Call for Chlamydia Screening
Irish Times 18/07/2006
by Theresa Judge
20% of young women attending clinic infected
An urgent need for Chlamydia screening among young
people has been highlighted by the Dublin Well Woman
Centre after it emerged that 20% of women aged under
20 who attended a clinic in Coolock tested positive
for the STI. At another clinic, on Liffey St in
the city centre, 14% of those aged under 20 had
the infection. Chlamydia testing has been offered
to young women attending the centres clinics since
the start of 2005.
to 70% of people with Chlamydia experience no symptoms,
but if it goes untreated in women it can cause pelvic
pain and damage to the Falopian tubes, which can
result in Eptopic pregnancies and infertility. It
is the most common bacterial infection worldwide.
medical director of the Well Woman centre Dr Shirley
McQuade, said it was a public health issue that
needed to be addressed urgently. It was "incredible,
given evidence of such high infection rates, that
public health doctors were not addressing the problem,
she said. Because there are no prevalence figures
for Chlamydia in Ireland, nobody knows how many
people are infected.
McQuade said statistics that were emerging suggested
a huge "underdiagnosis throughout the country".
For example the Health Protection Surveillance Centre
(HSPC) recorded just 2,258 cases of Chlamydia in
2004. Yet in 2005 the three clinics run by the Well
Woman centre in Dublin diagnosed 238 cases - or
one tenth of the national figure - once it started
to encourage people to be tested. "This suggests
there are vast areas where people are not being
tested at all". Dr McQuade said.
one entire health board area, there were no recorded
cases in 2002. The Well Woman Centre found much
higher among young women aged under 25 than in older
age groups and the problem appears to be greater
among women from poorer economic backgrounds. The
statistics compiled by the centre are based on 9,206
Chlamydia tests carried out at three clinics over
four years from 2002 to 2005. Among women aged 35
- 39, the rate in all three clinics was less than
6%. At the Pembroke Rd clinic in a more affluent
area of South Dublin, the rate among women under
20 was just 4%. The concerns expressed by Dr McQuade
about Chlamydia and the lack of information on its
prevalence in Ireland are not new.
Oct 2005, a report entitled, The Need for Chlamydia
Screening in Ireland, was produced by the scientific
advisory committee of the HSPC. It pointed out,
that because most people with the infection do not
have any symptoms, screening "is an essential component
of control programmes". It concluded, that, "data
from Irish research is urgently required" to establish
the prevalence of infection in different sub-populations
and to inform policy on the need for screening.
then, the HSPC has commissioned the Health Research
Board to undertake a pilot study to examine the
most effective way to screen for Chlamydia. Funding
of €500,000 has been allocated for this research.
It is not expected to be completed for about two
years however, as there must first be a tendering
process before the research contract can be awarded.
An expert steering group - with members from Ireland
and abroad - has been appointed to oversee the study.
Fidelma Fitzpatrick of the HSPC said this research
"was an important first step" as there were a number
of issues that needed to be addressed. She said
an approach to screening that was acceptable in
one country, may not be successful in a different
country. Another issue concerns the procedure that
would be followed in contacting the previous sexual
partners of a person diagnosed with Chlamydia.
that this research will take two years, there is
no possibility of screening being introduced for
a number of years. In the meantime, many young people
will be unaware they are infected and will affect
others if they engage in unprotected sex. The infection
can be passed on in a single sexual encounter.
executive of the Well Woman centre Alison Begas,
said one factor contributing to high levels of Chlamydia
among women under 20 was a lack of negotiating skills
to insist that condoms were used. In addition, people
are having sex much younger and with more partners.
If Chlamydia is detected early it can be treated,
but Ms Begas fears that people are being discouraged
from getting tested because public services are
so over stretched. Getting tested should be made
as easy as possible, but in reality it is very difficult
unless people can attend private clinics such as
the Well Woman centre.
STI clinic at the mater hospital in Dublin sometimes
has to close it's waiting list because it cannot
cope with the demand. At St James' hospital people
have had to wait up to 8 weeks for full STI screening.
In Britain, clinics operate on the basis that people
should be given appointments within 48 hours. If
a person is diagnosed with one STI they should automatically
be tested for other STI's.
Well Woman Centre points out that a urine sample
is all that is required to test for Chlamydia and
it encourages all women who attend the centre to
be tested. The Coolock Clinic accepts medical card-holders.
If Chlamydia is not detected early it can have devastating
effects. A study in Sweden found that just under
7% of women with Chlamydia were infertile. "Some
women don't realise they have it until they try
to start a family", said Ms Begas