Predominant sexually transmitted diseases among different age and ethnic groups of indigent sexually active adolescents attending a family planning clinic

Prevalence of sexually transmissible infections in adolescents treated in a family planning outpatient clinic for adolescents in the western Amazon

Sexually transmitted infections (STIs) are among the most common public health problems worldwide, especially among adolescents and young adults, who account for almost 50% of all STI patients. Studies on the subject in the western Amazon are limited. This study aimed to evaluate the prevalence of STIs (chlamydia, gonorrhea, trichomoniasis, herpes simplex virus, syphilis, human immunodeficiency virus [HIV], hepatitis B, and hepatitis C) in adolescents treated at a family planning outpatient clinic in the western Amazon: Porto Velho, Rondônia, Brazil. A total of 196 adolescents were enrolled. During the gynecological examination, endocervical samples were collected to test for four STIs (chlamydia, gonorrhea, trichomoniasis, and herpes simplex virus), and blood samples were collected for the detection of HIV, syphilis, and hepatitis B and C. The mean age was 17.3 ± 1.5 years, the age at sexarche was 14.4 ± 1.6 years, and 54.6% of participants had their first sexual intercourse at 14 years or younger. Only 1.0% of the adolescents used condoms in all sexual relations, and 19.9% had casual partner(s) in the last year. In the evaluation of prevalence, we found that 32% of the adolescents had at least one STI, with the most prevalent being chlamydia (23%), followed by trichomoniasis (5.6%), herpes simplex (4.6%), and gonorrhea (3.1%). No positive cases of hepatitis B, hepatitis C, or HIV were detected, but 1% of the adolescents tested positive for syphilis. These indicators will support more effective health care strategies aimed at improving the quality of life of populations in this region of the western Amazon. In conclusion, our findings demonstrated high rates of STIs in the studied patients, reinforcing the need to expand epidemiological studies to implement more appropriate public policies and intervention strategies to prevent STIs in adolescents and other vulnerable populations in the western Amazon.

Adolescence and other risk factors for Chlamydia trachomatis genitourinary infection in women in Melbourne, Australia

OBJECTIVE

To establish the prevalence of and risk factors for Chlamydia trachomatis infection to determine the role of universal versus targeted testing.

METHODS

A prospective study of 1107 women attending two sexual and reproductive health clinics in Melbourne, Australia, was carried out. A questionnaire was used to establish risk factors. Urine samples were tested for C. trachomatis by PCR. The main outcome measures were prevalence of and risk factors for C. trachomatis infection.

RESULTS

Of 1107 recruitable women, 851 (76.9%) consented and were successfully tested. C. trachomatis was detected in 18 (4.8% (95% CI 2.9 to 7.5)) of 373 women in the inner city and eight (1.7% (95% CI (0.7 to 3.3)) of 478 women in the suburban clinic. Of women under 25 years, 17 (6.2% (95% CI 3.7 to 9.8)) of 273 in the inner city in contrast with three (1.7% (95% CI 0.4 to 5.0)) of 174 in the suburban clinic were infected. In the inner city clinic, age under 25 years (OR 5.4 (95% CI 0.7 to 41.5)), vaginal discharge (OR 4.1 (95% CI 1.5 to 11.1)), and recent change of sexual partner (OR 4.6 (95% CI 1.6 to 12.9)) were associated with C. trachomatis. In contrast, in the suburban clinic, only vaginal discharge (OR 3.5 (95% CI 0.9 to 14.3)) and recent change of sexual partner (OR 3.4 (95% CI 0.8 to 15.7)) were identified as risk factors. Multivariate analysis showed that recent change of partner (OR 4.5 (95% CI 1.5 to 13.8)) was the most strongly associated independent risk factor for infection in the inner city clinic.

CONCLUSION

The high prevalence of C. trachomatis indicates that universal testing should be undertaken in the inner city clinic. Young age may not be a risk factor for C. trachomatis in more affluent populations with lower prevalence rates. No risk factors were identified with sufficient sensitivity and specificity to be useful for targeted testing. Prevalence and identifiable risk factors for C. trachomatis are not transferable between populations, even in the same city.

Bacterial vaginosis and Chlamydia trachomatis among pregnant abused and nonabused Hispanic women

OBJECTIVE

To compare the prevalence of bacterial vaginosis (BV) and Chlamydia trachomatis (CT) among abused and nonabused pregnant Hispanic women.

DESIGN

Retrospective audit of charts of 233 pregnant, abused Hispanic women and 468 pregnant, nonabused Hispanic women.

SETTING

Three urban prenatal clinics of a public health department in the southwestern United States.

SAMPLE

The medical records of 701 pregnant Hispanic women.

MAIN OUTCOME MEASURE

Diagnosis of BV and/or CT among abused and nonabused pregnant women.

RESULTS

Combined prevalence of BV and CT was significantly higher for abused women (z score = 2.55; df = 138; p < .05). There was no significant difference between abused and nonabused women for CT alone (z score = .96; df = 33; p < .05); however, prevalence of BV was significantly higher for abused women (z score = 1.99; df = 104; p < .05).

CONCLUSION

In this sample of pregnant Hispanic women prevalence of BV was significantly higher in those who had been abused, indicating the need for targeted screening of all abused pregnant women for BV.

Genital Chlamydia trachomatis infection in Australia

OBJECTIVE

To review available data on genital chlamydial infections in Australia, to determine trends and to make recommendations for improving future data collection.

DATA SOURCES

Data are presented from representative laboratories around Australia for the 11-year period 1980-1990. Studies of the prevalence of chlamydial infection in Australia and overseas for the same period were selected for review where relevant epidemiological information (such as patient population, reason for test, demographic data) was available.

RESULTS

Overall rates of chlamydial infection from the surveyed laboratories ranged from 3.2%-14.6% for the period 1980-1982 and 2.7%-5.5% for 1990. Rates of diagnosis of Chlamydia appeared to decline in some centres while remaining relatively stable at others. Between 2800 and 4000 cases per year have been reported to the CDI (Communicable Diseases Intelligence) scheme since 1985. Substantial increases in the number of tests performed were seen in nearly all laboratories, reflecting a shift towards screening asymptomatic lower-risk women, however detailed data on the populations tested were unavailable. Studies of prevalence of genital chlamydial infection in Australia revealed highest infection rates among sexually transmitted disease clinic clients (2.5%-14%) and a prevalence of more than 5% in women attending family planning clinics. Studies from overseas showed wide variations in prevalence of infection, from 6% to 28% depending on the populations studied.

CONCLUSION

Improved data collection is imperative for assessing the impact of intervention programs for chlamydial infection, which has potentially serious but largely preventable sequelae in women. Although diagnosis of genital chlamydial infection appears to be declining or at least stable in Australia, possibly due to intervention programs, it remains a relatively common sexually transmitted infection. Comparison of rates and interpretation of the figures is made difficult by changes in screening practices, lack of standard case definitions, denominator information and probable under-reporting. Recommendations proposed for improving data collection for Chlamydia include establishing sentinel sites, standardising the collection of data, and ensuring standard case definitions between sites.

Chlamydia trachomatis in sexually active teenage girls. Factors related to genital chlamydial infection: a prospective study

The incidence of new infections with C trachomatis was found to be 19%. Predisposing factors for a subsequent chlamydial infection were multiple partners, smoking and previous infection with C trachomatis. Girls with a spread cervical ectopy were not more likely to contract a chlamydial infection in one year than girls without an ectopy. Oral contraceptive use was not found to predispose for a chlamydial infection.

Chlamydia trachomatis: female pelvic infection

Chlamydia trachomatis is a bacterium that causes both symptomatic and asymptomatic infection. This infection has been associated with severe infections of the upper genital tract, such as salpingitis, which may be responsible for a significant number of cases of ectopic pregnancy and infertility. An unsettled question is the role of C. trachomatis in pregnant patients. In addition to causing cervicitis, it has been linked to chorioamnionitis, premature rupture of membranes, and premature delivery. However, chlamydial infection is an easily treatable disease. The main focus of prevention is appropriate prescreening of patients at risk.

Sexually transmitted disease treatment and return for test of cure of adolescents in a family planning clinic

This retrospective study assessed the return for treatment and test-of-cure rates for gonorrhea and chlamydial infection among 154 adolescents and young adults attending a family planning clinic. Eighty-four percent returned for treatment and 57% of those returned for a test of cure. No statistical differences in race/ethnicity, marital status, gravida, age, presence of symptoms, or type of infection were found between those returning and those not returning for treatment. Issues associated with sexually transmitted disease treatment and follow-up in the family planning clinic setting are discussed.

Survey of genitourinary organisms in a population of sexually active adolescent males admitted to a chemical dependency unit

Sixty-two males consecutively admitted to an adolescent chemical dependency unit for treatment over a one-year period were studied. When interviewed, all denied having urogenital symptoms. Forty-eight reported having had sexual intercourse. Of these 48, 34 were screened (urethral swab) for Neisseria gonorrhoeae, Chylamydia trachomatis, Ureaplasma urealyticum, and Gardnerella vaginalis. Eighteen of the 34 males who had complete screening were found to harbor one or more organisms: 3 had Chlamydia, 13 had Ureaplasma, and 11 had Gardnerella. In addition, 61 of the original 62 subjects were tested for serum antibodies to Treponema pallidum and for pyuria. No subjects were found to have syphilis. Pyuria was present in all subjects with Chlamydia but in only two with Ureaplasma or Gardnerella.