Knowledge of Chlamydia trachomatis genital infection and its consequences in people attending a genitourinary medicine clinic

OBJECTIVES

To assess knowledge of Chlamydia trachomatis infections, with a comparison of knowledge of Neisseria gonorrhoeae infections.

METHODS

A cross sectional survey, by self completed questionnaire, of 200 subjects attending a genitourinary outpatient clinic.

RESULTS

The response rate was 82% (90 male and 73 female). 51% of men (60% of females) had heard of chlamydia. 65 (82%) were unaware of the potential consequences of infection. 66% were unaware that the disease could be asymptomatic. Significantly more men (77%) than women (60%) had heard of gonorrhoea. Most participants (68%-82%) knew little of the possible consequences of this infection, and only 26% were aware that it could be asymptomatic. Knowledge was higher regarding fertility topics. There was no correlation between knowledge and either age or socioeconomic status. However, greater knowledge was displayed by those who read health information leaflets always or often. For both men and women, the preferred source of health information was the doctor. Other popular sources were health information leaflets, women's magazines, and television.

CONCLUSIONS

Barely half the participants had heard of chlamydia and gonorrhoea. Further knowledge of either infection was very poor. There are serious implications for public health. The reasons for this are unclear and require exploration before targeted health promotion. Doctors and the popular media are acceptable, and potentially effective, sources of information. Acquisition of knowledge is important, both to reduce sexual risk taking behaviour and its consequences, and to allow for informed consent for chlamydia screening programmes.

The transmission dynamics of gonorrhoea: modelling the reported behaviour of infected patients from Newark, New Jersey

A survey of the sexual behaviour of gonorrhoea patients in Newark was undertaken to evaluate parameters within a model of gonorrhoea transmission. Modelling work aimed to explain observed epidemiological patterns and to explore the potential impact of interventions. Reported behaviours, along with values derived from the literature, were used within a standard deterministic model of gonorrhoea transmission, where the population was stratified according to sex and rates of sex-partner change. The behaviours reported, particularly among women, are insufficient by themselves to explain the continued existence of gonorrhoea within the population. The majority of symptomatic patients seek treatment within a few days, and report that they do not have unprotected sex while symptomatic. The proportion of patients with low numbers of sex partners suggests that sexual mixing between people categorized according to sexual behaviour is near random. To explain the persistence of gonorrhoea, there must be some patients who, when infected, do not seek care in public clinics. In addition, gonorrhoea incidence in the model is sensitive to change, such that very small reductions in risk behaviour could lead to its elimination. This does not accord with the observed failure of many interventions to eliminate infection, suggesting that the modelled infection is too sensitive to change. The model, which has been influential in gonorrhoea epidemiology, is not consistent with the observed epidemiology of gonorrhoea in populations. Alternative models need to explore the observed stability of gonorrhoea before robust modelling conclusions can be drawn on how best to control infection. However, the current results do highlight the potential importance of asymptomatic infections and infections in those who are diseased and do not attend public health services. Screening and contact-tracing to identify asymptomatic infections in both men and women will be more effective in reaching those who maintain the infection within the community rather than simply treating symptomatic cases.

The role of sexual partnership networks in the epidemiology of gonorrhea

BACKGROUND

Empirical studies have the potential to collect data on patterns of sexual mixing and network structures.

GOAL

To explore the contribution of different network measures in sexually transmitted disease epidemiology.

STUDY DESIGN

Individual-based stochastic simulations of a network of sexual partnerships and sexually transmitted disease transmission are analyzed using logistic regression.

RESULTS AND CONCLUSIONS

Measures accumulated over times similar to the duration of infection are more informative than are static cross sections. The patterns of sexual mixing and network structure influence patterns of infection. In particular, the establishment of infection is most sensitive to the proportion of nonmonogamous pairs, the component distribution and cohesion among those with high activity. The subsequent prevalence is most sensitive to the assortativeness of mixing in the high-activity class and a measure of cohesion, both of which reflect the decrease in prevalence brought about by less widespread connections. A person's risk for infection is determined by local rather than global network structures.

Knowledge of gonorrhea in adolescent females with a history of STD

The purpose of this study is to examine how a previous infection with gonorrhea or another sexually transmitted disease (STD) will impact on patients' knowledge of gonorrhea. Adolescent girls were recruited from a primary-care adolescent clinic. Those with a history of an STD were overrecruited. Participants were given a standardized questionnaire regarding several symptoms and sequelae of STD. The results of this study revealed that girls (N = 248, mean age = 16.9 years) with a personal history of gonorrhea had more correct responses than those with no history of an STD, but they were not statistically different from those with a nongonococcal STD. No group had a mean correct score greater than 6.66 out of 13. Nearly two out of three participants reported that an individual had to always have one of four symptoms (discharge, pain on urination, rash, or sores) when there is a gonococcal infection. Overall, adolescents have an inaccurate foundation of knowledge regarding symptoms and sequelae of gonorrhea. Although those with a previous history of gonorrhea had higher mean scores than those with no history of an STD, they still identified the correct responses only half the time. Additionally, adolescents with a history of gonorrhea or another STD were no more likely to have identified the possibility of asymptomatic infection, despite several having only a history of asymptomatic infection.

Determinants of penicillinase producing Neisseria gonorrhoeae infections in heterosexuals in Amsterdam

BACKGROUND AND OBJECTIVES

At the STD clinic of the Municipal Health Service in Amsterdam, the annual number of infections with penicillinase-producing Neisseria gonorrhoeae (PPNG) strains remained relatively stable from 1983 until 1990, while the number of non-PPNG infections declined dramatically. To investigate the PPNG and non-PPNG epidemic, a cross sectional study was conducted in 1989 and 1990. The purpose of this study was to assess determinants of PPNG infections among heterosexuals diagnosed with gonorrhoeae.

METHODS

In addition to routinely collected data in new consultations for STDs, information on alcohol use, drug use and sexual behaviour was obtained from patients diagnosed with gonorrhoea. The diagnosis of gonorrhoea was based on a positive culture and isolates were screened for PPNG. Logistic regression analysis was used to assess independent predictors of PPNG infection.

RESULTS

Additional information was available of 328 women and 995 heterosexual men diagnosed with gonorrhoea. PPNG was diagnosed in 86/328 (26%) women and in 329/995 (33%) men. Logistic regression analysis identified a Central/South American nationality (odds ratio(OR) = 2.46) and older age (OR = 1.04 per year) as positively associated with PPNG infection in female patients. An inverse relation was found with use of hard drugs (OR = 0.29). Among men diagnosed with gonorrhoea, sexual contacts with window prostitutes (mainly women from Central/South America) (OR = 1.98) and a foreign nationality (OR = 1.78) were positively associated with PPNG infection, and sexual contact with drug using prostitutes (OR = 0.47) inversely.

CONCLUSIONS

PPNG infections were especially common among Central and South American window prostitutes and their clients, but not among hard-drug addicted prostitutes and their clients. Since window prostitutes originating from Central and South American countries are transient in Amsterdam, prevention activities targeted at these prostitutes and their clients should be continued to limit the spread of PPNG and other STDs within these groups.

Psychological consequences of genital herpes, an exploratory study with a gonorrhea control-group

Measurements of some psychosocial variables were obtained from 27 patients with a genital herpes infection and compared with those from 12 patients with a gonorrhea infection. The measurements referred to the period before and during the infection. Evidence was found that during the infection patients were more anxious, more sexually inhibited, more bitter towards their partners, and had more psychological complaints than before the infection. Generally there was no difference between the two groups of patients, with one exception: patients with genital herpes judged themselves as having fewer psychological complaints prior to the disease than did patients with gonorrhea.

Assessment of sexual mixing patterns

The manner in which people with varying partner change rates choose their partners may have important implications for the future of the AIDS epidemic. A relatively rapid but small epidemic can be expected if sexual mixing patterns are highly assortative so that those with high partner change rates nearly always choose partners with similar rates. Direct estimation of sexual mixing is exceedingly difficult. On the other hand, information on the way people mix is implicitly contained in the epidemiology of other sexually transmitted diseases (STDs). If mixing is highly assortative, one might expect gonorrhea to be largely confined to a small subsection of the population who would frequently contract the disease repeatedly. In this paper a model of gonorrhea transmission in which partner change rates and preference are dealt with as continuous variables is used to extract information on mixing from data on an Australian heterosexual population. It was found that in this population mixing is not far from random with respect to partner change rates.

Knowledge of AIDS and other sexually transmitted diseases among women attending a family planning clinic in Nairobi, Kenya

We interviewed 1,716 women attending a family planning clinic in Nairobi between January 1990 and May 1991 about their knowledge of the acquired immunodeficiency syndrome (AIDS) and other sexually transmitted diseases (STDs). When participants in the study were asked to name spontaneously the STDs they knew, more than 90% of the women named gonorrhea and AIDS, and 75.0% named syphilis; 65.4% could name two or more signs of AIDS; and 96.9%, 66.5%, and 58.3% mentioned sexual transmission, transmission via blood transfusion, and perinatal transmission, respectively, as routes of transmission of AIDS. Knowledge of most symptoms and routes of transmission of AIDS, as well as knowledge of gonorrhea and syphilis, was significantly positively associated with level of education. Unmarried women were significantly less likely to know symptoms and routes of transmission of AIDS than were married women. Level of knowledge of gonorrhea and syphilis was significantly positively associated with number of lifetime sexual partners. Although awareness of AIDS was very high, detailed knowledge of signs of AIDS and routes of transmission was deficient, particularly among less educated women. This positive association of detailed AIDS knowledge with level of education suggests a need to design AIDS prevention activities that are more accessible to, and better understood by, women who have little education.

Venereal diseases and aggression management among Native Americans

An analysis of secondary data yielded no significant ecological correlations for venereal disease rates and aggression management indices based on suicide and homicide rates for the 11 US Indian Health Services areas. This outcome does not cross-culturally replicate research on Field's aggression management hypothesis.

Consumption by semen loss in India and elsewhere

Using ethnographical data from a rural site of Oriya culture, the purpose of this article is to show that the Indian obsession regarding the harmful consequences of semen loss does not constitute a specific Indian culture-bound preoccupation, but represents a survival example of a much widespread system of beliefs that can be traced for instance in Western culture to the Hippocratic notion of "back consumption" and the classical concept of gonorrhoea. At the core of this system of beliefs are found ancient conceptions of the nature and functions of semen in human life. These conceptions and their cultural influences incidentally inform us about one of the origins of the reprobation of onanism, as well as one possible way, among many others, for traditional thinking to explain the clinical enigma of depressive syndrome.

Gonorrhea care in a clinic for low-income patients

There are few studies from family practice offices summarizing experience with culture-proven gonorrhea. Seventy-nine such cases were identified over a six-year period in a family practice model office in Gainesville, Florida, a rate of 5.8 cases per 10,000 patient visits. Ninety-six percent of the patients in the study had limited financial resources by insurance classification. The most commonly recognized presentations in men were complaints of discharge or dysuria or both. Nine (15%) of the women gave a history of contact with a person said to have a sexually transmitted disease, but none of the men did. Of the 62 women, gonorrhea was found on routine cervical culture in only two (3%), 38 (61%) had pelvic pain, and 40 (65%) had discharge as an initial complaint. Fifty-one of the patients (88%) reported symptomatic improvement with treatment, and seven (12%) reported no improvement by the treatment. Post-treatment gonorrhea cultures were positive in two (3%), negative in thirty-three (42%), not done in seventeen (22%), and twenty-seven of the patients (34%) did not return for scheduled follow-up. Difficulties in treating patients with gonorrhea in this population appeared to be largely related to problems with patient follow-up.

The patient with gonococcal infection

Despite the availability of effective antimicrobial therapy since the middle of the twentieth century, gonococcal disease remains a common and expensive public health problem. The patient who presents to the primary care office with gonococcal disease, or one who is found to be infected after screening, still faces significant emotional and economic barriers to effective treatment and control of the spread of the disease. Along with the emergence of resistant strains and the previously existing problems of asymptomatic carriers and reluctance to seek treatment, physicians are charged with the problems of identifying patients at risk for the disease, providing effective treatment for those infected, and preventing further spread of infection. Simple, effective, and inexpensive therapies that also treat the frequently present coinfections with other sexually transmitted diseases are not yet available. Antibiotic therapy must still be chosen with regard to the patient's history and circumstances. The approach to counseling the patient about avoidance of complications, prevention of reinfection, and prevention of transmission of infection must be mastered by the primary care physician if progress is to be made toward the eradication of gonococcal disease.

The impact of a clinic-based educational videotape on knowledge and treatment behavior of men with gonorrhea

The impact of a ten-minute, soap opera-style videotape on knowledge and treatment behavior of black men with gonorrhea was tested in randomized clinical trials. The videotape, shown to individual patients after diagnosis, produced a sizeable increase in the percentage of patients who returned for their test-of-cure examination: while only 43.3% of control group patients returned, 53.5% of those in the videotape group did so; chi 2(1) = 9.0; P less than 0.003. In a follow-up study, similar results were found: videotape group (59.0%), control group (39.1%); chi 2(1) = 6.2; P less than 0.015. The videotape also produced large, significant increases in patient knowledge, as measured by a test administered during patients' clinic visit (P less than 0.0001). No measureable effect of the videotape was detected on patients' willingness to refer sexual contacts for treatment. The findings suggest that clinic-based educational materials, particularly soap opera-style videotapes that engender audience identification, create emotional significance for the viewer, and model requisite communication skills, may have a significant role to play in control of sexually transmitted diseases.

Failure of a lottery incentive to increase compliance with return visit for test-of-cure culture for Neisseria gonorrhoeae

The impact of the financial incentive of playing a lottery on the rate of return for test-of-cure cultures was evaluated at a clinic for sexually transmitted diseases. All teenagers and young adults treated for gonorrhea (or as contacts of patients with gonorrhea) who were given a test-of-cure appointment were eligible to participate; in order to win, they had to keep the appointment. The return rate was documented during a baseline and a lottery phase for 519 patients. Females were significantly more likely to keep the appointment (47%) than males (27%), regardless of intervention, but there was no improvement in the return appointment rates with the lottery (baseline, 31% vs. lottery, 33%). Although teenaged males were more likely to participate in the lottery than young adult males and all females, only young adult females who participated were significantly more likely to return (68%). Reasons for failure of the lottery are discussed. Thus, despite the successful use of a lottery in previous studies, it is not always helpful in improving compliant behavior in certain populations.

Gonococcal strains from homosexual men have outer membranes with reduced permeability to hydrophobic molecules

Loci designated penA, penB, and mtr contribute additively to penicillin G resistance in Neisseria gonorrhoeae; the mtr locus also confers resistance to hydrophobic dyes, detergents, and antibiotics, env mutations suppress the phenotypic expression of mtr and penB and are responsible for increased sensitivity to various hydrophobic molecules. We postulated that the host environment is important in the selection of gonococcal strains with these particular outer membrane phenotypes. Thus, mtr strains should predominate in environments that are high in hydrophobic molecules. To test this hypothesis we determined the outer membrane phenotype of 152 strains of N. gonorrhoeae. Rectal and urethral isolates from 58 homosexual men, urethral isolates from 55 heterosexual men, and cervical and rectal isolates from 39 heterosexual women were used in this study. Strains from 43 of the homosexual men were matched with those from heterosexual men with respect to auxotype and year and season of isolation. Cell envelope phenotype was determined for each strain on the basis of its resistance to various hydrophobic compounds. The identity of mtr strains was confirmed by genetic transformation. Among the matched pairs, mtr strains were significantly more prevalent among isolates from homosexual men than among those from heterosexual men (P = 0.03). Serogrouping by coagglutination demonstrated that 17 of 19 mtr strains versus 76 of 131 non-mtr strains belonged to coagglutination group WII (P = 0.01). Coagglutination group WII strains were also associated with homosexuality (P = 0.02). Gonococci were also tested for resistance to fecal lipids, mtr strains were more resistant to growth inhibition by fecal lipids than were non-mtr strains.

Self-reported behavior patterns of patients attending a sexually transmitted disease clinic

Records of the sexually transmitted disease (STD) clinic visits of 12,728 patients in Columbus, Ohio were analyzed to better understand the behavior patterns of these patients. Among heterosexual men, a greater proportion of Blacks than Whites reported a previous history of urethritis. After controlling for previous STD among heterosexual men with discharge or dysuria, we found that Black men sought treatment sooner and were more likely to curtail sexual activity than White men after becoming symptomatic with gonorrhea or nongonococcal urethritis.