How accurate is presumptive Chlamydia trachomatis treatment? A 6-month clinical audit of a walk-in sexual health service.

Background Chlamydia trachomatis (chlamydia) is highly prevalent and is an important sexually transmitted infection as it can lead to increased risk of HIV seroconversion; and if left untreated, can cause infertility in women. Clinical guidelines recommend treating chlamydia presumptively when presenting symptomatically; however, clinicians are now questioning this due to increasing prevalence of antimicrobial resistance. Methods To determine the accuracy of presumptive chlamydia treatment practices at a walk-in sexual health service in regional Australia, we audited all same-day screen and treat presentations prescribed azithromycin over a 6-month period in 2018. Results A total of 325 cases were included in the analysis. Over half (54%) the presentations returned negative pathology for all pathogens investigated. One quarter (25%) of presentations were positive for chlamydia, and (4%) reported a dual infection. A further one fifth (20%) were negative for chlamydia but positive for another pathogen. More symptomatic males than females returned positive pathology for chlamydia (8% vs 4%). Conclusions While presumptive treatment is recommended in the current guidelines, our findings indicate this resulted in over-treatment. Considering the increasing resistance patterns for Mycoplasma genitalium, which include azithromycin, presumptive treatments need to balance immediate client care needs against long-term community antimicrobial resistance outcomes. This internal audit provided a feedback mechanism to the walk-in sexual service, enabling modification of practices to provide more precise, individual clinical care within the bounds of current STI guidelines, while balancing wider the objectives of antimicrobial stewardship.

Emergency contraception over-the-counter: practices and attitudes of pharmacists and pharmacy assistants in far North Queensland.

BACKGROUND: Emergency contraception (EC) has been available as a Schedule 3 (over-the-counter, OTC) medication through Australian pharmacies since 2004. This study aimed to describe OTC EC dispensing services in pharmacies in the Cairns and Hinterland Health Service District and to explore the knowledge and attitudes of pharmacy staff. The study findings will assist in developing resources to support pharmacy staff in their OTC EC provision role. STUDY DESIGN: We conducted semi-structured interviews with pharmacy managers and pharmacists to determine the availability, cost, dispensing processes and distribution estimates of EC and anonymous surveys of pharmacy staff to examine their knowledge and attitudes. RESULTS: Forty-six (88%) of the 52 local pharmacies participated; 43 (93%) provide OTC EC at an average cost of $28.95. One hundred and forty-five staff surveys were completed. Few pharmacists identified Family Planning Queensland (FPQ) or the Cairns Sexual Health Service (CSHS) as referral options for women not meeting the dispensing criteria. A range of written information is provided to EC customers by 23 (53%) of pharmacies. CONCLUSIONS: This study has documented OTC EC dispensing services in the District and identified areas for improvement. A working group has been established to oversee the development and distribution of customer information packs and information for pharmacists on referral options.