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The tip of the iceberg: opportunistic screening for Chlamydia trachomatis in asymptomatic patients attending a young people’s health clinic reveals a high prevalence — a pilot study

Stephanie Jones A C , Sue Barker B , Eugene Athan A and Stephen Graves A

A Barwon Health, Geelong, Vic. 3220, Australia;

B Clockwork Young Peoples Health Service, 60 Little Malop Street, Geelong, Vic. 3220, Australia.

C Author for correspondence; email:

Sexual Health 1(2) 115-119
Submitted: 22 September 2003  Accepted: 3 February 2004   Published: 24 June 2004


Objectives: We implemented an opportunistic screening programme for Chlamydia trachomatis amongst patients presenting to a young peoples’ health service in the city of Geelong, Australia, to define the prevalence of infection and to identify specific risk factors. Methods: Over a 7-month period sexually active patients attending the young peoples’ clinic were offered C. trachomatis screening by nucleic acid amplification test. There was 100% acceptance rate among those offered the test. Patient demographics, reason for presentation at the clinic and reported symptoms were documented by the clinicians and correlated with laboratory findings. Results: 163 patients between the ages of 12–25 were tested, nine males and 154 females. The prevalence of chlamydia infection was 5.8% and was highest (16.0%) among patients presenting for the morning after pill. Inhibition of the nucleic acid amplification test occurred in 11.0% of urine samples. All patients with inhibited tests were asked to provide a repeat sample for retesting, but only 50% complied with this request. The majority of repeat samples (88.9%) had no inhibitors present and yielded a negative result. There was no correlation between symptoms and a positive chlamydia result. Conclusions: Chlamydia infection is common in young people engaging in unsafe sexual practice and cannot be predicted by the presence of symptoms. The high prevalence of infection in Geelong would make screening cost effective in this age group. Ongoing population screening of sexually active young people should be encouraged in community health centres. Inhibition of the nucleic acid amplification test was common but repeat testing of urine a few days later usually gave satisfactory results.


[1]  Hocking J Fairley C 2003 Need for screening for genital Chlamydia trachomatis infection in Australia. Aust N Z J Public Health 27 1 80 1 Pubmed Abstract

[2]  Hollblad-Fadiman K Goldman SM 2003 American College of Preventive Medicine Practice Policy Statement: screening for Chlamydia trachomatis. Am J Prev Med 24 3 287 92 DOI Pubmed Abstract

[3]  Williams H Tabrizi SN Lee W Kovacs GT Garland S 2003 Adolescence another risk factors for Chlamydia trachomatis genitourinary infection in women in Melbourne, Australia. Sex Transm Infect 79 31 4 DOI Pubmed Abstract

[4]  Hocking J 2003 Genital chlamydia — investigating the problem in Victoria. Vic Infect Dis Bull 6 1 17 DOI Pubmed Abstract

[5]  Watson E Templeton A Russell I Paavonen J Mardh P Stary A et al. 2002 The accuracy and efficacy of screening tests for Chlamydia trachomatis: a systematic review. J Med Microbiol 51 1021 1031 DOI Pubmed Abstract

[6]  Counahan M Hocking J Fairley C 2003 Enhanced chlamydia surveillance indicates more screening needed. MJA 178 523 Pubmed Abstract

[7]  Cates W Jr Wasserheit JN 1991 Genital chlamydial infections: epidemiology and reproductive sequelae. Am J Obstet Gynecol 164 1771 81 Pubmed Abstract

[8]  Gleave T 2002 Implementing a chlamydia pilot screening programme. Nursing Times 98 50 Pubmed Abstract

[9]  Burstein GR Murray PJ 2003 Diagnosis and management of sexually transmitted disease pathogens among adolescents. Pediatr Rev 24 3 75 82 Pubmed Abstract

[10]  Clutterbuck DJ 2001 Managing genital Chlamydia trachomatis infection in Scotland: targeted opportunistic testing or a screening programme? Health Bull (Edinb) 59 6 396 404 Pubmed Abstract

[11]  Cohen D Nsuami M Martin D Farley T 1999 Repeated school-based screening for sexually transmitted diseases: a feasible strategy for reaching adolescents. Pediatrics 104 6 1281 5 Pubmed Abstract

[12]  Wiesenfeld HC Hillier SL Krohn MA Landers DV Sweet RL 2003 Bacterial Vaginosis is a strong predictor of Neisseria gonorrhoeae and Chlamydia trachomatis infection. CID 36 663 8 DOI

[13]  Honey E Augood C Templeton A Russell I Paavonen J Mardh P-A et al 2002 Cost effectiveness of screening for Chlamydia trachomatis: a review of published studies. Sex Transm Inf 78 406 12 DOI

[14]  Garland SM Tabrizi S Hallo J Chen S 2000 Assessment of Chlamydia trachomatis prevalence by PCR and LCR in women presenting for termination of pregnancy. Sex Transm Inf 76 173 6 DOI

[15]  Mahoney J Chong S Jang D Luinstra K Faught M Dalby D et al. 1998 Urine specimens from pregnant and nonpregnant women inhibitory to amplification of Chlamydia trachomatis nucleic acid by PCR, ligase chain reaction and transcription-mediated amplification: identification of urinary substances associated with inhibition and removal of inhibitory activity. J Clin Microbiol 36 11 3122 6 Pubmed Abstract

[16]  Genc M Mardh P-A 1996 A cost-effectiveness analysis of screening and treatment for Chlamydia trachomatis infection in asymptomatic women. Annal of Intern Med 124 1 1 7

[17]  Underhill G Hewitt G McLean L Randall S Tobin J Harindra V 2003 Who has chlamydia? The prevalence of genital tract Chlamydia trachomatis within Portsmouth and South East Hampshire, UK. J Fam Plann Reprod Health Care 29 1 17 20
Pubmed Abstract

[18]  Miller PF Law M Torzillo PJ Kaldor J 2001 Incident sexually transmitted infections and their risk factors in an Aboriginal community in Australia: a population based cohort study. Sex Trans Infect 77 1 21 5 DOI

[19]  McKay L Clery H Carrich-Anderson K Hollis S Scott G 2003 Genital Chlamydia trachomatis infection in a subgroup of young men in the UK (Research letter). Lancet 361 1792 DOI Pubmed Abstract

[20]  Smith R Miller K Storts DR 1996 Performance optimization of Promega’s Taq DNA polymerase in PCR. Promega Notes 56 24

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