Chlamydia is the most common bacterial sexually transmitted disease. Recent reports suggest that more than 10% of Japanese teenagers are infected with chlamydia, that the incidence of chlamydia infection in UK men rose by around 15% between 2001 and 2002, and that the prevalence of chlamydia in black American women is over 13%. The UK Health Protection Agency has found that in 45 to 64 year old women, rates of chlamydial infection rose by 177% between 1995 and 2003.
Melanie Johnson, UK public health minister, announced last week a two-year pilot scheme to offer free Chlamydia trachomatis testing in pharmacies. Although limited to London and Cornwall initially, if successful the scheme would be extended to involve the whole of the UK. However, as independent health-care providers submit bids to provide the service, the broader issues involved in screening for chlamydia, and STIs in general, must be addressed, states the editorial.
The Lancet comments: "Although pharmacists are experts in providing medicines and guidance about their use, will adequate training and staffing be available to explain the testing process and the meaning of the results, be they positive or negative? How will the testing process be linked to the provision of follow up for those testing positive whether or not they receive treatment? Who will provide the sexual contact tracing facilities for people with newly diagnosed sexual infections? Who will provide safe sex advice, and who will address the issues of testing for other STIs in an at risk population? These difficult and sensitive issues require careful consideration if the Government's innovation is to be a success."
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The Lancet