Chlamydia screening and sexual health

Abstract

Are we failing heterosexual men? Six years after publication of the first expert advisory recommendations1 and subsequent calls for the introduction of a national chlamydia screening programme, tentative steps are at last being made towards its implementation. Much of the baseline research required to support the evidence base for programme development has been undertaken or is nearing completion. Other initiatives (for example, the PHLS chlamydia incidence and reinfection study) are just beginning. To date, research and planning have largely centred on women, justified on the basis that such a strategy is evidence based, cost effective, and pragmatic.2 However, critics of the proposed policy have suggested that decisions about the inclusion or exclusion of men from any screening programme should be based on epidemiological evidence and that a useful strategy would be to collect such data before making recommendations about the future shape of any screening programme.3 Failure to more fully include men in the formative research and development work has resulted in a missed opportunity to gather the epidemiological data needed to make evidence based decisions about men’s participation. However, such evidence is now emerging. Results of the Department of Health funded chlamydia screening pilots in Portsmouth and the Wirral found a prevalence of up to 9% among young men attending youth centres and nearly twice this among men attending GUM clinics.4 More recently, a community recruited probability sample survey of sexual attitudes and lifestyles of British adults aged 18–44, found more men (1 in 45) than women (1 in 66) were identified as C trachomatis positive through ligase chain reaction (LCR) testing of urine.5 The study’s highest age specific prevalence (3.0%) was found among men 25–34 years of age. Both studies, along with STI surveillance reports, confirm the substantial disease prevalence among community and …