Title: 

An audit of the management of persistent and recurrent non-gonococcal urethritis (pNGU) in a large London teaching hospital

Background/introduction:

The British Association of Sexual Health and HIV (BASHH) released a new national guideline on the management of non-gonococcal urethritis (NGU) in 2015. This audit was completed to assess compliance and identify areas for service improvement.

Aim(s)/objectives:

To compare the management of pNGU against national guidelines.

Methods:

A retrospective case note review was performed for all patients having two or more NGU code (C4N) over a 12-month period from 1st April 2014. We collected demographic details, presenting symptoms, signs, investigations, management and number of visits. 

Results: ascertain

130 patients were identified from three different clinics within the same Trust. A total of 282 visits were recorded. 35.38% of visits were diagnosed as NGU and 66.15% as pNGU. We achieved 100% compliance with all four of BASHH auditable out comes (i.e. screening for C. trachomatis (CT) and gonorrhoea, documented offer of written information, delivery of first-line therapy and partner notification). Only one patient was diagnosed with CT. In recurrent visits, only 31% of further investigations were done and 12.6% of them were treated as pNGU according to the guideline. 55.2% of the patients had 4 or more visits. 

Discussion/conclusion:

We demonstrated high levels of compliance with national guidelines for managing NGU.  However, management of patients with pNGU was poor with lack of appropriate investigations and incorrect treatment regimes. Low levels of CT positivity in this cohort show the importance of further investigations and non-infectious causes of NGU which should be relayed to the patient at diagnosis.