Diagnosing Chlamydia and managing proctitis in men who have sex with men: current UK practice

Objectives: This study was undertaken to ascertain clinic practices with respect to testing men who have sex with men (MSM) for chlamydial infection and the management of men with proctitis. Methods: A cross-sectional survey of genitourinary medicine clinics in the United Kingdom undertaken in 2006. The questions concerned clinical practice regarding testing MSM for chlamydial infection at different anatomical sites, the clinical procedures used in the investigation of a MSM, the use of rectal smear microscopy, and the treatment used for rectal chlamydial infection. Results: A nucleic acid amplification test was used for the diagnosis of chlamydial infection in the majority of clinics, although 12 (11%) were using methods that are no longer recommended (enzyme immunoassays). Testing for rectal chlamydial infection was undertaken in most clinics: 63 (60%) for screening in all MSM; 28 (27%) for diagnostic purposes or in contacts; 15 clinics did not offer any rectal testing. Anoscopy was offered to MSM in 99 clinics (93%), and rectal smear microscopy was undertaken in 76 clinics (71%). In 48 of the 76 clinics that undertook microscopy (64%), the number of cells in a defined microscopical field was counted; there was little consistency in what constituted proctitis. Only 58 clinics (58%) used treatment regimens recommended for lymphogranuloma venereum in men with symptomatic chlamydial proctitis. Testing for pharyngeal chlamydial infection was undertaken in 38 clinics (36%). Conclusions: There is a wide variation in the diagnosis and management of chlamydial infection in MSM and there is an urgent need for a more consistent approach.