Use of a primary care database to determine trends in genital chlamydia testing, diagnostic episodes and management in UK general practice, 1990-2004

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: In those aged 12-64 years in 2004, rates of CT testing increased to reach 1439/100,000 person 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 to 34 year old women (3.7% tested in 2004). 0.5% of registered 16 to 24 year old women were diagnosed with CT in 2004. Three-quarters of patients with a recorded CT diagnosis had had an appropriate prescription issued in 2004, a proportion which increased from 1990 along with a decrease in referrals to genitourinary medicine. In 2004, general practitioners treated 25.0% of all recorded CT diagnoses in females and 5.1% of those in males. CONCLUSIONS: Testing for and diagnostic episodes of CT in primary care have increased since 1990. Testing continues disproportionately to target women over 24. Extremely low testing rates of testing in men, together with high positivity, demonstrate a missed opportunity for CT diagnosis and contact tracing in general practice