Abstract
To inform mathematical modelling of the impact of chlamydia screening in England since 2000, a complete picture of chlamydia testing is needed. Monitoring and surveillance systems evolved between 2000 and 2012. Since 2012, data on publicly funded chlamydia tests and diagnoses have been collected nationally. However, gaps exist for earlier years. We collated available data on chlamydia testing and diagnosis rates among 15–44-year-olds by sex and age group for 2000–2012. Where data were unavailable, we applied data- and evidence-based assumptions to construct plausible minimum and maximum estimates and set bounds on uncertainty. There was a large range between estimates in years when datasets were less comprehensive (2000–2008); smaller ranges were seen hereafter. In 15–19-year-old women in 2000, the estimated diagnosis rate ranged between 891 and 2,489 diagnoses per 100,000 persons. Testing and diagnosis rates increased between 2000 and 2012 in women and men across all age groups using minimum or maximum estimates, with greatest increases seen among 15–24-year-olds. Our dataset can be used to parameterise and validate mathematical models and serve as a reference dataset to which trends in chlamydia-related complications can be compared. Our analysis highlights the complexities of combining monitoring and surveillance datasets.
Highlights
Genital infection with Chlamydia trachomatis (‘chlamydia’) is the most commonly diagnosed sexually transmitted infection (STI) in Europe [1,2]
In 15–19-year-old women in 2000, diagnosis rates ranged from 891 to 2,489 diagnoses per 100,000 persons. In both scenarios and across all age groups (15–44-year-olds), estimated testing coverage and diagnosis rates were higher in women than men
In women and men of all age groups (15–44-year-olds), there was an overall increase in chlamydia testing coverage and diagnosis rates from 2000 to 2012 in all settings
Summary
Genital infection with Chlamydia trachomatis (‘chlamydia’) is the most commonly diagnosed sexually transmitted infection (STI) in Europe [1,2]. A recent systematic review found estimates of prevalence in Europe and other high-income countries among www.eurosurveillance.org sexually-experienced ≤ 26-year-olds ranged from 3.0% to 5.3% in women and 2.4% to 7.3% in men [7]. Chlamydia control activities vary across Europe, ranging from case management for diagnosed cases to opportunistic testing among asymptomatic individuals [8]. The NCSP recommends all sexually active under25-year-olds be tested for genital chlamydia infection annually or on change of sexual partner (whichever is the most frequent) and those who test positive should be offered a re-test around 3 months after treatment [3]. Screening is accessible through a range of providers, which include general practitioners (GPs), pharmacies, contraception services, sexual health and reproductive services and pregnancy termination services [9]. In 2013, over 1.7 million chlamydia tests were carried out among 15–24-year-olds in both specialist sexual health services (genitourinary medicine clinics (GUM)) and non-specialist services with over 139,000 positive chlamydia results reported (hereafter ‘diagnoses’ refers to ‘positive chlamydia results’) [10]
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