Rethink needed on Australia's chlamydia crisis

Australia’s most common sexually transmitted infection, chlamydia, is unlikely to be eliminated by opportunistic testing in general practice, according to research led by the University of Melbourne. Instead, researchers recommend greater emphasis on improving chlamydia management.

Chlamydia is hard to control because many people are unaware they have it. If left untreated, it can cause serious infections of the uterus or fallopian tubes (pelvic inflammatory disease) in women that can lead to hospital admission in severe cases and can ultimately cause infertility. This has led health departments in many high-income countries to recommend widespread testing for young adults.

Australian guidelines recommend ‘opportunistic’ testing in general practice, which means testing any young person visiting their GP for any reason, whether or not they have symptoms, to reduce the number of people with chlamydia. But researchers have found that although GPs were able to increase testing among young people aged 16–29 by 150%, it did not reduce the overall proportion contracting chlamydia.

The University of Melbourne’s Professor Jane Hocking and her team of collaborators from Monash University, UNSW, Deakin University and the University of Bern ran the trial from 2009–2015, involving 130 rural GP clinics in Victoria, NSW, Queensland and South Australia, over 1200 GPs and more than 90,000 people aged 16–29. Claimed to be the world’s largest and most comprehensive trial of opportunistic chlamydia testing in primary care, their research included several rounds of annual testing and measured the multiple biological outcomes of chlamydia prevalence, pelvic inflammatory disease in women and epididymitis in men (an inflammation in the testes, which can be caused by chlamydia infection).

Published in The Lancet, the research found that increasing opportunistic chlamydia testing did reduce the incidence of severe pelvic inflammatory disease requiring hospital admission, but did not reduce milder, more common cases in the community — many of which remain undetected. The researchers therefore argue that, rather than continue to focus on increasing chlamydia testing, GP resources would be better spent improving chlamydia management, which includes getting sexual partners tested and treated.

“While GPs should continue to test young men and women, we recommend focusing on better management of chlamydia once it’s been diagnosed as the best way to reduce the harm caused by chlamydia,” Prof Hocking said.

“One of the biggest risk factors for developing pelvic inflammatory disease in women is getting re-infected with chlamydia. So we need to stop re-infection by getting sexual partners tested and treated, in order to reduce the number of cases that develop into pelvic inflammatory disease.

“If it’s detected early enough it can be managed relatively simply, reducing the risk of tubal damage and infertility. Ideally it will be caught in general practice, and not end up with a hospitalisation.”

Image credit: ©stock.adobe.com/au/Andrey Popov