National screening programme for chlamydia exists in England

Editor—The news article on the coverage of chlamydia screening in England was disappointing.¹ Contrary to its suggestion that no “formal” chlamydia screening programme in England exists, the national chlamydia screening programme in England was established in 2002 after a successful pilot study in Portsmouth and Wirral and publication of the government's national sexual health and HIV strategy implementation plan.² It is currently the only such screening programme in Europe (N Low, British Association for Sexual Health-American Sexually Transmitted Diseases Association spring meeting, Bath, May 2004).

Over the past 18 months 26 local chlamydia screening programmes have been implemented in two phases across England, covering over 25% of all primary care trusts. A third phase of implementation will be launched in the autumn of 2004. The programme offers opportunistic screening to women and men younger than 25 in a range of settings outside genitourinary medicine. National guidelines for screening have been produced.³ The programme is guided by a multidisciplinary steering committee and operates within the framework of the national screening committee. The first year's annual report will be published in autumn 2004.

By suggesting that screening is the only effective intervention, the news article also obscures the range of prevention activities that are taking place concurrently. These include implementation of the highly sensitive nucleic acid amplification tests; public education campaigns; the development of rapid, near patient, diagnostic tests for chlamydia; and allied research and evaluation. No government indecision has occurred in this matter.

The so called slow progress of implementation reflects the time taken to roll out this complex public health programme, in a considered manner, over five years—precisely to avoid unmanaged growth. The scale of the exercise is considerable, given the unique nature of this programme, the range of sites being included, and the immense challenges of implementation in the context of a changing NHS.