National audit of asymptomatic screening in UK genitourinary medicine clinics: case-notes audit

Abstract

A national audit of screening of asymptomatic patients seen in UK genitourinary medicine clinics in 2009 was conducted against the national guidelines. Data were aggregated by regions and clinics in regions, allowing practice to be compared within and between regions, as well as to national averages and against national guidelines. The case-notes of 4428 patients were audited. Performance was over 80% against the national guidelines for screening of asymptomatic heterosexual men, men who have sex with men (MSM) and women for chlamydial, gonorrhoeal, syphilis and HIV infections. However, the recommended method of endocervical culture for gonorrhoea was performed in only 65% of women, with a further one-quarter being screened with endocervical or vulvovaginal nucleic acid amplification tests (NAATs). Although significant NAAT use for gonorrhoea was seen in all groups, testing for gonorrhoea by culture is still recommended as a first-line test on invasive samples. Over 80% of MSM, who were not known to be immune, were screened for hepatitis B. Urethral microscopy was performed in 22% of heterosexual men and 17% of MSM, and cervical microscopy in 12% of women.

Are the testing needs of key European populations affected by hepatitis B and hepatitis C being addressed? A scoping review of testing studies in Europe

“…At the same time, some categories in which the median proportion tested was 100% also included studies that reported relatively low levels of testing. For example, 33.6% of study participants in a study of people who use drugs were tested for HBV (39), and 13.0% of study participants in a study of asymptomatic patients in genitourinary medicine clinics were tested for HCV (59). However, we believe that our review findings around testing uptake are of limited value in assessing testing uptake levels in these populations because few studies had the specific purpose of examining HBV and HCV testing uptake.…”

The Ballseye programme: a mixed-methods programme of research in traditional sexual health and alternative community settings to improve the sexual health of men in the UK

“…67 The difference in approach to screening for men as opposed to women has probably developed as a result of widely held perceptions that young men are infrequent attenders at general practice whereas women are believed to attend more frequently and have multiple opportunities for screening as part of 'routine' visits for related health needs such as contraception. Data do not support this view 16 and the vast majority of men have attended their GP within the last year. 59 In spite of this, there appears to be a mismatch between GP's perceptions of men's low attendance rates and reality.…”

“…[13][14][15][16][17]. In brief, this is a compartmental transmission model which describes heterogeneous sexual behaviour that was parameterised by behaviour data from a number of key UK surveys and national surveillance data and with the natural history of NCNGU being informed from data in the literature.…”

“…3 However, recent interest has focused on M. genitalium, which accounts for between 10% and 46% of cases of NCNGU. 3,4 M. genitalium appears to be associated predominantly with symptomatic presentations [5][6][7][8] and, although associations have been reported with a number of adverse health consequences in women, including PID, tubal factor infertility (TFI) and ectopic pregnancy [9][10][11][12][13][14][15][16][17][18][19][20][21] and mucopurulent cervicitis 10,15 (around 20,000 cases reported annually, 70% of which are asymptomatically epidemiologically treated cases 22 ), testing for and treatment of M. genitalium is not a current standard of care in the UK. 23 Several studies have explored the role of M. genitalium in PID and found evidence for an association between exposure and outcome that is independent of C. trachomatis, an established cause of PID.…”

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“…In this context, screening tests for HIV are now offered routinely in various settings, for example, antenatal assessments and genitourinary medicine clinics 6 7. Screening in these settings alone, however, is not enough to detect all early cases of HIV.…”