Screening for Chlamydia trachomatis: whom and how?

Chlamydia trachomatis (Ct) infections are sexually transmitted, often asymptomatic, and may lead to reduced fertility in women. Available sensitive detection methods on urine and effective single-dose treatment have made home-based screening for Ct infections feasible. In Swedish surveillance data we interpretated increasing chlamydia trends while using more sensitive tests. In a home based screening study in the Netherlands, 15-29 year old men and women were invited by Municipal Health Services. Response was 41%, and Ct prevalence was 0.6% in rural areas and 3.2% in very highly urbanised areas. Nationwide systematic screening is not indicated in the Netherlands and targeted approaches are a better option. We developed a prediction rule based on risk factors which is a promising tool for selective Ct-screening at population level. A reasonable discriminative ability of the rule was shown in population based data from Amsterdam and an outreach screening project among high-risk youth. Conditions for successful management of cases and their partners was studied. The screening method was well accepted and participants with an elevated risk were interested in future screening provided that test kits are easily available. We evaluated whether offering urine test kits in combination with STI prevention activities by the Public Health Service can increase test rates, in high risk and hard to reach migrant populations. Test rate differed by venue , with no difference in test rate in group (80%) and school (73%) settings by sex or ethnicity. 14.5% were Ct positive. School screening may have impact on community prevalence of Ct infections.

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