Summary of main findings
In this study, we quantified the psychosocial impact related to C. trachomatis testing in general practice. In general the participants were satisfied with being offered a chlamydia test. A positive test result had an emotional impact on four out of five individuals, and women in particular needed someone with whom they could discuss the test result. One in ten patients infected with C. trachomatis split with their partner due to the test, and more than half of the infected participants were anxious about infertility after the test result. Only half of the uninfected individuals with no regular partner would intensify their use of condoms as a result of the test.
Strengths and limitations of the study
Problems defined in qualitative studies must be quantified in order to define to which extent the issue addressed has implications for clinical practice. To our knowledge, this study is the first to quantify the psychosocial impact on C. trachomatis testing and, indeed, the first study on the psychosocial consequences of testing men. Our study enjoys the major advantage that we had the possibility to develop a questionnaire based on an earlier published qualitative study4 among individuals tested positive for C. trachomatis.
However, since the British qualitative study only included interviews among women tested positive for C. trachomatis, men and women may think differently about these issues, as may the British and the Danish population in general. Another limitation in our study might lie in the high number of dropouts. However, the dropouts were mainly due to GPs who refused or forgot to inform their patients about the study, and these dropouts will only have caused limited bias in our study. A bias may, however, have been introduced because of the tested individuals who did not want to participate in the study, and it could have been interesting to be able to compare relevant parameters between participants and non-participants. Unfortunately we are not able to do so in our present study design.
Comparison with existing literature
Overall, the population tested had good knowledge about C. trachomatis infections as also reported for other populations.6,7 Earlier studies have shown that knowledge of STIs and sexual behaviour is not necessarily correlated,8–10 but since the large majority of participants in our study were well informed about STIs, we made no similar analysis of the correlation between knowledge and sexual behaviour.
In two qualitative studies from Britain,4,1 it was found that the C. trachomatis diagnosis was associated with thoughts about sexual behaviour, partner's reaction, and contraceptive use. Our findings support this, but we were also able to show that the vast majority of tested women, whether positive or negative, had such thoughts. In light of the many tests being performed each year, chlamydia testing, therefore, has a substantial psychosocial impact on the community.
Studies has also been conducted among people who were diagnosed with an STI at sexual health clinics.12 In these studies, anxiety, stigma and isolation were the major topics and having an STI was associated with feeling ‘dirty’. In our study, we found that more than a quarter of the individuals who had a diagnosis of C. trachomatis felt ‘dirty’ or felt sexually unattractive and this was a lot different from what was felt by individuals who were tested negative. Thus stigmatisation is, indeed, a problem in relation to a C. trachomatis diagnosis like in other STIs. It is important to note that screening for STIs including C. trachomatis makes the connection between infection and sex, and therefore demands a careful approach to the patients.13
Men reacted differently from women. In general, they were less influenced by having a test offer and a positive test result. In particular, the need for someone to talk to was lower among men than among women. Of particular interest is the high proportion of men who reported that they would not use condom more often after than before they were diagnosed with a chlamydia infection. This could reflect that men's major reason for choice of contraception was guided more by a wish to avoid pregnancy rather than by a wish to be protected from an STI.14 The finding should lead to a re-evaluation of the counselling procedure for infected men. There seems to be a need for a stronger focusing on education of men with regard to the responsibility they have in connection with an STI that mainly has complications for women.15,16
Despite the reactions to a positive, as well as a negative, test result, a remarkable 90% of the participants in this study were actually satisfied with being offered a test. This reflects the results from many other studies assessing participation rates in universal screening programmes.17 Universal screening programmes have shown to be instrumental in lowering the complication rated for the individuals2 and the prevalence of disease in the community,18 and it may therefore be speculated that universal screening programmes may become part of future public health measures to combat the problems of C. trachomatis infections. If such universal screening programmes are to be introduced, it is important to consider the findings of this study. Individuals will feel stigmatised by having a test offer, there will be a need for someone to talk to regardless of the test result, and there will still be a substantial need for counselling, in particular of infected men.
