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Patterns of chlamydia testing in different settings and implications for wider STI diagnosis and care: a probability sample survey of the British population
  1. Soazig Clifton1,
  2. Catherine H Mercer1,
  3. Sarah C Woodhall2,
  4. Pam Sonnenberg1,
  5. Nigel Field1,
  6. Le Lu1,
  7. Anne M Johnson1,
  8. Jackie A Cassell3
  1. 1Centre for Sexual Health and HIV Research, UCL, London, UK
  2. 2HIV & STI Department, National Infection Service, Public Health England, London, UK
  3. 3Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
  1. Correspondence to Professor Soazig Clifton, Centre for Sexual Health and HIV Research, UCL, 3rd floor, Mortimer Market Centre, off Capper Street, London WC1E 6JB, UK; s.clifton{at}ucl.ac.uk

Abstract

Background Following widespread rollout of chlamydia testing to non-specialist and community settings in the UK, many individuals receive a chlamydia test without being offered comprehensive STI and HIV testing. We assess sexual behaviour among testers in different settings with a view to understanding their need for other STI diagnostic services.

Methods A probability sample survey of the British population undertaken 2010–2012 (the third National Survey of Sexual Attitudes and Lifestyles). We analysed weighted data on chlamydia testing (past year), including location of most recent test, and diagnoses (past 5 years) from individuals aged 16–44 years reporting at least one sexual partner in the past year (4992 women, 3406 men).

Results Of the 26.8% (95% CI 25.4% to 28.2%) of women and 16.7% (15.5% to 18.1%) of men reporting a chlamydia test in the past year, 28.4% of women and 41.2% of men had tested in genitourinary medicine (GUM), 41.1% and 20.7% of women and men respectively tested in general practice (GP) and the remainder tested in other non-GUM settings. Women tested outside GUM were more likely to be older, in a relationship and to live in rural areas. Individuals tested outside GUM reported fewer risk behaviours; nevertheless, 11.0% (8.6% to 14.1%) of women and 6.8% (3.9% to 11.6%) of men tested in GP and 13.2% (10.2% to 16.8%) and 9.6% (6.5% to 13.8%) of women and men tested in other non-GUM settings reported ‘unsafe sex’, defined as two or more partners and no condom use with any partner in the past year. Individuals treated for chlamydia outside GUM in the past 5 years were less likely to report an HIV test in that time frame (women: 54.5% (42.7% to 65.7%) vs 74.1% (65.9% to 80.9%) in GUM; men: 23.9% (12.7% to 40.5%) vs 65.8% (56.2% to 74.3%)).

Conclusions Most chlamydia testing occurred in non-GUM settings, among populations reporting fewer risk behaviours. However, there is a need to provide pathways to comprehensive STI care to the sizeable minority at higher risk.

  • CHLAMYDIA TRACHOMATIS
  • SCREENING
  • HIV TESTING
  • GENERAL PRACTICE

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Twitter Follow Nigel Field at @fienige

  • Contributors This paper was conceived by SC, JAC, CHM and LL. SC wrote the first draft of the article, with further contributions from JC, CHM, SCW, PS, NF and AMJ. LL and SC carried out the statistical analysis, with support from CHM, and JAC. PS, CHM and AMJ, initial applicants for Natsal-3, wrote the study protocol and obtained funding. CHM, PS, SC, NF and AMJ designed the Natsal-3 questionnaire, applied for ethics approval and undertook piloting of the questionnaire. CHM, SC and LL managed data. All authors interpreted data, reviewed successive drafts and approved the final version of the article.

  • Funding Natsal-3 was supported by grants from the Medical Research Council (G0701757) and the Wellcome Trust (084840), with contributions from the Economic and Social Research Council and Department of Health. This report is independent research supported by the National Institute for Health Research (NIHR Research Methods Programme, Fellowships and Internships, NIHR-RMFI-2014-05-28).

  • Disclaimer The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.

  • Competing interests AMJ has been a governor of the Wellcome Trust since 2011. SCW is an employee of Public Health England and works on the evaluation of the National Chlamydia Screening Programme.

  • Patient consent Obtained.

  • Ethics approval The Natsal-3 study was approved by the Oxfordshire Research Ethics Committee A (reference: 09/0604/27).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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