title: Barriers to opportunistic chlamydia testing in primary care.
abstract: BACKGROUND
  Opportunistic testing and screening for genital chlamydia infection in sexually active women under the age of 25 years can lead to a reduction in chlamydia infection and its related morbidity.
  
  
  OBJECTIVE
  To explore the barriers to testing for genital chlamydial infection in primary care.
  
  
  METHODS
  Qualitative study with focus groups.
  
  
  METHODS
  Rural and urban general practice in Southwest England.
  
  
  METHODS
  Focus groups were held with randomly selected high- and lowtesting general practices in Herefordshire, Gloucestershire and Avon. The high- and low-testing practices did not differ in their age/sex make-up, or by deprivation indices. Open questions were asked about the management of genitourinary symptoms and opportunistic testing for chlamydia. Data were collected and analysed concurrently until saturation occurred.
  
  
  RESULTS
  Although staff from high test rate practices were much more aware of the evidence for opportunistic chlamydia testing and screening, none of the practices were happy to discuss chlamydia in a consultation unrelated to sexual health. The greatest barriers to opportunistic chlamydia testing and screening were lack of knowledge of the benefits of testing, when and how to take specimens, lack of time, worries about discussing sexual health, and lack of guidance. Healthcare staff stated that any increased testing should be accompanied by clear, concise primary care trust guidance on when and how to test, including how to obtain informed consent and perform contact tracing. Staff felt that testing could be undertaken at family planning clinics or with cervical smears if patients received information before the consultation. Alternatively, in larger practices specific chlamydia clinics could be held.
  
  
  CONCLUSIONS
  The Department of Health needs to be aware of the extreme pressures that primary care staff are under, and the potential barriers to any screening implementation. Efforts to increase chlamydia screening in this setting should be accompanied by clear guidance and education. Any chlamydia clinics or increased testing must have appropriate financial and staff resources. Genitourinary medicine (GUM) clinics, or level three practices with GUM expertise, will need to be increased in parallel with testing in primary care to provide appropriate contact tracing and follow-up.
authors.affiliation: Health Protection Agency, Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Gloucester. jill.whiting@hpa.org.uk
authors.forename: Cliodna A M
authors.initials: CA
authors.lastname: McNulty
authors.forename: Elaine
authors.initials: E
authors.lastname: Freeman
authors.forename: Jo
authors.initials: J
authors.lastname: Bowen
authors.forename: Julia
authors.initials: J
authors.lastname: Shefras
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Fenton
mesh_terms: D001294:Attitude to Health; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000517:prevention & control; D004739:England; D005194:Family Practice / Q000706:statistics & numerical data; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012423:Rural Health; D014504:Urban Health