Elsevier

Public Health

Volume 120, Issue 10, October 2006, Pages 984-988
Public Health

A comparison of the population diagnosed with chlamydia in primary care with that diagnosed in sexual health clinics: Implications for a national screening programme

https://doi.org/10.1016/j.puhe.2006.05.025Get rights and content

Summary

Objectives

To compare demographic, behavioural and HIV testing characteristics of individuals diagnosed with chlamydia infection in primary care with those in genitourinary medicine clinics, in the absence of a screening programme. The aim was to explore the current and potential contribution of primary care to the control of chlamydia.

Study design and methods

We analysed data on individuals who reported one or more chlamydia diagnoses in the past 5 years in a large probability sample survey of the resident, UK general population aged 16–44 years. Estimates were weighted and odds ratios calculated.

Results

Women diagnosed in primary care reported fewer sexual partners, and were less likely to have had an HIV test in the past 5 years than their counterparts diagnosed in genitourinary medicine clinics. Age, ethnicity, social class, educational attainment and urbanization of area of residence did not differ between the two groups. Too few men were diagnosed in primary care to allow for such a comparison.

Conclusions

Primary care already diagnoses a large number of women with chlamydia infection, who may perceive themselves as low risk through age or sexual behaviour, yet are likely to comprise a substantial proportion of all infections. Few men are diagnosed in primary care. These groups need to be strategically targeted in the context of a future chlamydia screening programme, which will focus on the screening of younger women at high risk, and in which the role of primary care is still in development.

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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