Chlamydia Screening Programs: A Review of the Literature. Part 1: Issues in the Promotion of Chlamydia Testing of Youth by Primary Care Physicians
Alexander McKay, Sex Information and Education Council of Canada (SIECCAN)

Rates of Chlamydia are highest among 15- to 24-year-old females. Often asymptomatic, untreated chlamydia can lead to Pelvic Inflammatory Disease (PID) and result in infertility, ectopic pregnancy, chronic pelvic pain, and increased susceptibility to HIV infection. Screening at risk women for chlamydia and treating those who test positive reduces the incidence of PID. This article reviews key data and research related to Chlamydia screening of youth by primary care physicians. These issues include the prevalence of chlamydia, the cost-effectiveness of chlamydia screening programs, the need to test males for Chlamydia, the discrepancy between guidelines for screening and the reality of physician screening practices as well as research on factors associated with the likelihood of physician Chlamydia screening of youth aged15-24 and factors associated with the likelihood of physicians conducting sexual health risk assessments with their patients. The data and research reviewed in this article highlight the need for increased primary care physician Chlamydia screening of youth and identify issues that need to be addressed in interventions designed to increase and improve physician Chlamydia screening practices (The Canadian Journal of Human Sexuality, 2006; 15: 1-11).

Chlamydia Screening Programs: A Review of the Literature. Part 2: Testing Procedures and Educational Interventions for Primary Care Physicians
Mary Bissell, Sex Information and Education Council of Canada (SIECCAN)

Taking Action on Chlamydia Campaign, a social marketing campaign designed by Toronto Public Health, was implemented in response to rising rates of infection among young adults in the Toronto area. In the first phase of the project, the goal has been to reach primary care physicians with educational messages related to the prevalence of chlamydia infection, the need for screening, and the current testing practices available. The following literature review addresses two areas of research relevant to the first phase of the project: (1) elements of successful educational interventions designed to change physician clinical practices and patient outcomes and (2) the accuracy and acceptability of chlamydia/STI screening tests. The research regarding educational interventions for primary care physicians in outlined in Section I. The importance of multifaceted approaches to learning is clearly indicated in the literature. The use of a single method of information delivery is less effective than a combination of methods that motivate, facilitate and reinforce positive behavioural change among physicans in a clinical setting. Section II focuses on the current state of screening tests used in the diagnosis of chlamydia infections. The accuracy of available tests is discussed, as is the acceptability of various forms of testing among both physicians and patients (The Canadian Journal of Human Sexuality, 2006; 15: 13-22).

Sexual Ideology and Sexual Physiology in the Discourses of Sex Advice Literature
Erin Connell and Alan Hunt, Carleton University

This paper explores the connection between changing knowledge of sexual physiology and normative prescriptions about gendered roles within sexual relations. An analysis of marital/sexual advice literature reveals a profoundly gendered construction of male and female roles within heterosexual relations. Texts from the opening years of the twentieth century stressed the duty of the husband to court and woo his wife and fulfill two distinct responsibilities: first, to arouse his wife and second, to control his climax. This gendered model of male as initiator and tutor and female as responding student has proved remarkably persistent throughout the twentieth century. The period between the two World Wars was decisive for the formation of modern heterosexuality. Shifts in the prevailing sexual knowledge induced significant changes in the normative prescriptions which responsibilized husbands for ensuring the sexual pleasure of their wives. The “sexual revolution” of the 1960s weakened the link between sex and marriage as demonstrated, for example, in the shift from “marriage” manuals to “sex manuals” and the increasingly hedonistic quest for mutual sexual pleasure through an emphasis on technique and the relocation of sex into the realm of consumption. In addition, the new sexology of Kinsey and Masters and Johnson insisted on the existence of strong female sexual desire equal to that of men. However, the underlying discourse emphasized polar differences between the sexes. The HIV/AIDS crisis has continued to advance themes of responsibilization, normalization and moralization where the new pattern of sexual advice moved decisively toward themes of “risk” and “safety” through the discourse of safer sex (The Canadian Journal of Human Sexuality, 2006; 15: 23-45).