May 2006

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By Annmaria Taylor, May 2006

The rate of reinfection within a

major City community based

Chlamydia Screening Programme

Liverpool: City of Culture 2008

May 2006

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Liverpool Chlamydia Screening Programme (CSP)

Targeted at young people (<25 years old) Since June 2004 we have screened 22,996 78 varied screening venues Chlamydia positives 2,833 (12%) Proven treatment success rate is 97% First line treatment is Azithromycin Erythromycin where risk of pregnancy Treatment by trained nurses

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Rates of diagnoses of uncomplicated genital Chlamydial infection by Sex and Age group

0

200

400

600

800

1000

1200

1400

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Ra

te p

er

10

0,0

00

po

pu

lati

on

<1616-1920-2425-3435-4445+

Males Females

0

200

400

600

800

1000

1200

1400

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Source: GUM clinics, United Kingdom: 1995 - 2004

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Aims & Objectives

Show the rate of reinfection of those tested over a 12 month period with those individuals followed up 6 months later.

To discover % of clients who were initially treated and became reinfected.

Identify factors which will help reduce the reinfection rate.

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Methodology

A. Chlamydia tests during one year from September 2004 to August 2005.

B. We then looked at those reinfection cases in the subsequent 6 months (i.e. Sept ’05 – Feb ’06).

Data sourced from Chlamydia database and case note auditing.

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A. Results (1 of 2)

1,284 clients tested positive and treated.

116 (9%) returned for retesting

49 (4%) were found to be reinfected.

Of those original positive clients who were treated and retested

- 42% Positive - 58% Negative

0

500

1000

1500

Sept '04 - Aug '05

Tested & Treated RetestedPositive on retest

58%42%

Re-tested - negativeRe-tested - positive

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A. Results (2 of 2)

Small numbers returned for re-testing (9%)

Of these 42% were positive

Most (98%) could identify a reason for reinfection

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B. Results for 6 month follow up

A 6 month follow up on the 49 positives on retesting during initial year showed:

27: did not attend for a retest

19: retested negative

3: retested positive for a third time49

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Vomiting4%

Sex too soon4%

Poor compliance with drugs

8%

Reason not found

2%

Sex with New partner

39%

Sex with Untreated

partner43%

Reasons for reinfection (9/04 – 8/05)

Total number of clients reinfected 49

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Strategies to reduce rates of reinfection

Treating all current partners promptly Obtaining good partner notification from

client• Health professional to stress importance of getting

this information as well as respecting confidentiality of the client.

Azithromycin as first choice even for women with a risk of pregnancy.

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Treatment consultation should include …

How to take medications correctly What to do if vomiting occurs What to do if treatment not completed correctly Abstinence from sex - how long? Safe sex /condom use Advise regarding retest and further S.T.I.

screening Potential offer of 2 week follow up call Give written advice supporting above

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Conclusion (1 of 2)

Chlamydia is common in our population

Low rate of re-testing may imply low risk• Greater practice of safe sex;

and / or

• Clients ambivolent to risk

Those re-tested were aware of risk

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Conclusion (2 of 2)

Key to reducing reinfection rate:• Good partner notification• Thorough treatment consultations for positive clients

and partners• Partners treated quickly and conveniently• Effective Health Education/safe sex

Azithromycin as 1st choice treatment

Greater client awareness of Chlamydia risks and ease of testing is a success of the programme.

May 2006

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The rate of reinfection within a major City

community based Chlamydia Screening Programme

By Annmaria Taylor, May 2006

Liverpool: City of Culture 2008

Any Questions?