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

ABSTRACT

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.