Feasibility of an RCT to improve management of STI in primary care
Chlamydia is a common sexually transmissible infection (STI) in young men and women but often has few obvious symptoms. Because of this infection is typically diagnosed and treated late, meaning infected individuals have longer to pass on chlamydia to others and are more at risk of developing the long term consequences themselves.
In women these consequences include chronic pelvic pain, ectopic pregnancy and infertility: problems that cost the NHS around £100 million a year. There is now a National Chlamydia Screening Programme, itself costing £40 million a year. This has led to a substantial increase in testing for chlamydia. There were nearly 35,000 tests in Bristol in 2012, with over 40 per cent of these in general practice, leading to 800 diagnoses in the community.
A side effect of this increased chlamydia testing is increased gonorrhoea testing, as the test detects both infections. Around 100 cases of gonorrhoea were diagnosed this way in Bristol in 2014. Many GPs don’t have the experience or the resources to manage STIs effectively, especially to trace and treat sexual partners to avoid reinfection and the continued spread in the community.
We plan to offer the option of a centralised, telephone-based STI management service to GPs for all positive chlamydia and gonorrhoea tests taken in primary care. Patients will be contacted by the centralised service and given their result. They will be asked to provide telephone numbers of recent partners, who will then be contacted to ensure they are also tested and treated as appropriate. The research will examine whether these changes can be introduced successfully and whether practices and patients find this new system acceptable.
This study aims to evaluate centralised telephone-based management of chlamydia and gonorrhoea that is diagnosed in the community. It will look at health care practitioner and patient experiences, and whether this telephone-based approach is acceptable and feasible in the treatment of index cases (the first case diagnosed in an investigation) diagnosed in primary care and the tracing and treatment of partners.
This research will support the development and evaluation of a new system of appropriate and effective patient and partner management. We hope this system will deliver better results for patients in terms of:
- Timely and appropriate treatment of chlamydia diagnosed in primary care
- Timely and appropriate treatment of gonorrhoea diagnosed in primary care
- Reduced reinfection through timely and appropriate partner management