Simplifying chlamydia testing:: an innovative Chlamydia trachomatis testing approach using the internet and a home sampling strategy:: population based study

Objectives: To measure the coverage, gender distribution, and participants' prevalence of genital Chlamydia trachomatis infections using a new internet based self selective testing approach by means of home sampling in the general population in Sweden. To investigate factors associated with these measures. Methods: Observational survey of people actively ordering coded testing packages, and checking their test results, from a known website. No personal invitations were sent out. All inhabitants ( 256 885 men and women) in a Swedish county were eligible to participate. A special interest was taken in coverage, gender distribution, participants' chlamydia prevalence, and determinants for infection. Results: Testing was highest in the age group 20 - 24 years, where 298/9495 (3.1%) of all women and 171/9574 (1.8%) of all men in the population participated. The overall population participation ( all ages) was 906/ 256 885 (0.4%). 40% (364/906) of the tests were from men and 60% (542/906) from women. The prevalence of Chlamydia trachomatis infection was 6.0% (95% CI: 3.6% to 8.4%) among male participants and 4.6% ( 95% CI: 2.8% to 6.4%) among female participants. Prevalence increased with decreasing age. Believing to be infected and having symptoms were the strongest determinants of infection. Conclusion: Simplifying and increasing the accessibility of chlamydia testing by means of internet and home sampling proved feasible. Self risk assessment improves the chance of finding people infected by Chlamydia trachomatis, especially among men, if an accessible testing method is offered. This new method can serve as a supplement to regular preventive methods and might encourage young people to be tested.