Postal urine specimens: are they a feasible method for genital chlamydial infection screening?

Background. A United Kingdom (UK) screening programme for Chlamydia trachom atis has recently been announced. Pilot projects involving the opportunisti c testing of women attending health facilities are due to commence in sever al sires. There is a danger that this approach will fail to obtain adequate population coverage. The alternative - true systematic population screenin g - is generally assumed to be unfeasible. Studies in Denmark using postal urine specimens have challenged this assumption. No such studies have been reported from the UK. Aim. To assess the potential of urine specimens sent by post as the basis f or a UK population screening strategy for genital chlamydial infection. Method. Two hundred patients (100 men, 100 women) aged 18 to 45 years were randomly sampled from the list of one urban group practice. Subjects were m ailed an explanatory letter, a urine sample container, a sexual lifestyle q uestionnaire, and a prepaid return envelope. Nonresponders were contacted b y telephone; persistent nonresponders were visited at home. Samples were te sted for Chlamydia by DNA amplification and enzyme immunoassay. Results. Sixty-four (32%) subjects were no longer living at their GP regist ered address. Of the remaining 136 126 (93%) responded to the survey and 11 3 (83%) accepted the request for a urine sample and completed a questionnai re. Acceptance rates were similar for men and women and across age groups. Four samples (3%) were Chlamydia positive. Conclusion. Home mailed urine specimen collection in conjunction with a sel f-completed postal questionnaire is feasible. This could provide a viable b asis both for determining population Chlamydia prevalence and for a UK Chla mydia population screening strategy. Overall cost effectiveness of such a s trategy will depend on the cost of the test used. Comparative performance c haracteristics of the different currently available tests in this setting h ave yet to be fully determined.