Chlamydia Testing and Management: A Framework for Derbyshire

Chlamydia Testing and Screening Management: A Framework for Derbyshire
Scope of document
Primary Care Guidelines for all patients that require testing (and or screening for <25 year olds), treatment
and partner notification for Chlamydia within Derbyshire County and Derby City.
Who to test for Chlamydia infection
a) Within the Derbyshire Chlamydia Screening Programme
All asymptomatic sexually active 15-24 year olds. Kits available as part of LES agreement within GP
surgeries or from various locations across Derbyshire.
See website www.fancyaquickie.org.uk for nearest location.
(National Chlamydia Screening Programme 2008)
b) Outside of National Chlamydia Screening Programme:
o
o
o
Patients aged 25+ who have had more than 2 partners in last 6 months
Patients aged 25+ who have had a change of sexual partner
Symptomatic patients (see below)
(British Association for Sexual Health and HIV BASHH, 2010)
Presenting Symptoms
Women
Vaginal discharge
Abnormal vaginal bleeding, Inter-menstrual
bleeding (IMB), Post-coital bleeding (PCB)
Pelvic Inflammatory Disease (PID)/low
abdominal pain
Inflamed/ friable cervix
Tubal infertility/ ectopic
Reactive arthritis
Dysuria
Men
Urethral discharge#
Dysuria#
Urethritis
Epidymo-orchitis
Reactive arthritis
#
Onward referral to specialist STI services is
appropriate.
(British Association for Sexual Health and HIV BASHH 2006 and BASHH 2010)
When else to test
Partners of those with Chlamydia or PID
Pre Intrauterine Device (IUD)/ Intrauterine
System (IUS) if sexual history indicates high
risk of STI
All patients with another STI
Mothers of babies with Chlamydia
conjunctivitis
Pre Termination of Pregnancy (TOP)
Semen and egg donors
Any patient on request
Which sample?
Women
Men
An endocervical swab if having a VE (vaginal
First void urine – 15ml more than 1 hour after
examination) or
last passed urine (PU)
*Self taken vaginal swab or
Men who have sex with men (MSM) also require
*First void urine (FVU)
rectal and pharyngeal swabs. Onward referral to
* Use these sample methods only if lab uses nucleic
specialist STI services is appropriate.
acid amplification (NAAT) test . NB in women, urine
testing has poorer sensitivity, therefore use of a swab
reduces false negative results (Falk et al 2010)
For Chlamydia screening programme use FVU
Reviewed July 2010 / October 2012
Next review date October 2014
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Starting Treatment
(British Association for Sexual Health and HIV BASHH 2006)
Which antibiotic? Treatment is free in GUM but not in Primary Care
Uncomplicated
Risk of Pregnancy
Suspected Chlamydial
Epidymitis/orchitis
infection
PID
Azithromycin 1g stat
Azithromycin 1g stat, but
Doxycycline 100mg bd 14
Doxycycline 100mg
important to discuss with
days and Metronidazole
bd for 14 days
woman as unlicensed for use 400mg bd 7-14 days
or
or
or
in pregnancy
or
Doxycycline 100mg
Erythromycin 500mg bd for
Ofloxacin (if no psychiatric
Ofloxacin 200mg bd
bd 7 days
14 days or 500mg qds for 7
history) 400mg bd 14 days
for 14 days
days
and Metronidazole 400mg
or
bd 7-14 days
Amoxicillin 500mg tds 7 days
(this regime has a lower cure
If Gonorrhoea suspected or (British Association
for Sexual Health and
rate than others - use only if
a risk, refer to GUM
HIV BASHH 2006)
unable to tolerate
(BASHH guidelines for PID)
Erythromycin)
Partner Notification support from trained health advisors is strongly recommended (contact details below)
(Society of Sexual Health Advisers 2004).
Symptomatic
Asymptomatic
All partners from 4 weeks prior to the development of All partners in the last 6 months
symptoms
Follow up – depends on the treatment given
After Erythromycin or Amoxicillin, re-test at least 5
After treatment with Azithromycin or Doxycycline, no
weeks after treatment completed
re-test is needed.
(British Association for Sexual Health and HIV
The only exception to this is if a pregnant patient is
BASHH 2006)
given Azithromycin, when she should be retested 6
(Society of Sexual Health Advisers 2004)
weeks after treatment is completed.
Please give patient leaflets about Chlamydia. These are available via the PCT websites
For further advice/support contact:
Department of GUM Chesterfield: telephone (01246) 513500
Health Advisor [email protected] (01246) 513142
Consultant [email protected]
Consultant [email protected] or
North Derbyshire Community Sexual Health Practitioners are available on 01246 293707.
Department of GUM Derby : (01332) 254 681 Consultant Dr Ade Apoola 01332 340131 ext 54720
Consultant Dr Raj Rajakumar 01332 340131 ext 54720 Health Advisors 01332 254681/ 01332 254897
References:
British Association for Sexual Health and HIV (2006) UK National Guideline for the Management of Genital Tract Infection
with Chlamydia trachomatis. http://www.bashh.org/documents/61/61.pdf
British Association for Sexual Health and HIV (2010) Standards for the management of sexually transmitted infections
http://www.medfash.org.uk/Projects/BASHH%20standards/Final%20pdfs/Standards_for_the_management_of_STIs.pdf
sexually transmitted infections
British Association for Sexual Health and HIV (2005) UK national guideline for management of PID.
http://www.bashh.org/documents/118/118.pdf
Falk L, Coble BI, Mjörnberg PA, Fredlund H. Sampling for Chlamydia trachomatis infection - a comparison of vaginal, firstcatch urine, combined vaginal and first-catch urine and endocervical sampling.International Journal STD AIDS. 2010 Apr;
21(4):283-7.PMID: 20378903
National Chlamydia Screening Programme (2008) Core requirements
http://www.chlamydiascreening.nhs.uk/ps/assets/pdfs/core_req/NSCP_CoreReq_4th_edition_latest.pdf
Society of Sexual Health Advisers (2004) http://www.ssha.info/wp-content/uploads/ha_manual_2004_section_a.pdf
Reviewed July 2010 / October 2012
Next review date October 2014
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