A REVIEW OF THE MANAGEMENT OF RECTAL CHLAMYDIA IN THREE CLINICS BEFORE AND DURING THE COVID-19 PANDEMIC

Background The British Association for Sexual Health and HIV guidelines for the management of rectal chlamydia recommend 1 week of doxycycline and testing for Lymphogranuloma venereum (LGV). Any difficulties in recalling LGV positive patients to extend the script to three weeks could cause treatment gaps or necessitate restarting treatment. Alternatively, a 3-week prescription can be given immediately, and the patient then instructed to stop if LGV negative. However, this approach raises concerns about potential antibiotic overuse if patients are hard to contact. This audit considers whether this proactive approach is indicated. Method Electronic patient records were reviewed to identify patients coded as C4 in 2020 and the first half of 2019 in one hospital and two community clinics. From these, patients with rectal chlamydia were selected. The following were recorded;rectal symptoms/signs, LGV swabs taken before/at time of treatment, treatment regime/duration, LGV results, HIV status, whether patients were contacted with LGV results. Results In 2020, of the 146 rectal chlamydia positive patients 75% were tested for LGV and 30% were prescribed 3 weeks of doxycycline. 4 patients tested positive with LGV. In the 2019 sample, 78% of the 55 rectal chlamydia positive patients were tested for LGV and 20% were prescribed 3 weeks of doxycycline. Only 1 tested LGV positive. Conclusion Low rates of LGV positivity suggest adhering to the recommendation of 1 week of doxycycline is advisable to avoid antibiotic overuse and potential associated resistance.

A REVIEW OF THE MANAGEMENT OF PELVIC INFLAMMATORY DISEASE AT A COMMUNITY CLINIC COMPARING PRACTICES BEFORE AND DURING THE COVID-19 PANDEMIC

Background Pelvic inflammatory disease (PID) usually results from infection ascending from the endocervix. The British Association for Sexual Health and HIV guidelines state that the diagnosis of PID should be considered in women under 25 with recent onset, bilateral lower abdominal pain and local tenderness on bimanual examination where pregnancy has been excluded. They recommend testing for chlamydia, gonorrhoea and mycoplasma genitalium. Method Electronic patient records were reviewed to identify episodes coded C5A during the last six months of 2019 and 2020. 46 patients were identified in 2019 and 43 in 2020. The following were recorded: demographics, symptoms, sexual history, examination findings, investigations, treatment, partner notification, follow-up. Results The age range of the 89 patients was 18-62, 51% were aged 25-34. Patients came from a range of ethnicities reflecting the diverse population. All patients were tested for chlamydia and gonorrhoea, none for mycoplasma genitalium. A pregnancy test was not performed in 19/89 (21%) patients. Documentation of examination findings was sometimes absent. Follow-up was recorded in 8/89 (9%) cases. Results were similar in 2019 and 2020, although ceftriaxone administration was more common pre-pandemic. Key results are summarised in the accompanying table 1. Conclusions PID management in 2019 and 2020 was similar. Increased testing for mycoplasma could guide antibiotic therapy. The importance of pregnancy testing in women presenting with lower abdominal pain should be highlighted to clinicians. Telephone calls could be used to facilitate follow-up appointments. (Figure Presented).