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
Rapid Response:
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