To the Editor: Elshaug and colleagues identified chlamydia screening of under-25-year-olds in the general population as a potentially low-value health care practice.1 They cite a systematic review that found that evidence from randomised controlled trials (RCTs) on the impact of chlamydia screening on reducing pelvic inflammatory disease (PID) was limited to high-risk populations, had methodological limitations and had never involved repeated rounds of screening.2 However, a recent RCT of a single round of screening, although underpowered to find a difference in PID incidence, did find that 9.5% of women with untreated chlamydia developed PID, compared with 1.6% of those who were treated (relative risk, 0.17; 95% CI, 0.17–1.01).3
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- 1. Elshaug AG, Watt AM, Mundy L, Willis CD. Over 150 potentially low-value health care practices: an Australian study. Med J Aust 2012; 197: 556-560. <MJA full text>
- 2. Low N, Bender N, Nartey L, et al. Effectiveness of chlamydia screening: systematic review. Int J Epidemiol 2009; 38: 435-448.
- 3. Oakeshott P, Kerry S, Aghaizu A, et al. Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial. BMJ 2010; 340: c1642.
- 4. Kong FYS, Guy RJ, Hocking JS, et al. Australian general practitioner chlamydia testing rates among young people. Med J Aust 2011; 194: 249-252. <MJA full text>
- 5. Guidelines for preventive activities in general practice. 8th ed. Melbourne: Royal Australian College of General Practitioners, 2012.
We are all named investigators on a clinical trial of a chlamydia testing intervention in general practice funded by the Department of Health and Ageing and National Health and Medical Research Council. This trial is currently in progress.