# Routine Treatment Versus Selective Treatment for Individuals Reporting Contact With Sexual Partners With Chlamydia: A Before-and-After Study

## TL;DR

This study compares routine versus selective treatment for people who had contact with someone with chlamydia and finds that selective treatment can reduce antibiotic use and clinic workload.

## Contribution

The study demonstrates that switching from routine to selective treatment for chlamydia contacts significantly reduces same-day treatment rates.

## Key findings

- Selective treatment reduced same-day treatment from 91% to 56%.
- Most selective treatments were given due to symptoms.
- Unnecessary treatment rates remained unchanged between periods.

## Abstract

Many international guidelines recommend routine treatment for individuals reporting sexual contact with sexual partners with chlamydia. In October 2019, the Melbourne Sexual Health Centre (MSHC) 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.

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).

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 91.1% (1380/1515) to 55.6% (739/1328) (P < .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 2 periods (3% [482/1380] vs 34.2% [253/739]; P = .750). The proportion of contacts who received unnecessary treatment (treated but tested negative) did not change between the 2 periods (65.1% [898/1380] vs 65.8% [486/739]; P = .750). Of the 60 who did not receive treatment but tested positive subsequently, 7 (11.7%) did not return for treatment, and it did not differ between the 2 periods (P = .370).

The selective treatment approach has reduced antibiotic consumption and likely decreased the overall workload of clinic staff by minimizing the need to treat all contacts.

Switching chlamydia contact management from routine to selective treatment could reduce same-day treatment from 91% to 56%. During the selective treatment period, in most contacts, receiving same-day treatment was due to the presence of symptoms.