title: Patterns of chlamydia testing in different settings and implications for wider STI diagnosis and care: a probability sample survey of the British population.
abstract: Following widespread rollout of chlamydia testing to non-specialist and community settings in the UK, many individuals receive a chlamydia test without being offered comprehensive STI and HIV testing. We assess sexual behaviour among testers in different settings with a view to understanding their need for other STI diagnostic services.
  
  
  
  A probability sample survey of the British population undertaken 2010-2012 (the third National Survey of Sexual Attitudes and Lifestyles). We analysed weighted data on chlamydia testing (past year), including location of most recent test, and diagnoses (past 5 years) from individuals aged 16-44 years reporting at least one sexual partner in the past year (4992 women, 3406 men).
  
  
  
  Of the 26.8% (95% CI 25.4% to 28.2%) of women and 16.7% (15.5% to 18.1%) of men reporting a chlamydia test in the past year, 28.4% of women and 41.2% of men had tested in genitourinary medicine (GUM), 41.1% and 20.7% of women and men respectively tested in general practice (GP) and the remainder tested in other non-GUM settings. Women tested outside GUM were more likely to be older, in a relationship and to live in rural areas. Individuals tested outside GUM reported fewer risk behaviours; nevertheless, 11.0% (8.6% to 14.1%) of women and 6.8% (3.9% to 11.6%) of men tested in GP and 13.2% (10.2% to 16.8%) and 9.6% (6.5% to 13.8%) of women and men tested in other non-GUM settings reported 'unsafe sex', defined as two or more partners and no condom use with any partner in the past year. Individuals treated for chlamydia outside GUM in the past 5 years were less likely to report an HIV test in that time frame (women: 54.5% (42.7% to 65.7%) vs 74.1% (65.9% to 80.9%) in GUM; men: 23.9% (12.7% to 40.5%) vs 65.8% (56.2% to 74.3%)).
  
  
  
  Most chlamydia testing occurred in non-GUM settings, among populations reporting fewer risk behaviours. However, there is a need to provide pathways to comprehensive STI care to the sizeable minority at higher risk.
authors.affiliation: Centre for Sexual Health and HIV Research, UCL, London, UK.
authors.forename: Soazig
authors.initials: S
authors.lastname: Clifton
authors.affiliation: Centre for Sexual Health and HIV Research, UCL, London, UK.
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Mercer
authors.affiliation: HIV & STI Department, National Infection Service, Public Health England, London, UK.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Woodhall
authors.affiliation: Centre for Sexual Health and HIV Research, UCL, London, UK.
authors.forename: Pam
authors.initials: P
authors.lastname: Sonnenberg
authors.affiliation: Centre for Sexual Health and HIV Research, UCL, London, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Field
authors.affiliation: Centre for Sexual Health and HIV Research, UCL, London, UK.
authors.forename: Le
authors.initials: L
authors.lastname: Lu
authors.affiliation: Centre for Sexual Health and HIV Research, UCL, London, UK.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Johnson
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.
authors.forename: Jackie A
authors.initials: JA
authors.lastname: Cassell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D060728:Reproductive Health; D012494:Sampling Studies; D012725:Sexual Behavior / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: CHLAMYDIA TRACHOMATIS; GENERAL PRACTICE; HIV TESTING; SCREENING