Chlamydia Screening

SW Chlamydia Support

Ellie RickettsSW Chlamydia Support

SW Chlamydia Support

Aim

The aim of this session is to feedback results from the 2009 NCSP Practitioner Questionnaire

Equip you with the information needed to support chlamydia screening in your practice.

SW Chlamydia Support

Questionnaire Responses Pre letter sent to 622 NCSP registered practices in South West.

(All practices registered for at least 6 months at Apr 2009), asking them to nominate 3 members of staff (1 Dr, 1 Nurse and 1 Receptionist), to complete a questionnaire about the NCSP.

301 surgeries responded to the letter asking for questionnaires (48% of sample population).

Of the 301 surgeries, 288 returned at least one questionnaire (60% response rate).

In total 873 Questionnaires were sent to practice staff

SW Chlamydia Support

Sample 471 participants

Majority of respondents female (93%)

Job type: 27% (n=124) GP 50% (n= 232) Practice/other nurse inc HCA’s 11% (n=51) Receptionist 12% other (n=54) (practice managers, various non-

patient facing admin and phlebotomists)

SW Chlamydia Support

Results - KnowledgeResults - Knowledge

Staff of all grades reported that they felt that extra training on

The microbiology & epidemiology of chlamydia

Knowledge about treatment and how to deal with a positive result

SW Chlamydia Support

Chlamydia trachomatis

Bacterial Sexually Transmitted

Infection Easily Treated

SW Chlamydia Support

Rates of diagnoses

Routine GUM clinic returns

Males Females

0

200

400

600

800

1000

1200

1400

1600

Ra

te p

er

10

0,0

00

po

pu

lati

on

<1616-1920-2425-3435-44>44

0

200

400

600

800

1000

1200

1400

1600

SW Chlamydia Support

Signs & Symptoms

Women > 80%

asymptomatic

post coital or intermenstrual bleeding

lower abdominal pain purulent vaginal

discharge mucopurulent cervicitis

and/or contact bleeding dysuria

Men

> 50% asymptomatic

urethral discharge dysuria (pain on passing

urine)(extent of severity may vary)

SW Chlamydia Support

SW Chlamydia Support

Transmission

vaginal sexual intercourse

anal sexual intercourse oral-genital contact mutual touching sharing of sex toys

SW Chlamydia Support

Relationship between genital chlamydial infection, pelvic inflammatory disease and the sequelae of PID

Female Infertility (~20%?)

Genital chlamydial infection

10 - 40% of untreated infections

PID

Ectopic pregnancy (~47%?)

HPA Communicable Disease Surveillance Centre

SW Chlamydia Support

Why target under 25’s?

Physiology

Presentation

Epidemiology

Behaviour

SW Chlamydia Support

Physiology

Older cervixColumnar epithelial cells have

retreated into endo-

cervical canal

Young cervix

Abundant columnar epithelial

cells

Sexually Transmitted Diseases, 3rd Edition. Holmes, KK, et al., eds. (USA: McGraw-Hill)

SW Chlamydia Support

Include…

All ♀ and ♂ under 25 years old The partner(s) of any person with a

positive chlamydia test - regardless of age

Assess need for repeat screening – recommend screen annually or at partner change

SW Chlamydia Support

Under 16’s

Research has shown that nearly a third of young people are sexually active before they reach 16yrs

Wellings et al. (2001) Sexual Behaviour in Britain: early heterosexual experience. Lancet 358: 1843-50

SW Chlamydia Support

Results - Normalise

The majority of respondents felt if screening was made ‘the norm’ it would make screening easier

SW Chlamydia Support

Which test / sample?

Men - first catch urine

Women - self-taken vulvo-vaginal swab (vvs) or first catch urine

SW Chlamydia Support

Accuracy

Sensitivity Specificity

Urine ♂ - first catch urine 95% 99%

Self-taken VulvoVaginal Swab

97% 95%

Urine ♀ - first catch urine 92% 95%

SW Chlamydia Support

Timing of tests

Annual screen

or screen at partner change

SW Chlamydia Support

Attendance

On average in the < 25 yrs age group 60% men 75% women

visit the GP for a consultation at least annually

Salisbury et al. Brit J Gen Pract 2006:56:99-103

SW Chlamydia Support

Your surgery data

Number of 15-24 year olds registered at the

surgery

217

Attendance

Average attendance

in 1 year

146 = (74%)

SW Chlamydia Support

Results - targets

75% (n=213) of clinicians, 94% (n=32) of receptionists and 89% (n=16) of practice managers think they do not know the proportion of the target sample the DoH wants to be screened

5% (n=13) of clinicians, no receptionists, and 6% (n=1) of practice managers gave a response in the correct range (i.e. 11-20%)

SW Chlamydia Support

NCSP TARGET 2010/2011

=35% (76 patients)

35% = 2 screens per week

SW Chlamydia Support

ResultResult

A lot of respondents felt young people don’t want to be asked as part of a consultation.

They thought it would either Offend the patient Would make the patient anxious

SW Chlamydia Support

SW Chlamydia Support

The surgery was the most convenient place

“I’m just more familiar, with my doctor so I’d feel better about coming somewhere that I knew rather than having to go somewhere else. It’s kind of embarrassing or bad enough as it is, so you want to go somewhere you’re familiar with I think.”

SW Chlamydia Support

They would accept an opportunistic screen if offered by

a doctor or nurse

“..just by promoting it more positively, it’s just that they just need to get across its good for their health anyway but, …. doctor or staff need to talk to them.”

SW Chlamydia Support

Patients prefer staff who display a non-judgemental attitude

“afraid that the doctors and nurses are gonna judge them, that, that’s what I think”

“It depends on the other person, really what they tell you about it or speak to you, how they speak to you about it.”

SW Chlamydia Support

The majority of the sample reported a preference for taking the sample at the surgery rather

than doing it at home

“yeah, do it while you are here, why not, because if they’re taking it home you’re not going to bring it back”

SW Chlamydia Support

Young people are happy to take information or kits from

receptionists

“…I suppose its handy, …. Its letting you know, what it involves and that should have like a self (test), you just take one.”

SW Chlamydia Support

Results - TimeResults - Time

Most clinical staff were concerned that there isn’t enough time in a consultation or

That they don’t know how to raise the subject

SW Chlamydia Support

SW Chlamydia Support

Scenario 1

50 seconds

SW Chlamydia Support

Scenario 2

1 min 40 secs

SW Chlamydia Support

Scenario 3

1min 55 sec

SW Chlamydia Support

Scenario 4

4 seconds

SW Chlamydia Support

“We like to think as a practice, once we decide to take on board something that’s going to help the clients or the patients, then the whole system is set.Like the reception is aware, all the clinical staff are aware and everyone will do whatever is necessary.”

Results - Whole team approach

SW Chlamydia Support

Chlamydia Support Team

Teaching sessions GP led posters & invitations Web site – screening data and

newsletter Advice and support via email Help to set up computer prompts and

templates Help to initiate other mechanisms to

increase screening

SW Chlamydia Support

www.swchlamydiasupport.org

SW Chlamydia Support

Contact us at

info@swchlamydiasupport.orgkatie@swchlamydiasupport.org

angela@swchlamydiasupport.org ellie@swchlamydiasupport.org

Telephone: 08454 225068

Website: www.swchlamydiasupport.org

SW Chlamydia Support

Summary Staff require more knowledge to feel able to

offer chlamydia testing Screening needs to be normalised – offer to

everybody! All staff need to know (and understand) the

target Young people want to be asked It doesn’t need to take a lot of time Whole team approach