May By Annmaria Taylor, May 2006 The rate of reinfection within a major City community based Chlamydia Screening Programme Liverpool: City of Culture 2008

May Liverpool Chlamydia Screening Programme (CSP)  Targeted at young people (<25 years old)  Since June 2004 we have screened 22,996  78 varied screening venues  Chlamydia positives 2,833 (12%)  Proven treatment success rate is 97%  First line treatment is Azithromycin  Erythromycin where risk of pregnancy  Treatment by trained nurses

May Rates of diagnoses of uncomplicated genital Chlamydial infection by Sex and Age group MalesFemales Source: GUM clinics, United Kingdom:

May Aims & Objectives  Show the rate of reinfection of those tested over a 12 month period with those individuals followed up 6 months later.  To discover % of clients who were initially treated and became reinfected.  Identify factors which will help reduce the reinfection rate.

May Methodology A.Chlamydia tests during one year from September 2004 to August B.We then looked at those reinfection cases in the subsequent 6 months (i.e. Sept ’05 – Feb ’06). Data sourced from Chlamydia database and case note auditing.

May A. Results (1 of 2)  1,284 clients tested positive and treated.  116 (9%) returned for retesting  49 (4%) were found to be reinfected.  Of those original positive clients who were treated and retested - 42% Positive - 58% Negative

May A. Results (2 of 2)  Small numbers returned for re-testing (9%)  Of these 42% were positive  Most (98%) could identify a reason for reinfection

May B. Results for 6 month follow up A 6 month follow up on the 49 positives on retesting during initial year showed: 27: did not attend for a retest 19: retested negative 3:retested positive for a third time 49

May Reasons for reinfection (9/04 – 8/05) Total number of clients reinfected 49

May Strategies to reduce rates of reinfection  Treating all current partners promptly  Obtaining good partner notification from client Health professional to stress importance of getting this information as well as respecting confidentiality of the client.  Azithromycin as first choice even for women with a risk of pregnancy.

May Treatment consultation should include …  How to take medications correctly  What to do if vomiting occurs  What to do if treatment not completed correctly  Abstinence from sex - how long?  Safe sex /condom use  Advise regarding retest and further S.T.I. screening  Potential offer of 2 week follow up call  Give written advice supporting above

May Conclusion (1 of 2)  Chlamydia is common in our population  Low rate of re-testing may imply low risk Greater practice of safe sex; and / or Clients ambivolent to risk  Those re-tested were aware of risk

May Conclusion (2 of 2)  Key to reducing reinfection rate: Good partner notification Thorough treatment consultations for positive clients and partners Partners treated quickly and conveniently Effective Health Education/safe sex  Azithromycin as 1 st choice treatment  Greater client awareness of Chlamydia risks and ease of testing is a success of the programme.

May The rate of reinfection within a major City community based Chlamydia Screening Programme By Annmaria Taylor, May 2006 Liverpool: City of Culture 2008 Any Questions?