Holland plans chlamydia screening in 300 000 young people

The Netherlands is set to launch a large scale, systematic pilot programme to screen young people for infection with Chlamydia trachomatis, the country’s commonest sexually transmitted infection.

Early next year 315 000 people aged between 16 and 29 years in three centres—Amsterdam, Rotterdam, and Heerlen (in the south east of the country near Maastrict)—will be invited by post to take part in the programme.

They will then be able to request, from a website, a chlamydia test kit, returning a vaginal swab or a urine sample for testing. Those who the test results indicate may be infected will be treated with antibiotics. All the potential 315 000 people will then be invited to do a second test to gauge how effective the screening programme is.

The pilot programme is due to take three years, and on the basis of its results the government will decide whether to roll out screening across the whole country.

Amsterdam and Rotterdam were chosen as the two largest urban areas where chlamydia infection was most likely to be found. Heerlen was chosen for purposes of comparison.

The screening programme will be coordinated by Soa Aids Netherlands (www.soaaids.nl), an independent centre of expertise on HIV and AIDS and other sexually transmitted infections, while the actual testing will be carried out by the local municipal health authorities.

Large scale, systematic screening was chosen after earlier studies indicated that such an approach was “sensible, necessary, and cost effective.” The project manager, Jan van Bergen, an epidemiologist, believes that such a systematic screening programme for chlamydia is unusual. Chlamydia screening in the United States is opportunistic, with doctors offering a test when patients visit for other reasons. England started an opportunistic screening programme for people under 25 in 2003, which is expected to cover the whole country by early 2008. The take-up rate among primary care trusts in November 2007 was 78%.

Dr van Bergen believes that non-systematic screening has little effect on the prevalence of the infection. He says that only 10% to 20% of the eligible population are screened this way, most of whom are women.

He said, “With our screening there will be an uptake issue too, but at least we will offer everyone in a systematic way the opportunity to be tested.” He hopes to achieve an uptake of about 30%.

Roel Coutinho, director of the Dutch Centre for Infectious Disease Control, which will evaluate the screening, said, “We will try to show if this systematic screening programme has an impact on prevalence and possibly on the number of complications.”

In 2003 the centre carried out a study of 8000 young people that found that 2.3% of those who were sexually active were infected with chlamydia. In urban areas this figure increased to 3.2%. Half of the infected men and 70% of the women were not aware of their infection.

At any one time there are an estimated 60 000 cases of chlamydia among the Dutch population of 16.4 million. Sexually transmitted infection clinics reported 3731 new cases in 2003. In five years the annual number of diagnoses has increased by 76%, but this may be partly due to better screening (www.rivm.nl/soahiv).

(See also Research doi: 10.1136/bmj.39402.463854.AE.)