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

Abstract

Background. Chlamydia trachomatis is the most common curable sexually transmitted infection (STI) in the UK. Prevalence of the infection in different health IntroductionChlamydia trachomatis is the most frequently occurring sexually transmitted infection (STI) in the UK. 1,2 It causes a spectrum of complications ranging from the simple and asymptomatic to the more complicated and severe and is most common in the younger sexually active population (20-24-year-old men and 16-19-year-old women). 3 In 1999 there were around 57 000 new episodes of the infection in genitourinary medicine (GUM) clinics in the UK, 4 which increased to over 62 500 in 2000. 5,6 In GUM clinics within DPHA, Wales, specifically Carmarthenshire and Pembrokeshire, the prevalence of chlamydia in new GUM attenders is about 10%, which is comparable to UK prevalence rates generally (estimated at between 2% and 29% in different health care settings) 7 and is amongst the highest in Wales. Not only is the absolute number of cases increasing year on year in DPHA but the percentage tested positive is significantly higher (doubled proportion tested positive between 1997 and 1999). 8 It is estimated, however, that only 10% of all chlamydial infections are diagnosed in the GUM setting. 3,9 This means that a high number of infected individuals are either seen and treated in other health care settings or that a large reservoir of undiagnosed infection exists within the general population. Research demonstrates that chlamydia has increasingly been detected outside the GUM setting, however that the number of cases isolated remains relatively low. The problem is exacerbated by the fact that chlamydia is asymptomatic in at least 70% of women and 50% of men which means detection is often limited. 10 Prevalence studies in the UK among women in different health care settings have shown there is a substantial level of asymptomatic infection even among those generally perceived to be at low risk of an STI. 10 If left untreated, chlamydial infection can lead to serious reproductive morbidity. 9 Chlamydia is the causative organism in one-third of cases of pelvic inflammatory disease (PID) which can result in chronic pelvic pain and ectopic pregnancy. It is the commonest single cause of infertility in women under the age of 35 years, and is the most frequent cause of epididymitis in young men. 10 General practitioners (GPs) and practice nurses are in a position, with the input of appropriate resources, to play an important role in the detection of chlamydial infection at an early stage. GPs and practice nurses are in need of, and are in favour of, further needs-based education and training in the identification and management of genital chlamydial infection.

Implementation of chlamydia screening in a general practice setting: a 6-month pilot study

“…A previous survey of reported management of chlamydia in general practice found that although 69% of GPs and 49% of nurses who responded felt screening for chlamydia was necessary, only 22% and 43% of those respondents, respectively, felt it was feasible. 10 In this study the recorded number of patients who were offered screening (115) was lower than we had originally estimated (151). The actual number may have been higher, due to the failure of GPs to document an offer of screening in some of the cases that declined.…”

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

“…Testing only those with symptoms or reported risk will achieve a very low testing coverage, with the baseline prevalence survey of patients attending ACCEPt clinics finding only 5% presented for STI-related reasons [ 31 ]. Previous Australian and UK research examining GPs’ chlamydia knowledge and practice also found that GPs were less likely to offer testing during asymptomatic presentations, even those related to chlamydia testing, such as pap smears [ 19 , 21 , 32 - 34 ]. Conversely, the participating PNs in our survey thought that testing should be offered in all the asymptomatic non-sexual health scenarios presented, even in age groups outside of that recommended guidelines current at the time of the survey suggesting a greater commitment to opportunistic testing.…”

The organisation and delivery of health improvement in general practice and primary care: a scoping study

“…[172][173][174] Furthermore, three papers identified in this review reported the involvement of receptionists in distributing leaflets or discussing screening with patients. [175][176][177] Treatment of chlamydia infection and partner notification can be provided by programme area screening team offices.…”