Genital Chlamydia Trachomatis Infection in a Subgroup of Young Men in the UK

Few data are available about frequency of Chlamydia trachomatis infection among men in the United Kingdom in settings outside of genitourinary medicine clinics. The largest study, in conjunction with the National Survey of Sexual Attitudes and Lifestyles survey, showed a rate of 2.2 percent in men. Two smaller studies showed a rate of 1.9 percent in young men in London, and a frequency of 1.2 percent among male students in Sheffield. However, these studies had low response rates (29 percent to 51 percent), raising concerns about selection bias.

As a part of the Healthy Respect project -- a Scottish Executive-funded program that aims to promote positive sexual health and relationships, to reduce the number of teenage pregnancies, and to prevent the spread of STDs among young people in Lothian, Scotland -- the authors are determining ways of making chlamydia testing available in new settings, with an emphasis on the involvement of men.

In a study conducted between April 2001 and April 2002, new recruits at the Glencorse military barracks, which includes recruits from all over the United Kingdom as well as from other Commonwealth countries, underwent a routine medical examination, including urinalysis. Recruits were given a leaflet with information about chlamydia and the study. After an individual interview by a civilian medical practitioner at the time the urine sample was provided, all recruits gave consent to participate in the study.

The urine samples were tested for chlamydia and positive results were given to the recruits in confidence. Nurses gave treatment with azithromycin and undertook contact tracing. A total of 798 tests on 15 separate intakes of recruits were done, of which 78 (9.8 percent) were positive for C. trachomatis. All age groups had similar rates of infection. Eighty-four of the 798 recruits were from countries other than the United Kingdom. Chlamydia frequency was 9.3 percent when all the non-British recruits were excluded. Sixty-nine (88 percent) of the 78 chlamydia-positive men were asymptomatic.

The study's strength was that it was not a self-selecting population in terms of sexual activity, and there was 100 percent participation. Because some of the recruits might never have had sexual intercourse, the chlamydia infection rate among the sexually active men is probably greater than 9.8 percent. The finding of similar rates of chlamydia in all age groups contrasts with others who have shown increased rates in men ages 25-34. The current finding "that the rate of asymptomatic infections was higher than that usually cited 50 percent shows the importance of involving men as well as women in opportunistic testing for chlamydia," the authors concluded.

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