A comparison of the population diagnosed with chlamydia in primary care with that diagnosed in sexual health clinics: Implications for a national screening programme
Introduction
Genital Chlamydia trachomatis infection is an important cause of tubal infertility, pelvic inflammatory disease and ectopic pregnancy.1 We previously reported that 3.1% of women and 1.4% of men describe previous infection with chlamydia.2 Tests for genital chlamydia infection are now widely available in primary care in the UK, as well as genitourinary medicine (GUM) clinics.3, 4 However, little is known about the population diagnosed in primary care, except in the context of studies of specific screening programmes.5, 6 Surveillance data currently report only diagnoses made in GUM clinics, which increased by 9% to reach 89 431 cases in England, Wales and Northern Ireland during 2003.7 Yet, 16.2% and 36.2% of men and women, respectively, interviewed for the British 2000 ‘National Survey of Sexual Attitudes and Lifestyles’ (‘Natsal 2000’), and who reported a chlamydia diagnosis in the past 5 years, reported that their (most recent) diagnosis was made in primary care.1
A national screening programme for chlamydia is due to be implemented by March 2007.8 Although it will use a variety of healthcare settings, the role for primary care is not yet clear. The implementation and planning of this screening programme in England requires an understanding of the risk profiles of individuals most likely to access screening in each setting. Exploration of the characteristics of those currently diagnosed in primary care, compared with genitourinary medicine, can contribute to the planning of appropriate services and development of appropriate health information materials for different settings.
Here, we compare demographic and behavioural characteristics of individuals interviewed for Natsal 2000 who reported a chlamydia diagnosis from primary care, with those who reported diagnosis with chlamydia in GUM clinics in the past 5 years. The aim was to understand better the contribution of primary care to chlamydia control before the introduction of chlamydia screening.
Section snippets
Methods
Natsal 2000 is a probability sample survey of 11 161 adults aged 16–44 years resident in the UK, conducted between 1999 and 2001. In 2001, an additional 949 Black Caribbean, Black African, Indian and Pakistani respondents were sampled in order to obtain more robust estimates for these ethnic groups. The response rates were 65.4% and 62.6%, respectively. Details of the methodology and question wording are published elsewhere.9, 10 Respondents were asked about their sexual lifestyles and
Results
A total of 78.4% (95% confidence interval [CI] 60.1–89.7%) of chlamydia episodes reported by men were diagnosed in GUM clinics, compared with 49.2% (96% CI 36.7–61.9%) of those reported by women.
Women diagnosed with chlamydia in primary care compared with women diagnosed in GUM clinics are shown in Table 1. Older women, and married or cohabiting women, were more likely to have been diagnosed in primary care.
Women diagnosed in primary care reported significantly fewer sexual partners, and were
Discussion
Although the study was based on small numbers and self-reported infection, these data from a national probability sample survey have important implications for health policies aimed at a greater role for primary care in the control of STI.
Primary care is capturing a different group of women infected with chlamydia, mainly those in regular relationships, with lower risk behaviours, who are likely to be less aware of their risk than women attending GUM clinics. At population level, such women are
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