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Войти в исследования BMJ open ophthalmology · 2026
Diagnostic delays and sexual health integration in Chlamydia trachomatis conjunctivitis: an 11-year retrospective study at a UK tertiary ophthalmic centre.
СтатьяНазвание и аннотация: Перевод в очереди
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Milligan Alice L, Abdulhussein Dalia, Neo Yan Ning, La Chuiki Jasmine, Quah Nicole, Palanivel Shara, Oomeer Soonita, Liu Siyin, Hoffman Jeremy
Аннотация
OBJECTIVES: To describe the epidemiology, clinical features, diagnostic pathways and sexual health integration in patients with Chlamydia trachomatis conjunctivitis (CTC) presenting to a UK tertiary eye hospital over an 11-year period.
DESIGN: Retrospective case study.
SETTING: Tertiary ophthalmic emergency department and corneal and external eye disease service in London, UK.
PARTICIPANTS: All patients with laboratory-confirmed CTC from conjunctival nucleic acid amplification tests between 1 January 2013 and 31 December 2023. Of 312 identified cases, 267 with available medical records were included.
PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were time to diagnosis, initial misdiagnosis rates and documentation of sexual history. Secondary outcomes were clinical signs, management (including systemic treatment and referral to sexual health services), complications and temporal trends in testing and positivity.
RESULTS: Median age was 26 years (range 14-78 years) and 67.8% (181/267) were male. Presentation was unilateral in 88.0% (235/267). Common signs included conjunctival hyperaemia (95.1%) and tarsal follicles (85.4%). Diagnostic samples were obtained at the first visit in 13.1%, with a median time to diagnosis of 14 days (range 1-194 days). An incorrect initial diagnosis was made in 63.6% (170/267), presumed adenoviral conjunctivitis. Sexual history was documented in 24.0% (64/267); among these, 4.5% reported genital symptoms and 7.1% had prior awareness of genital chlamydia. Appropriate systemic antibiotic therapy was documented in 52.4% (140/267). Despite a reduction in number of conjunctival swabs from 1728 in 2013 to 402 in 2023, positivity increased from 1.9% to 3.2%.
CONCLUSIONS: CTC is frequently misdiagnosed and late diagnosed in ophthalmic practice, with sexual history rarely documented and referral to sexual health services often unclear. These findings highlight opportunities for genital chlamydia detection and support routine sexual health assessment, clear referral pathways and increased clinician awareness. The retrospective, single-centre design and absence of a repeat audit cycle limit the generalisability of these findings.
DESIGN: Retrospective case study.
SETTING: Tertiary ophthalmic emergency department and corneal and external eye disease service in London, UK.
PARTICIPANTS: All patients with laboratory-confirmed CTC from conjunctival nucleic acid amplification tests between 1 January 2013 and 31 December 2023. Of 312 identified cases, 267 with available medical records were included.
PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were time to diagnosis, initial misdiagnosis rates and documentation of sexual history. Secondary outcomes were clinical signs, management (including systemic treatment and referral to sexual health services), complications and temporal trends in testing and positivity.
RESULTS: Median age was 26 years (range 14-78 years) and 67.8% (181/267) were male. Presentation was unilateral in 88.0% (235/267). Common signs included conjunctival hyperaemia (95.1%) and tarsal follicles (85.4%). Diagnostic samples were obtained at the first visit in 13.1%, with a median time to diagnosis of 14 days (range 1-194 days). An incorrect initial diagnosis was made in 63.6% (170/267), presumed adenoviral conjunctivitis. Sexual history was documented in 24.0% (64/267); among these, 4.5% reported genital symptoms and 7.1% had prior awareness of genital chlamydia. Appropriate systemic antibiotic therapy was documented in 52.4% (140/267). Despite a reduction in number of conjunctival swabs from 1728 in 2013 to 402 in 2023, positivity increased from 1.9% to 3.2%.
CONCLUSIONS: CTC is frequently misdiagnosed and late diagnosed in ophthalmic practice, with sexual history rarely documented and referral to sexual health services often unclear. These findings highlight opportunities for genital chlamydia detection and support routine sexual health assessment, clear referral pathways and increased clinician awareness. The retrospective, single-centre design and absence of a repeat audit cycle limit the generalisability of these findings.