Chlamydia Management Research Articles

Improving sexual healthcare delivery for men in prison: A nurse-led initiative.

The study aim was to develop and evaluate a nurse-led sexual health service and health promotion intervention for men in prison. Men in prison are particularly marginalised members of our society, negatively impacting on their ability to making healthy choices. In relation to sexual health, prison provides an opportunity for curative and preventive care, for an otherwise often hard-to-reach, priority population. Practice development, audit and evaluation. Employing a practice development and participatory methodology, we empowered prison nursing staff to provide robust asymptomatic testing for sexually transmitted infections, including the management of chlamydia, with appropriate treatment and partner notification. Collaboratively with young men and nursing staff, a short animation video to promote the service was developed. A case note audit of 172 patients seen in the service during the 6-month period 1 July 2018-31 December 2018 was undertaken. The Standards for Quality Improvement Reporting Excellence (SQUIRE, see Supplementary Material) checklist was followed. National outcome measures were exceeded for some clinical outcomes. During the 6-month period, there were 12 chlamydia-positive (7% positivity rate) and 3 gonorrhoea-positive results. In addition, two new cases of syphilis were detected and a further two cases of known HIV were highlighted. There were seven cases of hepatitis C (3 previously diagnosed) and three cases of hepatitis B. A short animation Dick Loves Doot was developed. Successful partnerships between sexual health and prison healthcare services, in partnership with service users, can achieve well-coordinated services and health promotion interventions. This nurse-led model of care increased detection and early treatment of asymptomatic STIs among men in prison, impacting positively the men, their partner (s) and the public health of the society to which they return.

An observational study of the acceptability of patient-delivered partner therapy for management of chlamydia

Partners of heterosexual cases with chlamydia, who were identified as having difficulty in attending the clinic, were offered patient-delivered partner therapy (PDPT). Medication was delivered by the index case after telephone consultation with the partner to assess symptoms and medical history. The opportunity for testing of partners for chlamydia was provided. The PDPT process was evaluated by standardised phone interview with index patients and partners. Telephone consultation enables safe medication prescribing and an opportunity for further contact tracing. Partners were unlikely to seek testing when provided with PDPT. Delivery of medication resulted in a reported rate of treatment of 100%. PDPT was an acceptable treatment option to both index and partner and should be considered if legislation permits.

Sexually transmissible infections, partner notification and intimate relationships: a qualitative study exploring the perspectives of general practitioners and people with a recent chlamydia infection.

In this study we use data from 43 semistructured interviews with general practitioners (GPs) and people with a recent diagnosis of chlamydia. The interviews examined experiences of chlamydia case management in the general practice context. Here, we focus specifically on the effect of a chlamydia infection on intimate relationships in the context of the consultation and beyond.? A chlamydia infection can have significant consequences for intimate relationships. Although GPs reported speaking to their patients about the importance of partner notification and participants with a recent chlamydia infection reported notifying their sexual partners, both would appreciate further support to engage in these conversations. Conversations with patients should go beyond simply informing them of the need to notify their sexual partners from the previous 6 months, and should provide information about why partner notification is important and discuss strategies for informing partners, particularly for those in ongoing relationships. Ensuring GPs have the training and support to engage in these conversations with confidence is vital.

Diagnosis and management of chlamydia: a guide for GPs

Chlamydia is a common sexually‐transmitted infection caused by Chlamydia trachomatis bacteria. This article discusses its diagnosis and treatment, and considers the GP's role in management.

Young people’s preferences for the use of emerging technologies for asymptomatic regular chlamydia testing and management: a discrete choice experiment in England

ObjectiveTo undertake a comprehensive assessment of the strength of preferences among young people for attributes of emerging technologies for testing and treatment of asymptomatic chlamydia.DesignDiscrete choice experiment (DCE) with sequential...

P030 Management of rectal chlamydia in an urban sexual health centre

IntroductionWe reviewed management of rectal chlamydia in our clinic and adherence to 2015 BASHH audit standards.MethodsElectronic patient records of 100 consecutive patients diagnosed with rectal chlamydia prior to 31 July 2016 were reviewed with respect to gender, sexuality, HIV status, symptoms, STI screening, treatment, test of cure (TOC) and partner notification (PN).Results64% were female (all heterosexual). 94% males were MSM; 18% were HIV positive. 1 male presented with rectal symptoms (pain). 23% patients had other genital symptoms. 76% were asymptomatic. 71% had concomitant STIs (including chlamydia at other sites). 90% received doxycycline 100mg bd for at least 1 week. 24% were treated with azithromycin before being recalled for doxycycline. Reasons included; not initially tested for rectal infection, attendance as a contact, initial treatment for presumed GC. All patients were advised to attend for TOC; 58% attended. All TOC were negative. All HIV positive patients were tested for LGV (1 positive). 1 MSM with rectal pain was not tested for LGV but subsequent TOC was negative. 36% received written information. PN was performed in 99% of cases with 81% of traceable contacts reported as attended and 47% of contacts being verified as attended.DiscussionHigh numbers of patients were issued with azithromycin as initial treatment requiring recall for doxycycline. This is concerning, particularly in an era of increasing antibiotic resistance. Education sessions have been provided, highlighting the importance of sexual history taking and use of doxycycline as first line chlamydia treatment where rectal infection is possible.

P159 Audits of both management of chlamydia and also emergency contraception provision as a marker of quality in an integrated service

IntroductionThe county wide sexual health service has been integrated long-term as regards health care worker (HCW) training and governance. Service delivery still remains in some units geared to towards either contraception (C+RHC) or sexually transmitted infections (STIs) management although all patient needs are addressed holistically. Is there equitable service delivery in all units?MethodsAudits of both chlamydia management and emergency contraception provision was carried out across all subunits regardless of subspecialisation.ResultsIn the chlamydia audit, standards were achieved for offering anti-chlamydial treatment (100% achieved) and partner notification verified by HCW (0.47 in STI units, 0.58 C+RHC units). Standards were suboptimal for a) the offer of written information (45% for STI units 18% for C+RHC units and b) offer of retesting for under 25s (61% for STI units, 68% for C+RHC units.) Emergency contraception audit standards were achieved in offering quick start contraception (96%) but suboptimal a) for IUCD offer (73% for STI based units, 57% for C+RHC units), b) documentation of hours since last unprotected sex (58% for STI units 89% for contraception based units), c) documentation of day of cycle (69% for STI units, 89% for contraception units and d) offer of STI screens (82% in STI based units, 76% in contraception units)DiscussionAlthough variation between units exists it is noteworthy that partner notification was best delivered in C+RHC unit setting and IUCD offer in STI unit setting. Emphasis on documentation was made to staff with reaudit planned.

O17 Transforming sexual health systems through online services

IntroductionOnline sexual health services can transform sexual health systems through increased access and self-management. They are one element of the whole sexual health economy. Best practice facilitates appropriate movement of users between online and clinic services according to their sexual health need.MethodsUsing routinely collected, anonymised service activity data, SHHAPT codes, and interviews with users/providers we studied online options for system transformation in sexual health services in two London Boroughs with high rates of sexual ill health. We focused on: Total sexually transmitted infection testing capacity; Access for new populations; Testing and treatment choices; Online contraceptive pills provisionResultsOnline services increase STI testing capacity, total testing in the area by 9.6% from 73,714 (01/04/14–31/3/15) to 80,757 (01/04/15–31/03/16). 90.8% of online users were asymptomatic with a positivity rate of 6.8%. Users move between online and clinic – 55% of online users had used a clinic within the last year and 6.8% of online users were referred to clinics. The online service engaged new populations – 19% of online users had never used a clinic before. 11,353 treatments for chlamydia were provided across the whole system (2015/16). A pilot of online treatment and partner notification shows 95% uptake demonstrating the potential impact of an online only chlamydia management pathway. Users engage with online medical histories, self reported blood pressure and SMS based clinical conversations for contraceptive prescribing.DiscussionOnline services can transform sexual health systems by increasing capacity, increasing access and by offering new treatment choices.

P216 Community pharmacy-delivered chlamydia testing and management in the UK - a comprehensive review

Background/introduction Provision of sexual health services in community pharmacies is perceived to be a desirable strategy for increasing access to STI testing and care. Aim(s)/objectives To comprehensively review the literature on chlamydia services in community pharmacies in the UK Methods Eight electronic databases (Medline, AMED, BNI, CINAHL, EMBASE, HBE, HMC, PsychInfo) were searched by two researchers independently, until 4.3.16. Search terms were: (1) chlamydia, AND (2) pharmac*. Studies with qualitative or quantitative evidence on community pharmacy-based chlamydia care including screening, testing, treatment, partner notification and training were included. Results 8 studies, published 2007–2015, met inclusion criteria. They were disparate in terms of subjects: (4 focused on pharmacy staff, 2 on clients), methodology: (2 surveys, 1 qualitative, 1 mixed methods, 1 RCT, 2 cross-sectional and 1 cost-consequence study). Focus varied: treatment 7, screening/testing 5, partner notification 4, training 1, studies respectively. Main findings: pharmacists appear willing to offer chlamydia services if appropriately trained and supported. Barriers to offering opportunistic screening were highlighted. Two studies reported acceptability of screening/treatment but uptake by men in one study was very low (6%). The largest study (1131 people tested positive through pharmacy) reported 47% treated in pharmacy. Preliminary feasibility and acceptability of accelerated partner therapy and expedited partner therapy were shown (2 studies). Discussion/conclusion Despite considerable policy appetite and pharmacist support for pharmacy-delivered chlamydia care, very little robust evaluation of any element of chlamydia testing and/or management has occurred. Well implemented studies of clinical efficacy, assessing quality of care and cost-effectiveness are warranted.

O040 A Partner Notification Bureau in action: outcomes for centralised management of positive gonorrhoea and chlamydia results from primary care by a sexual health service

Background/introduction Centralised management of positive results by a ‘Partner Notification Bureau’ has been suggested by the National Chlamydia Screening Programme. From September 2014 positive results for chlamydia and gonorrhoea from primary care were reported directly to the sexual health service in a UK city for management. Aim(s)/objectives To evaluate the effectiveness of centralised management of treatment and partner notification (PN) by assessing outcomes for the first year and to estimate impact on health adviser workload. Methods Health adviser records were reviewed retrospectively to assess outcomes in terms of : patients informed of their result, confirmed treated at any service, and offered PN discussion; partners attended. Results Gonorrhoea: between September 2014 and August 2015 there were 46 positives reported (31 female). Forty five were informed, confirmed treated, and had a PN discussion by phone. The number of partners reported or verified attended per case was 0.8 (37/46). Chlamydia: Between September 2014–August 2015, 457 positives were reported (352 female). Of these, 440 (96%) were informed and had PN discussion, and 448 (98%) were confirmed treated. The number of partners reported or verified attended per case was 0.98 (450/457). Outcomes for both exceeded the national PN standard of 0.6 partners attending per case. Partner notification workload increased by approximately 10%. Conclusion Centralised management of gonorrhoea and chlamydia positives from primary care resulted in excellent treatment rates and PN outcomes. However, additional health adviser resources are required to manage the extra workload.

S09.1 How can chlamydia screening work in australian general practice?

General practice potentially has an important role in the prevention and management of chlamydia in Australia, as most chlamydia infections are diagnosed in this setting. Although 80% of young adults attend their general practitioner (GP) annually, general practice chlamydia testing rates remain quite low. The Australian Chlamydia Control Effectiveness Pilot (ACCEPt) is a randomised controlled trial that aims to evaluate whether annual chlamydia testing for 16 to 29 year olds attending general practice can reduce the prevalence of chlamydia in the population. ACCEPt drew on the Normalisation Process Theory (NPT) to guide the design of the intervention for this trial. NPT argues that successfully embedding a complex intervention into routine clinical practice requires a ‘whole of practice’ approach which engages all clinic staff including GPs, practice managers and practice nurses. The intervention designed to facilitate increased chlamydia testing in ACCEPt intervention clinics consisted of computer alerts, incentive payments to GPs and practice nurses for each chlamydia test conducted, quarterly audit and feedback on testing performance to individual GPs, GP and practice nurse training, and patient recall and reminders for follow-up testing. A total of 143 clinics servicing over 70,000 16 to 29 year olds were recruited across Victoria, Queensland, NSW and South Australia. Clinics where the practice manager was engaged and interested in research were better equipped to enable the establishment of a chlamydia testing pathway and the necessary systems to allow chlamydia testing to be successfully adopted within the clinic. Testing rates almost doubled in intervention clinics compared with control clinics (RR = 1.9; 95% CI: 1.8, 2.0). Following three years of intervention, the numbers of 16–29 year olds who were screened annually for chlamydia rose to approximately 27% of women and 15% of men in intervention clinics.

P12.02 Developing and using the eclinical care pathway framework: a novel tool for creating online clinical care pathways and its application to management of genital chlamydia

Introduction Home sexually transmitted infection (STI) sampling and remote STI diagnostics create potential for online treatment. Currently there is no guidance on development or content of online clinical consultations and, particularly, no recommendations relevant to sexual health. We describe creation of a new framework for developing complex online clinical care pathways and its application to management of people with genital chlamydia. Methods We developed the eClinical Care Pathway Framework (eCCPF) consisting of a nine-step iterative process, Step 1: determines aims of the online clinical care pathway; Step 2: defines the functional units of the pathway; Step 3: drafts the online clinical consultation; Step 4: expert review; Step 5: comprehension testing; Step 6: user-centred interface testing; Step 7: specification development; Step 8: usability testing and further comprehension testing; Step 9: pilots the pathway. We then applied the framework to create the Chlamydia Online Clinical Care Pathway (Chlamydia-OCCP). Results Using the eCCPF enabled us to elucidate the different sequence of functional units of care, as in contrast to traditional medicine, the Chlamydia-OCCP starts with provision of test results (diagnosis). Users then obtain infection-related information, before completing an online automated clinical consultation (medical and sexual history, partner notification), before collection of antibiotics from a community pharmacy. This enables a more focussed approach to assessment of safety of antibiotic prescribing than lengthier traditional medication history questions. Conclusion By following each step of the eCCPF, the resulting Chlamydia-OCCP has a different sequence to traditional care pathways and is adapted to the needs of remote testing and online care. It provides the clinical services and surveillance functions required to meet UK national standards. This standardised method of collecting data on demography and sexual behaviour, with easily extractable data and potential for interoperability with surveillance systems, could be a powerful tool for public health and clinical management. Disclosure of interest statement Nothing to declare.

P04.16 “It opened my eyes” – examining the impact of the australian chlamydia control effectiveness pilot (accept) on chlamydia testing practices of general practitioners

Background In Australia, despite dramatic increases in chlamydia notifications and recommendations that young people be tested annually, testing rates in general practice remain low. ACCEPt is a randomised controlled trial to evaluate the impact of chlamydia testing on prevalence. General practitioners (GPs) in the intervention arm received regular feedback on testing performance, visual reminders and incentive payments to facilitate increased testing. To assess the acceptability of the intervention, participating GPs were interviewed at baseline and midpoint to investigate their chlamydia management practices and their opinions about the intervention. Methods Semi-structured interviews were conducted with purposively sampled GPs prior to randomization (baseline) and after one year in the intervention (midpoint) until saturation was reached. Data were analysed both thematically and using Normalisation Process Theory (NPT), a framework that explains how complex interventions can be successfully implemented, embedded and integrated in institutional settings. Emerging themes from each timepoint were compared and interpreted within the NPT framework. Results A total of 44 GPs at baseline and 24 GPs at midpoint were interviewed. The ACCEPt intervention increased GPs’ comfort and ease in offering a test, and were associated with a shift in attitudes from symptom-based testing to age-based testing. Many GPs highlighted that feedback, a key aspect to embedding the intervention, was a major driver of increased testing. The intervention was gradually implemented over time through increasing awareness and engagement with education and exposure to the project. Logistical issues, such as remembering to offer a test, were overcome with practical facilitators like computer alerts. However, integration was limited as not all GPs utilised the intervention components or other clinic staff to increase testing because of restrictions in clinic structure. Conclusion GPs reported that the ACCEPt intervention and its implementation within the NPT framework have been effective at facilitating chlamydia testing in general practice. Disclosure of interest statement ACCEPt was commissioned and funded by the Australian Government Department of Health and Ageing. Additional funding has been received from the National Health and Medical Research Council, the Victorian Department of Health and NSW Health.

P12.17 Should speciliast sexual health services still see self-referrals

Introduction There is an international trend in the re-development of specialist sexual health services as referral only services or with a reduced self-referral component. This study evaluates the value of retaining a self-referral component to service provision. Methods An audit of attendance reasons to a provincial sexual health service for 354 episodes of care from 2012–2013 were analysed. Data collected for national STI surveillance were analysed to compare the age and gender of patients treated for bacterial STIs in 2013 through the sexual health service with those treated by other providers. Further analysis will be undertaken to assess the characteristics of patients attending a specialist service for STI management and trends with time. Results Confidentiality is the most common reason for attending a specialist sexual health service (35%) followed by cost (29%). 35% of gonorrhoea cases and 20% of chlamydia cases in the region are managed through the sexual health service. However 35% of men with chlamydia are managed through the service and 56% of those over 30. Conclusion Despite youth health services and general practices seeing an increasing number of young people for chlamydia management, specialist services continue to see a concentrated group of patients with bacterial STIs to provide opportunities for training and to gain knowledge of local sexual networks. Disclosure of interest statement The work of Alex Carswell was sponsored by the Palmerston North Undergraduate Medical education Trust. No pharmaceutical grants were received in the development of this study.

Rectal chlamydia infection in women at high risk of chlamydia attending Canberra Sexual Health Centre.

Chlamydia is the most commonly notified sexually transmitted infection in Australia. Australian guidelines recommend urogenital screening in asymptomatic men and women, and rectal screening in men who have sex with men or women reporting anal sex/symptoms. International studies describe a rectal chlamydia prevalence in women of 5% to 21%. We found that in women at high risk of chlamydia, 57% (32/56) tested positive for rectal chlamydia. Of these, 97% (31/32) had concurrent urogenital chlamydia. Women with urogenital chlamydia were significantly more likely to have a positive rectal result (χ(2), p = 0.000). Neither anal symptoms nor reported anal sex were associated with a positive rectal chlamydia test. The recommended treatment of rectal chlamydia differs substantially from that of urogenital chlamydia, raising the possibility that Australian women are being regularly undertreated due to a lack of rectal testing. Untreated rectal chlamydia may increase the risk of persistent infection, reproductive tract reinfection, complications and transmission. Further work is needed to determine the optimal management of chlamydia in women.

Chlamydia trachomatis screening in pregnancy in New Zealand: translation of national guidelines into practice

Chlamydia trachomatis (C. trachomatis) is a common sexually transmitted infection (STI), and routine antenatal screening to reduce the risk of vertical transmission is recommended in New Zealand (NZ). To determine the proportion of pregnant women who have been screened for C. trachomatis in selected hospitals since the 2008 NZ Ministry of Health Chlamydia Management Guidelines were published, and to examine variation by age and ethnicity. Clinical audits were undertaken at four NZ hospitals, using electronic databases to determine if C. trachomatis screening had occurred. Only 24%, 31%, 35% and 61% of pregnant women were screened in Tauranga (2010), Auckland (2013), Waikato (2013) and Middlemore (2011) hospitals, respectively. Despite increases in the proportion of pregnant women screened in Auckland and Middlemore compared to pre-2008, and higher proportions of young women and Maori women screened, overall antenatal screening for C. trachomatis remains suboptimal. Several strategies are presented to support universal screening in pregnancy, as recommended by the NZ Ministry of Health.

The chlamydia knowledge, awareness and testing practices of Australian general practitioners and practice nurses: survey findings from the Australian Chlamydia Control Effectiveness Pilot (ACCEPt)

BackgroundACCEPt, a large cluster randomized control trial, aims to determine if annual testing for 16 to 29 year olds in general practice can reduce chlamydia prevalence. ACCEPt is the first trial investigating the potential role of practice nurses (PN) in chlamydia testing. To inform the design of the ACCEPt intervention, we aimed to determine the chlamydia knowledge, attitudes, and testing practices of participating general practitioners (GPs) and PNs.MethodsGPs and PNs from 143 clinics recruited from 52 areas in 4 Australian states were asked to complete a survey at time of recruitment. Responses of PNs and GPs were compared using conditional logistic regression to account for possible intra cluster correlation within clinics.ResultsOf the PNs and GPs enrolled in ACCEPt, 81% and 72% completed the questionnaire respectively. Less than a third of PNs (23%) and GPs (32%) correctly identified the two age groups with highest infection rates in women and only 16% vs 17% the correct age groups in men. More PNs than GPs would offer testing opportunistically to asymptomatic patients aged ≤25 years; women having a pap smear (84% vs 55%, P<0.01); antenatal checkup (83% vs 44%, P<0.01) and Aboriginal men with a sore throat (79% vs 33%, P<0.01), but also to patients outside of the guideline age group at the time of the survey; 26 year old males presenting for a medical check (78% vs 30%, P = <0.01) and 33 year old females presenting for a pill prescription (83% vs 55%, P<0.01). More PNs than GPs knew that retesting was recommended after chlamydia treatment (93% vs 87%, P=0.027); and the recommended timeframe was 3 months (66% vs 26%, P<0.01). A high proportion of PNs (90%) agreed that they could conduct chlamydia testing in general practice, with 79% wanting greater involvement and 89% further training.ConclusionsOur survey reveals gaps in chlamydia knowledge and management among GPs and PNs that may be contributing to low testing rates in general practice. The ACCEPt intervention is well targeted to address these and support clinicians in increasing testing rates. PNs could have a role in increasing chlamydia testing.

Prevalence of Chlamydia trachomatis infection in the general population of women in Qatar

ObjectivesThe Arabian Gulf region has limited epidemiological data related to sexually transmitted infections. The objective of this study was to estimate the prevalence of Chlamydia trachomatis infection among general population...

P2.050 Development of Molecular Beacon Based Diagnostic Assay For Detection of Neisseria Gonorrhoeae and Chlamydia Trachomatis

BackgroundDue to absence of cost effective and rapid diagnostic test syndromic management of Neisseria and Chlamydia was recommended in developing countries. Being nonspecific such a strategy has resulted in over...

P5.011 Are Australian General Practitioners (GPs) and Practise Nurses (PNs) Equipped For Increased Chlamydia Testing? Findings from the Australian Chlamydia Control Effectiveness Pilot (ACCEPt)

BackgroundACCEPt, a large cluster randomised control trial, aims to determine if annual testing for 16 to 29 year olds in general practise can reduce chlamydia prevalence. ACCEPt is also the...