Population prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in the Netherlands. Should asymptomatic persons be tested during population-based Chlamydia screening also for gonorrhoea or only if chlamydial infection is found?

Background: Screening and active case finding for Chlamydia trachomatis (CT) is recommended to prevent reproductive morbidity. However insight in community prevalence of gonococcal infections and co-infections with Neisseria gonorrhoea (NG) is lacking. Methods: Nested study within a large population-based Chlamydia Screening Pilot among 21.000 persons 15-29 year. All CT-positive (166) and a random sample of 605 CT-negative specimens were as well tested for gonococcal infection. Results: Overall Chlamydia prevalence in the Pilot was 2.0% (95% Cl: 1.7-2.3), highest in very urban settings (3.2%; 95% Cl: 2.4-4.0) and dependent of several risk factors. Four gonococcal infections were found among 166 participants with CT infection (4/166 = 2.4%; 95% Cl: 0.1%-4.7%). All four had several risk factors and reported symptoms. Among 605 CT-negative persons, no infection with NG could be confirmed. Conclusion: A low rate of co-infections and a very low community preval ence of gonococcal infections were found in this population based screening programme among young adults in the Netherlands. Population screening for asymptomatic gonococcal infections is not indicated in the Netherlands. Although co-infection with gonorrhoea among CT-positives is dependent on symptoms and well-known algorithms for elevated risks, we advise to test all CT-positives also for NG, whether symptomatic or asymptomatic.

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