Consultation outcome

Proposal for revised NCSP policy

Updated 24 June 2021

1. Background

Chlamydia is one of the most common sexually transmitted infections (STIs) in England; in 2018, chlamydia infection accounted for 49% of all newly diagnosed STIs. It is passed on through sex without a condom and is particularly common in sexually active young people^{[footnote 1]}.

If left untreated, the infection can spread to other parts of the body and lead to long-term health problems in women, such as pelvic inflammatory disease (PID), ectopic pregnancy and infertility.

To ensure that the design, implementation and evaluation of the National Chlamydia Screening Programme (NCSP) is based on the best available evidence, Public Health England (PHE) convened an external peer review of the scientific evidence for the NCSP. A panel of national and international experts was called together to review current policy, practice and evidence relating to screening for chlamydia. See the evidence pack the panel reviewed. The group met in London in October 2017. Having reviewed the evidence, the panel provided the NCSP with recommendations. See the panel’s report.

Initial comments on these recommendations were sought from professional stakeholders and young people in 2018. These have helped inform the proposed revised policy version 2 (v2) position.

The purpose of this document is to consult with a wider range of stakeholders on the proposed revised policy for chlamydia screening in England. This proposal would implement recommendations from the review group and align the NCSP with the latest scientific evidence. We are keen to hear views on these proposed changes.

2. Current NCSP policy version 1

The NCSP provides opportunistic testing to sexually active young people aged 15 to 24 years to:

• prevent and control chlamydia through early detection and treatment of asymptomatic infection
• reduce onward transmission to sexual partners
• prevent the consequences of untreated infection
• raise awareness and skills of health professionals to screen for chlamydia, and provide the information young adults need to reduce the risk of infection and transmission

The current chlamydia testing policy in England recommends that anyone under 25 who is sexually active gets tested for chlamydia every year or upon change of sexual partner.

3. Proposal NCSP policy version 2

Informed by the review’s findings, PHE is proposing that NCSP policy should focus on reducing the harms of untreated chlamydia rather than aiming to reduce infection in the overall population. Most of the harm caused by untreated chlamydia is in women.

The proposed revised principal aim of the programme is:

• to prevent the adverse consequences of untreated chlamydia infection

With secondary aims:

• to reduce re-infections and onward transmission of chlamydia
• to raise awareness of good sexual health

It is therefore proposed that opportunistic screening (that is the proactive offer of a chlamydia test to young people without symptoms) should focus on women^{[footnote 2]}, combined with reducing time to test results and treatment, strengthening partner notification and re-testing after treatment.

In practice this would mean that chlamydia screening offered in community settings, such as GPs and community pharmacies, will target young women only, for example through offering screening at contraceptive appointments. Services available at specialist sexual health services would remain unchanged.

Everyone can still get tested if they need, but men will not be proactively offered a test unless an indication has been identified, such as being a partner of someone with chlamydia or having symptoms.

3.1 Proposed revised policy version 2 for the NCSP

The best way to protect against any STI is to consistently use a condom. Health promotion should continue to be offered to people requesting or being offered a chlamydia test.

The NCSP recommends that anyone whose partner is known to be infected, or who has symptoms of chlamydia infection, has a chlamydia test. Symptoms include pain when peeing, unusual discharge from the vagina, penis or anus; symptoms in women include pain in the tummy, bleeding after sex and bleeding between periods; symptoms in men include pain and swelling in the testicles.

To detect and treat chlamydia infection in women as early as possible, the NCSP also recommends that all women under the age of 25 get tested:

• annually
• after having sex with a new partner

To ensure that this happens, it is recommended that all sexually active women under the age of 25 accessing a sexual and reproductive health service (including online), any service offering contraception, termination of pregnancy service, GP or pharmacy should be offered a chlamydia test. Local areas should also consider offering appropriate outreach programmes in line with local need.

Everyone who is diagnosed with chlamydia should be treated as early as possible and supported to notify their sexual partner(s) and should be re-tested around 3 months after treatment. The standard period between test and treatment is to be shortened from the current 6 weeks to 3 weeks.

Anyone of any gender who is concerned they might be at risk of chlamydia should contact their local sexual health clinic or GP for professional health advice about whether to get tested. Some groups of people are at higher risk of STIs (including chlamydia). More information about STI risks, how to protect against STI and where to access STI testing can be found on nhs.uk

4. Rationale

The reasons for focusing on prevention of the adverse consequences of untreated chlamydia infection in women are that:

• there is no consistent evidence that screening of both men and women at the levels that can be feasibly achieved has measurably reduced the prevalence of chlamydia infection in the population
• most of the harm caused by untreated chlamydia is in women - there is consistent evidence that untreated chlamydia infection in women increases their risk of ill-health and infertility
• shortening the duration of infection through early detection and treatment decreases the risk of pelvic inflammatory disease which can lead to infertility and ectopic pregnancy
• testing frequently and soon after any new sexual partner will reduce the duration women are infected, which should reduce the risk of harmful consequences for women
• men who have chlamydia are at much lower risk of harm, and infection will often resolve without treatment in those without symptoms - any man who is concerned they might be at risk of chlamydia can still access health advice at local services, online or by telephone
• many people get re-infected after treatment and there is evidence that repeat infections increase the risk of harm - it is therefore important that sexual partners of a person diagnosed with chlamydia are informed of the need to get tested and treated and that any person diagnosed with chlamydia gets re-tested 3 months after their treatment

5. Next Steps

The outcomes from this consultation will inform the final proposed NCSP policy. This proposed policy will then undergo an Equality Impact Assessment prior to a final decision being made.

If you have any queries about this consultation, please contact NcspTeam@phe.gov.uk

Respond to the consultation by 25 February 2020

1. Sexually transmitted infections and screening for chlamydia in England, 2018 Health Protection Report 13(19) ↩

2. As the proposed policy focuses on reproductive harms of untreated chlamydia, this includes cisgender women, transgender men and non-binary (assigned female at birth) people who have not had hysterectomy or bilateral oophorectomy. ↩