Chlamydia Screening Programs Don't Work: Expert

THURSDAY, April 5 (HealthDay News) -- Population-wide screening programs for chlamydia, the most commonly reported sexually transmitted disease, may not actually work, a Swiss expert contends.

That's especially true for so-called "opportunistic" programs, which routinely test patients for chlamydia whenever they seek medical care.

"We do not have sufficient evidence that this approach to a screening program does more good than harm at reasonable cost," said Dr. Nicola Low, an epidemiologist at the University of Bern.

But despite that, and despite increasing rates of infection in nations that have screening programs, more countries continue to adopt this approach, Low wrote in an article appearing in this week's British Medical Journal.

U.S. social health experts took a neutral tone when discussing the report.

"We support current guidelines from the Centers for Disease Control and Prevention, which recommend annual chlamydia screening for sexually active females ages 25 and younger as well as older women at risk for this disease," said Fred Wyand, a spokesman for the American Social Health Association in Research Triangle Park, N.C.

"We believe it's especially important for women to be tested for chlamydia, since the infection is often asymptomatic, but if undetected and untreated can lead to serious health complications, such as pelvic inflammatory disease and infertility," Wyand added. "We are also in favor of discussion and research to determine which approaches to screening are most effective, in terms of both cost and in reducing the incidence of chlamydia infection."

Infection with the Chlamydia trachomatis pathogen is the most common preventable cause of pelvic inflammatory disease (PID) in young women. PID, in turn, can lead to ectopic pregnancy and infertility.

Chlamydia infection, which usually causes no symptoms, is easily treated, often with a single dose of antibiotics. Detection is also easy, with a urine-sample test; results are generally available within a day.

But recent evidence is emerging to suggest that chlamydia may result in fewer severe complications that previously thought. Chlamydia is currently the only sexually transmitted infection for which population screening has been implemented, stated a BMJ editorial.

Two types of screening programs exist. Proactive screening involves using population registries to invite people to be screened for a particular infection at regular intervals. Opportunistic screening targets people using health services for other reasons.

Chlamydia screening is currently recommended in Sweden, the United States and Canada, according to the BMJ report. An opportunistic screening program for all sexually active women and men under 25 years of age, the National Chlamydia Screening Programme, is scheduled to start in England in 2008.

But the evidence for such programs is weak, Low said.

In Sweden, a drop in chlamydia rates in the mid-1990s was attributed to widespread testing, but, in fact, the fall in rates coincided with a national campaign to prevent a more dangerous pathogen, HIV. Since 1995, chlamydia infection rates have been rising again in Sweden.

Similarly, in the United States, decreases in rates of chlamydia infection have been attributed to opportunistic screening programs.

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