How can chlamydia diagnoses increase when their complications are declining? | Sexually Transmitted Infections

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How can chlamydia diagnoses increase when their complications are declining?

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Chlamydia screening can work if...
D. Scott LaMontagne
Published on: 13 May 2016

Published on: 13 May 2016
Chlamydia screening can work if...
- D. Scott LaMontagne, Clinical Scientist (Epidemiology)
Dear Editor,
The engaging editorial by Cassell and Low (STI 2005 Aug; 81(4):285-6) is timely and highlights a critical issue in the debate about the effectiveness of screening as an intervention for genital chlamydial infection. The authors correctly note that ecologic studies are limited in their inference but have a role to play in suggesting areas for further research. The authors hypothesize that targeting only...
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Dear Editor,
The engaging editorial by Cassell and Low (STI 2005 Aug; 81(4):285-6) is timely and highlights a critical issue in the debate about the effectiveness of screening as an intervention for genital chlamydial infection. The authors correctly note that ecologic studies are limited in their inference but have a role to play in suggesting areas for further research. The authors hypothesize that targeting only women, inferior intervention coverage, incomplete follow-up of partners, and irregular screening frequencies have played a role in the subsequent rise of incident chlamydial infections in Sweden and elsewhere, and infer that the current efforts in England are headed for similar failure.
However, the authors fail to appreciate the time and resources required to achieve the standard alluded. What proportion of the population has to be screened, how frequently does screening need to occur within that population, and what level of follow-up for partners have been under considerable debate recently, and the authors make no suggestion as to answers to these questions.
I contend that if chlamydia screening was given the appropriate resources and commitment from the start which would guarantee sufficient levels of uptake, ensure regular screening during the principal at-risk time (adolescence to young adulthood), treat a high proportion of the most recent partners, and sustain this effort for a minimum of three years, then the direct impact of this intervention would be certainly known. Completed work soon to be published suggests that if 50% of all sexually active women aged 16-24 years were screened (coverage) at least 4 times over these years (frequency) with at least 20% of partners successfully treated (good partner follow-up), reductions in prevalence up to 75% from baseline would occur within 3 years not only in the targeted populations, but those not targeted as well (through a 'herd immunity' effect).
The government has only recently committed itself to this effort with significant resources targeted in their public health white paper (Department of Health, Nov 2004), after years of debate and discussion. It would be unwise to suggest failure for a programme that has yet to be given the commitment necessary to see it a success.
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Conflict of Interest:
None declared.
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