Abstract
BackgroundWidespread testing and screening for genital Chlamydia trachomatis is often advocated as an important method to halt the epidemic. Sweden has long tradition of opportunistic screening services. Nevertheless infections rates have continued to rise over the past two decades, despite increased access to testing and treatment services.MethodsIn this retrospective cohort study we describe the testing behavior for genital Chlamydia trachomatis among youth in Stockholm County, with a focus on repeated testing. Specifically we (a) study positivity rates among single and repeat testers, we (b) estimate the incidence of repeat testing and the rates of infection in repeat testing episodes, and we (c) estimate time to repeat testing and factors associated with repeat testing. All youth (aged ≥12 and <26) that tested for Chlamydia trachomatis in one of 33 Youth Health Clinics in Stockholm County between 1 January 2010 and 31 December 2012 were included in the study.ResultsThe cohort comprised a total of 65,951 individuals who did 119,699 tests during the study period. 42% of youth were repeat testers, the incidence of repeat testing was 35.0/100 person years. The overall baseline prevalence was 7.9%. Positivity rates of baseline tests among repeat testers were nearly twice as high among single testers of either sex. These were 17.1% and 9.8% among male repeat and single testers respectively. The corresponding rates for women were 9.4% and 4.3%. Positivity rates among repeat tests did not decline compared to the overall baseline positivity. Baseline test result and sex significantly influenced the occurrence of repeat testing.ConclusionAmong repeat testers we found high rates of Chlamydia trachomatis both at baseline and at repeat tests which suggests the possibility that this group might be continuing to engage in unsafe sexual practices. Given the extent of repeat testing and the high positivity rates on repeat testing, further research among this group is required to inquire into reasons for repeated testing.
Highlights
Chlamydia trachomatis (C.trachomatis) has been identified as a major public health problem in Europe and worldwide.[1]
The cohort comprised a total of 65,951 individuals who did 119,699 tests during the study period. 42% of youth were repeat testers, the incidence of repeat testing was 35.0/100 person years
The main finding of this study was that repeat testing is common among youth using the services of the Youth Health Clinics (YHC) in Stockholm County and that tests performed by repeat testers tend have high positivity rates
Summary
Chlamydia trachomatis (C.trachomatis) has been identified as a major public health problem in Europe and worldwide.[1]. Laws and regulations govern prevention strategies on a national level and regional policies control the preventive work in each County.[13,14] Current recommendations include widespread and prompt C.trachomatis testing for youth and young adults in Stockholm County, Sweden.[15] As treatment failure seldom occurs, a test of cure and/or re-testing after testing positive for C.trachomatis is not routinely recommended.[15,16] While all positive cases of C.trachomatis are reported to the Public Health Agency of Sweden, information about who uses the testing services and frequency of repeat testing is poor. Infections rates have continued to rise over the past two decades, despite increased access to testing and treatment services
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