BMJ 2001;322:1160-1164 12 May
Sexually transmitted infections
Richard J C Gilson, senior lecturer a, Adrian Mindel, professor b.
a Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College London, London WC1E 6AU, b Sexually Transmitted Infections Research Centre, Westmead Hospital, Westmead, NSW 2145, Australia
Chlamydia trachomatis is the most commonly diagnosed bacterial sexually transmitted infection in the developed world and a leading cause of pelvic inflammatory disease.2 In 1999, 56 855 patients with uncomplicated chlamydial infection were seen at UK clinics dealing with genitourinary medicine, an increase of 61% since 1996.1 Given the potential for morbidity from ectopic pregnancy and tubal infertility the case for screening for chlamydia among those most at risk is strong.
Cervical cancer is almost always associated with human papillomavirus type 16; whether screening for high risk virus types will contribute to cancer prevention is still being evaluated and vaccines are in development
Sexually transmitted infections in young people are common and more needs to be done to control them at the same time as reducing the rate of teenage pregnancy
The numbers of reported cases of chlamydial infection are increasing, and strategies for widespread screening of those at risk are being evaluated
Treatment algorithms for countries with poor resources are valuable, and UK national guidelines for the management of sexually transmitted diseases are now available and should improve the consistency and quality of care
In 1998, proposals were published to extend chlamydia testing in the United Kingdom to include all patients attending clinics, with or without symptoms, and all women seeking termination of pregnancy.4 It was also recommended that sexually active people under 25 and those over 25 with a new sexual partner in the past year should be screened. How this would be implemented is problematic. A pilot study is underway to determine whether opportunistic screening of those in the age groups at highest risk can be undertaken in a variety of primary care settings and how patients should be managed.5 This pilot used nucleic acid amplification tests, but other studies are looking at which tests and clinical samples can be used.
A study in Portsmouth and the Wirral funded by the Department of Health aims to assess the feasibility and acceptability of opportunistic screening for chlamydia in both primary care and secondary care (including gynaecology, termination of pregnancy, and clinics for genitourinary medicine). The study is targeted principally at women aged 16-24. The one year pilot screening period ended in August 2000, and the data are now being analysed
Adler MW. ABC of sexually transmitted diseases, 4th ed, London: BMJ Books, 1998
www.agum.org.uk and www.mssvd.org.uk. Both these sites have copies of the UK national guidelines on sexually transmitted infections as well as directories of clinics dealing with genitourinary medicine in the United Kingdom and a large number of links to other sites with relevant material
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