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Opportunistic screening of those under the age of 25 in healthcare settings might not be cost‐effective. Adams et al's study is directly relevant to the National Chlamydia Screening Programme in England. They used empirical data from the programme's pilot studies, and modelled the main screening approach used in the programme in a state‐of‐the‐art mathematical model. The only scenarios that were cost effective required assumptions that the rate of progression of chlamydia to pelvic inflammatory disease was 10% and 40% of the target population was screened each year. The authors suggest that restricting screening to those under the age of 20 years would be cost effective. In a commentary, Roberts and Low discuss the uncertainty in measuring the cost effectiveness of chlamydia screening, and Adams et al respond.
See p 267–75
Mycoplasma genitalium is almost certainly a sexually transmitted infection, but its virulence is disputed. In a case–control study Jurstrand et al found weak statistical evidence of associations between serological evidence of M genitalium and pelvic inflammatory disease or ectopic pregnancy in women aged 15–30 years, but not in women aged 31–50 years. After controlling for serological evidence of Chlamydia trachomatis infection these associations were attenuated. In contrast, the associations between chlamydia and pelvic inflammatory disease or ectopic pregnancy remained unchanged after adjusting for the presence of mycoplasma. Large prospective studies are now required.
See p 319
The emergence of a mutant strain of Chlamydia trachomatis in Sweden is an exciting but worrying event. Herrmann summarises the story so far. The mutant escapes detection by two widely used nucleic acid amplification tests, so a large number of chlamydia infections went undetected throughout Sweden. This setback follows a previous problem with an earlier test produced by one of the affected companies, in which positive results could not be confirmed. Diagnostics companies should take note.
See p 253
Aral et al provide a major overview of trends in sexually transmitted infections in the USA. They report interesting differences between infections, and ethnic and geographic differences remain stark. Worryingly, syphilis rates in African–Americans are beginning to increase after a sustained decline. Conversely, the recent increase in gonorrhoea rates nationally has been among white men and women, while rates in African–Americans have declined. The review also highlights the future challenges of implementing and evaluating preventive efforts.
See p 257