Screening for Chlamydia – can we do better without any extra funding?

Screening for Chlamydia – can we do better without any extra


S. Uthayakumar, P. Thayaparan, F. Paruk, A. Agrawal

Department of Sexual Health, Woodlands clinic, Lister

Hospital, Stevenage, Hertfordshire, UK

Introduction Opportunistic testing for Chlamydia trachomatis has been

recommended to reduce long-term morbidity in women, especially at Family

Planning clinics. At present majority of the laboratories use Enzyme Immuno

Assay (EIA), which has a sensitivity of 60-70% and specificity of >99%. EIA

is cheaper compared to nucleic acid amplification tests (NAAT). The sensitivity

of an EIA test could be increased by carrying out dual sampling of Chlamydia

from the urethra and cervix and inoculated in the same tube but the cost would

be the same as a single swab. However, the pain when taking a urethral swab

might be a disadvantage. This study is aimed to compare the results of the

Chlamydia EIA test by dual sampling as opposed to cervical sample only.

Methodology Consecutive new female attendees to the Sexual Health clinic

between Dec. 2004 and May 2005 were enrolled into the study. During this period

cervical Chlamydia was tested in 223 women and dual sampling was carried out in

258 women. They also had screening for other sexually transmitted infections. 

Results Epidemiological data and the risk factors between both groups were

similar. The prevalence of Chlamydia on a cervical swab alone was 9% and on a

cervical and urethral swab was16.6%. Dual sampling significantly increases the

diagnosis of Chlamydia (p <0.001).

Discussion and conclusion For most FP

clinics, obtaining additional funding for NAAT screening test for Chlamydia is

an impossible task. The discomfort when taking urethral swab was tolerable by

over 95% of the women. This study showed, when Chlamydia screening is carried

out in women using and EIA test, dual sampling would be beneficial as it

increases the sensitivity of the tests at no extra cost.

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