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• Prevention of complications must be the primary outcome measure if a screening program is evaluated
  Veronique Verhoeven
  Published on: 16 February 2005

• Published on: 16 February 2005

  Prevention of complications must be the primary outcome measure if a screening program is evaluated

  • Veronique Verhoeven, researcher
  • Other Contributors:
    • Dirk Avonts, and Paul Van Royen

  Dear Editor,

  Senok et al. [1] present a very useful study on the evaluation of strategies for screening for chlamydial infection. The actual lack of information on effectiveness of different screening strategies leads to divergent opinions among Chlamydia researchers and various screening initiatives by policy makers. Evaluation of current screening programmes, which are carried out now in many countrie...

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  Dear Editor,

  Senok et al. [1] present a very useful study on the evaluation of strategies for screening for chlamydial infection. The actual lack of information on effectiveness of different screening strategies leads to divergent opinions among Chlamydia researchers and various screening initiatives by policy makers. Evaluation of current screening programmes, which are carried out now in many countries, will probably give some answers in the near future. The low participation of young women in both settings in this feasibility study (22% in postal screening and 60% in opportunistic screening) is also recently reported by others [2,3] and is problematic. This may indicate that the general practice setting is not optimal to reach this high risk target group. It is doubtful that a combination of postal and opportunistic screening, as suggested by the authors, will result in optimal coverage. Other than general practice-based strategies must be added, for example offering screening in secondary schools.

  An important issue in evaluating screening strategies is the choice of outcome measures: not so much the diagnosis of chlamydial infection as the prevention of complications following chlamydial infection determines the success of a screening programme. The burden of chlamydial disease, consisting of PID, ectopic pregnancy and infertility, is largely unknown in the general practice population. If an RCT with an adequate sample size is planned, which would be, as the authors point out, a challenging and expensive enterprise, the validity of the results would be greatly improved by adding an outcome parameter measuring the reduction of complications by screening.

  References

  (1) Senok A, Wilson P, Reid M, et al. Can we evaluate population screening strategies in UK general practice? A pilot randomised controlled trial comparing postal and opportunistic screening for genital chlamydial infection. J Epidemiol Community Health 2005;59:198-204

  (2) van Bergen J, Götz HM, Richardus JH, et al. Prevalence of urogenital Chlamydia trachomatis increases significantly with level of urbanisation and suggests targeted screening approaches: results from the first national population based study in the Netherlands Sex Transm Infect 2005;81:17-23

  (3) Verhoeven V, Avonts D, Van Royen P, et al. Performance of a screening algorithm for chlamydial infection in two samples of patients in general practice. Scand J Infect Dis 2004;36:873-5

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  Conflict of Interest:
  None declared.

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