How accurate is presumptive Chlamydia trachomatis treatment? A 6-month clinical audit of a walk-in sexual health service
Susan P. Jacups
A B , Caroline Potter C , Trent Yarwood C D E F , Simon Doyle-Adams C and Darren Russell C F *
+ Author Affiliations
- Author Affiliations
A School of Public Health, The University of Queensland, St Lucia, Qld 4067, Australia.
B The Cairns Institute, James Cook University, McGregor Road, Smithfield, Qld 4878, Australia.
C Cairns Sexual Health Service, Cairns and Hinterland Hospital and Health Service, Cairns, Qld 4870, Australia.
D Infectious Diseases, Cairns Hospital, Cairns and Hinterland Hospital and Health Service, Cairns, Qld 4870, Australia.
E School of Clinical Medicine, University of Queensland, Herston, Qld 4006, Australia.
F College of Medicine and Dentistry, James Cook University, Cairns, Qld 4870, Australia.
Sexual Health 18(5) 413-420 https://doi.org/10.1071/SH21078
Submitted: 16 April 2021 Accepted: 16 August 2021 Published: 8 November 2021
© 2021 The Author(s) (or their employer(s)). Published by CSIRO Publishing
Abstract
Background: Chlamydia trachomatis (chlamydia) is highly prevalent and is an important sexually transmitted infection as it can lead to increased risk of HIV seroconversion; and if left untreated, can cause infertility in women. Clinical guidelines recommend treating chlamydia presumptively when presenting symptomatically; however, clinicians are now questioning this due to increasing prevalence of antimicrobial resistance.
Methods: To determine the accuracy of presumptive chlamydia treatment practices at a walk-in sexual health service in regional Australia, we audited all same-day screen and treat presentations prescribed azithromycin over a 6-month period in 2018.
Results: A total of 325 cases were included in the analysis. Over half (54%) the presentations returned negative pathology for all pathogens investigated. One quarter (25%) of presentations were positive for chlamydia, and (4%) reported a dual infection. A further one fifth (20%) were negative for chlamydia but positive for another pathogen. More symptomatic males than females returned positive pathology for chlamydia (8% vs 4%).
Conclusions: While presumptive treatment is recommended in the current guidelines, our findings indicate this resulted in over-treatment. Considering the increasing resistance patterns for Mycoplasma genitalium, which include azithromycin, presumptive treatments need to balance immediate client care needs against long-term community antimicrobial resistance outcomes. This internal audit provided a feedback mechanism to the walk-in sexual service, enabling modification of practices to provide more precise, individual clinical care within the bounds of current STI guidelines, while balancing wider the objectives of antimicrobial stewardship.
Keywords: adolescent, adult, chlamydia infections/epidemiology, microbial resistance, NAAT, PCR, reproductive health, sexually transmitted diseases/*epidemiology, youth.
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