Cloaked representations of a cloaked disease : individualised experiences of dealing with genital chlamydial infection.

The aim of this study was to explore the impact of chlamydial infection from the perspective of the individual. One-off, unstructured interviews were conducted, either in the Genitourinary Medicine or the Family Planning Clinic, with 50 individuals (40 females and 10 males) who had contracted this sexually transmitted infection (STI). A grounded theory approach was used. STI's have long since been associated with moral reprobation and social sanctioning, particularly in relation to females. They are diseases that other people get, associated with specific types and behaviours. This legacy has shaped their institutional management and it largely determined the individual and interpersonal responses of the study participants. However this effect was modified by the specific location of chlamydia within the hierarchy of STI's where ranking occurs primarily on the basis of curability and visibility. In these terms chlamydia was classed as a 'little' infection. On an individual level, diagnosis of infection was strongly associated with a sense of discordance and a spoiled identity, commonly expressed as feelings of dirt and contamination. Some felt a need to feel clean following infection; the test of cure fulfilled this function marking the transition from liminality. Intentions to prevent reinfection centred on routine or relationship based strategies. Long term concerns were limited to possible female infertility. On an interpersonal level, information control decisions were influenced by fear of disapproval and potential threat to social reputation. Notification of sexual partners, which is necessary to prevent re-infection of self and infection of others, was fraught with anxieties. lt created opportunities for moral positioning and was associated with accusations of culpability and intent. The health interface influenced responses to infection. The female experience commonly included management in primary care which was associated with insensitive management and inadequate information. The GUM clinic produced anxieties concerning usage but attendance was associated with confidence in contained and comprehensive infection management. These findings are discussed in relation to policies and practices that focus disproportionately upon women, particularly the chlamydia screening programme.