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OBJECTIVES: To estimate the impact of the Check It program, a novel community-based chlamydia seek, test and treat program for young Black men who have sex with women, on test positivity rates for chlamydia in young Black women. METHODS: We used a synthetic control model to compare chlamydia test positivity rates in Orleans Parish (intervention site) to other similar parishes (control sites) in Louisiana. We estimated a model that used all other parishes as potential contributors to a synthetic control for Louisiana as well as a sample limited to the 40 parishes in Louisiana with the largest Black populations. RESULTS: The Check It program was associated with a 1.69 percentage point decline in chlamydia positivity in the first full year of operation and a 2.44 percentage point decline in chlamydia positivity in the second full year of operation compared to control sites with the largest Black populations (p = 0.05). Results were similar when the treatment site was compared to all other sites in Louisiana. CONCLUSIONS: The Check It program was associated with a significant decline in chlamydia testing positivity rates among women in Orleans Parish compared to control sites. Screening of young Black men who have sex with women can decrease rates in women living in the same community. Future recommendations for chlamydia screening of young men should be considered.

We implemented self-collected gonorrhea/chlamydia testing in 17 medical centers in California serving men who have sex with men living with HIV. From 2012 to 2018, gonorrhea/chlamydia testing increased from 45.2% to 63.4%. Among those tested, rectal testing increased from 42.0% to 77.3%; pharyngeal testing increased from 31.0% to 79.9% (all, Ptrend < 0.0001).

Using the 2013-2017 National Survey of Family Growth, 37.6% of women with ≥1 anal sex partner in the last 12 months reported chlamydia testing at unspecified anatomic sites in the past 12 months. Women whose medical provider asked about type of sex (i.e., vaginal, oral, anal), compared with those whose provider did not, reported higher chlamydia testing.

Background Adolescents and young adults are at higher risk of acquiring Chlamydia trachomatis infection (chlamydia), so testing is promoted in these populations. Studies have shown that re-testing for chlamydia is common amongst them. We investigated how sexual risk behaviour profiles are associated with repeated testing for chlamydia. Methods We used baseline data from a cohort of 2814 individuals recruited at an urban STI -clinic. We applied latent class (LC) analysis using 9 manifest variables on sexual behaviour and substance use self-reported by the study participants. We fitted ordered logistic regression to investigate the association of LC membership with the outcomes repeated testing during the past 12 months and lifetime repeated testing for chlamydia. Models were fit separately for men and women. Results We identified four LCs for men and three LCs for women with increasing gradient of risky sexual behaviour. The two classes with the highest risk among men were associated with lifetime repeated testing for chlamydia: adjOR = 2.26 (95%CI: 1.50–3.40) and adjOR = 3.03 (95%CI: 1.93–4.74) as compared with the class with lowest risk. In women, the class with the highest risk was associated with increased odds of repeated lifetime testing (adjOR =1.85 (95%CI: 1.24–2.76)) and repeated testing during past 12 months (adjOR = 1.72 (95%CI: 1.16–2.54)). An association with chlamydia positive test at the time of the study and during the participant’s lifetime was only found in the male highest risk classes. Conclusion Prevention messages with regard to testing for chlamydia after unprotected sexual contact with new/casual partners seem to reach individuals in highest risk behaviour classes who are more likely to test repeatedly. Further prevention efforts should involve potentially more tailored sex-specific interventions taking into consideration risk behaviour patterns.

Anorectal Chlamydia trachomatis (CT) may be clinically relevant for women in general practice. Although anorectal CT testing in this setting may prevent underdiagnosis and undertreatment, its feasibility is questioned as GPs currently rarely order anorectal CT tests, for yet unknown reasons.To explore the feasibility of anorectal CT testing in women in general practice.GPs across the Netherlands were invited directly (n = 1481) and by snowball sampling (n = 330) to join an online cross-sectional survey that asked about the acceptability of and barriers for (standard) anorectal testing in women during CT-related consultations. Data were analysed with univariable and multivariable logistic regression models.The questionnaire was opened by 514 respondents (28%, 514/1811) and 394 fully completed it. GPs' acceptability of anorectal testing by either self-sampling or provider-sampling was high (86%). Twenty-eight percent of GPs felt neutral, and 43% felt accepting towards standard anorectal testing. Nevertheless, 40% of GPs had never tested for anorectal CT in women, which was associated with a reported difficulty in asking about anal sex (odds ratio [OR]: 3.07, 95% confidence interval [CI]: 1.21-7.80), infrequency of anal sexual history taking (OR: 11.50, 95% CI: 6.39-20.72), low frequency of urogenital CT testing (OR 3.44, 95%-CI: 1.86-6.38) and with practicing in a non-urban area (OR: 2.27, 95% CI: 1.48-3.48). Acceptability of anorectal testing was not associated with the studied factors.This quantitative survey shows that anorectal CT testing is feasible based on its acceptability, but is likely hindered by a lower awareness of (anorectal) CT in GPs.Chlamydia trachomatis (CT) is a sexually transmitted disease that occurs both vaginally and anorectally (anally) in women. Testing for anorectal CT may improve treatment outcomes, but GPs currently rarely order anorectal CT tests. It is therefore uncertain whether anorectal CT testing is feasible.To find out whether anorectal CT testing in women by GPs is feasible.We sent an online survey to GPs across the Netherlands and asked about (1) the acceptability of and (2) barriers for anorectal CT testing in women.GPs thought anorectal CT testing, either when the patient self-sampled or when the GP sampled, was acceptable (86%). Twenty-eight percent of GPs felt neutral, and 43% felt accepting towards standard anorectal testing. Nevertheless, 40% of GPs had never tested for anorectal CT in women. These GPs were more likely to find it difficult to ask women about anal sex, to do so less frequently, to less frequently offer CT tests all together and to work in a non-urban area. These factors imply a lower awareness of (anorectal) CT.This study shows that anorectal CT testing is feasible based on its acceptability, but is likely hindered by a lower awareness of (anorectal) CT.

Background Reinfection after treatment for chlamydia is common and increases the risk of reproductive complications, particularly for women. Australian guidelines recommend retesting at 3 months after chlamydia treatment to identify reinfection. There are limited data about chlamydia retesting in Australia’s mainstream primary care setting, general practice. We investigated retesting patterns among young people treated for chlamydia infection in regional Australian general practice clinics during 2010–2015. Methods Chlamydia testing and attendance data for 16–29-year-olds attending 128 regional general practices were collected for a chlamydia testing intervention trial. Rates of retesting within recommended timeframes (defined as 6-weeks-6-months after an individual’s first positive chlamydia test) were calculated. We examined factors associated with retesting using logistic regression models adjusting for patient sex and age-group and clustered by clinic. Results A total of 2357 individuals (68.7% female) with a first positive chlamydia result formed the study population. In the following 6-weeks-6-months, 26.5% (95% CI 24.3–28.7) re-attended and were retested; 11.9% had a positive retest and positivity at retest was higher for males (19.2%, 95%CI 14.1–25.6) than females (10%, 95%CI 9.3–15.0). A further 39.1% (95% CI 36.1–42.2) re-attended but were not retested and 34.4% (95% CI 31.7–37.2) did not re-attend. Multivariable analysis showed that retesting was more likely for women (adjusted odds ratio (AOR) 2.23, 95% CI 1.79–2.79) and in intervention clinics (AOR 1.33; 95%CI 1.07–1.64,) and that individuals aged 20–24 years were less likely (AOR 0.73; 95%CI 0.59–0.92) to be retested than 16–19-year-olds. Conclusions Rates of retesting within recommended timeframes were low and there were missed opportunities for retesting. Age and sex differences in retesting and clinics highlight the need for processes within clinics and patient focused strategies to promote reattendance and retesting. High reinfection rates further highlight the importance of retesting for timely reinfection detection and treatment.

Background: As most chlamydia cases are asymptomatic, regular testing and timely management may be important for control. We aimed to determine the preferences of people living in Hong Kong for chlamydia testing and management services. Methods: An online panel of sexually active individuals living in Hong Kong completed the survey with two discrete choice experiments (DCEs). The first DCE examined the preferred attributes of a chlamydia testing service (cost, location, appointment time, speed of results, delivery of results and availability of other STI testing). The second DCE examined the preferred attributes of a chlamydia management service (cost, access to patient-delivered partner therapy (PDPT), location, travel time, type of person consulted, and attitude of staff). Results: In total, 520 individuals participated: average age 36·8 years (SD 9·9), 40% males and 66% had a bachelor’s degree or higher. Choosing to test was most influenced by cost, followed by speed of results, delivery of results, extra STI testing, appointment available, and the least important was location of testing. Choosing to attend for management was most influenced by the attitude of staff, followed by cost, who they consult, access to patient-delivered partner therapy, travel time and the least important was treatment location. Conclusion: To design effective chlamydia testing and management services, it is important to be responsive to patient needs and preferences. For people living in Hong Kong, cost and staff attitude were the most important factors for deciding whether to test or be managed for chlamydia, respectively. Funding Information: This research was funded by the Hong Kong Medical Research Fund (18171282). JJO is supported by an Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grant (GNT1193955). CKF is supported by an NHMRC Leadership Investigator Grant (GNT1172900). Declaration of Interests: All authors declare there are no conflicts of interest. Ethics Approval Statement: Ethics approval was obtained from the University of Hong Kong Institutional Review Board (UW 19-130).

Most juvenile detention facilities do not screen for Trichomonas Vaginalis (TV) despite being the most common parasitic STI. We aimed to assess TV prevalence and risk factors among young women in a large urban juvenile detention center. We evaluated a retrospective cohort from April to December 2016. Youth submitted an intake urine sample for gonorrhea and chlamydia testing; we tested remnant urine for TV. Outcomes included prevalence of TV and risk factors for infection. A total of 1009 samples were collected, 374 from young women ages 13 - 17 years old. Among females, 8% tested positive for TV with co-infection of either gonorrhea, chlamydia or both occurring in 12/29 (41%) patients. Compared to youth without TV females with TV were more likely to be African American (76%) and report symptoms (41%) (p0.05). In our study population, prevalence of TV was 8%. As nearly half of those with TV were asymptomatic, we recommend routine screening among this population.

During the COVID-19 pandemic in New York City, New York-Presbyterian Hospital provided HIV prevention patients with Gonorrhea/Chlamydia testing kits at home. This report describes the program implementation in order to provide other sexual health clinics with a roadmap in adapting to a “new normal” in providing comprehensive sexual health care virtually to patients.

Background Female sex workers (FSW) are highly susceptible to chlamydia and gonorrhea infection. However, there is limited literature examining their testing uptake to date. This study aimed to assess the uptake and determinants of chlamydia and gonorrhea testing among FSW in Southern China. Methods A cross-sectional study with convenience sampling was performed in five cities in Southern China. Data on socio-demographic characteristics, sexual behaviors, chlamydia and gonorrhea testing, and the utilization of health care services from participants were collected through face-to-face interviews. Univariate and multivariable logistic regressions were used to determine factors associated with chlamydia and gonorrhea testing, respectively. Results Overall, 1207 FSWs were recruited, with the mean age of 30.7 ± 6.8 years and an average number of clients of 7.0 (4.0–10.0) per week. 65.4% participants constantly used condoms with clients during the past month. Only 7.5 and 10.4% had been tested for chlamydia and gonorrhea in the last year, respectively. Multivariable analysis indicated that FSW who worked at low tiers (adjusted Odds Ratio (aOR) = 2.36, 95%CI:1.23–10.14), had more clients in the last month (aOR = 1.03, 95%CI:1.01–1.05), used condoms consistently (aOR = 1.79, 95%CI:1.12–2.86), had STD symptoms (aOR = 4.09,95%CI:2.62–6.40), had been tested for HIV (aOR = 5.16, 95%CI:3.21–8.30) or syphilis (aOR = 6.90, 95%CI:4.21–11.22) in the last year were more likely to have chlamydia testing. In addition, FSW who had more clients in the past month (aOR = 1.02,95%CI:1.00–1.04), had STD symptoms (aOR = 3.33, 95%CI:2.03–5.46), had been tested for HIV (aOR = 3.94, 95%CI:2.34–6.65) and syphilis (aOR = 3.27, 95%CI:1.96–5.46) in the last year were more likely to have gonorrhea testing. Conclusions The testing rates of chlamydia and gonorrhea are low among Chinese FSW. Integrating chlamydia and gonorrhea testing into HIV testing promotion programs may help bridge the gap among FSW.

Background and Objectives: Chlamydia trachomatis is the most prevalent bacterial sexually transmitted infection (STI) in the United States. Annual chlamydia screening of asymptomatic, sexually active women age 16 to 24 years and of older women who are at increased risk for infection is recommended. This study built on prior work in which our university-based family medicine clinic implemented quality improvement (QI) interventions in 2016 and 2017 to increase our chlamydia screening rate. Our primary aim in the current study was to increase the screening rate by 10%. Our secondary aim was to determine the number of patient contacts that yielded maximum test rates. Methods: For the most recent QI cycle, we conducted a prospective cohort study from December 2017 through March 2018. Using the FOCUS-PDSA model, a resident-led, interdisciplinary QI team developed the aims and implemented an intervention to streamline patient outreach. We also retrospectively analyzed data from the previous QI cycle to determine the number of tests obtained after each patient contact. Results: Chlamydia testing increased from 54% to 56.3% between December 2017 and March 2018. The majority of tests were completed by four patient contacts; additional contacts yielded few additional tests. Conclusions: Persistent outreach increases chlamydia screening rates. This QI project could be replicated in other clinical settings to improve the screening of chlamydia or other diseases.

In clinical practice, patients provide samples that violate specimen collection guidelines. As no research exists to guide clinical practice for such situations involving sexually transmitted infections (STIs), we reviewed our clinical data to determine how to proceed when patients provided urine specimen >30mL. We tracked the quantity of urine, test outcomes, and whether or not patients returned to provide subsequent samples when notified to do so. Over 6months, 33 patients provided overfilled samples; we submitted 70% (n=23/33). From the submitted specimens, 5 infections were identified from 4 patients: all were positive for chlamydia and 1 for gonorrhea and chlamydia. This yielded the following positivity rates: 17.4% for chlamydia (n=4/23), and 4.3% for gonorrhea (n=1/23). For the group, the positivity rate was 17.4% (4 of 23 patients with infections), or 21.7% (5 infections from 23 patients). Lastly, only 60% of the patients instructed to return to clinic for retesting did so. Due to the possibility of false negative results, the ability to detect infections in overfilled samples, and because patients may not return for retesting, we recommend submitting overfilled samples, while also notifying patients to return to retest. This approach could maximize diagnostic rates, at least within STI testing clinics.

Background Financial incentives (FI) and audit+feedback (AF) are often used to improve general practitioner (GP) performance. In the Australian Chlamydia Control Effectiveness Pilot (ACCEPt), a cluster-randomised controlled trial (RCT), GPs in the intervention arm received a FI of $5-$8 per chlamydia test and a quarterly AF report of chlamydia testing rates for their 16–29 year old patients. The objective of this present study was to examine the effects of removal of these measures on chlamydia testing rates. Methods At the end of the ACCEPt trial, we designed a new 2X2 factorial cluster-RCT. ACCEPt intervention clinics were re-randomised to four arms: remove AF/retain FI, remove FI/retain AF, remove both AF and FI, or retain both FI and AF. The main comparisons were: removal vs. retention of FI and removal vs. retention of AF. The primary outcome was the absolute difference in chlamydia testing rates (proportion of 16–29 year old patients tested for chlamydia within a 12-month period) at year 2 compared with baseline, estimated using mixed-effect logistic regression models accounting for clustering at the clinical level. Results 55 clinics were re-randomised. Chlamydia testing decreased from 20.0% to 11.7% in clinics with FI removed and from 20.1% to 14.4% in clinics that retained FI, with no evidence of a treatment effect between arms (difference=2.6%; 95%CI: -0.1, 5.7). Testing decreased from 20.8% to 11.5% in clinics with AF reports removed and from 19.7% to 14.8% in clinics that retained AF, with a larger reduction for removal than for retention of AF (difference=4.4% (1.1, 7.8). Conclusion Chlamydia testing rates declined in all clinics after the end of ACCEPt. Chlamydia testing rates fell more when quarterly audit+feedback reports were removed than when financial incentives were removed. Policy makers and clinicians should be aware of the challenge to sustaining chlamydia testing uptake in GP clinics. Disclosure No significant relationships.

Background Diagnosis rates of Chlamydia trachomatis (CT) are high in New Zealand (NZ), affecting 4.1% of women and 1.5% of men aged 15–29 from national laboratory surveillance in 2014. National data also shows high rates of testing in women. We sought to understand CT testing by demographic and behavioural characteristics, information not available in routine surveillance. Methods CT testing in the past year, sexual behaviour and demographic characteristics were self-reported by participants in the nationally representative 2014/15 NZ Health Survey (N= 10,198 adults aged 16–74). Those aged 16–44 who had an opposite or same-sex sexual partner in the past year were included in this analysis. The prevalence of testing was calculated and Poisson regression used to investigate associations. Results Of 3,917 eligible participants, 5.5% (95% CI 4.2–7.2%) of men and 16.6% (14.7–18.8%) of women had tested in the past year, higher among 16–29 year-olds (11.2% [7.8–15.7%] of men and 29.5% [24.5–35.1%] of women). Having multiple partners (adjusted relative risk 3.79, 95% CI 1.50–9.54) and condomless sex (2.98, 1.49–5.96) were associated with more testing in men. For women, testing was positively associated with multiple partners (2.46, 1.71–3.53) and pregnancy (1.67, 1.22–2.27) and negatively associated with lower income and Asian ethnicity. Men and women reporting a same-sex partner had elevated, but not statistically significantly, testing rates. A general check-up was the most common reason for testing; however, 18.1% of men tested because their partner was diagnosed (versus 2.2% of women, p Conclusion The study confirms men are much less likely to be routinely tested than women in NZ, and more likely to test due to risk factors. A lack of routine CT testing among NZ men is one potential reason for ongoing high incidence and diagnosis rates among both sexes. Disclosure No significant relationships.

Background The aim was to explore short-term effects of chlamydia testing on sexual behaviour also taking into account psychological characteristics, and to estimate the impact on chlamydia transmission of interventions aimed at sustaining or enhancing testing effects. Methods A cohort study was conducted among heterosexual STI clinic visitors aged 18–24 years. Risk classes based on behavioural and psychological characteristics, and transitions between classes three weeks after chlamydia testing, were identified using latent transition analysis. We developed a pair compartmental model with a susceptible-infected-susceptible structure informed by the cohort study. We estimated the impact of sustaining the found short-term effects of testing and of interventions enhancing these effects in those diagnosed, in those tested negative, or in all tested on chlamydia prevalence after five years relative to no effect. Results Four classes were identified (n=810, 13% chlamydia positive (CT+)): 19% of people were in class 1 (5% CT+), 15% in class 2 (10% CT+), 47% in class 3 (16% CT+), and 19% in class 4 (17% CT+). The number of new partners in the past year was higher in class 3 and 4, compared to class 1 and 2. Class 2 and 4 had lower intentions to use condoms, reported less condom use, and were more impulsive, compared to class 1 and 3. Chlamydia positives were more likely to move to a lower risk class after testing, compared to chlamydia negatives. Sustaining this short-term effect resulted in an estimated relative reduction in chlamydia prevalence of 27%. The impact of interventions enhancing behaviour change in those tested negative (−45%) or in all tested (−48%) was estimated to be larger than in those diagnosed (−31%). Conclusion Testing has strong short-term effects in chlamydia positives, but not in chlamydia negatives. Sustaining these effects is vital in controlling chlamydia transmission, as are interventions enhancing behaviour change in chlamydia negatives. Disclosure No significant relationships.

Background Gonorrhea and chlamydia testing is poor among Chinese MSM with HIV risk. Furthermore, gonorrhea and chlamydia testing programs are poorly funded and unlinked to HIV testing services. Pay-it-forward offers an individual a gift (e.g. an STD test) and then asks whether they would like to give a gift to another person. This study assesses the effectiveness of a pay-it-forward program in increasing gonorrhea/chlamydia testing among MSM compared to standard of care. Methods We conducted a cluster randomized controlled trial at three HIV testing sites run by MSM community-based organizations in Beijing and Guangzhou (NCT03741725). We included MSM aged 16 or older who had met indications for testing based on US CDC guidelines. Twenty clusters of 10 men each were randomized into pay-it-forward and standard of care arms. In pay-it-forward, men were offered free testing and then given the option to donate money toward future participants’ tests; in standard of care, testing was offered at the standard price of 150RMB (US$22). The primary outcome was dual gonorrhea/chlamydia test uptake ascertained by administrative record. Generalized estimating equations were used to assess the population-averaged effect of the pay-it-forward intervention. This analysis focuses on the primary comparison between pay-it-forward and standard of care. Results Overall, 201 participants were recruited. Most participants were younger than 30 years old (67.5%, 127/188) and had college or above education (85.1%, 165/194). 43.1% (69/160) reported condomless anal sex in the last three months. Gonorrhea/chlamydia testing rates were 56.4% (57/101) in pay-it-forward and 18.0% (18/100) in standard of care. Gonorrhea/chlamydia testing rates were three times higher in pay-it-forward compared to standard of care (RR:3.14, p Conclusion Findings suggest that pay-it-forward increases gonorrhea/chlamydia testing and may inform the integration of STD and HIV testing services among MSM. Disclosure No significant relationships.

Background Chlamydia reinfection increases the risk of pelvic inflammatory disease. Reinfection is common in Australia and while clinical guidelines recommend retesting 3 months post-treatment, less than 25% are retested. We aimed to examine general practitioner (GP) and patient views on retesting for chlamydia and recall/reminder systems to facilitate retesting. Methods As part of a trial of chlamydia testing in general practice, GPs were provided with resources and support to implement recall/reminder systems to increase retesting. GPs’ attitudes and practices were examined pre- and mid-intervention using semi-structured interviews. Semi-structured interviews were also conducted with patients throughout the trial. Data were analysed thematically. Results 44 GPs undertook a pre-intervention and 24 a mid-intervention interview; 22 patients were interviewed. GPs viewed recalls/reminders as essential to a formal chlamydia control program. There was disparity in whether systems to enable retesting were adopted during the intervention. Barriers to implementing these systems included concerns about costs and time required to ‘chase up’ patients; these barriers persisted during the intervention. Concerns about privacy were raised by most GPs but not patients. Over half of patients were not provided with advice about retesting at the time of their initial chlamydia test. Of the four patients who tested positive, two were retested as per guidelines. Patients were universally supportive of receiving reminders for chlamydia retesting, though retesting when at the clinic for another reason was viewed as ‘more practical’. Patients did not have strong preferences about reminder type (letter, SMS, email). Knowledge gaps were identified by both GPs and patients, and GPs identified a need to improve knowledge of the risks of chlamydia reinfection. Conclusion GPs raised more concerns about retesting and reminders than patients. Increasing GP and patient knowledge of the risks of reinfection is crucial. GPs require additional support to implement strategies to increase re-testing. Disclosure No significant relationships.

Objectives To investigate patient demographics and venue type preferences within community settings associated with re-attendance for chlamydia testing. Study design Data used for this analysis were obtained from the English National Chlamydia Screening Programme (NCSP) which focuses on prevention, control and treatment of chlamydia in sexually active under-25 year olds. A greater understanding of how young adults attend services helps to inform commissioners regarding where to focus resources within community settings. Methods Data from the Chlamydia surveillance system (CTAD) were used to count patient attendances at non-specialist sexual health services (SHSs) among 15–24-year-olds and monitor re-attendance for chlamydia testing within and between community services between 6 and 18 months of their first visit. Results From January 2013 to December 2016, 866,847 young people underwent 1,041,245 tests for chlamydia. Re-attendance for chlamydia testing was 20.1% (174,398/866,847). Re-attendance rate was 28.5% after a positive test and 19.5% after a negative test. For re-attenders, 64.2% used the same venue type for both visits. General practice (GP) and sexual and reproductive health services (SRH) were the most commonly re-attended services (31.0% and 30.6% respectively). Conclusions Only one in five re-attended for chlamydia testing. Re-attendance was associated with having a positive result, accessibility and convenience. Patients are likely to return for testing to services they know. This should be considered by commissioners implementing new re-attendance guidance based on the NCSP.

For many Black/African American gay, bisexual, and other young men who have sex with men (B-GBMSM), the House/Ball Community (HBC) offers a social network where they can be free to express diverse sexual and gender identities, but HIV prevalence and stigma are high. The POSSE project is an effectiveness-implementation trial of a popular opinion leader intervention designed to address HIV prevention in the Chicago and Philadelphia HBCs. In June 2016 baseline behavioral data were collected along with HIV, gonorrhea and Chlamydia testing. Eligible participants were sexually-active YMSM or transgender women (TGW), between the ages of 15-24, who self-identified as Black. One-third participants (32.5%) met or exceeded the clinical cut-off for depressive symptoms. Approximately 18% of the participants across both cities reported that they were HIV-positive. Overall, the baseline data establishes the need for HIV and STI prevention interventions across both cities, as well as interventions to address other co-occurring epidemics.

To consider whether a revision of the national chlamydia surveillance system is needed, the objectives were to estimate the proportion of laboratory confirmed cases at the Institute of Microbiology and Immunology (IMI) not reported to the National Institute of Public Health (NIPH), and to assess the completeness of reporting for individual data items.The dataset with information about the cases diagnosed at the IMI during 2007-2010, and the national chlamydia surveillance data at the NIPH, were linked using SOUNDEX code and the date of birth as unique identifier. The proportion of unreported cases was calculated. The proportions of records with missing data for individual variables were estimated for all reported cases during the same period. Chlamydia testing and reported rates for the period 2002-2010 were presented.Of 576 laboratory confirmed chlamydia cases at the IMI during 2007-2010, 201 were reported to the NIPH, corresponding to 65.1% of the overall underreporting (50.4% among dermatovenerologists, 90.1% among gynaecologist and 100% among other specialists). Item response was above 99% for demographic variables and from 69% to 81% for sexual behaviour variables. Higher testing rates corresponded to higher diagnosed rates.Surveillance data underestimated diagnosed chlamydia infection rates. Mandatory reporting of cases by laboratories with less variables, including unique identifier, gender, date of diagnosis, and reporting physician specialty, together with numbers of tests performed (for estimating testing and positivity rates) would simplify the surveillance system and eliminate underreporting of laboratory confirmed cases, while still providing necessary information for public health policies.Da bi presodili, ali je treba spremeniti nacionalni sistem epidemiološkega spremljanja spolno prenesene klamidijske okužbe, je bilo treba oceniti delež laboratorijsko potrjenih primerov na Inštitutu za mikrobiologijo in imunologijo (IMI) Medicinske fakultete Univerze v Ljubljani v obdobju 2007-2010, ki niso bili prijavljeni Nacionalnemu inštitutu za javno zdravje (NIJZ), in med vsemi prijavljenimi primeri v Sloveniji oceniti deleže manjkajočih podatkov za vse spremenljivke.Podatki laboratorijsko potrjenih primerov klamidijske okužbe na IMI v obdobju 2007-2010 so bili povezani s podatki nacionalne zbirke o prijavljenih primerih na NIJZ z uporabo šifre Soundex (šifriran priimek) in datuma rojstva, ki sta služila kot enoten identifikator. Izračunan je bil delež neprijavljenih primerov v celoti in glede različnih specializacij zdravnikov. Ocenjeni so bili deleži z manjkajočimi podatki za posamezne spremenljivke med vsemi prijavljenimi primeri v istem obdobju. Prikazane so tudi letne stopnje testiranja in prijavne stopnje klamidijske okužbe za obdobje 2002-2010 na osnovi podatkov iz nacionalne zbirke na NIJZ.Od skupno 576 laboratorijsko potrjenih primerov klamidijske okužbe na IMI v obdobju 2007-2010 je bil na NIJZ prijavljen le 201 primer, kar pomeni, da kar 65,1% laboratorijsko potrjenih primerov ni bilo prijavljenih. Dermatovenerologi niso prijavili 50,4% primerov, ginekologi 90,1% primerov, ostali specialisti pa niso prijavili nobenega primera laboratorijsko potrjene klamidijske okužbe. Pri prijavljenih primerih NIJZ v istem obdobju so bili podatki zelo popolni pri demografskih spremenljivkah (99% prijav je imelo vse podatke), medtem ko je bilo poročanje pri spremenljivkah o spolnem vedenju precej manj popolno (od 69 do 81% vrednosti pri različnih spremenljivkah). V obdobju 2002-2010 so bile v letih z višjimi stopnjami testiranja na klamidijske okužbe tudi prijavne stopnje klamidijskih okužb višje.Podatki o prijavni incidenčni stopnji klamidijskih okužb močno podcenjujejo incidenčno stopnjo laboratorijsko potrjenih primerov. To prispeva k nizki občutljivosti epidemiološkega spremljanja spolno prenesene klamidijske okužbe, ki pa je odvisna tudi od obsega testiranja. Obvezno prijavljanje prepoznanih primerov iz laboratorijev z manjšim naborom spremenljivk (šifra Soundex, datum rojstva, spol, regija bivanja, datum diagnoze, specialnost zdravnika, ki je naročil preiskavo) bi vsebovalo vse potrebne informacije za na dokazih temelječe javnozdravstveno odločanje, poenostavilo bi sistem epidemiološkega spremljanja in povečalo njegovo občutljivost (prijavljeni bi bili vsi laboratorijsko potrjeni primeri) ter obenem zmanjšalo delovno obremenitev zdravnikov. Obenem bi moralo laboratorijsko epidemiološko spremljanje dati tudi podatke o številu opravljenih testiranj, kar bi omogočilo oceniti stopnje testiranja in stopnje pozitivnosti (skupaj in po starosti in spolu pacientov in tudi po specialnosti zdravnikov, naročnikov).

OBJECTIVE: Describe chlamydia positivity among young women tested at college health centers by student characteristics: age, race/ethnicity, and institution type. PARTICIPANTS: During 2008–2010, colleges participating in a national infertility prevention program provided chlamydia testing data from females aged 18–24. METHODS: Chlamydia positivity (number of positive tests divided by the number tested) among females stratified by college type (4-year versus 2-year and minority serving institutes [MSIs]) was determined. RESULTS: Chlamydia testing data were provided by 148 colleges: 37 (26%) MSIs and 21 (15%) 2-year colleges. Of the 118,946 chlamydia tests, 6.5% were positive. Chlamydia positivity in females at 4-year colleges was 6.6% versus 5.3% at 2-year colleges (p = .0001). Positivity at MSIs was almost double of that at non-MSIs, 10.0% versus 5.4% (p = .0001). CONCLUSIONS: Chlamydia positivity may be higher among college females than previously thought. Higher positivity at MSIs suggests that targeted sexually transmitted infection prevention efforts may be useful for high-risk college populations.

Screening persons living with HIV for gonorrhea and chlamydia has been recommended since 2003. We compared annual gonorrhea/chlamydia testing to syphilis and lipid testing among 19,368 adults (41% men who have sex with men, 30% heterosexual men, and 29% women) engaged in HIV care. In 2004, 22%, 62%, and 70% of all patients were tested for gonorrhea/chlamydia, syphilis, and lipid levels, respectively. Despite increasing steadily [odds ratio per year (95% confidence interval): 1.14 (1.13 to 1.15)], gonorrhea/chlamydia testing in 2010 remained lower than syphilis and lipid testing (39%, 77%, 76%, respectively). Interventions to improve gonorrhea/chlamydia screening are needed. A more targeted screening approach may be warranted.

Background This study examined trends in chlamydia, gonorrhoea and syphilis diagnosis, and chlamydia testing and positivity, among older women in Australia between 2000 and 2018. Methods: Using national notifiable disease data and Medicare data, diagnosis rates were calculated for each sexually transmissible infection (STI), as well as testing and positivity rates for chlamydia. Data were compared between two older groups (55–64 and 65–74 years) and two younger groups (15–24 and 25–34 years). Poisson regression examined trends for 2000–18 and 2014–18 separately. Results: Rates for all STIs increased across all age groups and were highest in the two youngest age groups. From 2014 to 2018, chlamydia rates increased the most among those aged 55–64 years [incidence rate ratio (IRR) = 1.06; 95%CI: 1.02–1.10] and declined in those aged 15–24 years (IRR = 0.99; 95%CI: 0.99–0.99). Gonorrhoea rates increased the most among those aged 65–74 years (IRR = 1.47; 95%CI: 1.23–1.77) and least in those aged 15–24 years (IRR = 1.12; 95%CI: 1.10–1.13). Syphilis rates increased the most among those aged 55–64 years (IRR = 1.58; 95%CI: 1.25–1.99) and least in those aged 15–24 years (IRR = 1.29; 95%CI: 1.23–1.35). Chlamydia test positivity declined among younger women but remained stable in older women. Conclusions: In general, STIs are increasing among older women in Australia at a faster rate than among younger women. Although the greatest burden is among younger women, STIs need to be considered and monitored among older women.

We examined Medicaid claims data during 2004 to 2013. The proportion of sexually active females aged 15 to 25 years who had Papanicolaou testing or were pregnant significantly decreased during 2004 to 2013 (67.0% to 43.9%, P < 0.05), resulting in a slowed increasing trend in overall chlamydia screening rates. Structural-level interventions for improving chlamydia screening are urgently needed.

Chlamydia trachomatis is the most frequently-notified sexually transmitted infection in Australia. Effective and timely partner treatment of chlamydia is essential to reduce overall prevalence and the burden of infection. Currently in most of Australia, the only avenue for partner treatment of chlamydia ("standard partner therapy") is a tedious, and often inconvenient, process. The barriers and facilitators of standard partner therapy, and newer models of accelerated partner therapy (APT), need to be identified in the Australian setting. Additionally, the potential role of community pharmacists need to be explored. Semi-structured interview guides for two key stakeholder groups (prescribers and pharmacists) were developed and piloted. Eleven prescribers (general practitioners, sexual health clinicians and nurse practitioners) and twelve pharmacists practicing in the Perth metropolitan region were interviewed. Key reported barriers to standard partner therapy were lack of or delayed chlamydia testing. Key facilitators included ability to test and educate sexual partner. Key barriers for APT included prescribers' legal responsibility and potential for medication-related adverse effects. Healthcare provider consultation and chlamydia testing were seen as potential facilitators of APT. Pharmacists were receptive to the idea of expanding their role in chlamydia treatment, however, barriers to privacy must be overcome in order to be acceptable to prescribers and pharmacists.

Background: Chinese MSM rarely receive gonorrhea or chlamydia testing. The purpose of this pilot study was to evaluate a pay-it-forward strategy to increase gonorrhea/chlamydia testing among MSM. Methods: We used a quasi-experimental pragmatic study to compare a pay-it-forward model to standard of care at two free HIV testing sites for MSM. A pay-it-forward gonorrhea/chlamydia dual testing program was implemented for three months, during which men were offered free testing and given the option of donating money toward testing for future participants. Both sites then switched to standard of care for two months, offering dual testing at the standard price of $24 USD. All men completed a survey reporting sociodemographic characteristics, sexual behaviors, and previous STD testing. Findings: 408 men were included in this study. 203 men were offered pay-it-forward, and 205 were offered standard of care. Gonorrhea/chlamydia testing uptake was 53·7% (109/203) in the pay-it-forward group and 5·9% (12/205) in the standard of care group (aOR=19·74, 95%CI 10·03-38·85, p

Background The absolute number of travel-related Chlamydia cases in Sweden has consistently increased between 2000 and 2013. Given the growth in international travel, we aimed to study the trends of travel-related Chlamydia incidence to determine differences and identify high-risk groups and destinations. Methods For 2000–2013 we calculated annual Chlamydia incidence per 100,000 travels by dividing the number of notified travel-related cases by the number of travels; the latter were collected from a yearly survey among Swedish residents. For specific destinations 95% confidence intervals were calculated and monotonic yearly trends tested. Results The overall median annual travel-related Chlamydia incidence was higher for women than for men, but the opposite was true in age groups >25 years. For men, Thailand had the highest incidence, which was 3–7 times higher than the next highest destination in each age group. Spain, Turkey and Thailand had the highest incidence among women, but differences between countries were smaller than for men. For most destinations the yearly trends were stable. Conclusions We showed different profiles for men and women and age groups in terms of high incidence destinations. This specific information could allow to better tailor safe sex messages and advocate post-travel Chlamydia testing to target groups travelling to certain destinations.

Objectives: Chlamydia screening is widely advocated. General practice registrars are an important stage of clinical behaviour development. This study aimed to determine rates of, and factors associated with, registrars' chlamydia testing including asymptomatic screening. Methods: A cross-sectional analysis of data from Registrars Clinical Encounters in Training (ReCEnT), a cohort study of registrars' consultations. Registrars record details of 60 consecutive consultations in each GP-term of training. Outcome factors were chlamydia testing, asymptomatic screening and doctor-initiated screening. Results: Testing occurred in 2.5% of 29,112 consultations (398 registrars) and in 5.8% of patients aged 15–25. Asymptomatic screening comprised 47.5% of chlamydia tests, and 55.6% of screening tests were doctor-initiated. Chlamydia testing was associated with female gender of doctor and patient, younger patient age, and patients new to doctor or practice. Asymptomatic screening was associated with practices where patients incur no fees, and in patients new to doctor or practice. Screening of female patients was more often doctor-initiated. Conclusions: GP registrars screen for chlamydia disproportionately in younger females and new patients. Implications: Our findings highlight potential opportunities to improve uptake of screening for chlamydia, including targeted education and training for registrars, campaigns targeting male patients, and addressing financial barriers to accessing screening services.

Objective To assess chlamydia knowledge, willingness to undertake pharmacy-based chlamydia testing, and facilitators and barriers to such testing in consumers and community pharmacists, in Australia (AUS) and Switzerland (CH). Methods Statements of interest were retrieved from literature and assembled into a 12-item online survey (English and German versions). Survey was disseminated through Facebook, pharmacies’ publicly available emails and professional websites (March 2015). Results Consumers and pharmacists (AUS: ncons = 198, npharm = 162; CH: ncons = 209, npharm = 223) were predominantly female (>65%). Mean chlamydia knowledge scores (maximum of 8) were higher in Australia in consumers (AUS: 6.8 ± 1.5 vs CH: 4.2 ± 2.4; p Conclusion The majority of consumers and pharmacists support pharmacy-based chlamydia testing. There is now emerging evidence that the policy makers in Australia and Switzerland need to develop pharmacy-based chlamydia testing as core business.

Purpose To assess impact of the 2009 American College of Obstetricians and Gynecologists (ACOG) Pap guideline changes on chlamydia testing rates among sexually active young women. Methods The study included sexually active women aged 15–25 years enrolled in commercial health plans from 2005 to 2014. We identified sexually active women by diagnosis, procedure, and drug codes in inpatient, outpatient, and drug claims databases. We identified Pap tests and chlamydia tests among sexually active adolescents (15–20 years) and young adults (21–25 years) over time. Using piecewise regression models, we compared the change in chlamydia testing rates before and after 2009 ACOG guidelines. Results From 2005 to 2014, chlamydia testing rates in sexually active women increased from 23% to 37% among adolescents and from 24% to 43% among young adults. Although the overall increase in chlamydia testing was positive, the annual rate of change in chlamydia testing (slope) decreased significantly after the 2009 ACOG guideline change from 1.9% before to 1.0% after for adolescents ( p p Conclusions Although chlamydia test rates are increasing among sexually active women aged 15–25 years from 2005 to 2014, the slower growth in chlamydia testing rate after 2009 may relate to the change in the Pap testing guidelines. Our finding that more than half of sexually active women aged 15–25 years did not have chlamydia testing and that the rate of increased chlamydia testing slowed after 2009 suggests that interventions to improve chlamydia testing apart from combining with Pap testing are still needed.

BACKGROUND Optimising the diagnostic work-up and treatment of genital chlamydia infection requires knowledge of the sampling patterns of those who order chlamydia tests. We wished to determine which groups of doctors collect specimens for chlamydia testing, and to examine the sex and age distribution of patients tested, and the proportion of positive tests, from general practitioners, gynaecologists in private practice, and youth health services. MATERIAL AND METHOD The study includes 43 465 specimens analysed for genital infection with Chlamydia trachomatis at Vestfold Hospital Trust over the period 1 January 2007 to 31 December 2011. Data from the laboratory information system were used to classify the test requisitioners. RESULTS General practitioners requisitioned 60 % of all chlamydia tests and 63 % of all positive tests. Youth health services requisitioned 13 % of all tests and 22 % of positive tests; gynaecologists in private practice, 12 % of all tests and 5 % of positive tests. Overall, 26 % of specimens were from women over the age of 30 with 2.2 % testing positive, and 82 % of these specimens were submitted by general practitioners or gynaecologists in private practice. Twenty-three per cent of specimens were from men, and 78 % of these were collected in general practice. INTERPRETATION Knowledge of who requisitions chlamydia testing and of whom is important for planning and improving chlamydia diagnosis, treatment and contact tracing. In this study from Norway, we found that doctors in general practice play a key role in diagnosing and treating chlamydia. The testing of women over the age of 30 by general practitioners and gynaecologists in private practice probably leads to unnecessary use of resources and should be reduced.

Chlamydial genital infection is common and asymptomatic in most cases. National screening efforts developed to educate practitioners, expand screening, and link testing to local health laboratories are not meeting the needs of populations at great risk of disease, including young racial/ethnic minority women and sexual minorities. The development and availability of newer diagnostics will likely make chlamydia testing more efficient and widely available for patients and providers. Practitioners are reminded to have a low threshold to offer testing and presumptive treatment to patients that are deemed at high risk of disease, particularly those who are challenging to engage in care.

Annual chlamydia testing is recommended for all sexually active Australians aged 15–29 years; however, the testing rate is below recommended levels. Three surveys at a Melbourne music festival were conducted over 2012–14 to identify correlates of sexually transmissible infection (STI) testing among young people at risk of STIs. In total, 3588 participants were recruited; 72% reported having sex in the past year. Based on sexual behaviours, 38% of sexually active participants were classified as at risk of contracting STIs. In the past year, at-risk participants had significantly higher odds of reporting a STI test (37%) than participants classified as not at risk (24%) (OR=1.9; CI=1.6–2.3). Among at-risk participants, correlates of STI testing in the past year included being aged 20–24 years, visiting a GP, higher knowledge levels, earlier sexual debut and reporting more than five lifetime partners. Testing rates in our sample did not meet levels required to reduce chlamydia prevalence. However, the testing rate was higher in at-risk participants than participants who were not at risk. Future programs aiming to increase chlamydia testing should improve knowledge and promote the importance of testing after risk exposure, particularly among 16- to 19-year-olds.

OBJECTIVES To assess state variations in eligibility criteria based on enrollment length and sexual activity on chlamydia testing rates among Medicaid female enrollees aged 15 to 25 years and potential impact of the representatives of testing rates. METHODS We used 2010 Medicaid Analytic eXtract to estimate and compare the overall and state-level prevalence of gaps in coverage of ≥ 2 consecutive months, service utilization associated with sexuality, and chlamydia testing rates among Medicaid female enrollees aged 15 to 25 years who had ≥ 1 month of the full scope of Medicaid benefits and had ≥ 1 health service claim. The chlamydia testing rate was calculated as the proportion of sexually active Medicaid female enrollees who received a chlamydia test in 2010. RESULTS Of 5.7 million women aged 15 to 25 years enrolled in Medicaid in 2010, 42.3% had a 2-month gap of enrollment coverage in 2010. The proportion of women who had a 2-month gap varied from 26.1% to 73.2% across states. The proportion of women identified as sexually active was 59.8% among women who had a 2-month gap and 57.1% among women who had no 2-month gap. The chlamydia testing rate was 44.0% among sexually active women with a 2-month gap and 44.2% among sexually active women without a 2-month gap. Eleven states had ≥10% difference in sexual activity or chlamydia testing rates between women with a 2-month gap and women without a 2-month gap. CONCLUSIONS States which exclude a substantial proportion of Medicaid enrollees from inclusion in the chlamydia testing denominator may have less representative testing estimates because those excluded tend to be women aged 19 to 25 years.

OBJECTIVE: To estimate the percentage of young, sexually active Medicaid-insured women who were tested for chlamydia by age, race/ethnicity, and history of sexually transmitted disease (STD) diagnosis. METHODS: We used the medical diagnostic and procedural codes from Truven Health MarketScan Medicaid claims data from 10 states in 2012 and 2013 to estimate the rates of chlamydia testing in 2013 and previous STD diagnosis (diagnosed in 2012) among Medicaid-insured women aged 15–25 years who were sexually active in 2013. We also used a logit model to assess the association between chlamydia testing and women’s age, race/ethnicity, and previous STD diagnosis. RESULTS: Overall, among approximately 261,000 Medicaid-insured women aged 15–25 years in 2013 who were classified as sexually active, 50.2% were tested for chlamydia in 2013. The chlamydia testing rate was 45.6% for white women and 57.5% for black women. The chlamydia testing rate was 63.5% for women diagnosed as having an STD in 2012 and 46.8% for women not diagnosed as having an STD in 2012. The chlamydia testing rate was significantly (P < 0.05) associated with previous STD diagnosis, age, and race/ethnicity in our logit model. CONCLUSIONS: Higher chlamydia testing rates among black women can be explained in part by higher rates of previous STD diagnoses. Our finding that black women have the highest chlamydia testing rates is encouraging, as improved access to STD prevention services among racial/ethnic minorities can help to reduce racial/ethnic disparities in STDs. However, chlamydia screening remains an underused preventive health service for young women of all racial and ethnic groups.

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.

BACKGROUND Home-based self-collection of specimens for urogenital and anorectal chlamydia testing has been proven feasible and acceptable. We studied the efficiency of chlamydia home collection kits for young low-risk persons to optimize care at the Amsterdam sexually transmitted infection (STI) clinic. METHODS Low-risk heterosexual persons under 25 years submitting an appointment request online were offered 3 different ways of chlamydia testing: (1) receiving a home collection kit, (2) coming to the clinic without, or (3) with sexual health counseling. The collection kit was sent to the client by surface mail and was used to self-collect a vaginal swab or urine sample (men). This sample was sent back to the laboratory for testing and the results could be retrieved online. Testing for gonorrhea, syphilis, and human immunodeficiency virus was indicated after testing chlamydia-positive. RESULTS Between September 2012 until July 2013, from 1804 online requests, 1451 (80%) opted for the home collection kit, 321 (18%) preferred an appointment at the clinic without, and 32 (2%) with sexual health counseling. Of the requested home collection kits, 88% were returned. Chlamydia was diagnosed in 6.0% of the clients receiving a home collection kit, and none of the chlamydia-positive clients tested positive for other STI. CONCLUSIONS Home collection is the preferred method for most young low-risk heterosexual clients who seek STI care. With a high compliance to collect and return the samples, home collection can be used as a tool to increase efficiency and dedicate STI clinic workers efforts to those at highest risk.

Background This study uses the theory of planned behaviour (TPB) as a framework to investigate salient beliefs about chlamydia testing, amongst young people living in relatively deprived areas. These beliefs may form targets for intervention to increase testing in this high-risk population. Methods Participants recruited from colleges in deprived areas of a UK city, completed open-ended questions designed to elicit salient beliefs. Responses were content analysed and categorized as describing behavioural, normative or control beliefs. Results Beliefs were elicited from 128 respondents (51% male; median age ¼ 17). The commonest behavioural belief, which could have a positive or negative impact on screening intentions, was that testing provides information about health status. Partners were referred to most commonly amongst the normative beliefs. Practical aspects and concerns about social implications of testing were common control beliefs. References to several negative emotions emerged throughout. Conclusions This study indicates that raising awareness of chlamydia as a serious sexual health problem may not be the best way to increase the uptake of testing in a high-risk population. Promoting chlamydia testing as potentially providing reassurance may be an alternative. It may also be important to reduce perceptions of social disapproval as well as negative emotion regarding chlamydia testing.

Background Annual chlamydia screening for sexually active women aged ≤25 years is recommended, and chlamydia testing rates have continuously increased. However, several studies have shown that many providers screen all women of reproductive age in public settings. Purpose To examine chlamydia testing patterns in private settings for women and young women aged 15–44 years (hereafter referred to as women). Methods A large commercial claims database was used to estimate the chlamydia testing rate for women aged 15–44 years who had reproductive health services in 2008. Such services and tests were identified using diagnostic and procedural codes in 2008. Results Of 3.2 million women aged 15–44 years who had reproductive health services in 2008, 19.2% had at least a claim for a sexually transmitted disease (STD), 29.3% for pregnancy, and 81.2% for a gynecologic exam. Of those 3.2 million, 22.3% had chlamydia testing: 34.2% aged 15–25 years vs 18.3% aged 26–44 years. Of the 0.7 million who were tested, 65% were aged 26–44 years, and the reason for the healthcare visit in which their first chlamydia test was performed was an STD for 22.7% and pregnancy for 33.5%. Conclusions In this population of insured women, young women are undertested and older women are overtested for chlamydia. Efforts to improve screening practices should be evaluated.

Objectives To investigate the impact of repeat chlamydia testing on annual population coverage estimates and to examine repeat testing patterns in a New Zealand district with high chlamydia testing rates. Methods Chlamydia testing data for 15–44-year-old men and women in a single New Zealand district during February 2008 to January 2011 were analysed. Annual coverage of testing was estimated in two ways, using the number of tests and the number of individuals as the numerator. Rates of repeat testing were calculated using survival analysis. Results There were 73 879 tests (12 251 men, 61 628 women) from 41 342 individuals (8437 men, 32 905 women) during 3 years. Coverage estimates in 2010 using the number of individuals as the numerator were 17% lower for men and 26% lower for women than when the number of tests was used (5.9% vs 4.9% for men and 28.7% vs 21.2% for women). The rate of repeat testing was 16.9 per 100 person-years among men (95% CI 16.2 to 17.7) and 31.6 among women (95% CI 31.1 to 32.2). Rates of repeat testing were higher among women, in younger age groups and following a positive rather than a negative baseline test (p Conclusion Relatively high rates of repeat testing were observed among young women in Waikato district during 2008 to 2010. Estimates of population coverage by test for this group therefore considerably overestimate individual coverage. The findings will inform discussions about improving surveillance to capture more accurate chlamydia testing coverage rates in New Zealand.

A recent Australian paper suggests that chlamydia screening in pregnant women aged

Objective: To describe the proportion of 16–29-year-olds tested for chlamydia by Australian general practitioners in a 12-month period. Design and setting: Between October 2007 and September 2008, the national chlamydia testing rate in 16–29-year-olds was calculated by dividing the number of Medicare-reimbursed chlamydia tests by two denominators: (i) Medicare-reimbursed GP consultations; and (ii) estimated resident populations adjusted for the proportion who were sexually active. Main outcome measures: GP chlamydia testing rates in 16–29-year-olds per 100 patients attending a GP consultation and per 100 sexually active population, by patient age and sex, state/territory of residence, and remoteness area. Results: Among the estimated Australian population of 16–29-year-olds, 85.6% of females and 64.4% of males had at least one GP consultation in the 12-month period. The national GP chlamydia testing rate per 100 patients was 8.9% (95% CI, 8.88%–8.94%). The national GP chlamydia testing rate per 100 sexually active population was 8.0% (95% CI, 7.92%–7.98%). The rate per 100 sexually active population was higher in females (12.5%) compared with males (3.7%) (P < 0.01); higher in 20–24-year-olds (9.0%) compared with 16–19-year-olds (8.7%) and 25–29-year-olds (6.6%) (P < 0.01); higher in those living in non-metropolitan areas (11.0%) compared with metropolitan areas (8.4%) (P < 0.01); and highest in those living in the Northern Territory (21.4%) compared with other jurisdictions (P < 0.01). Conclusions: Despite clinical guidelines recommending annual chlamydia testing for sexually active 15–29-year-olds, our analysis showed that a high proportion of young people aged 16–29 years attend a GP each year, but few of the sexually active population in this age group were tested for chlamydia in general practice. Strategies are needed to support GPs to enhance chlamydia testing in young people.

Here's your starter for ten. Name me the most common sexually transmitted infection (STI) – the one that it just so happens is the subject of three other articles in this issue of the Journal (see pages 4, 10 and 17). Correct. Chlamydia. But while you and I know that answer, the general public – and especially that youthful segment of the general public that is most affected by the problem – often haven't had the chance to be so informed. Which is why so many under-25s are at risk of chlamydia, and why so many of us sexual health professionals spend vast amounts of time hitting our heads against this particular brick wall. Enter the Department of Health (DH) and the Central Office of Information (COI), which in the summer of 2009 decided to launch a nationwide advertising campaign to highlight sexual issues in general and chlamydia issues in particular. Enter too your intrepid reporter who, following her previous coverage of The Sex Education Show,1 decided to take a similar behind-the-scenes peek into the inner workings of yet another phenomenon, this time that of behavioural change. You'll have seen the advertising campaign, of course – it's the one with the animated bubbles and the tagline ‘Worth Talking About’. With luck, you'll also have seen that chlamydia testing uptake is on the rise and chlamydia incidence is on the decline – and if you are seeing that, then credit is due. But given that long-term statistics aren't yet available, what fascinates me currently is not whether the campaign works but why and how it was born. Why did it start? How was the core concept arrived at? How were the messages developed? How was it produced? And why, why, why those animated bubbles? The original initiative came 2 years …