Screening and treatment of Chlamydia trachomatis infections
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1915 (Published 21 April 2010) Cite this as: BMJ 2010;340:c1915
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The review by Kalwij et al does not mention the potential interaction
between
antibiotics and combined hormonal contraception (CHC). The National
Chlamydia Screening Programme in England is aimed at all sexually active
young people aged 15-24(1). According to the Office for National
Statistics
54% of women aged 20-24 are on the pill(2). Thus a significant proportion
of
the women diagnosed through the screening programme will be using CHC.
The Faculty of Sexual and Reproductive Healthcare states that women using
CHC should be advised to use additional precautions when on short-term
antibiotics as the efficacy of their method may be reduced.(3) Abortion
rates
have steadily risen in England and Wales since its legalisation in 1967.
They
are highest amongst the 20-24 yr old age group ( 32 per 1000 women) but
peak at the age of 19 (36 per 1000) (4). We cannot be complacent about
the
risks associated with contraceptive failure. It can lead to an unplanned
and an
unwanted pregnancy.
The National Strategy for Sexual Health and HIV set out aims to
reduce the
prevalence of undiagnosed STIs as well as to reduce the unintended
pregnancy rates.(5) When addressing one aim we must not forget the other.
Thus when treating chlamydia, we must remember to ask women if they are
using CHC and if so we advise them to avoid sexual contact in order to
prevent re-infection but also in order to prevent potential pregnancy.
1. http://www.chlamydiascreening.nhs.uk/ys/bigdeal.html
2.Opinions Survey Report No. 41 Contraception and Sexual Heath,
2008/09.
Available at
http://www.statistics.gov.uk/downloads/theme_health/contra2008-9.pdf
3.FFPRHC Guidance (April 2005) Drug interactions with hormonal
contraception Journal of Family Planning and Reproductive Health Care
2005;
31(2): 139–151
Available at
http://www.ffprhc.org.uk/admin/uploads/DrugInteractionsFinal.pdf
4.DoH Statistical Bulletin Abortion Statistics, England and Wales:
2008
Available at
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents
/digitalasset/dh_099714.pdf
5. DoH The national strategy for sexual health and HIV. Available at
http://www.medfash.org.uk/publications/documents/nat_shs-2001.pdf
Competing interests:
None declared
Competing interests: No competing interests
Treatment may not be so straightforward
Experience in General Practice in a University population suggests
that not all those who participate in ‘asymptomatic’ screening are truly
asymptomatic. Chlamydia screening kits may have been obtained without a
history having been taken by a health professional. When given a positive
result from their Chlamydia screening, a proportion of those who screened
positive may then admit to having had symptoms.
In the female patient the presence of lower abdominal pain,
dyspareunia, abnormal vaginal bleeding, or abnormal vaginal or cervical
discharge is suggestive of a diagnosis of Pelvic Inflammatory Disease.
These women need assessment and then treatment with antibiotics other than
the simple single dose of azithromycin. The only fully oral regime in the
BASHH guidelines for Pelvic Inflammatory Disease is oral ofloxacin 400mg
BD plus oral metronidazole 400mg BD for 14 days.1
In the male patient admitting to testicular or epididymal pain,
epididymo-orchitis needs to be considered. Again, these men need
assessment and then treatment with antibiotics other than the simple
single dose of azithromycin. BASHH guidelines for epididymo-orchitis most
probably due to chlamydia infection or other non-gonococcal, non-enteric
organisms currently recommend treatment with Doxycycline 100mg by mouth
twice daily for 10-14 days,2 although it should be noted that this
guideline is currently being updated3. The STIF Course Manual 2009
(revised December 2008) still recommends doxycycline 100mg bd 14 days
offering ofloxacin 200mg BD for 14 days as an alternative.4
1. United Kingdom National Guideline for the Management of Pelvic
Inflammatory Disease http://www.bashh.org/documents/118/118.pdf
2. 2001 National guideline for the management of epididymo-orchitis
http://www.bashh.org/documents/31/31.pdf
3. http://www.bashh.org/groups/clinical_effectiveness_group
4. STIF course manual 2009 (revised December 2008) BASHH
Competing interests:
None declared
Competing interests: No competing interests