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Unlabelled: Contact tracing is proved to be a good way to prevent asymptomatic sexually transmitted infections, such as Chlamydia trachomatis, from spreading. According to the Swedish law a physician has to report all cases of genital C. trachomatis to the County Medical Officer of Health and to the National institute for Infectious Disease Control and perform contact tracing. An evaluation of the sexual history 6 months back in time is recommended and standard in most of the country. The county of Västerbotten has one of the lowest incidenses of C. trachomatis in Sweden though the population is younger than the Swedish average. During year 2002 the contact tracing in Västerbotten was evaluated by sending a questionnaire to everyone who reported a case of genital C. trachomatis. We recived 534 (98%) out of 544 questionnaires. The patients reported 1360 partners, 2.5 on average, 1129 were identified. 761 had a known test result and 497 of them were positive, 0.9 on average. 72% of the contact tracers evaluated the sexual history > or = 12 months back in time. 78% of the contact tracings were performed by four social workers. Their patients reported 2.5 partners on average and 80% evaluated > or = 12 months back in time. 14 persons did only one contact tracing, 1.3 partners/index on average, 40% evaluated > or = 12 months back in time. 82% of the partners had sex with the infected patient 0-6 months before the patients was diagnosed with C. trachomatis, 75% out of those with a known test result were infected, 16% had sex 7-12 months before diagnosis, 30% infected. (The C. trachomatis prevalence in Sweden is estimated to be 2.7-4.9% among young women.), Conclusion: A few experienced persons tracing for at least 12 month back in time is probably two important reasons why Västerbotten has such a small C. trachomatis incidence.

The incidence of chlamydia in Göteborg, the second largest city in Sweden, increased by 81 percent between 1995 and 2001. The majority (82%) of men and women diagnosed with chlamydia were aged 15-29 years. The incidence of chlamydia was higher among teenagers from areas of lower socio-economic index during the first years of the study but after 1995 there was no difference between low and high socio-economic groups. Chlamydia tests were taken three times more often in women than men. Analysis of original data from the Swedish survey of sexual behaviour 1996 demonstrated a strong correlation between the number of sexual partners and STD. Strategies for preventing the spread of chlamydia should be to a greater extent directed towards men and include better accessibility for men to STD clinics as well as a general improvement in contact tracing. The general public should be informed about the fact that chlamydia infections do not always give symptoms and may lead to infertility. Campaigns about condom use in order to avoid chlamydia, HIV-infection and other STD are needed.

The incidence of Chlamydia trachomatis infections in Sweden is increasing. The primary health care encounters many of the patients with C trachomatis infections. The aim of this study was firstly to examine if the primary health care met the requirements of the Swedish STD legislation and secondly to find out why the testing was done. A total of 44 case-books of patients tested positive for C trachomatis in Orebro county were studied. Contact tracing was ignored in a fourth of the patients identified as contacts. In four cases partners received treatment without testing. Not even half of the patients were examined after treatment as required. Symptoms were the most common reason for testing. Dysuria was the predominant symptom. Almost half of all the cases in women but none in men were diagnosed by screening or voluntary testing in asymptomatic patients. In to many cases the primary health care did not meet the requirements of the STD Act. This must improve. Generous testing of asymptomatic women is supported by this study. Chlamydia trachomatis infection should be considered in patients with cystitis. Voluntary testing in men should be encouraged.

The incidence of gonorrhoea, chlamydia, syphilis and HIV infection is increasing among homosexual men in Stockholm, Sweden. This indicates that the frequency of unsafe sex is on the increase while the use of condoms is decreasing.