Infertility fears over plan to cut chlamydia screening

Published on Saturday 28 March 2009 20:00

HEALTH chiefs are planning to cut testing for one of the most common sexually-transmitted diseases in Scotland amid controversial claims the infection is less dangerous than once feared.

Chlamydia affects up to one in 10 people under 25 and cases reached a record high of 19,054 last year. But Scotland on Sunday can reveal new guidelines state there is no evidence that chlamydia causes widespread infertility, and will advise against a major screening programme.

Critics voiced alarm at the move and warned it was simply a "cost-cutting exercise" that would leave many people at risk of infertility.

Chlamydia often has no symptoms and is particularly problematic in women, leading to pelvic inflammatory disease, ectopic pregnancies and infertility in some cases. In England, around one million people have been tested as part of a multi-million pound screening programme.

Tomorrow, the Scottish Intercollegiate Guidelines Network (Sign), which issues advice to the NHS, will publish a report claiming chlamydia is far less likely to cause serious problems than previously feared, and advises against testing large numbers of people just in case they have the disease.

New research suggests just 3% of women who catch chlamydia are now thought to go on to suffer infertility and Sign has concluded that widespread screening is unlikely to be worth the cost. Instead, doctors will be told to concentrate on teenagers, those who have previously tested positive for the infection, and their partners.

The report also claims many cases "clear spontaneously" without the need for antibiotics.

The recommendation is a massive U-turn on previous policies. Scotland spends around 5m a year on sexual health, including chlamydia testing and treatment, and the infection has been at the centre of numerous public health campaigns.

In England, around 332,000 people are screened and treated annually in a nationwide campaign that has cost 80m over five years. There are no plans to scrap this campaign.

Dr Gordon Scott, chair of the Sign guideline development group and head of genitourinary medicine at NHS Lothian, said widespread screening was not a "good use of resources".

Scott said: "Chlamydia is not completely harmless, but it's much less likely to do serious harm than was previously thought. In the past people thought the complication rate was really, really high and significant proportion of women would end up with serious complications. But it's only a very small minority."

He added: "It has gradually dawned on us we had overestimated the risk. It goes away spontaneously in most people. Unfortunately, every now and again, someone does suffer a really nasty consequence. But it's not as predictively harmful as we thought."

He added that a number of studies, including a review by Health Protection Scotland, found no robust clinical studies linking chlamydia with infertility. Other new research suggests that just 3% of women could suffer infertility from chlamydia. Experts previously feared up to 40% of women who have chlamydia will develop pelvic inflammatory disease, many of whom will go on to have difficulties conceiving.

Current guidelines state tests should be offered to the under 25s and anyone who has had a new sexual partner in the past year. But the new guidelines state tests should be targeted at those under 25 and anyone who has had two or more partners in the past year. Doctors will also target those who have previously tested positive.

Scottish Conservative health spokeswoman Mary Scanlon, said:

"For the last decade chlamydia has been raised as a matter of serious concern because it is symptomless and can lead to infertility. It is shocking that they are suddenly denying that this is the case.

"The fact that England is going ahead with a massive screening campaign raises the question that this guideline is a cost-cutting exercise."

Susan Seenan, of the Infertility Network UK, warned a screening programme was vital to prevent as many cases of infertility as possible.

"We believe screening programmes are cost-effective in the long term and might prevent many hundreds of couples each year having to seek fertility treatment."

A Scottish Government spokeswoman said: "We welcome the publication of the Sign guidelines. There is no evidence to support a national screening programme. We will continue to carry out targeted testing."