Audit of treatment and contact-tracing rates in immediate (presumptive) versus delayed (polymerase chain reaction) diagnosis of chlamydial infection

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An audit of all cases of chlamydial infection diagnosed in men at the Edinburgh genitourinary (GU) medicine clinic over a six-month period from January 2003 is reported. In all, 189 men identified as requiring treatment for possible chlamydial infection on first attendance (because of contact with a partner with chlamydia or the diagnosis of non-gonococcal urethritis [NGU] on microscopy), who later proved chlamydia-positive by polymerase chain reaction (PCR), were compared with 83 men in whom infection was identified only on receipt of a PCR result. Treatment rates were 100% in the first group and 97.6% in the second group (chi(2) 0.046, P<0.05). In men presumptively diagnosed and treated, 88.6% of contacts identified were confirmed as traced, compared with 90% confirmed as traced in the group diagnosed by PCR alone. Our audit suggests that identifying men with chlamydial NGU by routine microscopy may carry a small but significant advantage in increasing treatment rates, but makes no difference to contact-tracing success rate.