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Editor,—Hillis et al1 reported that repeated episodes of infection of female genital tract with Chlamydia trachomatis increase the risk of hospital admission for pelvic inflammatory disease and ectopic pregnancy. The first diagnosed attack of genital infection with chlamydia presents the clinician with a unique opportunity to implement measures to minimise the risk of reinfection—that is, health promotion and contact tracing.
During April–June 1998 we reviewed the case notes of female patients who were diagnosed with genital chlamydia at Leicester Royal Infirmary and Derbyshire Royal Infirmary GUM clinics in the year 1996 for evidence of repeat episode of genital chlamydia. We also noted the following data: age at presentation with the first episode of infection, time for presentation with reinfection, test of cure if performed, co-infection with gonorrhoea, review by health adviser, contact(s) traced and treated in the first 3 months after diagnosis. For the purpose of the study we defined reinfection as a patient testing positive for genital chlamydia 30 days or more after the completion of treatment. We also looked at the genital chlamydia treatment protocols in both clinics.
A total of 540 female patients were diagnosed with chlamydia (311 at Leicester and 229 at Derby). The patients' mean age at first episode was 22.6 years for Leicester and 23.4 years for Derby. The health advisers had made contact with 94.5% (294) in Leicester and 97.8% (224) in Derby; 85.2% (265) of the patients diagnosed at Leicester returned at 30 days or more and were retested for chlamydia compared with 87.3% (200) at Derby; 9% (24) episodes of repeat infection were identified in Leicester group compared to 17% (34) episodes in the Derby cohort. The mean period for presentation with reinfection was 9.4 months (range 3–25) at Leicester and 9.8 months (range 2–24) at Derby. At Leicester the contacts of 66.5% (207) patients were traced and treated compared to 64.6% (148) at Derby. A test of cure was performed on 282 patient in Leicester (where it was routine practice); 2.5% (seven) were found to be positive for chlamydial infection, while the test of cure was performed on 22 patients in Derby (where it was performed selectively) revealed no positive cases.
Of the reinfected patients 58.3% (14) at Leicester were reinfected because of failure to trace and treat their partner(s) compared to 35.3% (12) at the Derby clinic.
Both clinics manage genital chlamydia with what was considered standard treatment and perform contact tracing wherever possible. Two reinfected patients from each clinic were also co-infected with gonorrhoea.
Other risk factors for reinfection—for example, ethnic origin, number of sexual partners,2 were not analysed as these data was not discernible from the notes.
This retrospective study highlights the fact that a substantial number of patients get reinfected with chlamydia despite health education and counselling by health advisers. Though the figures (66.5% and 64.6%) for partner notification and treatment were close to that proposed by the Central Audit Group (70%)3 the proportion of those reinfected is still too high. Does the message that repeat episodes of genital chlamydia are more damaging get through to our patients or do we need a new health education strategy?
Currently, as the success of management of genital chlamydia is evaluated by the level of contact tracing, the number of patients referred to health advisers, and number of contacts per index patient seen and treated,4–6 we believe it is time to evaluate outcome measures in terms of reinfection rates. Large prospective studies need to be done to elucidate this aspect of chlamydial infection management.
Contributions: PS had the original idea; EH collected and analysed the data EH and JD wrote the manuscript.
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