The rate of reinfection within a major City community based Chlamydia Screening Programme

1. The rate of reinfection within a major City community based Chlamydia Screening Programme Liverpool: City of Culture 2008 By Annmaria Taylor, May 2006

2. Liverpool Chlamydia Screening Programme (CSP) • Targeted at young people (<25 years old) • Since June 2004 we have screened 22,996 • 78 varied screening venues • Chlamydia positives 2,833 (12%) • Proven treatment success rate is 97% • First line treatment is Azithromycin • Erythromycin where risk of pregnancy • Treatment by trained nurses

3. Rates of diagnoses of uncomplicated genital Chlamydial infection by Sex and Age group Males Females Source: GUM clinics, United Kingdom: 1995 - 2004

4. Aims & Objectives • Show the rate of reinfection of those tested over a 12 month period with those individuals followed up 6 months later. • To discover % of clients who were initially treated and became reinfected. • Identify factors which will help reduce the reinfection rate.

5. Methodology • Chlamydia tests during one year from September 2004 to August 2005. • We then looked at those reinfection cases in the subsequent 6 months (i.e. Sept ’05 – Feb ’06). Data sourced from Chlamydia database and case note auditing.

6. A. Results (1 of 2) • 1,284 clients tested positive and treated. • 116 (9%) returned for retesting • 49 (4%) were found to be reinfected. • Of those original positive clients who were treated and retested - 42% Positive - 58% Negative

7. A. Results (2 of 2) • Small numbers returned for re-testing (9%) • Of these 42% were positive • Most (98%) could identify a reason for reinfection

8. B. Results for 6 month follow up A 6 month follow up on the 49 positives on retesting during initial year showed: 27: did not attend for a retest 19: retested negative 3: retested positive for a third time49

9. Reasons for reinfection (9/04 – 8/05) Total number of clients reinfected 49

10. Strategies to reduce rates of reinfection • Treating all current partners promptly • Obtaining good partner notification from client • Health professional to stress importance of getting this information as well as respecting confidentiality of the client. • Azithromycin as first choice even for women with a risk of pregnancy.

11. Treatment consultation should include … • How to take medications correctly • What to do if vomiting occurs • What to do if treatment not completed correctly • Abstinence from sex - how long? • Safe sex /condom use • Advise regarding retest and further S.T.I. screening • Potential offer of 2 week follow up call • Give written advice supporting above

12. Conclusion (1 of 2) • Chlamydia is common in our population • Low rate of re-testing may imply low risk • Greater practice of safe sex;and / or • Clients ambivolent to risk • Those re-tested were aware of risk

13. Conclusion (2 of 2) • Key to reducing reinfection rate: • Good partner notification • Thorough treatment consultations for positive clients and partners • Partners treated quickly and conveniently • Effective Health Education/safe sex • Azithromycin as 1st choice treatment • Greater client awareness of Chlamydia risks and ease of testing is a success of the programme.

14. The rate of reinfection within a major City community based Chlamydia Screening Programme Any Questions? Liverpool: City of Culture 2008 By Annmaria Taylor, May 2006