Improving the interface between family planning services and genitourinary medicine in Portsmouth, UK: a 'virtual corridor'.

BACKGROUND AND METHODS: In locations where the genitourinary medicine (GUM) department and the family planning services (FPS) are on separate sites, studies have shown a low rate of attendance of clients referred between the sites. We developed a coupon system to allow clients referred from one site to be seen without a wait in the open-access clinic at the other site. Data from the first 5 months were collected. RESULTS: A total of 59 clients were referred from the FPS to GUM during the time period studied. Of these, 54 (91.5%) attended the GUM clinic. The majority (67%) were referred with symptoms suggestive of a sexually transmitted infection (STI), while other reasons for referral included contacts of STI, high-risk behaviour, and following a sexual assault. Some 40% of clients were seen within 30 minutes of their referral. Of clients referred from GUM to FPS, 12/18 (67%) attended the clinic. This is significantly lower than the attendance of clients referred to GUM (p = 0.016). For GUM to FPS referrals, 63% were seen within 30 minutes of their referral. Seven clients were referred for consideration of intrauterine device insertion for emergency contraception but only four attended. Similarly, of the four clients referred who were not using any contraception only one attended. DISCUSSION AND CONCLUSIONS: We believe the coupon system helped increase attendance rates of clients referred between the two clinics, especially by eliminating the wait in the second clinic. The lower rate of attendance in those referred for contraception is of concern.

Relationship of cervical ectopy to chlamydia infection in young women.

OBJECTIVE: Genital Chlamydia trachomatis infection is the most common bacterial sexually transmitted infection (STI) in the UK. Behaviours including multiple sex partners and inconsistent condom use, and biological factors such as cervical ectopy, may increase susceptibility to STIs. Cervical ectopy is thought to increase risk of chlamydia infection by exposing columnar epithelium to a potential infectious inoculum. This study aimed to determine whether chlamydia was more prevalent in young women with cervical ectopy. METHODS: Clinical notes of women aged 16-24 years attending the Portsmouth Genitourinary Medicine Clinic for an STI screen during the period May-July 2003 were reviewed retrospectively. Information collected included the presence or absence of cervical ectopy, smoking habits, methods of contraception, number of sexual partners in the previous 3 months, and previous STIs. Chlamydia infection was diagnosed by using strand displacement amplification on cervical swabs. RESULTS: A total of 231 women were included in the study. The mean age was 19.8 years. Evidence of cervical ectopy was found in 107 women. Chlamydial infection was detected in 37.4% (40/107) of those women with cervical ectopy and 21.8% (27/124) in those without cervical ectopy. This difference was statistically significant (p = 0.009). The significance remained even when accounting for confounding variables. CONCLUSIONS: Cervical ectopy is a common physiological process in young women. Recognition of cervical ectopy should alert the clinician to the possibility of a genital chlamydia infection. Opportunistic screening for chlamydia in young people should be offered to reduce the prevalence of infection and its sequelae.

Atrophic vulvovaginitis in women aged 50 years and above, both current and non-users of hormone replacement therapy, attending a genitourinary medicine clinic.

INTRODUCTION: In women aged 50 years and over attending a genitourinary medicine (GUM) department the commonest presentation was with symptoms of vulval soreness, irritation or dryness. Atrophic vulvovaginitis (AVV) was the commonest diagnosis made. This study was undertaken to determine if the presence of AVV was related to the use, or not, of systemic hormone replacement therapy (HRT). METHOD: A prospective study was made of all women aged 50 years and over attending a GUM department over a 3-month period. RESULTS: Of the 124 women seen in this age group, 60 (40%) had AVV and 28 (23%) had vaginal candidiasis. No difference was found in current users or non-users of HRT. CONCLUSION: Accurate diagnosis is essential in women with vulval symptoms to ensure that appropriate therapy is given. In the present study symptomatic women aged 50 years and over were more likely to have AVV than candidiasis irrespective of their use of systemic HRT.

Who has chlamydia? The prevalence of genital tract Chlamydia trachomatis within Portsmouth and South East Hampshire, UK.

OBJECTIVE: To determine the prevalence of genital tract Chlamydia trachomatis infection in women and men attending different health care settings in Portsmouth and South East Hampshire. DESIGN: Prospective, opportunistic screening. SETTING: Multiple health care sites. PARTICIPANTS: Consenting sexually active women and men. INTERVENTION: A urine sample was tested for Chlamydia trachomatis and positive patients were offered treatment and partner notification. MAIN OUTCOME MEASURES: The presence or absence of chlamydia infection according to age, gender, health care setting and reason for attendance. RESULTS: A total of 14,756 samples were tested giving an overall prevalence of 9.6%. The prevalence was significantly higher in women attending for a termination of pregnancy, antenatal care, women and men attending genitourinary medicine and in those with genital tract symptoms. The prevalence was different for men and women at different ages. CONCLUSION: The prevalence of genital Chlamydia trachomatis infection was high but differed at various health care settings and by reason for attendance.

Incidence and reinfection rates of genital chlamydial infection among women aged 16-24 years attending general practice, family planning and genitourinary medicine clinics in England: a prospective cohort study by the Chlamydia Recall Study Advisory Group.

BACKGROUND: In England, screening for genital chlamydial infection has begun; however, screening frequency for women is not yet determined. AIM: To measure chlamydia incidence and reinfection rates among young women to suggest screening intervals. METHODS: An 18-month prospective cohort study of women aged 16-24 years recruited from general practices, family planning clinics and genitourinary medicine (GUM) clinics: baseline-negative women followed for incidence and baseline-positive women for reinfection; urine tested every 6 months via nucleic acid amplification; and behavioural data collected. Extra test and questionnaire completed 3 months after initial positive test. Factors associated with infection and reinfection investigated using Cox regression stratified by healthcare setting of recruitment. RESULTS: Chlamydia incidence was mean (95% CI) 4.9 (2.7 to 8.8) per 100 person-years (py) among women recruited from general practices, 6.4 (4.2 to 9.8) from family planning clinics and 10.6 (7.4 to 15.2) from GUM clinics. Incidence was associated with young age, history of chlamydial infection and acquisition of new sexual partners. If recently acquiring new partners, condom use at last sexual intercourse was independently associated with lower incidence. Chlamydia reinfection was mean (95% CI) 29.9 (19.7 to 45.4) per 100/person-year from general practices, 22.3 (15.6 to 31.8) from family planning clinics and 21.1 (14.3 to 30.9) from GUM clinics. Factors independently associated with higher reinfection rates were acquisition of new partners and failure to treat all partners. CONCLUSIONS: Sexual behaviours determined incidence and reinfection, regardless of healthcare setting. Our results suggest annual screening of women aged 16-24 years who are chlamydia negative, or sooner if partner change occurs. Rescreening chlamydia-positive women within 6 months of baseline infection may be sensible, especially if partner change occurs or all partners are not treated.

Chlamydia screening in primary care: is it useful, affordable and universal?

Genital chlamydial infection, with its possible long-term morbidity, is a serious public health problem. The number of new diagnoses is rising rapidly and, in the UK, recent evidence suggests that the infection rate in young women exceeds 10%. Screening programmes can reduce the population prevalence of infection, but uncertainty remains as to the ideal screening model. This may prove to be opportunistic screening of sexually active young women, less than 25 years of age, in primary care settings, and contact tracing of the partners of those with chlamydia. Recent literature on the practicalities of genital chlamydia screening is reviewed.