BackgroundSexually active young people attending London further education (FE) colleges have high rates of chlamydia, but screening rates are low. We will conduct a cluster randomised feasibility trial of frequent, rapid, on-site chlamydia testing and same-day treatment (Test and Treat (TnT)) in six FE colleges (with parallel qualitative and economic assessments) to assess the feasibility of conducting a future trial to investigate if TnT reduces chlamydia rates.MethodsWe will recruit 80 sexually active students aged 16–24 years from public areas at each of six colleges. All participants (total n = 480) will be asked to provide samples (urine for males, self-taken vaginal swabs for females) and complete questionnaires on sexual lifestyle and healthcare use at baseline and after 7 months. Participants will be informed that baseline samples will not be tested for 7 months and be advised to get screened separately. Colleges will be randomly allocated to the intervention (TnT) or the control group (no TnT).One and 4 months after recruitment, participants at each intervention college (n = 3) will be texted and invited for on-site chlamydia tests using the 90-min Cepheid GeneXpert system. Students with positive results will be asked to see a visiting nurse health adviser for same-day treatment and partner notification, (backed by genitourinary medicine follow-up). Participants in control colleges (n = 3) will receive ‘thank you’ texts 1 and 4 months after recruitment.Seven months after recruitment, participants from both groups will be invited to complete questionnaires and provide samples for TnT. All samples will be tested, and same-day treatment offered to students with positive results.Acceptability of TnT will be assessed by qualitative interviews of purposively sampled students (n = 30) and college staff (n = 12). We will collect data on costs of TnT and usual healthcare.DiscussionFindings will provide key values to inform feasibility, sample size and timescales of a future definitive trial of TnT in FE colleges, including:Recruitment ratesTnT uptake ratesFollow-up ratesPrevalence of chlamydia in participants at baseline and 7 monthsAcceptability of TnT to students and college staffEstimate of the cost per person screened/treated in TnT versus usual careTrial registrationInternational Standard Randomised Controlled Trials Registry, ID: ISRCTN58038795, Registered on 31 August 2016.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2674-8) contains supplementary material, which is available to authorized users.
A 61-year-old patient presented with drowsiness, decreased appetite and weight loss. On examination he had several splinter haemorrhages and a tender mass over the right temporal region. Respiratory and abdominal examinations were unremarkable and heart sounds were normal with no clinically audible murmurs. He spiked regular temperatures and consequently had several blood cultures taken. Transthoracic and transoeseophageal echocardiogram showed a 3 cm mitral valve vegetation. MRI confirmed suspicions of septic emboli in the brain. Blood cultures grew Rothia aeria and he was started on benzylpenicillin, rifampicin and gentamicin. After a period of observation he deteriorated clinically and biochemically, surgical intervention therefore ensued with an urgent metallic mitral valve replacement. Nineteen days postsurgery the patient was successfully discharged on outpatient antibiotic therapy and warfarin. In view of complications such as embolisation and cerebral infarction, R aeria endocarditis should be managed aggressively and with a high index of clinical suspicion.
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