Who tests whom? A comprehensive overview of Chlamydia trachomatis test practices in a Dutch region among different STI care providers for urogenital, anorectal and oropharyngeal sites in young people: a cross-sectional study.
OBJECTIVE
To evaluate and compare Chlamydia trachomatis (CT) diagnostic test practices of different sexually transmitted infection (STI) care providers in 16-29 year olds from one defined geographic Dutch region (280,000 inhabitants). Both number and proportion of positive CT tests (ie, test positivity) were assessed, and factors associated with these outcomes.


METHODS
Data on laboratory testing and diagnosis of urogenital, anorectal and oropharyngeal CT between 2006 and 2010 were retrieved from general practitioners (GPs), gynaecologists, an STI clinic and a population-based chlamydia screening programme. Multivariable regression analyses explored associations between age, sex, test year, socio-economic status (SES) and STI care provider and the outcomes being the number of tests and test positivity.


RESULTS
Overall, 22,831 tests were performed (1868 positive; 8.2%). Extragenital (ie, anorectal and oropharyngeal) tests accounted for 4% of all tests (7.5% positive) and were almost exclusively (99%) performed by the STI clinic. STI clinics tested most men (37.2% of all tested men), whereas GPs tested most women (29.9% of all tested women). GPs and STI clinics accounted for 73.3% (1326/1808) of urogenital CT diagnoses. In women, the number of tests increased with age, whereas test positivity decreased for all STI care providers. Lower SES was associated with higher test positivity in GP and gynaecology patients.


CONCLUSIONS
STI clinics performed most CT tests in men, whereas GPs performed most CT tests in women. GPs and STI clinics accounted for the majority of positives. Extragenital CT testing is rarely performed outside the STI clinic and needs to be promoted, especially in men who have sex with men.
Department of Medical Microbiology, Maastricht University Medical Centre, School of Public Health and Primary Care, Maastricht, The Netherlands Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands.
Casper D J
CD
den Heijer
Department of Medical Microbiology, Maastricht University Medical Centre, School of Public Health and Primary Care, Maastricht, The Netherlands Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands.
G A F S
GA
van Liere
Department of Medical Microbiology, Maastricht University Medical Centre, School of Public Health and Primary Care, Maastricht, The Netherlands Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands.
C J P A
CJ
Hoebe
Department of General Practice, University of Amsterdam, Amsterdam, The Netherlands Soa Aids Nederland, Amsterdam, The Netherlands.
J E A M
JE
van Bergen
Department of General Practice, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
J W L
JW
Cals
Department of Medical Microbiology, Atrium Medical Centre, Heerlen, The Netherlands.
F S
FS
Stals
Department of Medical Microbiology, Maastricht University Medical Centre, School of Public Health and Primary Care, Maastricht, The Netherlands Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands.
N H T M
NH
Dukers-Muijrers
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001003:Anal Canal / Q000382:microbiology; D001437:Bacteriuria / Q000382:microbiology; D002584:Cervix Uteri / Q000382:microbiology; D002690:Chlamydia Infections / Q000175:diagnosis*; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D009960:Oropharynx / Q000382:microbiology; D016012:Poisson Distribution; D012007:Rectum / Q000382:microbiology; D017678:Sex Distribution; D015231:Sexually Transmitted Diseases, Bacterial / Q000175:diagnosis* / Q000382:microbiology; D012959:Socioeconomic Factors; D014521:Urethra / Q000382:microbiology; D014621:Vagina / Q000382:microbiology; D055815:Young Adult
CHLAMYDIA TRACHOMATIS; CLINICAL STI CARE; LABORATORY METHODS; SURVEILLANCE