Over 150 potentially low-value health care practices: an Australian study

To the Editor: Elshaug and colleagues identified chlamydia screening of under-25-year-olds in the general population as a potentially low-value health care practice.1 They cite a systematic review that found that evidence from randomised controlled trials (RCTs) on the impact of chlamydia screening on reducing pelvic inflammatory disease (PID) was limited to high-risk populations, had methodological limitations and had never involved repeated rounds of screening.2 However, a recent RCT of a single round of screening, although underpowered to find a difference in PID incidence, did find that 9.5% of women with untreated chlamydia developed PID, compared with 1.6% of those who were treated (relative risk, 0.17; 95% CI, 0.17–1.01).3