Written by Veronica Wignall, Assistant Editor, BMC Series
Chlamydia, the most common bacterial sexually transmitted infection (STI), is easily tested for and easily treated. However, since the disease is asymptomatic in over 80% of cases it can remain undiagnosed, leading to increased transmission between sexual partners and a higher incidence in the population. Left untreated, chlamydia can lead to pelvic inflammatory disease (PID) in women, a painful infection of the upper genital tract that can lead to several complications including ectopic pregnancy, miscarriage and infertility; men can also become infertile.
While self-testing kits for chlamydia are available at many sexual health clinics and doctors’ surgeries, a primary source of testing is directly via a general practitioner (GP). But is every GP equally likely to test a patient for this STI? Not necessarily, according to a new study published recently in BMC Infectious Diseases, by Dr Jane Hocking and colleagues as part of the Australian Chlamydia Control Effectiveness Pilot trial (ACCEPt).
Female sex and living in the city
Female gender and living in a metropolitan environment have been linked to increased chlamydia testing rates in GPs; women tend to be more comfortable consulting a female GP, and as well as the fact that there can be fewer doctors in remote areas, people in remote, close-knit communities can be reluctant to seek sexual health advice due to privacy concerns. However, the influence of GP knowledge on their testing frequency for chlamydia has remained unexplored until now. Empirical testing rate and survey data were collected as part of ACCEPt, an ongoing Australian trial investigating the impact of a general practice-based chlamydia testing intervention on STI incidence.
A patient presents with lower abdominal pain…
The survey presented a variety of testing scenarios and knowledge-based questions that assessed GPs’ knowledge of appropriate chlamydia testing practice. When the survey data was analysed alongside demographic variables in two multivariable models, interesting associations were revealed.
Female general practitioners had better testing, re-testing and symptomatic knowledge than their male counterparts, and were three times as likely to test for chlamydia. Living in a city increased testing rates, while younger GPs were more likely to test irrespective of gender. Importantly, GPs with better knowledge were more likely to test for chlamydia.
Sexual health education
While models show that testing rates in Australia must be at least 30% to reduce chlamydia in the population, this figure remains below 10%. This trial suggests that comprehensive sexual health education for GPs could address this issue, since greater knowledge about chlamydia is correlated with higher testing rates; furthermore since there are fewer female than male GPs in Australia (41% vs 59%), it is all the more important to ensure that both sexes are equally aware of the need to test for chlamydia.