Countywide survey of the current practice of chlamydia detection in primary care

BACKGROUND: The Chief Medical Officer's (CMO's) Advisory Group on Chlamydia trachomatis (chlamydia) published its report in 1998 and a national screening programme is anticipated. Meanwhile the Public Health Laboratory Service (PHLS) reports that the number of positive diagnoses of genital chlamydia continued to rise throughout the last decade. OBJECTIVES: To consider the current practice of Gloucestershire general practitioners (GPs) for detecting genital chlamydia infections, and based on the findings to help the development of local guidelines and sexual health service provision. DESIGN: Questionnaire survey. SETTING: Primary care groups within a single English county. METHODS: A questionnaire survey was sent to GPs. Responses were handled anonymously and pooled for analysis. MAIN OUTCOME MEASURES: Response rates from GPs on the types of tests used for detection of chlamydia infection, how frequently they test different patient groups for chlamydia infection and attitudes to contact tracing. RESULTS: In women, opportunistic screening is not routinely performed and the rate of diagnostic testing varies with presentation. The rate of testing is comparatively lower in men and over 50% of GPs refer symptomatic men directly to a genitourinary medicine (GUM) clinic. Fewer than 50% of respondents always or usually forward details to GUM for contact tracing. CONCLUSIONS: Opportunistic screening is performed by a proportion of GPs but there is scope for more screening in higher risk groups. There is scope to increase the number of tests for chlamydia infection in patients presenting with symptoms. A programme of training and education in conjunction with guidelines may have merit in unifying practice and making detection and management of chlamydia more effective. This will have financial and resource implications.