Psychosocial impacts of chlamydia testing are important

Editor—The article by Duncan et al about the psychosocial impact of diagnosis of chlamydia infection has identified important issues that need to be considered before implementation of a national screening programme as described in the chief medical officer's report.¹,²

We conducted a cross sectional study in a local estate in Nottingham last year to measure knowledge and attitudes of women aged under 25 years attending a family planning clinic before and after a targeted campaign. Selective screening for Chlamydia trachomatis was undertaken by using urine testing by a commercial DNA amplification method. Follow up interviews were held at six months to examine attitudes to the result, results of contact tracing, and implications for the patient.

The response rate for the questionnaire was 100% (n=180). Awareness before the targeted chlamydia campaign was reported by 50% of the women. There was an increase in awareness of chlamydia after the campaign, with attendees aged under 20 reporting an 11% increase and attendees aged over 20 reporting a 7% increase in awareness. Female patients aged under 16 were at an increased risk of chlamydia owing to reported sex without a condom (χ²=4.59, P=0.03) and suspecting their partner was having sex with others as well as themselves (χ²=6.74, P=0.01) compared with older attendees. Sixty five women were screened for chlamydia; of these four (6%) had positive test results, and all of them were treated and helped with partner notification. The four women were re-tested and interviewed six months later, although they all had a negative test result, the psychological effects of testing positive for a chlamydia infection were evident.

The women's responses to the positive test result for the chlamydia infection were shock and worry, unhappiness, embarrassment, and surprise. Three of the women felt embarrassed about the need to trace contacts. None the less, two of the girls self referred their partner, one requested provider referral, and one was unable to contact her partners because they were out of the country. All four of the women were worried about the long term effects of chlamydia if left untreated. One was so concerned about the possible inability to conceive in the future, that when she returned for the six month follow up chlamydia test, she also requested a pregnancy test as she and her partner were trying to conceive. As discussed by Duncan et al in their article, our study, although small, would confirm this is a real issue that necessitates further development and discussion with girls before they are tested for chlamydia infection.