Our results identified three primary areas of concern after a diagnosis of chlamydia: the perceived stigma of sexually transmitted infections, worry about future reproductive health, and anxiety associated with notifying partners. Our results have several implications for the proposed screening programme. Firstly, information given to women before screening should seek to normalise and destigmatise chlamydial infection to reduce the negative psychological impact of a positive diagnosis. Secondly, although it was clear that the information given to women by staff served to lessen, if not eradicate, stigma, disclosure of the condition to others remained a source of anxiety (specifically, that others would react badly). This anxiety may be exacerbated if women feel unable to access their usual support network. Thus, support services should be available if required. Women attending a genitourinary medicine clinic highlighted the important role of health advisors in providing advice and reassurance. Given the uncertainties associated with chlamydial infection and that reassurance about one factor can increase anxiety about another, staff outside specialised services may require guidance in providing support to women diagnosed with infection. Finally the chief medical officer's report recommends that women with positive diagnoses should be referred to genitourinary medicine clinics for support and advice about telling partners. It acknowledges that some patients may not take up referral and that education is required to destigmatise genitourinary medicine services.4
The data reported here support this position. This is not simply a matter of partner notification; comorbidity is of concern, and those identified positive for chlamydia may require a full sexual health screen to ensure that other infections are diagnosed and managed appropriately. Genitourinary medicine clinics must be represented as accessible and non-judgmental sexual health services.
Our data were not from women who had undergone chlamydia screening as part of a national screening programme, but these accounts can help inform our understanding of some of the possible reactions of women identified through such a programme to the news that they are infected with C trachomatis
. We do not make any claims regarding the generalisability of this exploratory study, but, given the lack of available research in this area, the data provide important insights. Some of our results echo those of other studies—for example, the stigma,11,12
associated with a diagnosis of sexually transmitted infection and relatively low levels of knowledge of chlamydia.13
It is notable that only six of the women in the study (three who had attended the genitourinary medicine clinic and three who had attended the family planning clinic) had, before diagnosis, perceived themselves to be personally vulnerable to a sexually transmitted infection and had actively sought treatment for this reason. Thus, this sample of women is unlikely to differ substantially from women recruited to a national screening programme in terms of perceived risk of chlamydia, and their reactions to diagnosis (and to referral to a genitourinary medicine clinic) are likely to be comparable. A recent study of 20 women who had been screened for chlamydia in general practice yielded similar results.14
From the accounts of these women, a diagnosis of chlamydia triggered rather than allayed uncertainty about future reproductive morbidity. Current knowledge of the natural course of chlamydia is insufficient to provide complete reassurance for individual women about their future reproductive health. It is imperative that care is taken to ensure that women do not develop unrealistic expectations of chlamydia screening—for example, accompanying information should not inadvertently imply that diagnosis and treatment of chlamydia will, in itself, prevent infertility. Indeed, given the current state of knowledge about chlamydia, some uncertainty about future reproductive health may be an inevitable cost of screening for those with positive diagnoses; this should be made clear to women before participation.
The proposed chlamydia screening programme has the laudable public health aim of reducing the incidence, and possibly eradicating, a treatable sexually transmitted infection with potentially serious effects on reproductive health. Before the implementation of any new national screening programme, however, research is required to identify strategies to maximise the uptake of the service while minimising uncertainty and allaying anxiety associated with positive test results.
What is already known on this topic
Little is known about the psychosocial implications of a diagnosis of chlamydia, which is an important issue in the context of the proposed UK chlamydia screening programme
What this study adds
Women are concerned about the perceived stigma of sexually transmitted infections, future reproductive health, and notifying partners
Messages accompanying screening should not imply that diagnosis and treatment will prevent infertility, and uncertainty about future reproductive morbidity may be an inevitable cost of screening
Information given to women before screening should seek to normalise and destigmatise chlamydial infection to reduce the negative psychosocial impact of a positive diagnosis