As many as one in three primary care trusts in England are failing to deliver opportunistic screening for chlamydia, according to figures released this week during the annual conference of the Health Protection Agency.
The new data show that at the end of July 2007—by which time all English trusts were expected to be offering chlamydia screening—only 99 of 152 (65%) were doing so.
Mary Macintosh, director of the national chlamydia screening programme, said that 93% of trusts had “plans and structures in place” for screening, and she was hopeful that they would have services up and running before the end of the year.
But when they do they will be hard pressed to meet the government's target to screen 15% of all 15 to 24 year olds for chlamydia. “That's nearly one million young people and is a very challenging target,” said Dr Macintosh.
The Health Protection Agency took over responsibility for the chlamydia screening programme from the Department of Health in 2005. Screening is carried out in 24 different types of location, the most popular being general practices, youth services, and community contraceptive services. It is aimed primarily at young people aged 16 to 24 years.
More women than men are being screened through the programme, although more men are testing positive, the conference heard. Most areas are attempting to address this anomaly by trying harder to reach young men. In Lambeth, Lewisham, and Southwark primary care trusts in London, for example, screening is being offered in gyms and boxing clubs.
Simon Barton, president of the British Association of Sexual Health and HIV, told conference delegates that “one size does not fit all in sexual health.” Diagnostic testing in sexual health was increasingly quicker and easier for staff and patients alike, he said, but it was important that care was individualised. Dr Barton said that National Institute for Health and Clinical Excellence guidelines recommend that “where individuals are engaging with a health worker, there has to be a consultation that involves an assessment of risk which determines signposting, targeting, and future screening.”
Healthcare workers have to determine whether patients have symptoms of a sexually transmitted infection, he added. “No patient can tell the difference between being asymptomatic and symptomatic, and this matters because we need to know whether the test we are doing is relevant. A clinical history often discerns symptoms, including anxiety or dyspareunia—things that are not spontaneously self reported.”
Treatment aimed to treat symptoms, prevent sequelae, and prevent transmission. It was therefore important to prepare the patient for the test, said Dr Barton. “If you are going to test you have to understand what the impact will be of a positive test.
“STIs [sexually transmitted infections] occur in symptomatic and asymptomatic people, because of their behaviour. Detection, management, and follow-up need skilled, trained individuals,” he said.
