Chlamydia testing: Reaching high-risk sexually active young people in the community

Falasinnu et al. found strong evidence highlighting the importance of age, number of sexual partners and ethnicity in identifying at-risk populations for chlamydia and gonorrhoea. ¹ We aimed to explore if offering on the spot, rapid sexually transmitted infections (STI) tests might be an acceptable way of accessing sexually experienced people aged <25. In September 2014, as part of improving clinical outreach in the community, we conducted the first UK one-day service evaluation pilot of the Cepheid GeneXpert rapid Chlamydia trachomatis/Neisseria gonorrhoeae testing system in an inner London further education college.^2,3

Consecutive students in public areas were invited to provide urine samples for ‘on-the-spot’ chlamydia/gonorrhoea testing, and to give telephone feedback in the next two weeks. The mean age of 52 eligible students was 19 years (range 16 to 24), 65% were female and 37% were smokers. Reported ethnicity was Afro-Caribbean 67%, white 22% or other 11%. Mean number of sexual partners in the last 12 months was three (range 0–18), with most students (64%) never having been tested for STIs. Of 39 participants with a new sexual partner in the last six months only seven had been tested for chlamydia during this period.

Seven urine samples (13%, 95% confidence interval 4% to 22%) were positive: six for chlamydia and one for gonorrhoea. Negative results were sent by text in a mean time of 2 h 12 min after providing the sample (range 1 h 30 min–5 hr 50 min). Students with infections were telephoned and given advice about obtaining treatment. Six were given their result in a mean time of 3 h 18 min (range 1 h 40 min–5 h 40 min). The final student was contacted 55 h later. Five students were confirmed treated by two weeks of whom four had notified partners. None of the seven infected students had planned to get tested.

A total of 42 students (81%) provided feedback: all were happy to be tested and liked the rapid results. Comments included: ‘it is good to be safe’, ‘helps people – makes them aware’, ‘easy’, ‘reliable’, ‘less technical’, ‘in college so right there’, ‘good so you don’t get worried a lot’, ‘sooner you know the better’, ‘other clinics should do that’, ‘couldn’t believe I got the result the same day’. As this was the first STI test for most students, this level of engagement is encouraging. They also suggested advertising testing; making it less obvious the testing was for STIs; testing for a range of infections including HIV and providing same day treatment.

We provided same day results to a group shown by Falasinnu et al. ¹ to be at high risk of STIs. Most students would not otherwise have been tested, including all those who had positive results. Our pilot could inform commissioning of future community-based service delivery of chlamydia/gonorrhoea testing in this high-risk group.