Previous reports of up to 22% treatment failure in rectal Chlamydia informed our local clinic policy of routine test of cure (TOC) following rectal chlamydia or lymphogranuloma venereum (LGV) treatment. We set out to review our local TOC practice and treatment failure rates for both chlamydia and LGV.Methods
Case notes of patients diagnosed with rectal chlamydia and LGV between 01/07/15 and 01/07/16 were reviewed. Data was collected on symptoms, antibiotic choice, compliance and TOC.Results
There were 89 patients identified with rectal chlamydia; 7 (8%) were confirmed LGV. Median age was 30 years; 69 (78%) men who have sex with men (MSM) and 20 (22%) female. Treatment was primarily with 1 week of doxycycline (81/89; 91%).Results
Of 89 patients, 53 (60%) attended for a TOC with the remainder (36; 40%) lost to follow-up. There were 3/48 (6%) positive TOC results in those with non-LGV rectal chlamydia with one reporting sexual contact during treatment giving a failure rate of 4% (2/48). Of those with LGV 5/7 (71%) attended for a TOC and all were negative. Of those with a negative TOC 3/45 (6%) patients reported sexual contact during treatment.Discussion
Over a 12-month period our local treatment failure rate was low at 4% for rectal chlamydia and 0% for LGV. A significant proportion of patients failed to return for TOC. These results suggest that removal of routine TOC would be locally acceptable, reduce health advisor workload and be in line with current BASHH guidance.