Only 1% of men under 25 and 3% of women in this age group in the South East underwent chlamydia screening in the fourth year of the national programme.

Community contraception services, youth services and general practice detected the majority of positive results in both sexes, nearly half of positive men and almost two-thirds of positive women.

Future strategies should prioritise increasing testing of young men in healthcare settings, researchers conclude.

The National Chlamydia Screening Programme (NCSP) is an opportunistic screening programme for chlamydia in under-25s that has been rolled out in England since 2003. All anonymised data from the NCSP from April 2006 to March 2007 were analysed in the South East region.

The authors looked at the relationship between coverage and positivity in relation to demographic characteristics or settings.

The data available included: test result; sex; postcode of residence; ethnicity; age and clinic type.

A postcode directory was used to map postcodes to administrative areas based on population size to estimate coverage. Healthcare settings, according to NCSP guidance at that time, included: A&E (also walk-in centres and minor injury units); community contraceptive clinics; general practice; obstetrics and gynaecology; pharmacy; prison; sexual health and termination of pregnancy services. Non-healthcare settings included: chlamydia screening offices; military outreach; postal kits; universities, colleges and schools and youth services.

Overall coverage was low in both young men and women, 1.0% and 3.3% respectively. Coverage in women was lower in the least deprived areas compared with the most deprived areas, odds ratio (OR) 0.48 (95% CI: 0.45-0.50). Testing rates were lower in 20-24 year olds compared with 15-19 year olds OR 0.69 (95% CI: 0.67-0.72) for women and OR 0.67 (95% CI: 0.64-0.71) for men, but positivity was higher in men aged 20-24.

Women were tested most often in healthcare settings, which also identified the most positives. The greatest proportion of tests on men were carried out in university (27%) and military settings (19%) which only identified 11% and 13% of positives retrospectively. More positive cases in men were identified through healthcare settings despite fewer numbers of tests. Community contraception services, youth services and general practice detected the majority of positive results in both sexes, 44% of positive men and 61% of positive women.

The authors suggest that a strategy that can give access to both high numbers of the target population and a wide variety of individuals needs to be developed. They call for greater engagement with general practice, contraceptive services and youth clinics - all of which can generate large volumes with relatively high positivity compared with other settings.

Dr Richard Ma