Chlamydia

Document Sample
Chlamydia Powered By Docstoc
					Chlamydia Screening

    by Dr Vicki Purser
                  Aim
• To improve our understanding of
  Chlamydia screening
               Objectives
• To be aware of the prevalence and age
  distribution of Chlamydia
• To understand the different ways in which
  patients can present with Chlamydia
• To develop confidence when taking a sexual
  history
• To demonstrate the appropriate management of
  Chlamydia
• To understand how the Chlamydia screening
  programme works locally
               Chlamydia
• Chlamydia commonest STI in UK
• 20% women and 50% men symptomatic
• Sequelae if untreated:
  – Women (PID, Ectopic pregnancy, Tubal
    Infertility)
  – Men (Epididymo-Orchitis, Infertility)
• Management: Azithromycin 1g stat
• Contact tracing always required (GUM)
                                Rates of diagnoses of uncomplicated genital
                              chlamydial infection by sex and age group, GUM
                                   clinics, United Kingdom: 1997 - 2006
                                     Males
                              1400
                                                  <16      Females
                                                  16-19   1400
                              1200                20-24
Rate per 100,000 population




                                                  25-34   1200
                              1000                35-44
                                                          1000
                                                  >44
                               800
                                                           800

                               600
                                                           600

                               400
                                                           400

                               200
                                                           200

                                 0
                                                             0
                                      19

                                      19

                                      19

                                      20

                                      20

                                      20

                                      20

                                      20

                                      20

                                      20




                                                                 19

                                                                 19

                                                                 19

                                                                 20

                                                                 20

                                                                 20

                                                                 20

                                                                 20

                                                                 20

                                                                 20
                                         97

                                         98

                                         99

                                         00

                                         01

                                         02

                                         03

                                         04

                                         05

                                         06




                                                                    97

                                                                    98

                                                                    99

                                                                    00

                                                                    01

                                                                    02

                                                                    03

                                                                    04

                                                                    05

                                                                    06
                         Routine GUM clinic returns
       Chlamydia Screening
• Local PCT Initiative, being rolled out
  nationally
• “Got it” Campaign
• Chlamydia screening for those sexually
  active aged 16-25
• NAAT testing
• Low vaginal swab or urine for women
• Urine sample (first pass urine) for men
   National Chlamydia Screening
            Programme
• To control Chlamydia through the early detection
  and treatment of asymptomatic infection,
  preventing the development of sequelae and
  reducing onward transmission of the disease
• Increase acceptability of chlamydia screening
• Reduce the stigma associated with chlamydia
  infections
• Increase awareness of chlamydia screening in
  sexually active young people
           Sexual History
• Emphasise confidentiality and privacy
• Be purposeful
• Do not make assumptions or stereotype
• Use patient’s own words and language
  where possible
• Ask if you are unclear
               Sexual History
• Pain/dysuria
• Discharge
• Duration of symptoms
• Sexual contacts (are they known?
  Contactable?)
• Sexual preference and practices
• Other factors …pregnancy, menstruation
    problems, systemic illness, sexual violence
           Sexual History
• A: Be Alert…For what could be an STI
• B: Blissful unawareness…Is still being
  seen in patients with HIV (30% unaware)
• C: Chlamydia…Always offer screening
Contact Tracing

Chlamydia and female
infertility

  by Dr Peter Bruck
     What is Contact Tracing ?
• Also known as “partner notification”
• Used to pass information to partners of persons
  identified as having a sexually transmitted
  infection (STI)

• A partner (or contact) is anyone with whom a
  person has had vaginal, anal and / or oral sex

• Is a confidential service
    How are contacts traced?
• By the patients themselves

• By a health professional (usually a health
  advisor), with consent from the patient

• By the patient, with agreement that the other
  person can be contacted by a health
  professional, if they have not attended within a
  specified period of time
         Why contact trace?
• To reduce infection in the community by offering
  treatment as appropriate

• People often do not know they have an STI and
  may unknowingly spread it to others

• To offer contacts screening for a range of STIs

• To advise on strategies to avoid catching STIs -
  “safer sex”
   Does Chlamydia always cause pelvic
      inflammatory disease (PID)?
• Repeated Chlamydia infection well recognised
  to be associated with increased rates of PID 1

No of infections                    Odds ratio
    1                                     1
    2                                     2
    3                                     4.5

• Tubal damage may also occur in a single
  infection left untreated over a long time

1. Am J Obstet Gynecol. 1997 176(1 Pt 1):103-7
      Does PID always cause infertility?
• Repeated episodes of PID recognised to be
  associated with increased rates of PID 2,3

No. of PID episodes Infertility rates (%)
     1                     5 - 12
     2                    10 - 35
    ≥3                    18 – 75

    One of these studies 2 reported increased rates of
     infertility (up to 36% of cases) with increasing
     severity of a single episode of acute PID

2. Am J Obstet Gynecol. 1975; 121(5):707-13.
3. J Br Fer Soc. 1996; 1(1):23-30.
Don’t forget HIV!
Any questions?

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:4
posted:12/28/2011
language:
pages:19