ArticleBMJ open ophthalmology2026
Diagnostic delays and sexual health integration in
Article in BMJ open ophthalmology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo describe the epidemiology, clinical features, diagnostic pathways and sexual health integration in patients with
designRetrospective case study.
settingTertiary ophthalmic emergency department and corneal and external eye disease service in London, UK.
participantsAll patients with laboratory-confirmed 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.
resultsMedian 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%.
conclusionsCTC 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.
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