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Testing for Chlamydia trachomatis: is more choice a good thing?

Published on Jan 1, 2011in Journal of Family Planning and Reproductive Health Care1.821
· DOI :10.1136/jfprhc.2010.0002
Joanna Smith3
Estimated H-index: 3
,
Alison Cook9
Estimated H-index: 9
(University of Birmingham)
+ 1 AuthorsHelen Stokes-Lampard12
Estimated H-index: 12
Abstract
Chlamydia trachomatis (chlamydia) is the most common bacterial sexually transmitted infection (STI). Its incidence in the UK has risen steadily since the mid-1990s, with new diagnoses rising by 1% from 121 791 to 123 018 (from 197 to 199 per 100 000 population) between 2007 and 2008.1 Generally the rates of chlamydia infections in other Western European countries are lower than those in the UK. Young people aged under 25 years are most likely to be infected, with 65% (80 258) of all new chlamydia diagnoses in the UK in 2008 in individuals between the ages of 16 and 24 years.2 The incidence of re-infection among women is estimated to be 15–30% at 1 year.3 4 Repeated infection is associated with an increased risk of complications including infertility.5 6 In 2003, the English Department of Health launched the National Chlamydia Screening Programme (NCSP), overseen by the Health Protection Agency. Since the NCSP's launch it has cost an estimated £100 million.7 The NCSP enables young people (<25 years) to access screening for chlamydia in a variety of community settings including general practitioner surgeries, and sexual health and genitourinary medicine (GUM) clinics. There have also been high-profile education campaigns targeted at younger age groups, and STIs are now discussed in school-based sex education programmes.8 Concurrently, there has been an increase in the number of rapid, self- and point of care tests (POCTs) for many conditions including chlamydia. However, these are not yet part of routine UK health service practice in the diagnosis and management of chlamydia. This is mainly because laboratory-based nucleic acid amplification tests (NAATs) are still the most sensitive and specific tests available and the NCSP stipulates that chlamydia screening must be carried out using NAATs.9 POCTs are tests where both sampling and …
  • References (14)
  • Citations (1)
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References14
Newest
Michel et al (see page 187) present documentation in this issue that a Conformitee Europeenne (CE) marked home-use test for Chlamydia trachomatis that is available over the internet performs very poorly.1 The authors demonstrated a lack of accuracy of this assay compared with Amplicor PCR with sensitivities of 12.5% and 20% in both a lower (8% prevalence) and high prevalence (22.9% prevalence) population, respectively. False-positive results were equally as problematic, since the specificities w...
5 CitationsSource
#1Claude-Edouard C. Michel (University of Cambridge)H-Index: 6
#2Francis G SaisonH-Index: 2
Last. Helen LeeH-Index: 31
view all 5 authors...
Objectives: To evaluate the performance of a Conformitee Europeenne (CE)-marked home test for Chlamydia trachomatis (CT) that is available over the internet. Methods: A total of 231 eligible women attending the Social Hygiene Clinic (SHC) or Obstetrics–Gynecology (OB-GYN) Clinic in Iloilo City, Philippines were recruited to an evaluation of the HandiLab-C Chlamydia home test (HandiLab-C). One vaginal swab was tested with HandiLab-C on-site and the second in Cambridge, UK with two nucleic acid am...
36 CitationsSource
#1L. MelvinH-Index: 3
#2Sharon T. CameronH-Index: 6
Last. R. Elton (Edin.: University of Edinburgh)H-Index: 3
view all 6 authors...
Objectives To determine men and women’s preferred strategies for managing chlamydial infection: partner notification (patient referral), postal testing kit (PTK) or patient-delivered partner medication (PDPM). Design Interviewer-conducted questionnaires (women) and anonymous, self-administered questionnaires (men). Population Women infected with chlamydia who were participating in a randomised study assigning partners to patient referral, PTK or PDPM. Men attending genitourinary medicine, family...
5 CitationsSource
#1Laura G. Greer (UTSW: University of Texas Southwestern Medical Center)H-Index: 10
#2George D. Wendel (UTSW: University of Texas Southwestern Medical Center)H-Index: 41
Sexually transmitted infections (STIs) are common infections throughout the developed and the developing world. It is estimated that worldwide there are 1 million new cases per day of curable bacterial STIs. As part of the World Health Organization 2001 Sexually Transmitted Diseases Diagnostics Initiative, the organization explored the need for simple, affordable, point-of-care STI testing for curable bacterial STIs. This article reviews the evidence supporting the implementation of currently av...
46 CitationsSource
#2Vivian LaitilaH-Index: 2
Last. Beng T Goh (QMUL: Queen Mary University of London)H-Index: 6
view all 10 authors...
Objective To evaluate the performance of a new Chlamydia Rapid Test with vaginal swab specimens as a potential tool for chlamydia diagnosis and screening. Design Performance evaluation study. Settings A young people’s sexual health centre (site 1) and two genitourinary medicine clinics (sites 2 and 3) in the United Kingdom. Participants 1349 women aged between 16 and 54 attending one of the three clinics. Main outcome measures Sensitivity, specificity, positive predictive value, and negative pre...
75 CitationsSource
#1Sue Skidmore (Princess Royal Hospital)H-Index: 1
#2Sarah Randall (HPA: Health Protection Agency)H-Index: 2
Last. H Mallinson (HPA: Health Protection Agency)H-Index: 13
view all 3 authors...
©FFPRHC J Fam Plann Reprod Health Care 2007: 33(4) Background Increasing publicity about sexually transmitted infections (STIs), in particular about screening young people for Chlamydia trachomatis (CT), is accompanied by some confusion about the various types of tests available including those done outside the usual health care settings (Box 1). At the present time, nucleic acid amplification tests (NAATs) are considered to be the most sensitive and specific tests available for CT testing and a...
6 CitationsSource
Background: In England, screening for genital chlamydial infection has begun; however, screening frequency for women is not yet determined. Aim: To measure chlamydia incidence and reinfection rates among young women to suggest screening intervals. Methods: An 18-month prospective cohort study of women aged 16–24 years recruited from general practices, family planning clinics and genitourinary medicine (GUM) clinics: baseline-negative women followed for incidence and baseline-positive women for r...
125 CitationsSource
#1Angela Ryan (University of Birmingham)H-Index: 11
#2Sheila Greenfield (University of Birmingham)H-Index: 32
Last. S. Wison (University of Birmingham)H-Index: 36
view all 3 authors...
Background Self-tests can be used by members of the public to diagnose conditions without involving a doctor, nurse or other health professional. As technologies to design and manufacture diagnostic tests have developed, a range of self-tests have become available to the public to buy over-the-counter and via the Internet. This study aims to describe how many people have used self-tests and identify factors associated with their use.
17 CitationsSource
The development of near-patient testing in the sexual health field in recent years provides a much needed opportunity to improve the control of sexually transmitted infections (STIs). However, in many fields, this opportunity to improve sexual health is not being fully realised. Sexual health has deteriorated markedly over the past decade. Diagnoses of the most common STIs have risen markedly,1 with these increases almost certainly caused at least partly by changes in behaviour and by worsening ...
12 CitationsSource
The definition of a near-patient, or “point-of-care” test (POCT), is an investigation carried out in a clinical or non-clinical setting, or in the patient’s home, for which the result is available without reference to a laboratory, perhaps rapidly enough to affect immediate patient management. The characteristics of an ideal POCT, as outlined by the World Health Organisation Sexually Transmitted Diseases Diagnostics Initiative in 2001 (http://www.who.int/std\_diagnostics/about\_SDI/priorities.ht...
9 CitationsSource
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#1Jamie Frankis (GCU: Glasgow Caledonian University)H-Index: 13
#2Jane Oakland (GCU: Glasgow Caledonian University)H-Index: 4
Last. Paul Flowers (GCU: Glasgow Caledonian University)H-Index: 29
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