By Emma Wilkinson
Health reporter, BBC News
Young people account for two-thirds of chlamydia cases
GPs are not promoting chlamydia screening because they fear it will embarrass patients, researchers say.
A snapshot study of 25 practices in England found most were not prominently displaying posters and leaflets.
And most staff were not routinely offering tests to the target population of 15 to 24-year-olds, the BMC Public Health journal reported.
The researchers said education was needed to change staff attitudes towards sexual health.
Chlamydia is the most common sexual infection with 120,000 new cases diagnosed last year, with young people accounting for two thirds of them.
It is known as the "silent infection", as it often shows no symptoms, but if left untreated can cause infertility.
Screening, which was first introduced in 2003, is done via urine tests, mainly in contraceptive clinics, GP surgeries or through outreach work in bars, clubs and colleges, as it has been designed to get to people not using sexual health services.
Uptake was at first slow but latest figures show 15.9% of the target age group was tested in 2008/09.
However, this is still shy of the 17% that the programme was meant to have reached by now.
The researchers from the Health Protection Agency Primary Care Unit in Gloucestershire had previously found that general practice staff were reluctant to bring up sexual health matters.
In the latest study, they looked specifically at whether practices were making use of the posters and leaflets provided by the national screening programme.
Although two-thirds of the practices interviewed reported they had displayed promotional material, it was not used prominently.
Many staff said they thought the posters caused offence and several practices had received complaints from older people about the posters.
Some staff were also reluctant to routinely hand out leaflets for fear of embarrassing or offending young patients.
More discreet information, such as a credit card-sized information pack that would fit in a wallet, may be more acceptable the researchers concluded.
Study leader Dr Cliodna McNulty said there was a perception among some staff that offering chlamydia screening would be an insult to the patient and would be inappropriate.
She added that young people were generally not bothered by the posters advertising the service but some older people did complain and that more subtle posters and leaflets should be developed.
"It's not just about making the promotional material available, it's about making sure they're used as well as educating GPs and other staff about how to follow up their use," she added.
"Screening is still very low in most practices."
Jules Hillier, director of communications at Brook, said displaying information for patients was vital.
She said: "It's really important to promote positive sexual health messages to young people and also to make them aware of what services are available locally.
"Promotional literature should be bright, informative, and young people-friendly."
A Department of Health spokesman said they recognised that GPs and practice nurses need training and support to ensure they have the skills and confidence to offer this to young people in an open and non-judgemental way.
"Evidence from pilot screening studies suggests that offering tests in GP surgeries to people under 25 is acceptable to them.
"The National Chlamydia Screening Programme is working to encourage local health care services to offer testing."