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  4. Sexually transmitted infections (STIs)
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  6. Chlamydia
  7. Management and follow up
Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

Management and follow up

Management

All patients diagnosed with chlamydia should be:

  • advised to avoid genital, oral or rectal sex until patient and partner have
    completed treatment (or wait 7 days after completion of treatment if treatment
    was azithromycin). If a test of cure is indicated (see ‘Test of Cure’ section)
    patients should abstain until they are in receipt of a negative result.
  • encouraged to have testing for other STIs including HIV, syphilis and where
    indicated tested for hepatitis and offered hepatitis and HPV vaccination. If the
    patient is within the window periods then tests should be repeated at an
    appropriate interval.
  • given detailed information on the natural history of chlamydia infection, as well as
    transmission, treatment and complications, and directed to clear accurate written
    or web based patient information.

NHS Inform (Scotland’s National Health Information Service)

www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/chlamydia/

NHS Inform (Scotland’s National Health Information Service) https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/lymphogranuloma-venereum-lgv

The British Association of Sexual Health and HIV produce leaflets on Chlamydia
and LGV available in print and screen versions
https://www.bashhguidelines.org/media/1133/ct-pil-screen-oct-2016.pdf

https://www.bashhguidelines.org/media/1033/lgv_pil_digital_2_2015.pdf


Structured discussions should take place with patients diagnosed with chlamydia on the basis of behavioural change theories to address factors that can reduce risk taking and improve self efficacy and motivation. In most cases this can be a brief intervention discussing condom use and re-infection. Some patients may require more in-depth risk reduction work and referral to a healthcare worker competent in motivational interviewing.

Treatment

See section explaining the LGV confirmatory PCR service offered by SBSTIRL. Doxycycline and ofloxacin should not be used in pregnancy or when breast feeding.

 

Uncomplicated genital and pharyngeal chlamydia

1st Line:
Doxycycline 100mg orally twice daily for 7 days.


2nd line:
Azithromycin 1g orally as a single dose followed by 500mg daily for 2 days.


3rd line:
Erythromycin 500mg orally twice daily for 14 days

or

Ofloxacin 200mg orally twice daily or 400mg orally once daily for 7 days.

 

Asymptomatic rectal chlamydia (LGV status unknown)

Doxycycline 100mg orally twice daily for 7 days with the need for a test of cure*

or

Doxycycline 100mg orally twice daily for 21 days and in general no need for test of cure.*

 

Asymptomatic rectal chlamydia (LGV negative)

Doxycycline 100mg orally twice daily for 7 days and in general no need for test of cure.*

 

Asymptomatic rectal chlamydia (LGV positive) and all symptomatic rectal chlamydia

Doxycycline 100mg orally twice daily for 21 days.

 

*Please refer to Test of Cure section below

Partner notification

All patients diagnosed with chlamydia infection should see a Sexual Health Advisor (SHA) or a clinician appropriately trained in partner notification.

The look back period for all (except symptomatic males at urethral site) should be six months, or to the previous partner if no partners in the last 6 months.

The look back period for symptomatic males (urethral sites) should be four weeks before the onset of symptoms, or to the previous partner if no partners in the last 4 weeks. All sexual partners within the look back period should be offered and encouraged to take up testing.

Current partners should be tested then treated epidemiologically and advised to abstain from sex for one week following commencement of treatment. For partners who test positive and where a test of cure is indicated abstinence should continue until the test of cure is reported and negative. See ‘Test of cure’ section, below.

Test of cure

Genital or pharyngeal infection

A test of cure following treatment is not routinely indicated. Indications for a test of cure include:

  • persistent symptoms after treatment
  • concerns re adherence to treatment or reinfection
  • pregnancy
  • use of treatment other than azithromycin or doxycycline
  • known LGV and treatment was not 21 days of doxycycline.

 

Rectal infection

A test of cure is needed unless the patient fulfils all of the following criteria:

  • free of symptoms after treatment
  • no concerns re adherence to treatment or re-infecton
  • not pregnant
  • was treated with 21 days of doxycyline irrespective of LGV testing or treated with 7 days of doxycyline and had a negative LGV test.

 

When indicated a test of cure should ideally be done no earlier than three weeks after
completion of treatment.

Follow up

Patients who presented with complicated infection and in patients in whom there is the intention to do a test of cure should be followed up in person.

When there are outstanding issues following the initial interview with the SHA, patients should be given a follow up telephone interview. If apparent during telephone follow up that symptoms are present, arrange a clinical review in person.

At all follow up interviews:

  • Check compliance with therapy.
  • Check that genital, oral or rectal sex was avoided until patient and partner had completed treatment (or waited 7 days if treatment was azithromycin).
  • Ensure completion of any outstanding partner notification work.

 

Further recommendations

Consideration should be given to re-treatment of patients who have failed to adhere to treatment instructions, or where azithromycin was used and the patient vomited within 2 hours of any dose.

If symptoms have not responded to treatment or recur soon after treatment, consideration should be given to treatment failure or reinfection.
In pregnancy, further testing is advised at 36 weeks gestation.

References

  1. British Association of Sexual Heath and HIV Clinical Effectiveness Unit BASHH 2015 UK
    National Guideline for the Management of Infection with Chlamydia trachomatis (2015).
    https://www.bashhguidelines.org/media/1192/ct-2015.pdf [accessed 4th August 2022]
  2. Update on the treatment of Chlamydia trachomatis (CT) infection BASHH Clinical
    Effectivesness Group September 2018 [accessed 4th August 2022] https://www.bashhguidelines.org/media/1191/update-on-the-treatment-of-chlamydia-trachomatis-infection-final-16-9-18.pdf [accessed 4th August 2022]
  3. British Association of Sexual heath and HIV Clinical Effectiveness Unit BASHH UK National Guideline for the Management of Lymphogranuloma Venerum (2013) https://www.bashh.org/documents/2013%20LGV%20guideline.pdf [accessed 4th August 2022]
  4. 2019 European Guideline on the Management of Lymphogranuloma Venereum
    https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.15729 [accessed 4th August 2022]
  5. UK National Guidelines for the Management of Pelvic Inflammatory Disease 2018
    https://www.bashhguidelines.org/media/1170/pid-2018.pdf [accessed 4th August 2022]
  6. United Kingdom National Guideline for the Management of Pelvic Inflammatory Disease
    (2019 Interim Update) https://www.bashhguidelines.org/media/1217/pid-update-2019.pdf[accessed 4th August 2022]
  7. Scottish Bacterial Sexually Transmitted Infections Reference Laboratory (SBSTIRL)
    Samples and Request Forms | Edinburgh and Lothians Laboratory Medicine LGV PCR form Dec 20.pdf (edinburghlabmed.co.uk) [accessed 4th August 2022]
  8. Dr Kate Templeton, Head of Service, Regional Virus Laboratory Specialist Virology
    Centre, Edinburgh [pers comm. 4th August 2022]

Editorial Information

Last reviewed: 30/09/2022

Next review date: 30/09/2024

Author(s): West of Scotland Managed Clinical Network for Sexual Health Clinical Guidelines Group.

Version: 8.1

Approved By: West of Scotland Managed Clinical Network for Sexual Health