Chlamydia - an increasing scandal of our times

The statistics for Chlamydia are a bit puzzling. If you go here, they tell you that the rate of infection has grown by 222% since 1995. And that this is more than double the growth of any other STD. Incidentally the second biggest ‘growth’ STD is gonorrhoea, but that declined by 10% in the 12 months 2003 – 2004. Chlamydia grew by 8% in the same period.

And according the The Times this week, that acceleration continues unabated. Here’s what the august journal says (25 Nov 2005): “Chlamydia, one of the commonest (STD), recorded a 9 per cent rise, with 104,155 new cases last year. Chlamydia screening among the 16-24 age group has found that about one in eight is infected, though only a minority is aware of it.”

But whatever the figures, I think the end result is clear: it’s no exaggeration to say that Chlamydia is one of the bigger of the serious issues facing society.

What is Chlamydia? Here’s what the Dept of Health says about it on their own website here “Genital Chlamydia trachomatis infection is the most commonly diagnosed bacterial sexually transmitted infection in genitourinary medicine (GUM) clinics in the United Kingdom. The number of diagnoses of uncomplicated genital chlamydial infection in GUM clinics has risen steadily since the mid-1990s. The prevalence is highest in sexually active adults, especially women aged 16 to 24 years and men aged 18 to 29 years. As most people are asymptomatic, large proportions of cases remain undiagnosed. Untreated genital chlamydial infection may have serious long-term consequences, especially in women in whom it is a well-established cause of pelvic inflammatory disease (PID), ectopic pregnancy and infertility. The annual cost of Chlamydia and its consequences in the United Kingdom is estimated to be more than £100 million.”

It’s fair to conclude from this information that Chlamydia is on the increase. Further, it’s our fastest growing STD today. You might draw the conclusion from this that Chlamydia is a difficult little bug to shift: that a cure is hard, and prevention harder. And that’s the scandal. Nothing could be further from the truth. It’s easy to cure, and with a little sense, easy to prevent. But the pain and heartache this little microrganism is settled in to cause in some of those hundred of thousands of (mainly) girls who have it now is a national disgrace. If it was your daughter, or sister, or someone you knew - and because it is so prevalent (one in eight 16-24 year old women. One in eight!), you probably know someone affected - you would want something done. And the shame is that prevention and cure is really quite straightforward.

Let’s examine the status quo. Even though it is a ‘silent’ disease (ie. virtually symptomless) Chlamydia is simple to diagnose. There are two common types of test, one lab test which takes about one to two weeks and is very accurate, and one in-surgery test which takes about ten minutes and is marginally less accurate. We are talking very high 90’s in percentage terms for both tests. Naturally both test cost a little to instigate; the lab test a few tens of pence, the in-surgery test maybe a pound or so, per patient.

For men, it is less simple, and the main test involves shoving a cotton-bud like item up the urethra: uncomfortable, and so, not surprisingly, many men refuse. There is also an in-stream test, for bother genders, but it is the least accurate at the moment. However, history shows that if the market developed, competition among diagnostic companies would soon improve the quality of the tests.

So that’s easy then, you test sexually active girls who are under thirty and men who are symptomatic. You get the results in about ten minutes and that’s an opportunity, instead of twiddling your thumbs and whistling while you are waiting, to talk through some of the risks of STDs including our dear friend Chlamydia, and safe sex in general. Because, apparently, we have message fatigue. So it needs drumming home. Meanwhile the test result shows positive or negative and treatment can be chosen as appropriate.

Only that’s not what happens.

If a test is carried out at all (and I’m talking about tests in GPs practices, not under the government STD screening programme), it is most likely to be the lab test. So the results are back in what, a week or so. And that means that the patient has to make another appointment, remember to come back, and be interested in the result. But they don’t feel ill. Remember 70% of infected people show no symptoms. And they are presumably shagging away in the interim possibly infecting a new partner, or worse more than one, with no knowledge of their STD status and, likely, little or no discussion about safe sex. If they knew about safe sex, and practised it they are unlikely to have picked up Chlamydia in the first place.

If someone has Chlamydia it is easily dealt with. A prescription of appropriate antibiotics for seven days should clear it up, and prevent its most damaging consequences which include pain and infertility from blocked fallopian tubes. And at the moment there's only one way round those if you want to get pregnant: IVF.

So the most likely thing to happen is that some young women, especially those who attend a clinic, are sometimes given a dose of cheap generic antibiotics costing maybe 30p. But where is the motivation to take them: you are given them for something you may not have and don’t understand?. So, although I have no evidence for this, logic says that most courses won’t get finished. They probably hang on to them for next time they get a cold. Or the clap. And what’s more both partners have to take it. And if s/he has more than one partner, or one takes it and the other doesn’t … it is a fatally flawed policy. And transparently failing our 16-30 sexually active population.

I think this is a serious scandal. More than 100,000 people are getting infected each year with something so potentially damaging and devastating to their lives. To say nothing of the on-cost of resolving the pain and infertility issues in these women later in life.

But there’s more. What about the morals of handing out doses of antibiotics as prophylaxis? Let’s talk about SARS or MRSA shall we?

And so what’s the government doing? A decent policy instigated now should, in about 15 years see Chlamydia reduced to the ranks of insignificance where it belongs. But this government, and this is straight from the horses mouth, are not interested in anything with a longer window than four years. And that’s official. So they’ll keep banging out £100 million per annum, and looking forward to an ever increasing bill than cure their people, our friends and relatives of a disease that is easy to deal with.

It makes my blood boil. The government primarily, and may I say the medical profession for allowing this outrage to continue unabated, should all should be hanging their heads in shame.

Happy Christmas.

More info on Chlamydia here: www.netdoctor.co.uk and here www.nhsdirect.nhs.uk

You can buy self-tests if you are concerned (and if you have had a new partner who's exact sexual history is unknown to you, and I mean very exact, or more than one partner this year, you should consider a check). Or visit your GP and ask to be tested. They will do it, but I'd love to know how they do it and what else they offer you. Or you can visit any GUM clinic and your GP will not be informed. Find them at the Society of Sexual Health Advisors here.

And please, always Practise Safe Sex

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