The Great Chlamydia Control Bake Off: the same ingredients (evidence) but different recipes for success

Successful baking requires careful measurement, the precise mixing of ingredients and an attentive eye while the mixture is in the oven. However, the environment may have an impact on the final product. Humidity, quality of ingredients, type of oven used and altitude can all mean the difference between a perfect cake and a goopy mess. Although chlamydia control may seem quite different from baking, there are some important parallels, notably the context in which control programmes are developed, implemented and evaluated. The same inputs and approaches applied in different contexts may produce drastically different results. van Bergen et al 1 describe the methods of and conclusions from addressing the question ‘Where to go to in Chlamydia control?’ for the Netherlands in this issue of Sexually Transmitted Infections . The author and colleagues1 convened a panel that met in November 2019 and discussed expert perspectives on chlamydia control. This panel considered the interpretation of available evidence on the impact and/or effectiveness of a variety of testing scenarios: asymptomatic screening including opportunistic testing of asymptomatic patients in routine healthcare settings, syndromic testing, and at-home specimen collection and/or testing. Their paper reports on a problem analysis and the consensus viewpoint that evolved from this expert meeting, which suggested that future strategies should reduce rather than expand the role of widespread testing for asymptomatic chlamydial infections, and therefore the authors conclude that they ‘do not recommend age-based screening and widespread testing for chlamydia in asymptomatic persons in the Netherlands’.1 In this thought-provoking paper, van Bergen et al 1 focus on the assessment of three points: evidence for prevalence reductions, the rate of severe long-term complications caused by chlamydia and the potential harms of overdiagnoses and overtreatment. They find that all three points argue for the need to reassess and question current practices. …