title: Use of a primary care database to determine trends in genital chlamydia testing, diagnostic episodes and management in UK general practice, 1990-2004.
abstract: OBJECTIVE
  To determine the extent of testing, diagnostic episodes and management of genital Chlamydia trachomatis (CT) infection in UK primary care using a large primary care database.
  
  
  METHODS
  The incidence of CT tests, diagnostic episodes, treatments and referrals was measured for all adult patients in the General Practice Research Database between 1990 and 2004.
  
  
  RESULTS
  Rates of CT testing in those aged 12-64 years in 2004 increased to 1439/100,000 patient years (py) in women but only 74/100,000 py in men. Testing rates were highest among 20-24-year-old women (5.5% tested in 2004), followed by 25-34-year-old women (3.7% tested in 2004). 0.5% of registered 16-24-year-old women were diagnosed as having CT infection in 2004. Three-quarters of patients with a recorded diagnosis of CT had had an appropriate prescription issued in 2004, a proportion that increased from 1990 along with a decrease in referrals to genitourinary medicine. In 2004, general practitioners treated 25.0% of all recorded diagnoses of CT in women and 5.1% of those in men.
  
  
  CONCLUSIONS
  Testing for and diagnostic episodes of CT in primary care have increased since 1990. Testing continues disproportionately to target women aged >24 years. Extremely low rates of testing in men, together with high positivity, demonstrate a missed opportunity for diagnosis of CT and contact tracing in general practice.
authors.affiliation: Department of HIV and STIs, Health Protection Agency Centre for Infections, London, UK. gwenda.hughes@hpa.org.uk
authors.forename: Gwenda
authors.initials: G
authors.lastname: Hughes
authors.forename: Tim
authors.initials: T
authors.lastname: Williams
authors.forename: Ian
authors.initials: I
authors.lastname: Simms
authors.forename: Catherine
authors.initials: C
authors.lastname: Mercer
authors.forename: Kevin
authors.initials: K
authors.lastname: Fenton
authors.forename: Jackie
authors.initials: J
authors.lastname: Cassell
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D002692:Chlamydia trachomatis; D005194:Family Practice / Q000639:trends; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000639:trends; D012017:Referral and Consultation; D006113:United Kingdom / Q000453:epidemiology; D014686:Venereology / Q000639:trends*