Accelerating Chlamydia screening attendance

Chlamydia is one of the most common sexually transmitted infections (STI) in the UK, and can lead to infertility and long-term pelvic pain in both women and men. Often referred to as the “silent infection”, as most infected people do not have any obvious signs or symptoms, Chlamydia presents a formidable challenge for healthcare practitioners and organisations. The infection poses a particular risk to sexually active young people aged 16 to 24. This age group makes up only 12% of the population, but it accounts for 65% of Chlamydia cases.1 In 2003, the Department of Health (DH) established the National Chlamydia Screening Programme (NCSP) to tackle Chlamydia among under-25s. In Britain, according to the NCSP, one in every fourteen young people under 25 who are tested are infected with Chlamydia.2 The NCSP particularly emphasises the availability of free and confidential testing services, the need for annual screenings, and the ease with which the disease can be treated if caught in its early stages. The DH established the goal of testing 25% of 15 to 24-year-olds between April 2009 and March 2010, but, despite the NCSP’s efforts to increase testing levels, the programme still fell just short of target, achieving 22%.3 While the year-on-year increase in testing levels has undoubtedly been significant (since the NCSPs creation, testing levels increased from around 17,000 in 2003/4 to just over 1.5 million in 2009/10) Chlamydia cases are still increasing. In 2008, cases were up to 123,018 from 121,791 in 2007.4 Chlamydia tests have an overall positivity rate of 6% for screened women and men, with the highest positivity levels appearing in women aged 15 to 19 and men aged 20 to 24.2

 Critical communications

The NCSP must now implement a plan to reach its 35% testing target for 2010/11. In the most recent sexual health survey conducted by the Office for National Statistics, responses revealed that some ground still needs to be covered in order to reach these ambitious testing figures. The survey showed that 93% of women know that Chlamydia is an STI, and 85% of men were aware.5 Healthcare practitioners are reassessing the channels of communication used to convey awareness and encourage people to get tested. It has long been suspected that a significant portion of the target population is unwilling to be tested at an STI clinic, while others will not present in person at any location. In 2008, the NCSP and the Department of Health undertook research among under-25s to identify ways to quell this reluctance and shape more “appropriate and compelling communication messages” to drive the target population towards screening.6 The NCSP sought to identify how best to inform under-25s of the risks Chlamydia poses, and it remains an ongoing challenge to delve into the reasons why members of the most at-risk portion of the population do not present for testing.