Chlamydia In General Practice Research Articles

P027 Re-testing of patients with positive chlamydia results in primary care

IntroductionWe aimed to establish how many young people (aged 15–24 years) diagnosed with genital Chlamydia infection in General Practice (GP) in 2015 in an inner city area had Partner Notification...

Socio-demographic and structural barriers to being tested for chlamydia in general practice.

Socio-demographic and structural barriers to being tested for chlamydia in general practice.

Socio-demographic and structural barriers to being tested for chlamydia in general practice.

To investigate socio-demographic and structural factors associated with not providing a specimen for chlamydia testing following a request by a general practitioner. Cross-sectional analysis of chlamydia testing data for men and women aged 16-29 years attending general practice clinics participating in a cluster randomised controlled trial evaluating the effectiveness of a chlamydia testing intervention. The study period was the 2013 calendar year. The proportion of chlamydia test requests for which the patient did not provide a specimen for testing. During the study period, there were 13 225 chlamydia test requests, for which a chlamydia test was not performed in 2545 instances (19.2%; 95% CI, 16.5-22.3%). Multivariate analysis indicated that the odds for not undertaking a requested test were higher for men (adjusted odds ratio [aOR], 1.4; 95% CI, 1.3-1.6), those aged 16-19 years (aOR, 1.3; 95% CI, 1.1-1.4), those living in areas of greater socio-economic disadvantage (aOR, 1.2; 95% CI, 1.1-1.4 for each additional quintile of Index of Relative Socio-economic Disadvantage), and those attending clinics without on-site pathology collection (aOR, 1.4; 95% CI, 1.0-1.9). One in five young people did not submit a specimen for chlamydia testing despite their GP requesting it. This highlights the need for clinics to establish systems which ensure that men and those aged 16-19 years undertake chlamydia tests requested by a GP.

P186.1 Does chlamydia testing in general practice mean missed opportunities for the diagnosis of other stis?: a comparison of the population tested in general practice versus sexual health clinics in britain

Background Chlamydia testing in general practice may provide opportunities to diagnose those who do not attend sexual health (GUM) clinics. However, as comprehensive STI testing is less likely to be offered in general practice, opportunities could be missed to test, diagnose and treat other STIs including HIV if people at higher sexual risk test in general practice. Aim To compare demographic, behavioural, and HIV testing characteristics of those tested for chlamydia in general practice with those tested in GUM. Methods A probability sample survey of the British population undertaken 2010–2012. We analysed weighted data on individuals aged 16–44, reporting at least one sexual partner ever, who reported a chlamydia test in the past year (n = 1583). Results 26.0% (24.7–27.4) of women and 16.1% (14.9–17.3) of men reported testing for chlamydia in the past year, of whom 41.4% (38.6–44.2) of women and 20.5% (17.4–24.0) of men tested in general practice. Women tested in general practice were more likely to be older, in a relationship, and to live in rural areas. Men and women tested in general practice reported lower STI risk in terms of (past 5 years): partner numbers, same-sex partners, and overlapping partnerships. Those tested in general practice were less likely to report an HIV test (past 5 years). Discussion/conclusion While those tested for chlamydia in general practice generally reported lower risk behaviours, rural populations were over-represented, and HIV testing was lower. Pathways to comprehensive STI care need to be universally available for higher risk individuals.

Testing and screening for chlamydia in general practice: a cross‐sectional analysis

ObjectivesChlamydia screening is widely advocated. General practice registrars are an important stage of clinical behaviour development. This study aimed to determine rates of, and factors associated with, registrars' chlamydia testing including asymptomatic screening. MethodsA cross‐sectional analysis of data from Registrars Clinical Encounters in Training (ReCEnT), a cohort study of registrars' consultations. Registrars record details of 60 consecutive consultations in each GP‐term of training. Outcome factors were chlamydia testing, asymptomatic screening and doctor‐initiated screening. ResultsTesting occurred in 2.5% of 29,112 consultations (398 registrars) and in 5.8% of patients aged 15–25. Asymptomatic screening comprised 47.5% of chlamydia tests, and 55.6% of screening tests were doctor‐initiated. Chlamydia testing was associated with female gender of doctor and patient, younger patient age, and patients new to doctor or practice. Asymptomatic screening was associated with practices where patients incur no fees, and in patients new to doctor or practice. Screening of female patients was more often doctor‐initiated. ConclusionsGP registrars screen for chlamydia disproportionately in younger females and new patients. ImplicationsOur findings highlight potential opportunities to improve uptake of screening for chlamydia, including targeted education and training for registrars, campaigns targeting male patients, and addressing financial barriers to accessing screening services.

Men's attitudes towards chlamydia screening: a narrative review

Chlamydia trachomatis is a sexually transmissible infection (STI) that affects significant numbers of men. Research on men's perspectives on chlamydia screening (or testing) has been limited. We conducted a narrative review to examine: (1) what factors encourage or discourage men from attending health services for chlamydia screening, and/or from accepting screening once it has been offered to them, and (2) where men want chlamydia screening services to be located. A narrative review of the recent peer-reviewed literature (published between 1999 and 2009) on men's attitudes towards chlamydia screening. To be included, articles had to explore men's perspectives on screening (which could be ascertained through quantitative or qualitative studies, or from relevant discussion papers or reviews). Forty-eight articles were included in all. Men's attitudes towards chlamydia screening are influenced by their knowledge about the infection, their perceived vulnerability to the infection, the degree of embarrassment and shame that they associate with screening and the stigma that they associate with screening. Men prefer to be offered urine testing for chlamydia. Men want to be offered screening by non-judgemental professionals. Men's attitudes towards screening for chlamydia in general practice, genito-urinary medicine clinics, home and outreach settings are also explored in this review. Several factors influence men's attitudes towards screening. Two central themes underlie and influence many of these factors: men's needs to make positive impressions on others, and men's identification with particular ideals of masculinity. The review concludes with suggestions for future research on this topic.

Australian general practitioner chlamydia testing rates among young people

To describe the proportion of 16-29-year-olds tested for chlamydia by Australian general practitioners in a 12-month period. Between October 2007 and September 2008, the national chlamydia testing rate in 16-29-year-olds was calculated by dividing the number of Medicare-reimbursed chlamydia tests by two denominators: (i) Medicare-reimbursed GP consultations; and (ii) estimated resident populations adjusted for the proportion who were sexually active. GP chlamydia testing rates in 16-29-year-olds per 100 patients attending a GP consultation and per 100 sexually active population, by patient age and sex, state/territory of residence, and remoteness area. Among the estimated Australian population of 16-29-year-olds, 85.6% of females and 64.4% of males had at least one GP consultation in the 12-month period. The national GP chlamydia testing rate per 100 patients was 8.9% (95% CI, 8.88%-8.94%). The national GP chlamydia testing rate per 100 sexually active population was 8.0% (95% CI, 7.92%-7.98%). The rate per 100 sexually active population was higher in females (12.5%) compared with males (3.7%) (P < 0.01); higher in 20-24-year-olds (9.0%) compared with 16-19-year-olds (8.7%) and 25-29-year-olds (6.6%) (P < 0.01); higher in those living in non-metropolitan areas (11.0%) compared with metropolitan areas (8.4%) (P < 0.01); and highest in those living in the Northern Territory (21.4%) compared with other jurisdictions (P < 0.01). Despite clinical guidelines recommending annual chlamydia testing for sexually active 15-29-year-olds, our analysis showed that a high proportion of young people aged 16-29 years attend a GP each year, but few of the sexually active population in this age group were tested for chlamydia in general practice. Strategies are needed to support GPs to enhance chlamydia testing in young people.

Take the sex out of STI screening! Views of young women on implementing chlamydia screening in General Practice

BackgroundAustralia is developing a chlamydia screening program. This study aimed to determine the attitudes of young women to the introduction of chlamydia screening in Australian General Practice.MethodsIn-depth face-to-face interviews with 24 young women from across Victoria, Australia, attending a randomly selected sample of general practices.ResultsYoung women reported that they would accept age-based screening for chlamydia in general practice, during both sexual-health and non-sexual-health related consultations. Trust in their general practitioner (GP) was reported to be a major factor in the acceptability of chlamydia screening. The women felt chlamydia screening should be offered to all young women rather than targeted at "high risk" women based on sexual history and they particularly emphasised the importance of normalising chlamydia screening. The women reported that they did not want to be asked to provide a sexual history as part of being asked to have a chlamydia test. Some reported that they would lie if asked how many partners they had hadConclusionWomen do not want a sexual history taken when being asked to have a chlamydia test while attending a general practitioner. They prefer the offer of chlamydia screening to be based on age rather than assessment of sexual risk. Chlamydia screening needs to be normalised and destigmatised.

Chlamydia screening: Needs and initiatives

Patients may be embarrassed by being offered a test for Chlamydia in general practice. Julie Orr considers the rising incidence of Chlamydia and some ways to address the problem of unrecognized cases

General practice intervention to increase opportunistic screening for chlamydia

We describe an 18-month intervention that was designed to improve opportunistic screening for chlamydia in General Practice. Key strategies included engaging and informing general practitioners, adopting a simplified screening protocol, providing feedback on practice testing performance and developing resources for use with patients. This uncontrolled before and after study found that the overall impact on testing was modest and largely transient, and was insufficient to impact on the current chlamydia epidemic. Major additional measures would be required to further substantially increase testing levels. These could include financial incentives linked to screening performance and increased community awareness to increase patient demand for testing.

Clinical management of chlamydia in general practice: A survey of reported practice

BackgroundChlamydia trachomatis is the most common curable sexually transmitted infection (STI) in the UK. Prevalence of the infection in different health care settings has been found to be between 2%...

Screening for Chlamydia in general practice: a literature review and summary of the evidence.

Genital Chlamydia trachomatis infection is the commonest curable sexually transmitted disease (STD) in England and Wales and is one of the chief causes of pelvic inflammatory disease (PID) in women. Infection in women is complicated by the fact that the majority of women with this infection are asymptomatic. It is feasible for general practitioners (GPs) to test for this infection, and there has been debate as to which is the most appropriate screening strategy. In the absence of any national UK guidelines, the purpose of this systematic literature review is to appraise critically and summarize the evidence for screening for genital chlamydia infection in sexually active women attending UK general practice. The four areas to be reviewed are: prevalence of genital chlamydia infection in women attending UK general practice; evidence for routine screening of women attending general practice; evidence for selective screening of women attending general practice; evidence for screening women requesting termination of pregnancy (TOP) or intrauterine device (IUD) insertion. This review should allow GPs and public health practitioners to become aware of the quality of evidence underlying various screening strategies and inform any local guideline development.