Routine treatment versus selective treatment for individuals reporting contact with sexual partners with chlamydia: A Before-and-After Study

Abstract

Background Many international guidelines recommend routine treatment for individuals reporting sexual contact with sexual partners with chlamydia. In October-2019, the Melbourne Sexual Health Centre changed routine treatment of all chlamydia contacts to selective treatment, reserving same-day treatment for those testing positive, unless patients presented with symptoms or with specific reasons. Methods We conducted a before-and-after study among chlamydia contacts at MSHC by comparing 12 months before the ‘routine treatment period’ (December-2018 to October-2019) and after the ‘selective treatment period’ (November-2019 to December-2020). Results Of the 2843 chlamydia contacts included in the analysis, chlamydia positivity was 31.9% (907/2843). The proportion of contacts who received treatment before test results decreased from 91% (1380/1515) to 56% (739/1328) (p<0.0001). We reviewed 232 of the 739 chlamydia contacts in the selective period to determine reasons for treatment, 41.4% (96/232) were treated due to the presence of symptoms. The proportion of those who received treatment and later tested positive did not change between the two periods (35% [482/1380] vs. 34% [253/739], p=0.750). However, the proportion of contacts who received unnecessary treatment (treated but tested negative) did not change between the two periods (65% [898/1380] vs. 66% [486/739], p=0.750). Of the 60 who did not receive treatment but tested positive subsequently, seven (11.7%) did not return for treatment, and it did not differ between the two periods (p=0.370). Conclusions The selective treatment approach has reduced antibiotic consumption and likely decreased the overall workload of clinic staff by minimising the need to treat all contacts.