MYCOPLASMA GENITALIUM TESTING: A VICTIM OF TENDERING AND COVID?

Introduction Mycoplasma Genitalium is a relative newcomer to sexual health clinics;but is testing now routinely embedded in practice? In a clinic victim to a traumatic tendering process and then to the pandemic, a full audit cycle revealed the truth and some unexpected findings. Methods 1. Patient list based on GUMCAD codes for: Mycoplasma Genitalium, Pelvic inflammatory disease, Non-specific urethritis, epididymo-orchitis. Cycle 1 looked retrospectively at March-August 2021 (6 months) comparing findings to BASHH standards. 2. Intervention: Presentation of audit findings and a teaching session on Mycoplasma Genitalium 3. Retrospective second cycle audit looking at October 2021- January 2022 (3 months). Results Cycle 1: • 53 patients tested. Of the 11 women tested, 9 were mycoplasma contacts. • 41% NSU and 10% PID presentations were tested • 14 cases positive (26%), 25% had test of cures Cycle 2: • 68 patients tested. • 64% NSU and 46% PID presentations tested • 12 cases positive (18%), 100% contacted for test of cure. Other findings • Testing is dependent on clinician: Nurses met guidelines in 100% of patients, GUM doctors 64% and GP Trainees 50%. Health advisors contacted 100% of patients for test of cures. • No routine resistance testing provided, but 17% had documented resistance, 33% clinical resistance Discussion Mycoplasma was overlooked with tendering and covid no doubt playing a part. This audit highlighted the deficiencies, but interventions improved testing;nurses effectively adopting it into routine practice whilst uptake from doctors was limited. Resistance levels are concerning and support the need for routine resistance testing.

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).