Crew Club Chlamydia Testing & Confidentiality Policy
Chlamydia is a little known infection that if left untreated can have serious consequences.
This policy is part of The Crew Club’s aim to educate everyone about Chlamydia and to ensure that the sexually transmitted infection (STI) is understood.
The policy also aims to ensure that confidentiality is maintained.
This policy applies to all paid staff members of The Crew Club.
For the purpose of this policy, the following types of information should be respected as confidential:
All personal details in relation to STI
Further actions needed to be taken in relation to STI
All information related to STI unless agreed otherwise with the individual
Any written information relating to STI and an individual
NB Other issues may also be confidential, the list is not exhaustive.
The inappropriate disclosure of confidential information will be considered a serious offence and be regarded as a disciplinary matter.
Members of staff are expected to make personal judgements as to the confidential nature of unmarked or oral information in relation to STI and apply appropriate discretion.
What is Chlamydia?
Chlamydia is a sexually transmitted infection STI caused by a tiny bacterium, Chlamydia trachomatis.
If you haven't heard of Chlamydia, you're in good company - a substantial proportion of the UK population hasn't heard of it either.
Most people who are at risk of this infection, don’t really know what it is, or understand it, even if they have heard about it.
Why should you know about it?
Chlamydia is the most common treatable STI. It often presents no symptoms in men or women unless it leads to complications - when treatment may be too late to stop permanent damage.
In some women, infection can damage the Fallopian tubes, which conduct eggs from the ovaries to the womb. This can stop the tubes working properly and they can become completely blocked.
Chlamydia is the most common preventable cause of infertility in women. When the fallopian tubes are blocked, no pregnancy is possible naturally. One option is IVF (in-vitro fertilisation), but availability on the NHS is still patchy and has variable success rates: usually no more than 20 per cent of women end up with a baby.
Women with damaged tubes do occasionally fall pregnant, but there is an increased risk of the pregnancy developing in the tubes rather than the womb. This is called an ectopic pregnancy. The tube can split apart causing serious pain and bleeding. This is an emergency, because the bleeding can be life threatening.
Infection sometimes leads to pain in the lower abdomen that is often mistaken for some other problem rather than pelvic infection.
Men can also run into trouble. Chlamydia is the most common cause of inflammation in the testicles and sperm-conducting tubes (epididymo-orchitis) in men under 35. This causes marked pain, swelling and redness in the scrotum on the affected side, or on both sides. Chlamydia infection can also trigger joint inflammation in some men.
Why don't I know about it?
In the UK, we have one of the best networks of clinics in Europe to diagnose and treat STIs: genitor-urinary medicine (GUM) or sexual health clinics. But women often have no reason to suspect they have Chlamydia, so they don't seek advice at one of these clinics.
Apart from sexual health experts, many doctors don't have sufficient knowledge to suspect Chlamydia when assessing a person’s symptoms, so don't do an appropriate test. And healthcare professionals are often unaware of how common the problem is and that it can be present without causing symptoms.
An education campaign for professionals is badly needed. Some clinicians find it difficult to talk about sex or to put their patients at ease. Most GPs are so pushed for time that the thought of embarking on a discussion about a sexually transmitted infection is a bridge too far.
However, some GP surgeries do have good arrangements for dealing with sexual health matters. The practice nurse or health visitor might be the best person to ask about what the practice can offer in this area.
Often the best place to get help and advice is from the health advisers who are part of the team working in sexual health clinics. To find your nearest clinic, check the phone book or NHS Direct (NHS 24 in Scotland).
How is Chlamydia diagnosed?
A Chlamydia test is not routinely carried out when you have a smear test.
Many women are under the illusion that it is, and are falsely reassured.
If you are unable to get the test at your local practice, get a check-up at your nearest GUM clinic.
This is really important if:
· you are under 25
· You changed sexual partner recently and developed symptoms a few months later.
Until five years ago, testing for Chlamydia in women involved taking a swab taken from the cervix (neck of the womb) during a speculum examination (i.e. similar to a smear test).
New tests have now been developed that are done on urine samples, or on swabs that a woman inserts into the vagina herself, which are then put into a container and sent to the laboratory. These new tests avoid the need for an intimate and uncomfortable examination and makes testing much easier for women.
For men, the only sample that was satisfactory was a swab put into the opening of the urethra at the tip of the penis. Now the urine test, although not quite as reliable as one done on a swab, is easy and doesn't hurt!
Unfortunately, the new tests are twice as expensive as the old ones. Some clinics and practices have found the resources to buy the newer tests, but they are still unavailable in about 70 per cent of labs. Recently, the government has provided some extra money so laboratories can adopt the newer tests.
The infection is most common and most likely to cause serious complications in younger women.
If you are under 25 and sexually active, you have a 1 in 10 chance of having Chlamydia, so it may be worth getting checked out.
Your risk is even higher if you are under 20 and have had unprotected sex.
If you are over 25 and have had two partners within a year, or recently changed partner, your risk is also increased.
Not so much is known about risk of infection in men, in whom the highest risk group are aged between 20 and 30 years. As with females, Chlamydia can be present, but give no symptoms in males.
In a recent survey of young male army recruits, almost 10 per cent proved positive on Chlamydia urine tests. However, 88 per cent had no symptoms whatsoever.
What are the symptoms?
Some women may have symptoms such as cystitis, change in vaginal discharge or mild lower abdominal pain. These are very 'non-specific’ symptoms and can be caused by other infections.
If you go to a GP or family planning doctor with these symptoms, make sure you have a Chlamydia test taken. You are perfectly entitled to ask for it if the test isn’t offered spontaneously.
In men, Chlamydia is the most common cause of urethral discharge from the penis.
Sometimes Chlamydia can cause mild irritation at the end of the penis, which disappears after two or three days. Many men suffering some discomfort will just wait to see if it goes away.
Unfortunately, the discomfort may disappear but the infection can still be present. They can, therefore, transmit it to a sexual partner and also risk the complication of inflamed and swollen testicles.
Chlamydia infection can affect sperm function and fertility in men. Chlamydia has too often been publicised as a problem that only affects women. Nothing could be further from the truth.
How can it be prevented?
Use condoms and before you stop using them, make sure you and your partner get checked out for STIs by your local GUM clinic or GP.
If you have concerns, act on them and get yourself checked out.
Make sure your friends have heard about the infection and its consequences. Encourage them to get a check-up if they think they may be at risk.
What if tests show I have Chlamydia?
If you are infected, make sure your sexual partner gets treatment. Otherwise, the untreated partner just becomes re-infected. Repeated infection can cause far worse fertility problems in women.
If possible, encourage your ex-partners to get tested, because this infection can stay unrecognised for months, if not years.
How common is Chlamydia?
Over the past few years, more publicity has been given to Chlamydia infection and its consequences. However, reports between 1996 and 2002 from the GUM clinics in England show diagnosed Chlamydia infections more than doubled.
In 2001-2002, the figures were up 14 per cent, with an estimated 1 per cent of 16-19 year old women having the infection.
In other Western European countries, particularly Scandinavia, Denmark and Holland, Chlamydia infections have decreased over the last 15 years - in some instances to almost zero, with an accompanying decrease in complication rates of pelvic infection and ectopic pregnancies.
Over the last three years, some countries have started to see resurgence in infections, but at much lower levels than exist in the UK.
Why are UK infection rates so high?
There are many contributing factors. In countries that have tackled Chlamydia more successfully:
STIs are discussed in school-based sex education programmes
Chlamydia tests are widely available
there are high profile public education campaigns
Attention has been paid to educating the practitioners who deal with the consequences of Chlamydia infection, particularly obstetricians and gynaecologists.
In Sweden these initiatives were started more than 20 years ago.
Now the new tests have been introduced in most Western European countries and the USA. Educational initiatives are also underway for professionals and public, the latter through the ‘sex lottery’ launched by the Department of Health.
The issue of national screening
Following a report on the feasibility of Chlamydia screening in 1998, there were two pilot studies in the Wirral and Portsmouth. They showed infections were more common than expected and that screening in general practice contraceptive clinics (using urine samples) was feasible and acceptable.
Because it is not clear which is the best way to undertake screening, or how to ensure that sexual partners get treated, these pilot studies have been extended to 10 areas of the country. Unfortunately, the studies exclude resources for screening in general practices. Some of these pilots are looking at including men for screening.
In Lothian, the excellent results achieved by a pilot study offering free postal urine test kits in outlets such as colleges and record stores, have shown that Chlamydia screening in young people is feasible with the right approach.
Such examples are the forerunners of national screening. Although more money has been made available, we are still some way off the ideal in which all under 25s have easy access to a Chlamydia test.
How can we change the current situation?
We could do with some patient power. If you ask for a test and your GP is unable to provide it, demand may lead to a change in priorities in your local area.
As well as thinking about your own situation, don't forget the health and safety of your own children. It is time we accepted that about half of under 16-year-olds are having sex. Some do not use any contraception when they first start having sex or they use condoms inconsistently.
With a high teenage pregnancy rate, you would also expect a high Chlamydia rate so you need to talk to your teenagers about this STI. Discussing sex isn't easy for everyone, but surveys suggest that kids like to hear about sex and relationships from a parent in preference to anyone else.