UK National Audit of Chlamydial Infection Management

1. UK National Audit of Chlamydial Infection Management National Audit Group British Association for Sexual Health & HIV

2. Case notes audit Interim results 20 February 2008

3. Case definition • Any one of the KC60 C4A, C4B, or ISD(D)5 C41A, C41B or C41R and seen in the audit interval • GUM clinic or Sexual Reproductive Healthcare clinic • Audit interval: 2 January and 31 March 2007 inclusively • Sample number: first 30 patients seen in the audit interval (or all cases if less than 30 seen) • Data collected: 3 September 2007 to 31 October 2007

4. Demography

5. *Note: South East & South West Thames is “South Thames” Essex data included in “North Thames”

6. Number of cases (N=5032)

10. Sample *Health Protection Scotland: http://www.documents.hps.scot.nhs.uk/ewr/pdf2007/0720.pdf † Health Protection Agency. Personal Communication

11. Reasons for testingMore than 1 reason possible

12. Presenting features: female cases (n=2474)

13. Presenting features: male cases (n=2546)

14. Test method - NAATs Overall, 4679 (93%, regional range 100-69%) cases had NAAT testing documented from at least one of urinary, cervical, vulvovaginal, urethral or rectal sampling

15. Other chlamydial tests

16. Chlamydial tests in women • 2093 (85%) women had cervical or vaginal NAATs • of the remaining 381 not having cervical or vaginal NAATs • 134 (35%) had urine NAATs (of whom 52 (39%) had a genital examination performed) • 18 (5%) had urethral NAATS • 229 (60%) had no cervical, vulvovaginal, urinary or urethral NAATS

17. Chlamydial tests in men • 1723 (68%) men had urinary NAATS • Of the remaining 823 not having urinary NAATs • 699 (85%) had urethral tests • 124 (15%) had neither urinary nor urethral tests

18. Other tests for STIs: Syphilis

19. Other tests for STIs: HIV

20. Treatment: uncomplicated infxn.

21. Treatment: pregnant women • Twenty of 26 pregnant women were treated with azithromycin • ?suggests that most prescribers treating pregnant women consider that erythromycin is not an “adequate alternative” to azithromycin (the manufacturer’s advice stated by the British National Formulary British National Formulary. [http://www.bnf.org/bnf/bnf/current/126828.htm]. (Accessed 09 February 2008)

22. Information-giving

23. Follow-up: modes of FU

24. Follow-up: time to FU

25. Partner notification

26. CEG standard for contact tracing • Auditable Outcome Measures • Partner notification recommendation: In 2004, a systematic review of UK GUM clinics’ work showed that a mean of 0.43 contacts per case of chlamydia were screened in large city clinics and 0.64 contacts per case of chlamydia were screened in other clinics http://www.bashh.org/guidelines/2006/chlamydia_0706.pdf

28. Note: please look at the corresponding question in the Case notes questionnaire for this table

29. Conclusions: 1 • Largest national audit to date (more clinics) • 187 (71%) of the 262 UK GUMed clinics plus 6 SRH clinics • Ethnic group not always recorded 8% (0-32%) • 83% aged 19 years or over • Relatively few MSM overall (3% all cases) • About ½ cases no symptoms • 1/3 attending for routine or asymptomatic screens, • ?implications for service provision/workloadreduction

30. Conclusions: 2 • Main test used are NAATs • Main testing sites in women are cervical or vulval • 73% MSM tested for HIV, range 58-100% • Main treatment is azithromycin (54% cases), but a lot of doxycycline is also used (37% cases) • Most pregnant women treated with azithromycin • Lack of written information provided (only 50% cases overall) • More follow-up done by ‘phone or texting than in clinic • 25% cases no FU

31. Conclusions: 3 • >90% of cases having PN had this provided by a HA or other suitably trained HCP • PN outcomes not documented for 25% cases provided with PN advice • 40% cases not documented as having treatment verified for contact(s), with wide range 0-51% • The national estimate of average number of contacts screened per index was 0.45, with regional performances between 0.29 to 0.73

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