Background

Chlamydia trachomatis (chlamydia) is the most common bacterial sexually transmitted infection (STI). Its incidence in the UK has risen steadily since the mid-1990s, with new diagnoses rising by 1% from 121 791 to 123 018 (from 197 to 199 per 100 000 population) between 2007 and 2008.1 Generally the rates of chlamydia infections in other Western European countries are lower than those in the UK. Young people aged under 25 years are most likely to be infected, with 65% (80 258) of all new chlamydia diagnoses in the UK in 2008 in individuals between the ages of 16 and 24 years.2 The incidence of re-infection among women is estimated to be 15–30% at 1 year.3 4 Repeated infection is associated with an increased risk of complications including infertility.5 6

In 2003, the English Department of Health launched the National Chlamydia Screening Programme (NCSP), overseen by the Health Protection Agency. Since the NCSP's launch it has cost an estimated £100 million.7 The NCSP enables young people (<25 years) to access screening for chlamydia in a variety of community settings including general practitioner surgeries, and sexual health and genitourinary medicine (GUM) clinics. There have also been high-profile education campaigns targeted at younger age groups, and STIs are now discussed in school-based sex education programmes.8

Concurrently, there has been an increase in the number of rapid, self- and point of care tests (POCTs) for many conditions including chlamydia. However, these are not yet part of routine UK health service practice in the diagnosis and management of chlamydia. This is mainly because laboratory-based nucleic acid amplification tests (NAATs) are still the most sensitive and specific tests available and the NCSP stipulates that chlamydia screening must be carried out using NAATs.9

Point of care testing

POCTs are tests where both sampling and …