UK Chlamydia Guidelines 2015

1 Guidelines2015 UK national guideline for themanagement of infection withChlamydiatrachomatisNneka C Nwokolo1, Bojana Dragovic2, Sheel Patel1,CY William Tong3, Gary Barker4and Keith Radcliffe5 AbstractThis guideline offers recommendations on the diagnostic tests, treatment regimens and health promotion principlesneeded for the effective management ofChlamydia trachomatisgenital infection. It covers the management of the initialpresentation, as well the prevention of transmission and future infection. The guideline is aimed at individuals aged16 years and older presenting to healthcare professionals working in departments offering Level 3 care in sexuallytransmitted infections management within the UK.

2 However, the principles of the recommendations should be adoptedacross all levels, using local care pathways where transmitted infection, Chlamydia , Chlamydia trachomatis, lymphogranuloma venereum, LGV, bacterial STIs, treat-ment, diagnosis, guidelineDate received: 13 June 2015; revised: 6th October 2015; accepted: 9 October 2015 New in the 2015 of nucleic acid amplification tests (NAATs) andpoint of care testing;.Advice on repeat Chlamydia testing;.Discussion of adequacy of single-dose azithromycintreatment;.Treatment of individuals co-infected with chlamydiaand gonorrhoea.

3 Treatment of rectal Chlamydia ;.Vertical transmission and management of and methodologyScope and purposeThis guideline offers recommendations on the diagnos-tic tests, treatment regimens and health promotionprinciples needed for the effective management ofChlamydia trachomatisgenital infection. It covers themanagement of the initial presentation, as well the pre-vention of transmission and future guideline is aimed at individuals aged 16 yearsand older (see specific guideline for under 16 year olds)presenting to healthcare professionals working indepartments offering Level 3 care in sexually trans-mitted infections (STIs)

4 Management within the , the principles of the recommendationsshould be adopted across all levels, using local carepathways where strategyThis document was produced in accordance with theguidance set out in the CEG s document Frameworkfor guideline development and assessment at has accredited the process used by BASHH to produce its European Guidelines for themanagement of Chlamydia trachomatis. Accreditation is valid for 5 yearsfrom 2011. More information on accreditation can be viewed at and Westminster Hospital, London, UK2 Queen Mary s Hospital, Roehampton, UK3 Bart s Health NHS Trust, London, UK4St Helens Hospital, St Helens, UK5 British Association for Sexual Health and HIV Clinical EffectivenessGroup, London, UKCorresponding author:Nneka Nwokolo, Chelsea and Westminster Hospital, 56 Dean Street,London W1D 6AQ, : Journal of STD & AIDS2016, Vol.

5 27(4) 251 267!The Author(s) 2015 Reprints and : by guest on February 12, from The following reference sources were used to providea comprehensive basis for the guideline:1. Medline, Pubmed and NeLH Guidelines Databasesearches up to 1 April 2015 The search strategy comprised the following terms inthe title or abstract: Chlamydia trachomatisManagement ofChlamydia trachomatisManagement of neonatal Chlamydia infectionNatural history ofChlamydia trachomatisPelvic inflammatory diseaseChlamydia screeningChlamydia treatmentChlamydia partner notificationChlamydia sequelaeChlamydia repeat testingChlamydia treatment failureExtra genital Chlamydia infection2.

6 2006 UK National Guideline on Management ofGenital Tract Infection withChlamydia trachomatis3. 2012 BASHH statement on partner notification(PN) for sexually transmissible infections4. The Scottish Intercollegiate Guidelines Network(SIGN)5. 2015 CDC Sexually Transmitted InfectionsGuidelines6. Cochrane Collaboration Databases ( )7. 2009 NICE Guidelines on management of uncompli-cated genital chlamydia8. UK National Chlamydia Screening Programme9. 2013 UK National Guideline on the management oflymphogranuloma venereum (LGV)MethodsArticle titles and abstracts were reviewed and if relevantthe full text article obtained.

7 Priority was given to ran-domised controlled trial and systematic review evi-dence, and recommendations made and graded on thebasis of best available evidence (Appendix 1).Piloting and consultation, including public and patientinvolvementThe initial draft of the guideline, including the patientinformation leaflet (PIL), was piloted for validation bythe CEG and a number of BASHH pilot sites. A stan-dardised feedback form was completed by each pilotsite for the PIL. The final draft guideline was thenreviewed by the CEG using the AGREE instrumentbefore posting it on the BASHH website for externalpeer review for a two-month period.

8 Concurrently, itwas reviewed by the BASHH Public and Patient received were collated by the CEG editorand sent to the guideline chair for review and final guideline was approved by the CEG, and areview date agreed before publication on the chlamydial infection is caused by the obligateintracellular bacteriumC. trachomatis. Serotypes D Kcause urogenital infection, while serovars L1-L3 is the most commonly reported curablebacterial STI in the UK. In 2013, 208,755 cases ofinfection were reported to Public Health England(PHE formerly Health Protection Agency,England)

9 , with approximately 70% of these in sexuallyactive young adults aged less than 25 high-est prevalence rates are in 15 24-year olds and are esti-mated at in the most recent National Surveyof Sexual Attitudes and Lifestyles2and 5 10% in 6 Risk factors for infection include age under 25 years,a new sexual partner or more than one sexual partner inthe past year and lack of consistent condom ,3,7 12 Chlamydia infection has a high frequency of trans-mission, with concordance rates of up to 75% of part-ners being ,14 The natural history of Chlamydia infection is poorlyunderstood.

10 Infection is primarily through penetrativesexual intercourse, although the organism can bedetected in the conjunctiva and nasopharynx withoutconcomitant genital ,16If untreated, infection may persist or resolve 25 Studies evaluating the natural historyof untreated genitalC. trachomatisinfection haveshown that clearance increases with the duration ofuntreated infection, with up to 50% of infectionsspontaneously resolving approximately 12 monthsfrom initial 25 The exact mechanism ofspontaneous clearance ofC. trachomatisis not fullyunderstood.