You might call it a silent epidemic. Chlamydia rates have
risen consistently in Canada since 1996, with the highest
number of cases seen in girls aged 15 to 19. But unlike
the discomfort that accompanies most sexually transmitted
infections (STIs), the vast majority of women infected
with Chlamydia trachomatis remain symptom free
— until it's too late. By the time most women seek
treatment, they have already become infertile or developed
pelvic inflammatory disease.
TESTING
AS PREVENTION
Data from the Canadian Institute for Health Information
shows that in 2001 the total rate of reported cases
of infection in Canada was 161 per 100,000 — for
girls aged 15 to 19 it was a staggering 1,236.2 per
100,000. Back in 1996, those same rates were 114.8 and
998.6, respectively. A similar trend is seen globally.
Regular screening is considered
as one way to slow the spread of the STI. The UK, in
an effort to address the problem, announced in early
February that it would be inviting bids to test the
feasibility of free chlamydia screening for those aged
15 to 24, to take place in community pharmacies in London
and Cornwall, beginning late summer 2005.
"Specimens may be urineb or swab,
with results available in two working days," explains
Malcolm Fawcett, a spokesman for the UK's Department
of Health. "Bidders will determine the detail of the
screening process. It is envisaged that some [independent
service providers] will be able to deliver the service
from existing high street facilities by training existing
staff." He adds that when a positive test is reported,
patients will have to get a prescription from a doctor,
which the pharmacy might facilitate.
DOCS
NOT SOLD ON PLAN
Canadian experts in the field are looking on the British
scheme with a great deal of skepticism. Dr Gina Ogilvie,
associate director STD-AIDS control at the BC Centre
for Disease Control, is concerned about the potentially
limited followup of patients in the pharmacy setting.
"There's a lot more that happens in the clinical interaction
than simply a diagnostic test and some medication,"
she says. "There are issues of prevention." Dr Ogilvie
points to counselling as an effective and essential
way to prevent the spread of STIs and questions where
this service will fit in to the British model. "Is a
better way to have youth-focused clinics in high schools?
I don't know," she adds. "There's a lot of innovative
ways to improve access, and this is but one."
WHERE'S
THE FOLLOWUP?
Dr Ignatius Fong, of the division of infectious diseases
at St Michael's Hospital and a professor at the University
of Toronto, also has reservations about the program.
"If you drop off your sample at the pharmacy, it may
be positive, and what if you don't come back to get
the results and you don't get treatment?" he asks. "Normally,
if you have a positive test, you recommend a treatment
of partners and followup. It has to be more comprehensive."
Dr Fong says he just can't see
such a program working well in Canada. Rather, he explains,
"I think physicians should be more aware of screening
any sexually active person." He adds that it should
be routine and explains that a patient who has chlamydia
might also be carrying other STIs. "The time when people
look for it is when there are signs of sexually transmitted
diseases. It's common for chlamydia to run together
with other STIs."
SHOW
ME SOME PROOF
Nevertheless, Dr Ogilvie says she is pleased the UK
project will include an evaluation, and she'll be interested
to hear its findings. "I tend to make my decisions based
on evidence," she says. "Let's see what the evaluation
is and whether it works, and then we can talk about
whether we need it [in Canada]."
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