MANAGEMENT OF CHLAMYDIA TRACHOMATIS GENITAL INFECTIONS : REPORTED PRACTICES OF PRIMARY CARE PHYSICIANS

OBJECTIVE: To determine the knowledge of primary care physicians about Chlamydia trachomatis genital infection and its management. DESIGN: Self-administered questionnaire comprising direct questions and hypothetical cases. PARTICIPANTS: All 108 general and family practitioners on the north shore of Vancouver were sent the questionnaire; 79 (73%) responded. RESULTS: There was a reasonable level of knowledge in many areas, particularly among the physicians who had graduated more recently than the others. Virtually all stated that they have access to chlamydial diagnostic testing, and most indicated that they test for chlamydial infection at least occasionally. However, many of the respondents failed to consider that youths in their practice may be sexually active, and only 28% knew that women 15 to 19 years of age have the highest reported rates of chlamydial infection. Many of the physicians were confused about syndromes that are or are not associated with C. trachomatis infection; this indicated the possibility of inappropriate testing and treatment decisions. If they had to test for C. trachomatis in a prepubescent girl 34% reported that they would obtain a specimen from the endocervix, a technique that is inappropriately invasive. When presented with a positive test result many of the respondents failed to consider the possibility of a false-positive result. Fortunately all of the physicians were well informed about correct treatment regimens for C. trachomatis infection, although many did not realize how effective they really are. In the case of a young man with suspected or proven gonorrhea or a young female outpatient with pelvic inflammatory disease, only 19% and 20% respectively stated that they would prescribe a regimen appropriate for both penicillinase-producing Neisseria gonorrhoeae and C. trachomatis. Many of the respondents had not heard of management guidelines, and fewer still reported that they consult them. CONCLUSIONS: Despite the availability of several sets of guidelines there appear to be important gaps in the knowledge and practice of many primary care physicians with respect to genital infections. Since the preparation of guidelines is time-consuming and expensive, further work should be done to evaluate their impact and to address their limitations.