The testing of women for Chlamydia and management of positive Chlamydia results.
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Anticipated outcomes
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- women who are at risk for Chlamydia will be tested
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- consistency in assessment and management of women with Chlamydia
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- optimal care in the management of women with Chlamydia
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- continuity of primary care and secondary referral as required
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- prevention of complications resulting from untreated Chlamydia infection
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Women's Health Nurse Practitioners are responsible for provision of the primary service, testing as appropriate, treatment, contact tracing and referral as appropriate.
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Women's Health Nurse Practitioners are responsible for establishment of a process for ensuring follow up of women who fail to attend the required medical consultation.
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Women eligible for testing for Chlamydia are non pregnant women who:
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- present for testing of Genital Tract Infections (GTI) and Blood Borne Viruses (BBV)
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- are identified as at risk for contracting Chlamydia through any of the following criteria:
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- have had a change of partner in the last six months
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- have had unprotected sexual intercourse
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- have returned positive test for another GTI / STI
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- exchange sex for money or drugs
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Women eligible for treatment of Chlamydia are non pregnant women who:
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- return positive test results for Chlamydia
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History and examination
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Risk assessment
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- A risk assessment for Sexually Transmissible Infections and Blood Borne Viruses should be undertaken.
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Assessment of reported symptoms
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The Women's Health Nurse Practitioner should document any:
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- postcoital bleeding or any abnormal vaginal bleeding
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- pelvic pain and deep dyspareunia
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- features of any abnormal vaginal discharge
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- features of any vulvovaginal itching
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Examination
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The Women's Health Nurse Practitioner should inspect the external genitalia, perineum and anus, perform a speculum examination of the vagina and cervix and bimanual pelvic examination.
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The Women's Health Nurse Practitioner should document any
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- purulent vaginal, cervical or urethral discharge
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- inflamed friable ectropian with contact bleeding
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If following assessment and examination signs and symptoms of Pelvic Inflammatory Disease are evident, the woman should be referred to a Medical Practitioner.
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Testing
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If cervix present
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- first void urine, Chlamydia OR
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- endocervical swab, Chlamydia
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If cervix absent
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- first void urine, Chlamydia
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Management of results
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Women should be notified of the result by telephone, letter or in person and prescription for treatment given according to current recommendations.
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If screening for other GTIs and BBVs has not been attended at the primary consultation, women testing positive for Chlamydia should also be tested for:
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- Trichomonas vaginalis, Neisseria gonorrhoea
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- Human Immunodeficiency Virus (HIV), Hepatitis B, Syphilis
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- Herpes Simplex Virus if lesion present
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Symptomatic women should also be tested for:
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NB: Counselling must be carried out by a certified HIV Pre and Post Test Counsellor when HIV tests are performed.
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Treatment
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Prescription management
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Women's Health Nurse Practitioners should check the client's medical history, medication history and history of allergies when prescribing medications.
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Drug interactions including those with oral contraceptive pill and its reduced effectiveness while taking antibiotics should be carefully noted, and women should be reminded of the 7 Day rule, as required. (Women's Health Nurse Practitioner Management: Prescription of Oral Contraceptives CPG)
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All relevant fields on the medication order chart should be completed. This includes the name of the prescriber, the commencement date, the dose, the frequency, the date and time of prescribing, and the prescriber's name.
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Women's Health Nurse Practitioners should also ensure that the patient understands the drug regimen and inform client of possible adverse reactions. Details of the prescription should be recorded in the client's file.
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Women's Health Nurse Practitioners should utilise the current prescribing information regarding the following medication and ensure that the patient is aware of appropriate storage required for the medication.
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Azithromycin
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1 gram as a single dose (2 tablets) taken with or without food.
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| Doxycycline hydrochloride
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100 mg bd for 7-10 days. Take with or after food followed by glass of water. Avoid lying down immediately after taking.
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| Roxithromycin
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150mg bd (or 300 mg daily as a single dose) for 10 days. Take ½-1 hour before food.
Pack (28) x4, 2 repeats. On PBS. |
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Follow up
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A pelvic examination is advised following a positive first void urine specimen to exclude Pelvic Inflammatory Disease.
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A repeat pelvic examination is also advised if the woman reports new symptoms suggestive of Pelvic Inflammatory Disease at the follow up appointment.
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A test of cure is indicated after 4 weeks if it is likely that treatment has not been completed. Retesting for Chlamydia 3-4 months following treatment may be advised if symptoms persist and particularly in high risk populations, ie less than 25 years of age, recent change of sexual partner & unprotected sexual intercourse. In sexually active adolescents testing for Chlamydia may be advised every six months.
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Women testing positive for Chlamydia should be advised to abstain from sexual intercourse until they and their partners have completed the course of treatment. Following treatment with azithromycin, clients should abstain from sexual intercourse for 7 days.
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Contact tracing
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All sexual contacts require treatment. Medical treatment is not dependent on a positive Chalmydia test result nor on any abnormal symptoms. This process should be followed even in the absence of a positive test result. Women's Health Nurse Practitioners should provide contacts with letter for Medical Practitioner (pdf 5 KB) to this effect. Contacts should also be provided with an information leaflet.
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Contacts should be traced back 6-12 months if possible. If unable to contact previous partners, Contact Tracers at Melbourne Sexual Health Centre may be notified.
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Notification
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It is a legislative requirement that the Department of Human Services is notified following a positive Chlamydia result. The Women's Health Nurse Practitioner or the laboratory reporting the positive result is required to notify using the Communicable Disease Notification form.
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Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
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