Screening programmes for chlamydial infection: when will we ever learn?

Abstract

Screening for chlamydial infection in SwedenSwedish researchers were key players in demonstrating the importance of sexually transmitted chlamydial infection in the 1970s and 1980s. They were instrumental in developing diagnostic testsw1 and defining the role of C trachomatis in pelvic inflammatory disease and infertility.w2 The first documented “program to identify asymptomatics” started in 1982 and tested women under 30 years seeking contraception, abortion, or antenatal care and male partners of infected women.7 In 1988, a change in the Swedish infectious diseases law required doctors to provide free testing, treatment, and partner notification for anyone with suspected chlamydia and to report cases.7 There were educational campaigns, and young people's clinics were established to make testing easily available.8Rates of chlamydia and its complications decreased up to the mid-1990s, at the same time as widespread testing was introduced (fig 1⇓).7 8 9 Financing services,8 strong infrastructure,8 open attitudes to sexual health,1 and a small population1 were suggested to contribute to this success. Studies such as these have now been cited as evidence of success of organised chlamydia screening programmes up to 80 times in Web of Science indexed journalsw3 and in official reports.3View larger version: In this window In a new window Fig 1 Rate of laboratory diagnosed chlamydial infection in Sweden, 1985 to 2005In fact, the fall in rates of chlamydia infection in Sweden coincided with the national campaign to prevent HIV (fig 1⇑).10 Desire to believe in chlamydia screening seems to have displaced alternative explanations, such as changing sexual behaviour,8 10 even though parallel decreases in sexually transmitted infections in countries with no efforts to control chlamydia were attributed to HIV prevention campaigns.11 Reports of the effectiveness of screening in Sweden persist,3 4 despite increasing rates of diagnosed chlamydia since 1995 (fig 1⇑).w4