Introduction of chlamydia screening to a busy, inner city contraception
and reproductive health clinic
K. Jones (1), C. Hazledine (2)
Royal Liverpool and Broadgreen Hospitals, Liverpool, UK (1)l Abacus
Clinics, Liverpool, UK (2)
Introduction: Our city is recognised as a clubbing capital attracting
many young visitors nationally and internationally. It also has three
universities and a number of colleges of higher education, attracting many young
people. Between 1996 and 2002 the overall rates of uncomplicated chlamydia
diagnoses among 16 to 19 year olds more than doubled, from 7,324 cases to
21,027.
Objectives: To evaluate whether it was possible to reproduce results
of a successful chlamydia screening service from a previous small study. To
evaluate how quickly and easily the staff assimilated the screening process. To
confirm acceptability of urine testing and community based management. To
improve the sexual health of the local young population.
Design & methods: From May 02 to March 03, testing was offered in
the large city centre sexual health clinic. All staff received written and oral
training, reiterated on various occasions, enabling them to offer enough
information to make an informed choice. All clients under the age of 25, who
were asymptomatic, were offered urinary screening for chlamydia during their
contraceptive and reproductive health discussion. All urine samples, which
tested positive for chlamydia, were also tested for gonorrhoea. Clients with a
negative result were contacted via a letter. Those clients who tested positive
were contacted by telephone, with postal contact as back up. They were seen by
appointment for discussion, treatment and partner notification. Regular audit of
case notes was performed to determine whether staff offered the test
appropriately.
Results: 80% of eligible clients had documented evidence that the test
had been discussed. Most clients offered testing accepted screening at the
initial contact. Of 2337 clients tested, 304 were positive. 4 also had
gonorrhoea. All clients with a positive result were contacted and all but 4
definitely received treatment. 94% chose to receive treatment at the testing
site, others chose to attend local GUM services. 69% of named contacts were seen
and treated.
Conclusions: It is possible to introduce acceptable chlamydia
screening service into a large, busy city centre clinic. There is a high
incidence of asymptomatic chlamydia infection in the population targeted for
screening. The management of uncomplicated genital chlamydia infection in this
setting was acceptable to both clients and staff. Follow up of positive clients
by a designated team with links into genitourinary medicine clinic worked well.
