Telephone based Sexually transmitted infections management in primary care

Chlamydia and Gonorrhoeae are the two most commonly diagnosed sexually transmitted infections (STIs) in England. However, they often have few obvious symptoms. Because of this infection is typically diagnosed and treated late, meaning infected individuals have longer to pass on the infection to others and are more at risk of developing the long-term consequences themselves.

In women the consequences of Chlamydia include chronic pelvic pain, ectopic pregnancy and infertility: problems that cost the NHS around £100 million a year. Gonorrhoea treatment is threatened by new strains of the bacteria becoming resistant to the antibiotics designed to kill them (antimicrobial resistance), which is now a global public health priority for gonorrhoea and may become a future issue for chlamydia.

National guidelines recommend appropriate management includes timely testing and treatment, with the right antibiotic, of both the patient and their sexual partner(s).

Budget cuts for sexual health services resulting in fewer sexual health clinics, means patients are not always able to easily access specialist care. Up to 18% of genital Chlamydia infections and 9% of Gonorrhoea infections in England are diagnosed in GP practices. However, 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 examined the acceptability and feasibility of a centralised, telephone based STI management service to GPs for all positive chlamydia and gonorrhoea tests taken in primary care. Patients with negative results received a text from the service and positive patients received a telephone call from a specialist nurse. Any questions were answered, and appropriate treatment via a nominated pharmacy or sexual health clinic arranged along with partner treatment. Patients with positive gonorrhoea tests were referred to a STI clinic. The research examined whether these changes can be introduced successfully and whether practices and patients find this new system acceptable.

Chlamydia and Gonorrhoeae are the two most commonly diagnosed sexually transmitted infections (STIs) in England. However, they often have few obvious symptoms. Because of this infection is typically diagnosed and treated late, meaning infected individuals have longer to pass on the infection to others and are more at risk of developing the long-term consequences themselves.

In women the consequences of Chlamydia include chronic pelvic pain, ectopic pregnancy and infertility: problems that cost the NHS around £100 million a year. Gonorrhoea treatment is threatened by new strains of the bacteria becoming resistant to the antibiotics designed to kill them (antimicrobial resistance), which is now a global public health priority for gonorrhoea and may become a future issue for chlamydia.

National guidelines recommend appropriate management includes timely testing and treatment, with the right antibiotic, of both the patient and their sexual partner(s).

Budget cuts for sexual health services resulting in fewer sexual health clinics, means patients are not always able to easily access specialist care. Up to 18% of genital Chlamydia infections and 9% of Gonorrhoea infections in England are diagnosed in GP practices. However, 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 examined the acceptability and feasibility of a centralised, telephone based STI management service to GPs for all positive chlamydia and gonorrhoea tests taken in primary care. Patients with negative results received a text from the service and positive patients received a telephone call from a specialist nurse. Any questions were answered, and appropriate treatment via a nominated pharmacy or sexual health clinic arranged along with partner treatment. Patients with positive gonorrhoea tests were referred to a STI clinic. The research examined whether these changes can be introduced successfully and whether practices and patients find this new system acceptable.

Project aims
This study aims to evaluate centralised telephone-based management of chlamydia and gonorrhoea that is diagnosed in primary care. We examined the feasibility and acceptability to GPs, nurses and patient experiencing this telephone-based approach.

What we did
We set up a trial in 11 GP practices in Bristol. In some of these practices (the intervention group), all patients tested for chlamydia and gonorrhoea, the GPs and nurses were able to choose between going through the centralised, nurse-led telephone-based management system or receiving their usual GP care. In the other practices (the control group), all patients tested for chlamydia and gonorrhoea received their usual GP care.

We also interviewed 11 GPs, five nurses and 12 patients (8 female) to find out what they thought about the telephone management service.

In six months, 1,154 tests took place: 2.6 per cent were positive for chlamydia and 0.8 per cent positive for gonorrhoea. The telephone management service managed 335 patients’ cases.

The interviews found that GPs and nurses were positive about the telephone management service and expected the impact of the service on their workload to be positive and to provide benefits for patients in relation to better and timely follow-up – particularly with regards to partner notification, which is essential for comprehensive case management.

Patients found the telephone management service acceptable, more convenient and provided greater anonymity than usual care. Patients appreciated getting a text message about a negative result and valued talking to a sexual health specialist about positive results