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Managing Chlamydia

Managing Chlamydia. What’s New?. Results by age(2007/8). Total Neg Pos 25+ 16861 16237 534(3.2%) <25 12450 11119 1331(10.7%) Only 42% of test were done in under 25% . Why are we still talking about it?. Common

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Managing Chlamydia

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  1. Managing Chlamydia What’s New?

  2. Results by age(2007/8) Total Neg Pos 25+ 16861 16237 534(3.2%) <25 12450 11119 1331(10.7%) Only 42% of test were done in under 25%

  3. Why are we still talking about it? • Common • Potential serious sequelae of untreated infection • High infectivity

  4. Ectopic pregnancy

  5. Tubal Infertility

  6. How common are complications? • Adhesions Most models assume complication rates of 30-40% in untreated infection No data to back this up and the real figure thought to be closer to 3-7%

  7. Should we have a screening programme in Scotland? Screening only cost effective if complication rates >10% No evidence that screening is cost effective in any population even in those <20years old as serious complications rates <10%

  8. So who should we be testing? • All individuals with symptoms suggestive of an STI • All patients tested positive for chlamydia within last 6-12 months • All partners of individuals with chlamydia • Repeat testing if partner change • All women undergoing termination of pregnancy • All patients attending GUM clinics • Opportunistic testing of all under 20’s

  9. What test is best? NAAT testing Combined test for chlamydia and gonorrhoea available from 1/11/08

  10. What sample to take? • FVU – in men • SOLV – in women • Symptomatic individuals will probably still require examination

  11. Treatment • Azithromycin is the treatment of choice in uncomplicated infection. • Effective • Stat 1g dose • Observed administration • Can be used in pregnancy though off label as safety data is limited

  12. Partner Notification QIS Sexual Health Standards – March 2008 Standard 4 • Individuals with an STI see an appropriately trained member of staff for PN • This should happen regardless of where the individual was diagnosed

  13. Partner Notification • Minor changes to the current STI request form to allow patient contact details to be included with patient consent • With cooperation from local GP’s and other services providing sexual infection testing the GUM health advisors informed of all positive results and they then able to action appropriate management and PN

  14. Summary • Targeted testing of high prevalence groups • High quality partner notification regardless of where tested- supported by local GUM • Retesting within 12 months to exclude reinfection Revised SIGN Guidelines available Jan 2009

  15. Aberdeen Scotland

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