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Improving clinical practice and service delivery
P145 Audit of the use of microscopy in heterosexual male patients diagnosed with non-specific urethritis and chlamydial urethritis
  1. A Cucinella,
  2. C J F Priestley
  1. Dorset County Hospital, Dorset, UK


Background In 2006 BASHH guidelines for STI testing stated that there is no need to do a urethral smear in asymptomatic men. However there are concerns that this could result in delayed treatment of Chlamydia, or failure to diagnose an STI (eg, Mycoplasma genitalium).

Aims (1) To ascertain the female pathology associated with NGU. (2) To ascertain the number of women with significant pathology, (Chlamydia or PID) who attended only as a result of partner notification by a man with asymptomatic NGU. (3) To quantify the number of asymptomatic men who would have delayed treatment for chlamydia without immediate microscopy.

Methods Note review of heterosexual males and their female contacts with NSU (100) and Chlamydia (50).

Results 74% of 100 men treated for NSU were asymptomatic. Of these, 38 attended as a contact of infection and would have been treated anyway without microscopy. Of the remaining 36, 3 female partners had uncomplicated chlamydia and 3 PID but had not sought help for pelvic pain prior to their attendance in GUM. Overall, 70% of partners of men with NSU had significant pathology: Diagnoses in female partners of men with NSU Non-specific PID 35 Chlamydial PID 4 Uncomplicated Chlamydia 6 Non-specific cervicitis 9 Epidemiological treatment 46 of 50 men treated for Chlamydia 42% were asymptomatic. 28 (56%) had evidence of urethritis and a further 11 (22%) without pus on microscopy had noticeable threads in their urine. 47 attended prior to or with their partner, and 15 (30%) were treated at their initial visit due to immediate microscopy. These patients would have had to have been recalled for treatment.

Conclusions In our cohort, 70% of female partners of men with NSU had significant pathology. 6/36 (17%) might not have been treated had they not attended as a contact of NSU. Microscopy can result in earlier treatment of asymptomatic men with Chlamydia due to immediate diagnosis of NGU, and may still be of value in GUM clinics.

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