New research carried out by researchers from the Royal College of Surgeons in Ireland (RCSI), NUI Galway and the Health Service Executive (HSE) has found that a national screening campaign for chlamydia in young people would not prove cost effective. The research also explored the attitudes, fears and preferences of young Irish men and women aged 18-29 years old towards accepting tests to detect chlamydia.

The Chlamydia Screening in Ireland Pilot Study, which was funded by the Health Protection Surveillance Centre and supported by the Health Research Board, looked at the feasibility of opportunistic screening in a general practice setting for chlamydia, which is a sexually transmitted infection (STI). Like other countries, Ireland is experiencing a steady increase in the numbers of young women and men presenting to the health services with STIs; the annual numbers of cases of chlamydia rose from 1000 in 1997 to around 6000 in 2008-09.

Chlamydia is the most commonly reported bacterial STI in Ireland, with highest numbers reported among 20-29 year-olds. More often than not it is silent and causes no symptoms - especially in women - but can cause serious complications such as infertility and ectopic pregnancies.

Dr Emer O'Connell, Consultant in Public Health Medicine in the HSE presented study findings at Ireland's first ever Sexual Health Awareness Week, which was officially launched in the Royal College of Physicians of Ireland today. "Screening for chlamydia is available in many countries. However, some countries such as Australia are reviewing the effectiveness of this measure. In Ireland, due to our small population and the strain already on our health service, a screening programme for chlamydia would not be cost effective because it would be difficult to achieve the necessary coverage levels to reduce the level of infection."

The research found that the main barrier reported by young people to seeking or accepting an STI test was the stigma associated with chlamydia and other STIs. This stigma was greatest among women especially those from rural backgrounds and in urban working class areas who feared the consequences of being publicly exposed - to their families and peers -through asking for an STI test.

Despite the stigma associated with an STI test, there was a high level of willingness among young men and women to take a chlamydia test if offered by a health professional. 95% said it would be acceptable to be offered the test and 75% of students said they would accept the test if offered. The research also found that 80% of those involved in the study said they would inform their current partner if they tested positive for chlamydia but this rate fell to 55-60% in the case of previous partners.

Professor Ruairi Brugha, Head of the Department of Epidemiology & Public Health Medicine, RCSI, said: "While this study demonstrated that a national chlamydia screening programme would not be cost-effective in Ireland, it reports important positive findings. Young people are aware of the risks and are anxious that STI testing services be made accessible and acceptable. We also found that there are primary care providers who are willing to provide such services."

Dr Diarmuid O'Donovan, College of Medicine, Nursing and Health Sciences, NUI Galway, said: "The study findings provide evidence of how to protect the sexual health of young Irish people. Given these findings, a national sexual health plan should include primary prevention activities such as sex education, condom distribution and the provision of information on how to seek care for STIs. Therefore, we recommend the inclusion of primary care-delivered chlamydia detection and case management services as part of a national action plan to promote sexual health."

The research from The Chlamydia Screening in Ireland Pilot Study will be presented today during Ireland's first ever national Sexual Health Awareness Week (SHAW). SHAW is being hosted by the Royal College of Physicians of Ireland (RCPI). A range of public meetings, debates and interactive workshops promoting sexual health awareness at a national leave are taking place in RCPI from 28th -31st May, all of which are free and open to the public.

About the study
Background studies for the Chlamydia Screening in Ireland Pilot Study were conducted between 2007 and 2009 by researchers in RCSI, NUI Galway and the HSE. In-depth interviews were conducted with 18 to 29 year-olds in Dublin and Galway, including 35 women who had never been tested for a STI and 30 men and women who had had a STI test. Focus group discussions were run with four sets of students. 5685 students across five Higher Education Institutions and 400 patients attending GPs and other primary care settings completed structured questionnaires.

Over a 15-month period, women and men aged 18-29 years who attended general practices, student health units, and a family planning clinic in the West of Ireland were invited by the staff to give a urine sample to test for chlamydia. Students in two colleges were invited to provide urine samples in anonymous settings, called ‘pee-in-the-pot', during one week Sexual Health Awareness and Guidance (SHAG) college events.

Around 1,000 young people were screened across these clinical and non-clinical settings of whom 48 tested positive. Almost all were traced and all these were treated. The one-week college pee-in-the-pot events accounted for half of those screened due to the ease of access to free, private and anonymous testing.

The study used accepted international benchmarks - incremental cost per quality adjusted life year (QALYs) saved - to compare investment in chlamydia screening with other uses of health resources. The estimated costs per QALY were too high to be considered cost effective.

The full reports are available on: http://epubs.rcsi.ie/ephmrep/8.