan 2, Geleen 6166 GR, The Netherlands; casper.denheijer{at}ggdzl.nl

Abstract

Objectives To evaluate and compare Chlamydia trachomatis (CT) diagnostic test practices of different sexually transmitted infection (STI) care providers in 16–29 year olds from one defined geographic Dutch region (280 000 inhabitants). Both number and proportion of positive CT tests (ie, test positivity) were assessed, and factors associated with these outcomes.

Methods Data on laboratory testing and diagnosis of urogenital, anorectal and oropharyngeal CT between 2006 and 2010 were retrieved from general practitioners (GPs), gynaecologists, an STI clinic and a population-based chlamydia screening programme. Multivariable regression analyses explored associations between age, sex, test year, socio-economic status (SES) and STI care provider and the outcomes being the number of tests and test positivity.

Results Overall, 22 831 tests were performed (1868 positive; 8.2%). Extragenital (ie, anorectal and oropharyngeal) tests accounted for 4% of all tests (7.5% positive) and were almost exclusively (99%) performed by the STI clinic. STI clinics tested most men (37.2% of all tested men), whereas GPs tested most women (29.9% of all tested women). GPs and STI clinics accounted for 73.3% (1326/1808) of urogenital CT diagnoses. In women, the number of tests increased with age, whereas test positivity decreased for all STI care providers. Lower SES was associated with higher test positivity in GP and gynaecology patients.

Conclusions STI clinics performed most CT tests in men, whereas GPs performed most CT tests in women. GPs and STI clinics accounted for the majority of positives. Extragenital CT testing is rarely performed outside the STI clinic and needs to be promoted, especially in men who have sex with men.

  • CHLAMYDIA TRACHOMATIS
  • SURVEILLANCE
  • LABORATORY METHODS
  • CLINICAL STI CARE

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