Sarah Randall

Incidence and reinfection rates of genital chlamydial infection among women aged 16–24 years attending general practice, family planning and genitourinary medicine clinics in England: a prospective cohort study by the Chlamydia Recall Study Advisory Group

Background: In England, screening for genital chlamydial infection has begun; however, screening frequency for women is not yet determined. Aim: To measure chlamydia incidence and reinfection rates among young women to suggest screening intervals. Methods: An 18-month prospective cohort study of women aged 16–24 years recruited from general practices, family planning clinics and genitourinary medicine (GUM) clinics: baseline-negative women followed for incidence and baseline-positive women for reinfection; urine tested every 6 months via nucleic acid amplification; and behavioural data collected. Extra test and questionnaire completed 3 months after initial positive test. Factors associated with infection and reinfection investigated using Cox regression stratified by healthcare setting of recruitment. Results: Chlamydia incidence was mean (95% CI) 4.9 (2.7 to 8.8) per 100 person-years (py) among women recruited from general practices, 6.4 (4.2 to 9.8) from family planning clinics and 10.6 (7.4 to 15.2) from GUM clinics. Incidence was associated with young age, history of chlamydial infection and acquisition of new sexual partners. If recently acquiring new partners, condom use at last sexual intercourse was independently associated with lower incidence. Chlamydia reinfection was mean (95% CI) 29.9 (19.7 to 45.4) per 100/person-year from general practices, 22.3 (15.6 to 31.8) from family planning clinics and 21.1 (14.3 to 30.9) from GUM clinics. Factors independently associated with higher reinfection rates were acquisition of new partners and failure to treat all partners. Conclusions: Sexual behaviours determined incidence and reinfection, regardless of healthcare setting. Our results suggest annual screening of women aged 16–24 years who are chlamydia negative, or sooner if partner change occurs. Rescreening chlamydia-positive women within 6 months of baseline infection may be sensible, especially if partner change occurs or all partners are not treated.

Overcoming the barriers to chlamydia screening in general practice—a qualitative study

BACKGROUND There is low uptake of chlamydia screening in general practices registered with the English National Chlamydia Screening Programme (NCSP). Aims. To explore staffs attitudes and behaviour around chlamydia screening and how screening could be optimized in general practice. METHODS A qualitative study with focus groups and interviews, in general practices in seven NCSP areas. Twenty-five focus groups and 12 interviews undertaken with a purposively selected diverse group of high and low chlamydia-screening practices in 2006-08. Data were collected and analysed using a framework analytical approach. RESULTS Higher screening practices had more staff with greater belief in patient and population benefits of screening and, as screening was a subjective norm, it was part of every day practice. Many staff in the majority of other practices were uncomfortable raising chlamydia opportunistically and time pressures meant that any extra public health issues covered within a consultation were determined by Quality Outcomes Framework (QOF) targets. All practices would value more training and feedback about their screening rates and results. Practices suggested that use of computer prompts, simplified request forms and more accessible kits could increase screening. CONCLUSION Practice staff need more evidence of the value of opportunistic chlamydia screening in men and women; staff development to reduce the barriers to broaching sexual health; simpler request forms and easily accessible kits to increase their ability to offer it within the time pressures of general practice. Increased awareness of chlamydia could be attained through practice meetings, computer templates and reminders, targets and incentives or QOF points with feedback.

Who has chlamydia? The prevalence of genital tract Chlamydia trachomatis within Portsmouth and South East Hampshire, UK

Objective To determine the prevalence of genital tract Chlamydia trachomatis infection in women and men attending different health care settings in Portsmouth and South East Hampshire. Design Prospective, opportunistic screening. Setting Multiple health care sites. Participants Consenting sexually active women and men. Intervention A urine sample was tested for Chlamydia trachomatis and positive patients were offered treatment and partner notification. Main outcome measures The presence or absence of chlamydia infection according to age, gender, health care setting and reason for attendance. Results A total of 14 756 samples were tested giving an overall prevalence of 9.6%. The prevalence was significantly higher in women attending for a termination of pregnancy, antenatal care, women and men attending genitourinary medicine and in those with genital tract symptoms. The prevalence was different for men and women at different ages. Conclusion The prevalence of genital Chlamydia trachomatis infection was high but differed at various health care settings and by reason for attendance.

Promoting chlamydia screening with posters and leaflets in general practice--a qualitative study.

BackgroundGeneral practice staff are reluctant to discuss sexual health opportunistically in all consultations. Health promotion materials may help alleviate this barrier. Chlamydia screening promotion posters and leaflets, produced by the English National Chlamydia Screening Programme (NCSP), have been available to general practices, through local chlamydia screening offices, since its launch. In this study we explored the attitudes of general practice staff to these screening promotional materials, how they used them, and explored other promotional strategies to encourage chlamydia screening.MethodsTwenty-five general practices with a range of screening rates, were purposively selected from six NCSP areas in England. In focus groups doctors, nurses, administrative staff and receptionists were encouraged to discuss candidly their experiences about their use and opinions of posters, leaflets and advertising to promote chlamydia screening. Researchers observed whether posters and leaflets were on display in reception and/or waiting areas. Data were collected and analysed concurrently using a stepwise framework analytical approach.ResultsAlthough two-thirds of screening practices reported that they displayed posters and leaflets, they were not prominently displayed in most practices. Only a minority of practices reported actively using screening promotional materials on an ongoing basis. Most staff in all practices were not following up the advertising in posters and leaflets by routinely offering opportunistic screening to their target population. Some staff in many practices thought posters and leaflets would cause offence or embarrassment to their patients. Distribution of chlamydia leaflets by receptionists was thought to be inappropriate by some practices, as they thought patients would be offended when being offered a leaflet in a public area. Practice staff suggested the development of pocket-sized leaflets.ConclusionThe NCSP should consider developing a range of more discrete but eye catching posters and small leaflets specifically to promote chlamydia screening in different scenarios within general practice; coordinators should audit their use. Practice staff need to discuss, with their screening co-ordinator, how different practice staff can promote chlamydia screening most effectively using the NCSP promotional materials, and change them regularly so that they do not loose their impact. Education to change all practice staffs attitudes towards sexual health is needed to reduce their worries about displaying the chlamydia materials, and how they may follow up the advertising up with a verbal offer of screening opportunistically to 15-24 year olds whenever they visit the practice.

UK Department of Health Guidance on Prescribing for Impotence Following the Introduction of Sildenafil Potential to Contain Costs in the Average Health Authority District

AbstractObjectives: To evaluate the effectiveness at containing service costs of the UK’s Department of Health (DoH) guidance on prescribing for impotence implemented after the introduction of sildenafil and taking effect from 1 July 1999. Design: A pragmatic economic analysis of the impact of the DoH guidance on specialist-care activity and costs and primary-care prescribing costs from the perspective of the UK National Health Service. Primary-care prescribing costs and specialist-care activity and cost data were collected for 12-month periods before and after the introduction of the guidance. Setting: Portsmouth and South East Hampshire Health Authority. Results: Specialist-care activity and associated costs fell by 70% in the first year following the introduction of the DoH guidance while primary-care prescribing costs doubled. The overall cost for providing impotence services in Portsmouth and South East Hampshire in 1999–2000 was £232 619, and is similar to the cost incurred in 1998–1999 of £225 108 (uplifted to 1999–2000 values). Conclusions: The DoH guidance on prescribing for impotence has effectively reduced specialist-care activity and costs in Portsmouth and South East Hampshire. It offers the potential to allow the overall costs of impotence services in the district to be contained even with the use of higher cost drugs, such as sildenafil.

Screening for chlamydia: seize the day

Genital Chlamydia trachomatis is the commonest bacterial sexually transmitted infection in the UK with the number of cases diagnosed in genitourinary medicine (GUM) clinics having increased continuously since the early 1990s to over 89 000 in 2003 an 8% increase on the previous year. The prevalence in the UK has been reported between 2% and 29% depending on the testing site population being tested and type of test. As expected the highest rates of diagnoses are reported from GUM clinics and are among 16–19-year-old females (1334/1001000] and 20–24-year-old males (961/1001000). It is estimated that approximately 70% of infections in women and 50% of infections in men are asymptomatic and therefore a large proportion of cases remain undiagnosed. Although easily treatable with oral antibiotics most people remain untreated as they are unaware of their infection. Between 10% and 40% of untreated cases of chlamydia may develop pelvic inflammatory disease (PID) with the risk of long-term sequelae namely ectopic pregnancy and infertility being dependent on the number of PID episodes. Approximately 20% of infertility cases and 43% of ectopic pregnancies are said to be caused by chlamydia. Recent studies suggest chlamydial infections in men may impair a couple’s ability to conceive independent of the presence of tubal damage in the female partner. Research has postulated that chronic chlamydial infection may be a risk factor associated with reproductive tract cancers. (excerpt)

IUD/IUS insertions and atropine

We have read with interest the correspondence relating to intrauterine device (IUD)/intrauterine system (IUS) insertions and atropine. This letter aims to provide an understanding of how this guidance was developed. The Clinical Standards Committee is responsible for providing guidance on clinical governance in the form of auditable standards to enable the provision of high-quality patient-centred care. There is no division within the Standards between that which should be provided by a doctor or by a nurse, unless there is a clinician-specific issue, for example, issuing medication under a patient group direction (PGD) for non-prescribers. The updated Resuscitation Standard of the Faculty of Sexual and Reproductive Healthcare was published in November 2010.1 Work began on updating the document in January 2010 and …