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UK National Audit of Chlamydial Infection Management. National Audit Group British Association for Sexual Health & HIV. Case notes audit Interim results. 20 February 2008. Case definition. Any one of the KC60 C4A, C4B, or ISD(D)5 C41A, C41B or C41R and seen in the audit interval

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uk national audit of chlamydial infection management

UK National Audit of Chlamydial Infection Management

National Audit Group

British Association for Sexual Health & HIV

slide2
Case notes audit

Interim results

20 February 2008

case definition
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
slide5

*Note: South East & South West Thames is “South Thames”

Essex data included in “North Thames”

sample
Sample

*Health Protection Scotland: http://www.documents.hps.scot.nhs.uk/ewr/pdf2007/0720.pdf

† Health Protection Agency. Personal Communication

test method naats
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

chlamydial tests in women
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
chlamydial tests in men
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
treatment pregnant women
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)

ceg standard for contact tracing
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

conclusions 1
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
slide30

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
conclusions 3
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