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Title: How accurate is presumptive Chlamydia trachomatis treatment? A 6-month clinical audit of a walk-in sexual health service
Authors: Jacups, Susan P
Potter, Caroline
Yarwood, Trent 
Doyle-Adams, Simon
Russell, Darren 
Issue Date: 2021
Source: Jacups SP, Potter C, Yarwood T, Doyle-Adams S, Russell D. How accurate is presumptive Chlamydia trachomatis treatment? A 6-month clinical audit of a walk-in sexual health service. Sex Health. 2021 Nov;18(5):413-420. doi: 10.1071/SH21078. PMID: 34742364.
Journal: Sexual health
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.
Description: Cairns & Hinterland Hospital and Health Service (CHHHS) affiliated authors: Caroline Potter, Trent Yarwood, Simon Doyle-Adams, Darren Russell.
DOI: 10.1071/SH21078
Keywords: adolescent;adult;chlamydia infections/epidemiology;microbial resistance;NAAT;PCR;reproductive health;sexually transmitted diseases/*epidemiology;youth
Type: Article
Appears in Sites:Cairns & Hinterland HHS Publications

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