Background We established a young persons level 2 community sexual health service (YP clinic) to encourage access to care. BASHH STI Management Standards warrants in-house microscopy for managing men with dysuria and/or urethral discharge symptoms not currently available at this clinic.
Aims To determine percentage of men presenting with dysuria and/or urethral discharge, rates of Chlamydia in men attending with and without these symptoms and number of untreated men after their clinic visit.
Methods Case notes of all new male heterosexual patient attendances at the YP clinic from 5 January 2011 to 23 October 2011 were reviewed. The management of symptomatic men were compared retrospectively with the outcome to look for missed/untreated STIs (sexually transmitted infections).
Results Total 91 attendances. 23 patients (25%) were asymptomatic of which 5 tested positive for Chlamydia. Commonest symptoms were dysuria (29%) rash/skin problem (25%) or lumps (20%). 10 patients presented with dysuria only, 1 tested positive for Chlamydia. 16 patients presented with discharge and dysuria, 5 tested positive for Chlamydia. In patients presenting with other symptoms (46%) the following STIs were diagnosed: warts n=15, ulcers n=1, scabies n=1. Two patients tested positive for Chlamydia.
Discussion 43% of patients who did not report symptoms required treatment for an STI. Overall 23% of the dysuria and/or discharge group and 11% of patients without these symptoms tested positive for Chlamydia. 86% of the positive Chlamydia test results in the dysuria and/or discharge group had been treated in clinic compared with only 57% of positive Chlamydia results in the remaining patients.
Conclusion The absence of microscopy did not lead to more untreated Chlamydia infections in men with discharge and/or dysuria but denying symptomamtic young men the opportunity of being seen in the community may risk untreated infection, onward transmission and complication.