National Chlamydia Screening Programme

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National Chlamydia Screening Programme

• Clare Scholfield
• Chlamydia Screening Coordinator for Portsmouth
  and South East Hants Programme
• 02392 866762
• Chlamydia.Coordinator_at_porthosp.nhs.uk

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Aims of the Programme

• To offer opportunistic screening to sexually
  active men and women under the age of 25, in
  clinical and non-clinical settings
• To reduce the prevalence of chlamydia
• To improve general sexual health awareness

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Background

• 1999-2000 - Portsmouth was part of the pilot
  study which identified a 10 prevalence of
  chlamydia
• 2003 - Portsmouth was part of the first phase of
  the screening programme
• April 2006 - Screening programme rolled out
  across England
• April 2007 - the NCSP included in the NHS Local
  Delivery Plan (LDP)

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LDP Target April 07 March 08

• To screen 15 of the total 15-24 yr old
  population
• For South East Hants this equals 6,681 new
  screens
• 1.4 completed in first quarter 2007
• 1.8 completed in second quarter 2007

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Why screen?

• 50 of men and 70 of women infected are
  asymptomatic
• Chlamydia causes one-third of cases of Pelvic
  Inflammatory Disease
• Potential consequences of PID include
• - ectopic pregnancy
• - infertility
• - chronic pelvic pain (Griffiths Cuddigan 2002)

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Why screen? cont.

• Other complications of chlamydia include
• - Epididymo-orchitis
• - Conjunctivitis in adults and newborns
• - Reiters syndrome
• - Psychological effects
• The financial cost of the complications of
  chlamydia is thought to exceed 200 million per
  year (Dodd et al 2002)

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Screening Sites Included in the Portsmouth and SE
Hants Programme

• GUM
• CASH
• GP practices
• Sex Sense
• Naval bases
• Youth centres
• University/colleges

• Unplanned pregnancy clinic
• Ante-natal clinics
• Adolescent health team
• Haslar detention centre
• School nurses

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Criteria for Screening

• Inclusion
• Asymptomatic male or female aged 15-24yrs who is
  sexually active and
• - has never been screened for chlamydia before
  or
• - was previously screened more than a year ago
  or
• - was screened within last 12 months but
• - tested positive in the last 6 months or
• - is a contact of chlamydia or
• - has changed their sexual partner

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Criteria for Screening

• Exclusion
• Anyone who is not 15-24 yrs old
• Anyone who has symptoms
• Anyone who has had a chlamydia screen within the
  last year unless
• - they have changed their sexual partner
• - are a sexual contact of someone diagnosed with
  chlamydia
• - they have had a positive test 6 or more months
  ago
• A standard yellow microbiology form should be
  used for patients who do not fit the inclusion
  criteria

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Initiators Role

• To offer chlamydia test to anyone who fits the
  inclusion criteira
• Discuss sample options and obtain specimen
• Complete microbiology form
• Send sample and form to the microbiology
  laboratory
• Treat patient if they refuse to attend CSO

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Samples

• Women
• Self-taken vaginal swab or
• First catch urine (urine must have been held for
  1 hr prior to test, and must be refrigerated
  within 4 hours) or
• Endo cervical swab if undergoing internal
  examination

• Men
• First catch urine (urine must have been held for
  1 hr prior to test, and must be refrigerated
  within 4 hours)

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Completing Microbiology Forms

• Blue part of form to be completed by patient
• Orange part of form to be completed by
  Doctor/Nurse
• If patient does not fit into inclusion criteria,
  send sample on normal yellow microbiology form,
  or refer patient to GU Medicine

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Dr/Nurse to complete
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Patient to complete
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How do patients receive results?

• Chlamydia Screening Coordinator will inform all
  patients of their results
• Negative or inhibitory results
• - By letter, text or email (depending on what
  patient has requested on blue form)
• Positive results
• - By letter, phone call or email
• All positive patients will be invited to attend
  the Chlamydia Screening Office for treatment
  and Partner Notification
• A letter will be sent to initiators outlining
  treatment given

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Chlamydia Treatment

• Doxycycline 100mg bd for 7/7
• or
• Azithromycin 1g stat
• or
• Erythromycin 500mg bd for 14/7 if patient
  pregnant or unable to rule out pregnancy repeat
  test 5/52 after completing treatment
• Advise no SC until treatment completed or 1/52 if
  treating with Azithromycin and until partner
  treated

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Management Form

• To be completed by GP if treating patient
• Document
• - Treatment given
• - Patients sexual contacts in the last 6/12
• - Whether patient is going to inform contacts or
  patient gives permission for the screening office
  to inform contacts confidentially
• Return completed form to Chlamydia Screening
  Office via post or fax

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National Chlamydia Screening Programme advises

• A repeat test in 6/12 if patient positive
• A repeat test in 1yr if patient negative
• OR
• A repeat test after a change of partner

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Payment

• Payment will only be made if patient meets
  screening criteria set out in the LES and has a
  postcode and reason for test documented
• Payment will be made quarterly, 2/12 in arrears

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Topics for discussion

• Ideas for screening in GP practices
• Previous experience
• Obstacles to screening in a GP practice

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References

• www.bashh.org.uk
• www.haveyougotit.nhs.uk
• Dodd.A., Comber.D.L., Hernon.M. (2002)
  Chlamydia-inside out, International Journal of
  STD AIDS
• Griffiths.C., Cuddigan.A. (2002) Clinical
  management of chlamydia in general practice A
  survey of reported practice, The Journal of
  Family Planning and Reproductive Health Care
• Underhill.G., Hewitt.G., Mclean.L., Randall.S.,
  Tobin.J., Harindra.V. (2003) Who has Chlamydia?
  The prevalence of genital tract chlamydia
  trachomatis within Portsmouth and South East
  Hampshire UK, Journal of Family Planning and
  Reproductive Health Care