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Xu X, Chow EPF, Fairley CK, Chen M, Aguirre I, Goller J, Hocking J, Carvalho N, Zhang L, Ong JJ. Determinants and prediction of Chlamydia trachomatis re-testing and re-infection within 1 year among heterosexuals with chlamydia attending a sexual health clinic. Front Public Health 2023; 10:1031372. [PMID: 36711362 PMCID: PMC9880158 DOI: 10.3389/fpubh.2022.1031372] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023] Open
Abstract
Background Chlamydia trachomatis (chlamydia) is one of the most common sexually transmitted infections (STI) globally, and re-infections are common. Current Australian guidelines recommend re-testing for chlamydia 3 months after treatment to identify possible re-infection. Patient-delivered partner therapy (PDPT) has been proposed to control chlamydia re-infection among heterosexuals. We aimed to identify determinants and the prediction of chlamydia re-testing and re-infection within 1 year among heterosexuals with chlamydia to identify potential PDPT candidates. Methods Our baseline data included 5,806 heterosexuals with chlamydia aged ≥18 years and 2,070 re-tested for chlamydia within 1 year of their chlamydia diagnosis at the Melbourne Sexual Health Center from January 2, 2015, to May 15, 2020. We used routinely collected electronic health record (EHR) variables and machine-learning models to predict chlamydia re-testing and re-infection events. We also used logistic regression to investigate factors associated with chlamydia re-testing and re-infection. Results About 2,070 (36%) of 5,806 heterosexuals with chlamydia were re-tested for chlamydia within 1 year. Among those retested, 307 (15%) were re-infected. Multivariable logistic regression analysis showed that older age (≥35 years old), female, living with HIV, being a current sex worker, patient-delivered partner therapy users, and higher numbers of sex partners were associated with an increased chlamydia re-testing within 1 year. Multivariable logistic regression analysis also showed that younger age (18-24 years), male gender, and living with HIV were associated with an increased chlamydia re-infection within 1 year. The XGBoost model was the best model for predicting chlamydia re-testing and re-infection within 1 year among heterosexuals with chlamydia; however, machine learning approaches and these self-reported answers from clients did not provide a good predictive value (AUC < 60.0%). Conclusion The low rate of chlamydia re-testing and high rate of chlamydia re-infection among heterosexuals with chlamydia highlights the need for further interventions. Better targeting of individuals more likely to be re-infected is needed to optimize the provision of PDPT and encourage the test of re-infection at 3 months.
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Affiliation(s)
- Xianglong Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China,Melbourne Sexual Health Centre, The Alfred, Melbourne, VIC, Australia,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Eric P. F. Chow
- Melbourne Sexual Health Centre, The Alfred, Melbourne, VIC, Australia,Central Clinical School, Monash University, Melbourne, VIC, Australia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, The Alfred, Melbourne, VIC, Australia,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Marcus Chen
- Melbourne Sexual Health Centre, The Alfred, Melbourne, VIC, Australia,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Ivette Aguirre
- Melbourne Sexual Health Centre, The Alfred, Melbourne, VIC, Australia
| | - Jane Goller
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jane Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Natalie Carvalho
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Lei Zhang
- Melbourne Sexual Health Centre, The Alfred, Melbourne, VIC, Australia,Central Clinical School, Monash University, Melbourne, VIC, Australia,China Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi, China,*Correspondence: Lei Zhang ✉
| | - Jason J. Ong
- Melbourne Sexual Health Centre, The Alfred, Melbourne, VIC, Australia,Central Clinical School, Monash University, Melbourne, VIC, Australia,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom,Jason J. Ong ✉
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2
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Van Gerwen OT, Muzny CA, Marrazzo JM. Sexually transmitted infections and female reproductive health. Nat Microbiol 2022; 7:1116-1126. [PMID: 35918418 PMCID: PMC9362696 DOI: 10.1038/s41564-022-01177-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 06/20/2022] [Indexed: 11/26/2022]
Abstract
Women are disproportionately affected by sexually transmitted infections (STIs) throughout life. In addition to their high prevalence in women, STIs have debilitating effects on female reproductive health due to female urogenital anatomy, socio-cultural and economic factors. In this Review, we discuss the prevalence and impact of non-HIV bacterial, viral and parasitic STIs on the reproductive and sexual health of cisgender women worldwide. We analyse factors affecting STI prevalence among transgender women and women in low-income settings, and describe the specific challenges and barriers to improved sexual health faced by these population groups. We also synthesize the latest advances in diagnosis, treatment and prevention of STIs. Women are more affected by sexually transmitted infections than men. This Review examines the impact of non-HIV STIs on women’s health, and discusses recent advances and current challenges in the treatment and prevention of STIs.
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Affiliation(s)
- Olivia T Van Gerwen
- Division of Infectious Diseases, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA.
| | - Christina A Muzny
- Division of Infectious Diseases, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Jeanne M Marrazzo
- Division of Infectious Diseases, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
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3
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Khosropour CM, Dombrowski JC, Vojtech L, Patton DL, Campbell LA, Barbee LA, Franzi MC, Hybiske K. Rectal Chlamydia trachomatis Infection: A Narrative Review of the State of the Science and Research Priorities. Sex Transm Dis 2021; 48:e223-e227. [PMID: 34475361 PMCID: PMC8595876 DOI: 10.1097/olq.0000000000001549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chlamydia trachomatis (CT) is the most commonly reported infection in the United States. Most chlamydial research to date has focused on urogenital infection, but a growing body of research has demonstrated that rectal chlamydia is a relatively common infection among clinic-attending men and women. We know that most rectal CT infections are asymptomatic, but the health implications of these infections, particularly for women, are unclear. In addition, there are key knowledge gaps related to the epidemiologic parameters of rectal chlamydia, the routes of acquisition, the duration of infection, and the clinical significance of a positive rectal CT test result. This lack of information has led to a blind spot in the potential role of rectal chlamydia in sustaining high levels of CT transmission in the United States. Furthermore, recent findings from animal models suggest that the immune response generated from gastrointestinal chlamydial infection can protect against urogenital infection; however, it remains to be determined whether rectal chlamydia similarly modulates anti-CT immunity in humans. This is a critical question in the context of ongoing efforts to develop a CT vaccine. In this narrative review, we summarize the state of the science for rectal chlamydia and discuss the key outstanding questions and research priorities in this neglected area of sexual health research.
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Affiliation(s)
| | - Julia C. Dombrowski
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - Lucia Vojtech
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Dorothy L. Patton
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Lee Ann Campbell
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Lindley A. Barbee
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | | | - Kevin Hybiske
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Microbiology, University of Washington, Seattle, WA, USA
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4
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Gannon-Loew KE, Holland-Hall C, Ebersole AM, Alexy E, Jackson K, Bonny AE. Expedited Partner Therapy in Female Adolescents: A Study of Acceptance and the Impact on Reinfection Rates. Sex Transm Dis 2021; 48:828-833. [PMID: 33833149 DOI: 10.1097/olq.0000000000001436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Given the high risk of sexually transmitted infections (STIs) in adolescents and young adults (AYAs), this study evaluated expedited partner therapy (EPT) acceptance and STI reinfection rates in female AYA before and after availability of EPT. METHODS The pre-EPT cohort was a 3-year (November 2012 to November 2015) retrospective chart review of female AYA positive for Chlamydia trachomatis (CT) and/or Trichomonas vaginalis (TV) before introduction of EPT. An EPT protocol for CT and TV infections was implemented after legalization in Ohio in 2016. The post-EPT cohort was a prospective review of patients positive for CT and TV for 2 years (5/2016-5/2018) after EPT introduction. We evaluated EPT acceptance and compared reinfection rates (positive test 1-6 months after initial infection) in the pre-EPT versus post-EPT cohorts and by EPT acceptance. RESULTS Among patients offered EPT, 28% (67/237) with CT and 25% (24/97) with TV accepted EPT. There were no significant differences in the reinfection rates for CT or TV in the pre-EPT versus post-EPT cohorts (CT: 24% (57/240) vs 20% (38/192), P = 0.42; TV: 23% (22/97) versus 14% (12/87), P = 0.11). Although lower, reinfections rates were not significantly different among patients who accepted versus did not accept EPT (CT, 13% (6/48) vs 21% (23/110), P = 0.50 and TV, 6% (1/18) vs 18% (9/49), P = 0.69). CONCLUSIONS Despite the implementation of an EPT protocol, STI reinfection rates among female AYA remained high, and many declined EPT. Further research is needed to identify barriers to the provision and acceptance of EPT and ways to address these factors.
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 772] [Impact Index Per Article: 257.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for
sexually transmitted infections (STIs) were updated by CDC after consultation
with professionals knowledgeable in the field of STIs who met in Atlanta,
Georgia, June 11–14, 2019. The information in this report updates the
2015 guidelines. These guidelines discuss 1) updated recommendations for
treatment of Neisseria gonorrhoeae, Chlamydia trachomatis,
and Trichomonas vaginalis; 2) addition of
metronidazole to the recommended treatment regimen for pelvic inflammatory
disease; 3) alternative treatment options for bacterial vaginosis; 4) management
of Mycoplasma genitalium; 5) human papillomavirus vaccine
recommendations and counseling messages; 6) expanded risk factors for syphilis
testing among pregnant women; 7) one-time testing for hepatitis C infection; 8)
evaluation of men who have sex with men after sexual assault; and 9) two-step
testing for serologic diagnosis of genital herpes simplex virus. Physicians and
other health care providers can use these guidelines to assist in prevention and
treatment of STIs.
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Shamash Z, Catallozzi M, Dayan PS, Chernick LS. Preferences for Expedited Partner Therapy Among Adolescents in an Urban Pediatric Emergency Department: A Mixed-Methods Study. Pediatr Emerg Care 2021; 37:e91-e96. [PMID: 30883535 PMCID: PMC6744998 DOI: 10.1097/pec.0000000000001746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Expedited partner therapy (EPT) refers to treating sexual partners of patients with sexually transmitted infections by providing prescriptions or medications to give to their partners. Expedited partner therapy is not routinely prescribed in the emergency department (ED). Our objective was to explore adolescent preferences for EPT use in the ED. METHODS We conducted a mixed-methods study using surveys and semistructured interviews in one urban ED. Sexually active patients aged 15 to 19 years completed an anonymous survey eliciting (1) sexual history and risky sexual behaviors, (2) preferences for partner notification when hypothetically testing positive for an STI, and (3) preferences for EPT. A subsample of survey respondents participated in the interviews, which were conducted until no new perspectives emerged. Investigators analyzed interviews using thematic analysis. RESULTS A total of 247 participants completed surveys; the majority were female (183/247, 74%), Hispanic (209/243, 86%), and did not use a condom at last intercourse (129/243, 53%). Two thirds of participants (152/236, 64%) did not prefer EPT for partner notification. Preference for EPT was not associated with sex, age, ethnicity, condom use, a steady sexual partner, or STI history. Qualitative data from both surveys and interviews revealed the following reasons for not preferring EPT: concern for partner safety, importance of determining partner STI status, perceived benefit of clinical interaction, and partner accountability. Reasons for preferring EPT included increased treatment accessibility and convenience. CONCLUSIONS The majority of adolescent patients in a pediatric ED did not prefer EPT. Emergency department practitioners should address common concerns regarding EPT to increase EPT adherence if prescribed.
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Affiliation(s)
- Zohar Shamash
- Zohar Shamash, MD, Division of Pediatric Emergency
Medicine, Department of Pediatrics, 3959 Broadway, CHN 1-116, Columbia University
Medical Center, NY, NY, United States;
| | - Marina Catallozzi
- Marina Catallozzi, MD, MSCE, Population and Family Health
and Pediatrics at the Columbia University Medical Center, 622 W 168
Street, PH-520, NY, NY, United States;
| | - Peter S Dayan
- Peter S Dayan, MD MSc, Division of Pediatric Emergency
Medicine, Department of Pediatrics, 3959 Broadway, CHN 1-116, Columbia University
Medical Center, NY, NY, United States;
| | - Lauren S Chernick
- Lauren Chernick MD MSc, Division of Pediatric Emergency
Medicine, Department of Pediatrics, 3959 Broadway, CHN 1-116, Columbia University
Medical Center, NY, NY, United States; ,
212-305-9825 (phone), 212-305-0682 (fax)
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7
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Sultan B, Benn P, Schembri G, Patel H, Brima N, Alexander S, Ison CA. Test of cure study: a feasibility study to estimate the time to test of cure (TOC) for Neisseria gonorrhoeae and Chlamydia trachomatis infections. Sex Transm Infect 2020; 96:402-407. [PMID: 32447324 DOI: 10.1136/sextrans-2019-054302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/21/2020] [Accepted: 03/17/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Test of cure (TOC) for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infection is an important tool in the public health management of STIs. However, there are limited data about the optimal time to perform TOC using nucleic acid amplification tests (NAATs) for NG and CT infections. A study was performed to assess the feasibility of a larger study to determine the optimal time to TOC using NAATS. METHODS The Sexually Transmitted Bacteria Reference Unit at Public Health England undertook testing of gonococcal and chlamydial nucleic acids within neat urine stored in different conditions over 25 days to provide evidence of the stability of the nucleic acid prior to recruitment. Individuals diagnosed with uncomplicated NG or CT infection were recruited from three sexual health clinics. Individuals were asked to return nine self-taken samples from the site of infection over a course of 35 days. Survival analyses of time to first negative NAAT result for NG and CT infection and univariate regression analysis of factors that affect time to clearance were undertaken. RESULTS At room temperature, chlamydial DNA in urine is stable for up to 3 weeks and gonococcal DNA for up to 11 days. We analysed data for 147 infections (81 NG and 66 CT). The median time to clearance of infection was 4 days (IQR 2-10 days) for NG infection and 10 days (IQR 7-14 days) for CT infection. Vaginal CT infections took longer to clear (p=0.031). NG infection in men who have sex with men took longer to clear (p=0.052). CONCLUSION Chlamydial and gonococcal nucleic acids are stable in urine before addition of preservatives, longer than recommended by the manufacturer. The TOC results suggest that it may be possible to undertake TOC for NG and CT infections earlier than current guidelines suggest and that anatomical site of infection may affect time to clearance of infection.
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Affiliation(s)
- Binta Sultan
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
| | - Paul Benn
- The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK.,Department of Clinical Development, ViiV Healthcare, Brentford, London, UK
| | - Gabriel Schembri
- Manchester Centre for Sexual Health, Manchester Royal Infirmary, Manchester, UK
| | - Hemanti Patel
- Sexually Transmitted Bacteria Reference Unit, Public Health England Colindale, London, UK
| | - Nataliya Brima
- King's Global Health Partnership, King's College London, London, UK
| | - Sarah Alexander
- Sexually Transmitted Bacteria Reference Unit, Public Health England, London, UK
| | - Catherine A Ison
- Sexually Transmitted Bacteria Reference Unit, Public Health England, London, UK
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8
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Chemaitelly H, Majed A, Abu-Hijleh F, Blondeel K, Matsaseng TC, Kiarie J, Toskin I, Abu-Raddad LJ. Global epidemiology of Neisseria gonorrhoeae in infertile populations: systematic review, meta-analysis and metaregression. Sex Transm Infect 2020; 97:157-169. [PMID: 32423944 PMCID: PMC7892374 DOI: 10.1136/sextrans-2020-054515] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/14/2020] [Indexed: 01/04/2023] Open
Abstract
Objective To provide an in-depth systematic assessment of the global epidemiology of gonorrhoea infection in infertile populations. Methods A systematic literature review was conducted up to 29 April 2019 on international databases and WHO regional databases, and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All prevalence measures of gonorrhoea infection among infertile populations, based on primary data, qualified for inclusion. Infertile populations were broadly defined to encompass women/men undergoing infertility evaluation or treatment (infertility clinic attendees and partners). Pooled mean prevalence by relevant strata was estimated using random-effects meta-analysis. Associations with prevalence and sources of heterogeneity were explored using metaregression. Risk of bias was assessed using four quality domains. Findings A total of 147 gonorrhoea prevalence studies were identified from 56 countries. The pooled mean prevalence of current gonorrhoea infection was estimated globally at 2.2% (95% CI 1.3% to 3.2%), with the highest prevalence in Africa at 5.0% (95% CI 1.9% to 9.3%). The mean prevalence was higher for populations with tubal factor infertility (3.6%, 95% CI 0.9%–7.7%) and mixed cause and unexplained infertility (3.6%, 95% CI 0.0% to 11.6%) compared with other diagnoses, such as ovarian and non-tubal infertility (0.1%, 95% CI 0.0% to 0.8%), and for secondary (2.5%, 95% CI 0.2% to 6.5%) compared with primary (0.5%, 95% CI 0.0% to 1.7%) infertility. Metaregression identified evidence of variations in prevalence by region and by infertility diagnosis, higher prevalence in women than men and a small-study effect. There was a trend of declining prevalence by about 3% per year over the last four decades (OR=0.97, 95% CI 0.95 to 0.99). Conclusions Gonorrhoea prevalence in infertile populations is several folds higher than that in the general population, with even higher prevalence in women with tubal factor infertility and in individuals with secondary infertility. These findings support the potential role of gonorrhoea in infertility and suggest that some infertility is possibly preventable by controlling gonorrhoea transmission. PROSPERO registration number CRD42018102934.
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Affiliation(s)
- Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar
| | - Alzahraa Majed
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar
| | - Farah Abu-Hijleh
- Department of Public Health, College of Health Sciences, Academic Quality Affairs Office, QU Health, Qatar University, Doha, Qatar
| | - Karel Blondeel
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Thabo Christopher Matsaseng
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Department of Obstetrics & Gynaecology, Stellenbosch University, Stellenbosch, South Africa
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar .,Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, USA
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9
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Dee EC, Hsu KK, Kruskal BA, Menchaca JT, Zambarano B, Cocoros N, Herrick B, Weiss MDP, Hafer E, Erani D, Josephson M, Young J, Torrone EA, Flagg EW, Klompas M. Temporal Patterns in Chlamydia Repeat Testing in Massachusetts. Am J Prev Med 2019; 56:458-463. [PMID: 30777163 PMCID: PMC6931253 DOI: 10.1016/j.amepre.2018.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION National guidelines recommend test-of-cure for pregnant women and test-of-reinfection for all patients with chlamydia infections in order to interrupt transmission and prevent adverse sequelae for patients, partners, and newborns. Little is known about retesting and positivity rates, and whether they are changing over time, particularly in private sector practices. METHODS Electronic health record data on patients with chlamydia tests were extracted from three independent clinical practice groups serving ≅20% of the Massachusetts population. Records were extracted using the Electronic medical record Support for Public Health platform (esphealth.org). These data were analyzed for temporal trends in annual repeat testing rates by using generalized estimating equations after index positive chlamydia tests between 2010 and 2015 and for differences in intervals to first repeat tests among pregnant females, non-pregnant females, and males. Data extraction and analysis were performed during calendar years 2017 and 2018. RESULTS An index positive C. trachomatis result was identified for 972 pregnant female cases, 10,309 non-pregnant female cases, and 4,973 male cases. Test-of-cure 3-5 weeks after an index positive test occurred in 37% of pregnant females. Test-of-reinfection 8-16 weeks after an index positive test occurred in 39% of pregnant females, 18% of non-pregnant females, and 9% of males. There were no significant increases in test-of-cure or test-of-reinfection rates from 2010 to 2015. Among cases with repeat tests, 16% of pregnant females, 15% of non-pregnant females, and 16% of males had positive results. CONCLUSIONS Chlamydia test-of-cure and test-of-reinfection rates are low, with no evidence of improvement over time. There are substantial opportunities to improve adherence to chlamydia repeat testing recommendations.
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Affiliation(s)
- Elizabeth C Dee
- Department of Population Medicine, Harvard Medical School, Harvard University, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Katherine K Hsu
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts
| | | | - John T Menchaca
- Department of Population Medicine, Harvard Medical School, Harvard University, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Noelle Cocoros
- Department of Population Medicine, Harvard Medical School, Harvard University, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | | | - Ellen Hafer
- Massachusetts League of Community Health Centers, Boston, Massachusetts
| | - Diana Erani
- Massachusetts League of Community Health Centers, Boston, Massachusetts
| | - Mark Josephson
- Massachusetts League of Community Health Centers, Boston, Massachusetts
| | - Jessica Young
- Department of Population Medicine, Harvard Medical School, Harvard University, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Elizabeth A Torrone
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elaine W Flagg
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School, Harvard University, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
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10
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Silva GARD, Motta HLDSN, Souza EFAD, Cardoso PANM, Pilotto JH, Eyer-Silva WA, Ribeiro LCP, Santos MSD, Azevedo MCVMD, Pinto JFDC, Motta RN, Ferry FRDA. Chlamydia trachomatis asymptomatic urethritis recurrence among males living with HIV-1. Rev Inst Med Trop Sao Paulo 2018; 60:e65. [PMID: 30379232 PMCID: PMC6201765 DOI: 10.1590/s1678-9946201860065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/21/2018] [Indexed: 11/22/2022] Open
Abstract
A prevalence of 3.47% of asymptomatic Chlamydia trachomatis
urethritis has been previously reported among males living with HIV infection in
Brazil. This study aims to assess the recurrence of C.
trachomatis urethritis three years later in the same cohort of
patients and analyze associated risk factors. A total of 115 male patients
diagnosed with HIV infection, with no symptoms of urethritis and observed since
May of 2015 in followup visits were enrolled. They had urine samplers tested by
PCR for C. trachomatis and N. gonorrhoeae
between February and March 2018. Results: Three of the four patients who had
asymptomatic C. trachomatis urethritis three years before were
recurrently positive for C. trachomatis urethritis. Two new
patients were diagnosed as positives, accounting for a total asymptomatic
C. trachomatis urethritis prevalence of 4.34%. The
prevalence during the whole study was 5.21%. The relative risk for a new
urethritis episode among those previously diagnosed with urethritis is RR=41.62
(95% CI: 9.42-183.84), p < 0.01. Patients who presented asymptomatic
urethritis anytime and who were recurrently positive for C.
trachomatis had a lower mean age (p<0.01). Married individuals
were protected regarding asymptomatic urethritis [p<0.01, OR = 0.04
(0.005-0.4)] and had lower risk to develop recurrence [p<0.01, RR = 0.86
(0.74-0.99)]. Illicit drugs users had risk associated to asymptomatic urethritis
[p=0.02, OR= 5.9 (1.03-34)] and higher risk to develop recurrence [p<0.01,
RR=1.1 (1-1.22)]. Conclusion: The recurrence of asymptomatic C.
trachomatis urethritis after treatment among males living with HIV
infection in Brazil can be considered high and should not be neglected.
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Affiliation(s)
- Guilherme Almeida Rosa da Silva
- Universidade Federal do Estado do Rio de Janeiro, Serviço de Clínica Médica, 10ᵃ Enfermaria, Rio de Janeiro, Rio de Janeiro, Brazil.,Fundação Oswaldo Cruz, Laboratório de AIDS e Imunologia, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Erik Friedrich Alex de Souza
- Universidade Federal do Estado do Rio de Janeiro, Serviço de Clínica Médica, 10ᵃ Enfermaria, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - José Henrique Pilotto
- Fundação Oswaldo Cruz, Laboratório de AIDS e Imunologia, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Walter Araujo Eyer-Silva
- Universidade Federal do Estado do Rio de Janeiro, Centro de Ciências Biológicas e da Saúde, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mônica Soares Dos Santos
- Hospital Universitário Gaffrée e Guinle, Laboratório de Imunologia, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Jorge Francisco da Cunha Pinto
- Universidade Federal do Estado do Rio de Janeiro, Serviço de Clínica Médica, 10ᵃ Enfermaria, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rogerio Neves Motta
- Universidade Federal do Estado do Rio de Janeiro, Serviço de Clínica Médica, 10ᵃ Enfermaria, Rio de Janeiro, Rio de Janeiro, Brazil
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Azithromycin Treatment Failure for Chlamydia trachomatis Among Heterosexual Men With Nongonococcal Urethritis. Sex Transm Dis 2017; 43:599-602. [PMID: 27631353 DOI: 10.1097/olq.0000000000000489] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Three recent prospective studies have suggested that the 1-g dose of azithromycin for Chlamydia trachomatis (Ct) was less effective than expected, reporting a wide range of treatment failure rates (5.8%-22.6%). Reasons for the disparate results could be attributed to geographic or methodological differences. The purpose of this study was to reexamine the studies and attempt to harmonize methodologies to reduce misclassification as a result of false positives from early test-of-cure (TOC) or reinfection as a result of sexual exposure rather than treatment failure. METHODS Men who had sex with women, who received 1-g azithromycin under directly observed therapy for presumptive treatment of nongonococcal urethritis with confirmed Ct were included. Baseline screening was performed on urethral swabs or urine, and TOC screening was performed on urine using nucleic acid amplification tests. Posttreatment vaginal sexual exposure was elicited at TOC. Data from the 3 studies were obtained and reanalyzed. Rates of Ct retest positive were examined for all cases, and a sensitivity analysis was conducted to either reclassify potential false positives/reinfections as negative or remove them from the analysis. RESULTS The crude treatment failure rate was 12.8% (31/242). The rate when potential false positives/reinfections were reclassified as negative was 6.2% (15/242) or when these were excluded from analysis was 10.9% (15/138). CONCLUSIONS In these samples of men who have sex with women with Ct-related nongonococcal urethritis, azithromycin treatment failure was between 6.2% and 12.8%. This range of failure is lower than previously published but higher than the desired World Health Organization's target chlamydia treatment failure rate of < 5%.
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Kollars K, Plegue M, Riley M. Testing for Chlamydia Reinfection Among Adolescent Patients in Different Clinical Settings: How Are We Doing? PRIMER : PEER-REVIEW REPORTS IN MEDICAL EDUCATION RESEARCH 2017; 1:16. [PMID: 32944702 DOI: 10.22454/primer.2017.582445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Introduction Chlamydia trachomatis is the most frequently reported infectious disease in the United States, with high reinfection rates and highest prevalence among adolescents and young adults. National guidelines suggest testing for reinfection 3 months after chlamydia treatment, and 3 to 4 weeks after treatment during pregnancy. Our needs assessment evaluated retesting rates among adolescent and young adult patients across several clinical settings within one community. Methods We performed retrospective chart reviews to examine chlamydia retest rates among 14 to 21-year-old patients treated for chlamydia within three different settings: an academic primary care site with family medicine and pediatrics clinics, an adolescent health center, and a group of school-based health centers (SBHCs). Per CDC guidelines, the goal treatment window was defined as retests conducted between 60 to 183 days after documented treatment for nonpregnant patients, and those conducted within 21 to 42 days posttreatment for pregnant patients. Results Overall, 77/134 (57.5%) of patients were retested, with 59/143 (44%) retested within the goal time frame. Site rates of retesting within guideline timeframe were as follows: 38.5% at the academic family medicine site, 46.2% at the academic pediatrics site, 42.7% at the adolescent health center, and 55.0% at SBHCs. The reinfection rate among those appropriately retested was 22.0% (13/59). Of patients not retested appropriately, 25.3% had return visits at which they were not retested (a missed opportunity). Conclusions Our results indicate a need for interventions that encourage patients to return for retesting, and that trigger retesting during unrelated return visits.
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Affiliation(s)
- Kate Kollars
- University of Michigan Medical School, Department of Family Medicine
| | - Melissa Plegue
- University of Michigan Medical School, Department of Family Medicine
| | - Margaret Riley
- University of Michigan Medical School, Department of Family Medicine
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A Review of Expedited Partner Therapy for the Management of Sexually Transmitted Infections in Adolescents. J Pediatr Adolesc Gynecol 2017; 30:341-348. [PMID: 28167140 DOI: 10.1016/j.jpag.2017.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/24/2017] [Accepted: 01/27/2017] [Indexed: 11/22/2022]
Abstract
Adolescents are at high risk of acquiring and becoming reinfected with sexually transmitted infections. Partner notification and treatment are essential to preventing the spread of sexually transmitted infections. Expedited partner therapy (EPT) is a method of partner treatment used by medical providers to treat patients' sexual partners without direct medical evaluation or counseling. The objective of this article is to review the current literature regarding EPT effectiveness, patients' attitudes and acceptance of EPT, and providers' views and practices surrounding the use of this method of partner treatment. In this article potential concerns associated with EPT use, current policy statements, and the legal status of EPT are discussed. EPT results in improved or equivalent rates of reinfection in adolescents and adults with Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Overall, patients are accepting of this method of partner treatment, however, providers continue to have concerns that limit its routine use. Additional studies in adolescents will help providers better understand if EPT is a useful method to prevent reinfection in this population.
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Risk Factors for Incident and Redetected Chlamydia trachomatis Infection in Women: Results of a Population-Based Cohort Study. Sex Transm Dis 2016; 43:113-9. [PMID: 26760181 DOI: 10.1097/olq.0000000000000394] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate risk factors for incident and redetected Chlamydia trachomatis (CT) infection in women, including the role of high-risk human papillomavirus (HPV). METHODS In this population-based, prospective cohort study conducted in Copenhagen, Denmark, 10,729 women aged 20 to 29 years were tested for CT and HPV DNA and provided information on sexual and health behavior at baseline. Of these, 7998 (74.5%) participated in a follow-up visit 2 years later with identical data collection. We used logistic regression to investigate risk factors for incident and redetected CT infection at follow-up. RESULTS Among CT DNA negative women at baseline (n = 7529), 106 (1.4%) were CT DNA positive at follow-up (incident infection). Increasing number of sexual partners during follow-up (odds ratio [OR], 1.07 per partner; 95% confidence interval (CI), 1.02-1.11), low educational level (OR, 1.69; 95% CI, 1.11-2.56; for basic education vs. high school or higher), and high-risk HPV positivity at baseline (OR, 1.66; 95% CI, 1.06-2.58) were risk factors for incident infection, whereas older age (OR, 0.86 per year increase; 95% CI, 0.80-0.93) and condom use (OR, 0.60; 95% CI, 0.38-0.94) were associated with reduced risk. Among CT DNA positive women at baseline (n = 469), 108 (23.0%) tested positive at follow-up (redetected infection). We found no statistically significant associations between age, educational level, sexual behavior, smoking, or high-risk HPV status and the risk for redetected CT. CONCLUSION Young age, low educational level, high number of sexual partners, failure to use condoms, and high-risk HPV positivity are associated with increased risk for incident CT infection. These findings may guide the development of targeted CT prevention strategies, including screening and information campaigns.
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Bettahar K, Pinton A, Boisramé T, Cavillon V, Wylomanski S, Nisand I, Hassoun D. Interruption volontaire de grossesse par voie médicamenteuse. ACTA ACUST UNITED AC 2016; 45:1490-1514. [DOI: 10.1016/j.jgyn.2016.09.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
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Chlamydia trachomatis re-infection in Spain: A STI clinic-based cohort study. Enferm Infecc Microbiol Clin 2016; 35:165-173. [PMID: 27743678 DOI: 10.1016/j.eimc.2016.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Chlamydia trachomatis (C. trachomatis) is the most frequently reported sexually transmitted infection (STI) in developed countries, but there is a lack data on its incidence and population dynamics in Spain. The objectives of this study were to estimate the incidence of C. trachomatis in patients seeking medical attention in an STI clinic with a defined population catchment area, to identify factors associated with this infection, and to explore differences between factors associated with new infections and re-infections. METHODS A retrospective study was conducted on a cohort of patients from a STI clinic who underwent chlamydia testing at least twice between 2007 and 2015. RESULTS Of the 2633 patients who met study selection criteria, 795 (30.2%) tested positive for C. trachomatis at baseline (baseline Chlamydia). The overall incidence was 7.97/100 person-years (95% CI: 7.2-8.8): 5.9/100 person-years (95% CI: 5.2-6.7) among patients testing negative for C. trachomatis at baseline, and 18.3 person-years (95% CI: 15.6-21.5) among those testing positive at baseline. In multivariate analysis, the factors independently associated with overall incidence were a history of infection with C. trachomatis in the previous 6 months (hazard ratio=3.6; 95% CI: 2.3-5.4), younger age (HR <20 vs ≥35 years=5.5; 95% CI: 3.2-9.5), male sex, 2 or more sexual partners in the previous month and year, and inconsistent condom use. CONCLUSIONS Guidelines should be established for C. trachomatis in Spain, including recommendations on the need for follow-up and re-testing, independently of age. Though data concerning the optimal timing of re-testing are inconclusive, our findings support the establishment of a 3-6 month interval.
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Wind CM, Schim van der Loeff MF, Unemo M, Schuurman R, van Dam AP, de Vries HJC. Time to clearance of Chlamydia trachomatis RNA and DNA after treatment in patients coinfected with Neisseria gonorrhoeae - a prospective cohort study. BMC Infect Dis 2016; 16:554. [PMID: 27724878 PMCID: PMC5057251 DOI: 10.1186/s12879-016-1878-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 09/29/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Performing a test of cure (TOC) could demonstrate success or failure of antimicrobial treatment of Chlamydia trachomatis infection, but recommendations for the timing of a TOC using nucleic acid amplification tests (NAATs) are inconsistent. We assessed time to clearance of C. trachomatis after treatment, using modern RNA- and DNA-based NAATs. METHODS We analysed data from patients with a C. trachomatis and Neisseria gonorrhoeae coinfection who visited the STI Clinic Amsterdam, The Netherlands, from March through October 2014. After treatment with ceftriaxone plus either azithromycin or doxycycline, patients self-collected anal, vaginal or urine samples during 28 consecutive days. Samples were analysed using an RNA-based NAAT (Aptima Combo 2) and a DNA-based NAAT (Cobas 4800 CT/NG). We defined clearance as three consecutive negative results, and defined "blips" as isolated positive results following clearance. RESULTS We included 23 patients with C. trachomatis and N. gonorrhoeae coinfection. All patients cleared C. trachomatis during follow-up, and we observed no reinfections. The median time to clearance (range) was 7 days (1-13) for RNA, and 6 days (1-15) for DNA. Ninety-five per cent of patients cleared RNA at day 13, and DNA at day 14. The risk of a blip after clearance was 4.4 % (RNA) and 1.7 % (DNA). CONCLUSIONS If a TOC for anogenital chlamydia is indicated, we recommend performing it at least 14 days after initiation of treatment, when using modern RNA- and DNA-based assays. A positive result shortly after 14 days probably indicates a blip, rather than a treatment failure or a reinfection.
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Affiliation(s)
- Carolien M. Wind
- STI Outpatient Clinic, Department of Infectious Diseases, Public Health Service Amsterdam, PO Box 2200, 1000 CE Amsterdam, The Netherlands
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten F. Schim van der Loeff
- Department of Infectious Diseases, Public Health Service Amsterdam, PO Box 2200, 1000 CE Amsterdam, The Netherlands
- Center for Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Örebro University, SE-701 85 Örebro, Sweden
| | - Rob Schuurman
- Department of Medical Microbiology, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Alje P. van Dam
- Public Health Laboratory, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Department of Medical Microbiology, Onze Lieve Vrouwe Gasthuis General Hospital, Amsterdam, The Netherlands
| | - Henry J. C. de Vries
- STI Outpatient Clinic, Department of Infectious Diseases, Public Health Service Amsterdam, PO Box 2200, 1000 CE Amsterdam, The Netherlands
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Center for Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Chorba T, Scholes D, Bluespruce J, Operskalski BH, Irwin K. Sexually Transmitted Diseases and Managed Care: An Inquiry and Review of Issues Affecting Service Delivery. Am J Med Qual 2016; 19:145-56. [PMID: 15368779 DOI: 10.1177/106286060401900403] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To understand the potential role of managed care organizations (MCOs) in prevention and control of sexually transmitted diseases (STDs), we conducted a systematic review of articles on STDs and managed care and sought qualitative information from MCOs on STD-related activities. The review focused on prevention, risk assessment, patient education, counseling, screening, and costs of care, but revealed relatively few published articles. Barriers to STD service delivery included competing priorities, lack of time or supporting organizational structures, and differing mandates of health departments and MCOs. Facilitators included collaboration between health departments and MCOs, regulatory and performance incentives, buy-in from key stakeholders, availability of infrastructure to support data collection, and inclusion of chlamydia screening in the Health Employer Data and Information Set to monitor plan performance. Because of the shift of STD service delivery from the public to private sector, incentives need to maximize interest and cooperation of patients, clinicians, and MCOs in STD prevention.
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Affiliation(s)
- Terence Chorba
- Health Services and Evaluation Branch, Division of STD Prevention, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Hai J, Serradji N, Mouton L, Redeker V, Cornu D, El Hage Chahine JM, Verbeke P, Hémadi M. Targeted Delivery of Amoxicillin to C. trachomatis by the Transferrin Iron Acquisition Pathway. PLoS One 2016; 11:e0150031. [PMID: 26919720 PMCID: PMC4768884 DOI: 10.1371/journal.pone.0150031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/08/2016] [Indexed: 01/13/2023] Open
Abstract
Weak intracellular penetration of antibiotics makes some infections difficult to treat. The Trojan horse strategy for targeted drug delivery is among the interesting routes being explored to overcome this therapeutic difficulty. Chlamydia trachomatis, as an obligate intracellular human pathogen, is responsible for both trachoma and sexually transmitted diseases. Chlamydia develops in a vacuole and is therefore protected by four membranes (plasma membrane, bacterial inclusion membrane, and bacterial membranes). In this work, the iron-transport protein, human serum-transferrin, was used as a Trojan horse for antibiotic delivery into the bacterial vacuole. Amoxicillin was grafted onto transferrin. The transferrin-amoxicillin construct was characterized by mass spectrometry and absorption spectroscopy. Its affinity for transferrin receptor 1, determined by fluorescence emission titration [KaffTf-amox = (1.3 ± 1.0) x 108], is very close to that of transferrin [4.3 x 108]. Transmission electron and confocal microscopies showed a co-localization of transferrin with the bacteria in the vacuole and were also used to evaluate the antibiotic capability of the construct. It is significantly more effective than amoxicillin alone. These promising results demonstrate targeted delivery of amoxicillin to suppress Chlamydia and are of interest for Chlamydiaceae and maybe other intracellular bacteria therapies.
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Affiliation(s)
- Jun Hai
- ITODYS, Interfaces, Traitements, Organisation et Dynamique des Systèmes, Université Paris Diderot, Sorbonne Paris Cité, CNRS-UMR 7086, 15 rue Jean-Antoine de Baïf, 75205 Paris Cedex 13, France
| | - Nawal Serradji
- ITODYS, Interfaces, Traitements, Organisation et Dynamique des Systèmes, Université Paris Diderot, Sorbonne Paris Cité, CNRS-UMR 7086, 15 rue Jean-Antoine de Baïf, 75205 Paris Cedex 13, France
| | - Ludovic Mouton
- ITODYS, Interfaces, Traitements, Organisation et Dynamique des Systèmes, Université Paris Diderot, Sorbonne Paris Cité, CNRS-UMR 7086, 15 rue Jean-Antoine de Baïf, 75205 Paris Cedex 13, France
| | - Virginie Redeker
- Paris-Saclay Institute of Neuroscience, CNRS-UMR 9197, 1 avenue de la Terrasse, 91190 Gif-sur-Yvette, France
| | - David Cornu
- Service d’Identification et de Caractérisation des Protéines, CNRS-UMR 9198, 1 avenue de la Terrasse, 91190 Gif-sur-Yvette, France
| | - Jean-Michel El Hage Chahine
- ITODYS, Interfaces, Traitements, Organisation et Dynamique des Systèmes, Université Paris Diderot, Sorbonne Paris Cité, CNRS-UMR 7086, 15 rue Jean-Antoine de Baïf, 75205 Paris Cedex 13, France
- * E-mail: (MH); (JEHC); (PV)
| | - Philippe Verbeke
- UMR 1149 Inserm, Université Paris Diderot, Sorbonne Paris Cité, ERL-CNRS 8252, Faculté de Médecine, site Bichat, 16 rue Henri Huchard, 75018 Paris, France
- * E-mail: (MH); (JEHC); (PV)
| | - Miryana Hémadi
- ITODYS, Interfaces, Traitements, Organisation et Dynamique des Systèmes, Université Paris Diderot, Sorbonne Paris Cité, CNRS-UMR 7086, 15 rue Jean-Antoine de Baïf, 75205 Paris Cedex 13, France
- * E-mail: (MH); (JEHC); (PV)
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Lanjouw E, Ouburg S, de Vries HJ, Stary A, Radcliffe K, Unemo M. Background review for the '2015 European guideline on the management of Chlamydia trachomatis infections'. Int J STD AIDS 2015:0956462415618838. [PMID: 26608578 DOI: 10.1177/0956462415618838] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
SummaryChlamydia trachomatis infections are major public health concerns globally. Of particular grave concern is that the majority of persons with anogenital Chlamydia trachomatis infections are asymptomatic and accordingly not aware of their infection, and this silent infection can subsequently result in severe reproductive tract complications and sequelae. The current review paper provides all background, evidence base and discussions for the 2015 European guideline on the management of Chlamydia trachomatis infections (Lanjouw E, et al. Int J STD AIDS 2015). Comprehensive information and recommendations are included regarding the diagnosis, treatment and prevention of anogenital, pharyngeal and conjunctival Chlamydia trachomatis infections in European countries. However, Chlamydia trachomatis also causes the eye infection trachoma, which is not a sexually transmitted infection. The 2015 European Chlamydia trachomatis guideline provides up-to-date guidance regarding broader indications for testing and treatment of Chlamydia trachomatis infections; clearer recommendation of using validated nucleic acid amplification tests only for diagnosis; advice on (repeated) Chlamydia trachomatis testing; recommendation of increased testing to reduce the incidence of pelvic inflammatory disease and prevent exposure to infection and recommendations to identify, verify and report Chlamydia trachomatis variants. Improvement of access to testing, test performance, diagnostics, antimicrobial treatment and follow-up of Chlamydia trachomatis patients are crucial to control its spread.
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Affiliation(s)
- E Lanjouw
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - S Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - H J de Vries
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands STI Outpatient Clinic, Infectious Disease Cluster, Health Service Amsterdam, Amsterdam, The Netherlands Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - A Stary
- Outpatients' Centre for Infectious Venereodermatological Diseases, Vienna, Austria
| | - K Radcliffe
- University Hospital Birmingham Foundation NHS Trust, Birmingham, UK
| | - M Unemo
- WHO Collaborating Center for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Reed JL, Zaidi MA, Woods TD, Bates JR, Britto MT, Huppert JS. Impact of Post-visit Contact on Emergency Department Utilization for Adolescent Women with a Sexually Transmitted Infection. J Pediatr Adolesc Gynecol 2015; 28:144-8. [PMID: 26046603 PMCID: PMC7046152 DOI: 10.1016/j.jpag.2014.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 06/12/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVES To understand Emergency Department (ED) utilization patterns for women who received sexually transmitted infection (STI) testing and explore the impact of post-visit telephone contact on future ED visits. DESIGN, SETTING, PARTICIPANTS We performed a secondary analysis on a prospectively collected dataset of ED patients ages 14-21 years at a children's hospital. INTERVENTIONS AND MAIN OUTCOME MEASURES The dataset documented initial and return visits, STI results, race, age and post-visit contact success (telephone contact ≤7 days of visit). Logistic regression was performed identifying variables that predicted a return visit to the ED, a return visit with STI testing, and subsequent positive STI results. RESULTS Of 922 women with STI testing at their initial ED visit, 216 (23%) were STI positive. One-third (315/922) returned to the ED, 15% (141/922) returned and had STI testing, and 4% (38/922) had a subsequent STI. Of 216 STI-positive women, 59% were successfully contacted. Of those who returned to the ED, age ≥ 18 and Black race were associated with increased STI testing at a subsequent visit. Successful contact reduced the likelihood of STI testing at a subsequent ED visit (OR 0.28, 95% CI 0.01-0.8), and ED empiric antibiotic treatment had no effect on subsequent STI testing. CONCLUSION Contacting women with STI results and counseling them regarding safe sex behaviors may reduce the number of ED patients who return with symptoms or a new exposure necessitating STI testing. The high STI prevalence and frequent return rate suggest that ED interventions are needed.
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Affiliation(s)
- Jennifer L Reed
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Mohsin A Zaidi
- University of Cincinnati College of Medicine, Cincinnati, OH
| | - Tiffany D Woods
- Universidad Iberoamericana (UNIBE) School of Medicine, Santo Domingo, Republica Dominicana
| | - Justin R Bates
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Maria T Britto
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jill S Huppert
- Division of Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Cabeza J, García PJ, Segura E, García P, Escudero F, La Rosa S, León S, Klausner JD. Feasibility of Chlamydia trachomatis screening and treatment in pregnant women in Lima, Peru: a prospective study in two large urban hospitals. Sex Transm Infect 2015; 91:7-10. [PMID: 25107711 PMCID: PMC4417475 DOI: 10.1136/sextrans-2014-051531] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Chlamydia trachomatis, which is asymptomatic in most women, causes significant adverse effects for pregnant women and neonates. No programmes conduct antenatal screening in Latin America. We determined chlamydia prevalence, feasibility and acceptability of chlamydia screening, and adherence to treatment in pregnant women in two urban public hospitals in Lima, Peru. METHODS We offered chlamydia screening using self-collected vaginal swabs to pregnant women ≥ 16 years of age during their first antenatal visit. Chlamydia-infected women were contacted within 14 days and asked to bring partners for counselling and directly observed therapy with oral azithromycin. Unaccompanied women received counselling, directly observed therapy, and azithromycin to take to partners. Test of cure was performed ≥ 3 weeks after treatment. RESULTS We approached 640 women for the study and enrolled 600 (93.8%). Median age was 27.3 years (range 16-47), median lifetime partners 2.3 (range 1-50), and median gestational age 26.1 weeks (range 4-41). Chlamydia prevalence was 10% (95% CI 7.7% to 12.7%). Of 60 infected patients, 59 (98%) were treated with one dose of azithromycin. Fifty-two of 59 (88%) returned for test of cure, all of whom were treated successfully, with 46 (86%) achieving negative test of cure with one dose of azithromycin, and 6 (12%) after retreatment with a second dose. CONCLUSIONS C. trachomatis screening and treatment in pregnancy was feasible and highly acceptable in two urban hospitals in Peru. Chlamydia prevalence was high. Clinical trials to evaluate efficacy and cost-effectiveness of chlamydia screening, and treatment of pregnant women to prevent adverse pregnancy outcomes in low-resource settings, are warranted.
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Affiliation(s)
- Jeanne Cabeza
- Department of Medicine/Division of Infectious Diseases, UCLA Geffen School of Medicine, Los Angeles, California, USA
| | - Patricia J García
- Unit of Epidemiology, STD and HIV, School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eddy Segura
- Department of Medicine/Division of Infectious Diseases, UCLA Geffen School of Medicine, Los Angeles, California, USA
| | - Pedro García
- Instituto Nacional Materno Perinatal, Lima, Peru
| | | | - Sayda La Rosa
- Unit of Epidemiology, STD and HIV, School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Segundo León
- Department of Global Health, University of Washington, Seattle, Washington, USA Instituto de Medicina Tropical, Universidad Mayor de San Marcos, Lima, Peru
| | - Jeffrey D Klausner
- Department of Medicine/Division of Infectious Diseases, UCLA Geffen School of Medicine, Los Angeles, California, USA
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Allen UD, MacDonald NE. Sexually transmitted infections in adolescents: Maximizing opportunities for optimal care. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.8.429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Allen UD, MacDonald NE. Les infections transmises sexuellement chez les adolescents : maximiser les occasions de soins optimaux. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.8.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tingey L, Strom R, Hastings R, Parker A, Barlow A, Rompalo A, Gaydos C. Self-administered sample collection for screening of sexually transmitted infection among reservation-based American Indian youth. Int J STD AIDS 2014; 26:661-6. [PMID: 25228666 DOI: 10.1177/0956462414552139] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 08/25/2014] [Indexed: 11/15/2022]
Abstract
American Indians suffer a disproportionate burden of sexually transmitted infection, particularly adolescents. Screening access barriers in rural and reservation-based communities necessitate alternatives to clinic-based options. Self-administered screening for three sexually transmitted infections was piloted among 32 American Indian adolescents aged 18 to 19. Participants self-collected in a private location; specimens were processed by trained, American Indian paraprofessionals and analysis was conducted by an outside laboratory. Participants testing positive were treated by a Public Health Nurse from the Indian Health Service. Results suggest high overall acceptability: 69% preferred a self-administered method over clinic-based screening, 75% would encourage their friends to use this method and 100% would use it again. A self-administered screening method has the ability to reach this and other high-risk populations that might not otherwise access screening, with added potential within the Indian Health Services system for uptake and dissemination in rural, reservation communities facing significant screening barriers.
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Affiliation(s)
- Lauren Tingey
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel Strom
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ranelda Hastings
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Anthony Parker
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Allison Barlow
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Anne Rompalo
- Johns Hopkins Center for American Indian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Charlotte Gaydos
- International Sexually Transmitted Diseases Research Laboratory, Johns Hopkins University, Baltimore, MD, USA
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Rönn M, Hughes G, Simms I, Ison C, Alexander S, White PJ, Ward H. Challenges Presented by Re-Emerging Sexually Transmitted Infections in HIV Positive Men who have Sex with Men: An Observational Study of Lymphogranuloma Venereum in the UK. JOURNAL OF AIDS & CLINICAL RESEARCH 2014; 5:1000329. [PMID: 26301124 PMCID: PMC4544700 DOI: 10.4172/2155-6113.1000329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND United Kingdom has reported the largest documented outbreak of lymphogranuloma venereum (LGV), a re-emerging sexually transmitted infection (STI) which is primarily seen in HIV-positive men who have sex with men (MSM). A diagnostic service was established in response to the outbreak linked to a voluntary LGV Enhanced Surveillance system. We examined the performance of this novel surveillance system to identify utility in tracking a re-emerging infection. METHODS We described laboratory data on samples and surveillance data from case reports for LGV from 2004-2010. We performed a cross-sectional analysis comparing clinical and behavioural characteristics of HIV-positive and HIV-negative/unknown LGV cases diagnosed in MSM using multivariable logistic regression models with generalised estimating equations to control for repeat infections. RESULTS LGV Surveillance data were available for 87% (1,370/1,581) of LGV cases (after de-duplication). There were 1,342 episodes in 1,281 MSM, most of whom were known to be HIV-positive (1,028/1,281, 80.2%,). HIV-positive men reported a shorter duration of symptoms (aOR 0.5; 95%CI 0.3, 0.8 for reporting more than a week compared to a week or less) in comparison to HIV-negative/unknown MSM, and were more likely to report unprotected receptive anal intercourse (aOR 2.7; 95% CI 1.3, 5.8). CONCLUSION The surveillance identified the population at greater risk of infection based on higher levels of risk behaviour in HIV-positive LGV cases. However, there was diagnostic bias towards HIV-positive LGV cases who presented with a shorter duration of symptoms when compared to HIV-negative/unknown LGV cases.
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Affiliation(s)
- Minttu Rönn
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Gwenda Hughes
- STI Section at the Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Ian Simms
- STI Section at the Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Cathy Ison
- Sexually Transmitted Bacteria Reference Unit, Public Health England, London, UK
| | - Sarah Alexander
- Sexually Transmitted Bacteria Reference Unit, Public Health England, London, UK
| | - Peter J White
- MRC Centre for Outbreak Analysis and Modelling and NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
- Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Helen Ward
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
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Teng Y, Kong N, Tu W. Estimating age-dependent per-encounter chlamydia trachomatis acquisition risk via a Markov-based state-transition model. J Clin Bioinforma 2014; 4:7. [PMID: 24872872 PMCID: PMC4022339 DOI: 10.1186/2043-9113-4-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 04/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chlamydial infection is a common bacterial sexually transmitted infection worldwide, caused by C. trachomatis. The screening for C. trachomatis has been proven to be successful. However, such success is not fully realized through tailoring the recommended screening strategies for different age groups. This is partly due to the knowledge gap in understanding how the infection is correlated with age. In this paper, we estimate age-dependent risks of acquiring C. trachomatis by adolescent women via unprotected heterosexual acts. METHODS We develop a time-varying Markov state-transition model and compute the incidences of chlamydial infection at discrete age points by simulating the state-transition model with candidate per-encounter acquisition risks and sampled numbers of unit-time unprotected coital events at different age points. We solve an optimization problem to identify the age-dependent estimates that offer the closest matches to the observed infection incidences. We also investigate the impact of antimicrobial treatment effectiveness on the parameter estimates and the differences between the acquisition risks for the first-time infections and repeated infections. RESULTS Our case study supports the beliefs that age is an inverse predictor of C. trachomatis transmission and that protective immunity developed after initial infection is only partial. CONCLUSIONS Our modeling method offers a flexible and expandable platform for investigating STI transmission.
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Affiliation(s)
- Yu Teng
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Dr, West Lafayette, IN 47907, USA
| | - Nan Kong
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Dr, West Lafayette, IN 47907, USA
| | - Wanzhu Tu
- Division of Biostatistics, School of Medicine, Indiana University, 340 W 10th Street, Indianapolis, IN 46202, USA
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Carmine L, Castillo M, Fisher M. Testing and treatment for sexually transmitted infections in adolescents--what's new? J Pediatr Adolesc Gynecol 2014; 27:50-60. [PMID: 24119658 DOI: 10.1016/j.jpag.2013.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 06/03/2013] [Accepted: 06/04/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Significant changes are taking place in the diagnosis and management of sexually transmitted infections (STI) in adolescents and young adults. FINDINGS In this review article, we provide an update of STIs in adolescents and young adults including: (1) Adolescent risk; (2) Screening guidelines; (3) Clinical manifestations; (4) Diagnostic testing; (5) Treatment; and (6) Prevention; with an emphasis on "what's new" in the field. CONCLUSIONS/SIGNIFICANCE While the impacts of STI epidemiology and health care access are leading to new recommendations for screening and prevention, changes in technology and drug resistance are promoting new methods of STI testing and ongoing revisions of STI treatment recommendations.
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Affiliation(s)
- Linda Carmine
- Division of Adolescent Medicine, Steven and Alexandra Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, New Hyde Park, NY; Hofstra North Shore-LIJ School of Medicine at Hofstra University, Hempstead, NY.
| | - Marigold Castillo
- Division of Adolescent Medicine, Steven and Alexandra Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, New Hyde Park, NY; Hofstra North Shore-LIJ School of Medicine at Hofstra University, Hempstead, NY
| | - Martin Fisher
- Division of Adolescent Medicine, Steven and Alexandra Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, New Hyde Park, NY; Hofstra North Shore-LIJ School of Medicine at Hofstra University, Hempstead, NY
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Hidden in plain sight: chlamydial gastrointestinal infection and its relevance to persistence in human genital infection. Infect Immun 2014; 82:1362-71. [PMID: 24421044 DOI: 10.1128/iai.01244-13] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although the concept of persistence in chlamydial infections has been recognized for about 80 years, there is still very little known about the mechanism by which this occurs. In this review, we revisit an old paradigm, long known to chlamydiologists and veterinarians, that in virtually all hosts of chlamydiae, including mammals and birds, chlamydiae reside in the gastrointestinal tract for long periods of time in the absence of clinical disease. Thus, if gastrointestinal infection occurs in most hosts, then it is very likely that gastrointestinal infection occurs in humans as well. We demonstrate that gastrointestinal infection does indeed occur in humans and propose that this anatomical site is the source of persistent infection in humans. The data in ruminants and animal models demonstrate that the immune system is unable to clear chlamydiae from the gut, so they can remain indefinitely, with continual shedding in feces. Clearly, many women become reinfected from an untreated partner; however, we propose that women, cured of genital infection, remain at risk for autoinoculation from the lower gastrointestinal tract. Moreover, there are substantial data demonstrating treatment failure of chlamydial infections, particularly with azithromycin. New data in the mouse model have shown that azithromycin is far less effective against chlamydial gastrointestinal infection than against genital infections. Therefore, it is possible that women cured of genital infection by antibiotics remain infected in the gastrointestinal tract and can become reinfected by autoinoculation from that site.
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It takes 2: partner attributes associated with sexually transmitted infections among adolescents. Sex Transm Dis 2013; 40:372-8. [PMID: 23588126 DOI: 10.1097/olq.0b013e318283d2c9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of this study were to identify partner attributes associated with sexually transmitted infections (STIs) among adolescents and to summarize implications for research and prevention. DESIGN The design of this study was systematic review. METHODS We identified peer-reviewed studies published in 1990 through 2010 that assessed 1 or more partner attributes in relation to a biologically confirmed STI among adolescents (15-24 years) by searching MEDLINE and included articles. Studies that included adolescents but more than 50% of the sample or with mean or median age of 25 years or greater were excluded. RESULTS Sixty-four studies met the eligibility criteria; 61% were conducted in high-income countries; 80% were cross sectional; and 91% enrolled females and 42% enrolled males. There was no standard "partner" definition. Partner attributes assessed most frequently included the following: age, race/ethnicity, multiple sex partners, and STI symptoms. Older partners were associated with prevalent STIs but largely unrelated to incidence. Black race was associated with STIs but not uniformly. Partners with multiple partners and STI symptoms seem to be associated with STIs predominantly among females. Although significant associations were reported, weaker evidence exists for the following: other partner sociodemographics, sexual and other behaviors (sexual concurrency, intimate partner violence, substance use, travel), and STI history. There were no apparent differences by STI. CONCLUSIONS Partner attributes are independently associated with STIs among male and female adolescents worldwide. These findings reinforce the importance of assessing partner attributes when determining STI risk. Prevention efforts should continue to promote and address barriers to condom use. Increased efforts are needed to screen and treat STIs and reduce risky behavior among men. A standard partner definition would facilitate the interpretation of findings in future studies.
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Adolescents’ Attitudes Toward Expedited Partner Therapy for Sexually Transmitted Infections. Sex Transm Dis 2013; 40:894-7. [DOI: 10.1097/olq.0000000000000034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Differential susceptibilities to azithromycin treatment of chlamydial infection in the gastrointestinal tract and cervix. Antimicrob Agents Chemother 2013; 57:6290-4. [PMID: 24100498 DOI: 10.1128/aac.01405-13] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Evidence from animal studies suggests that chlamydiae may persist in the gastrointestinal tract (GI) and be a reservoir for reinfection of the genital tract. We hypothesize that there may be a differential susceptibility of organisms in the GI and genital tracts. To determine the effect of azithromycin on persistent chlamydial gut infection, C57BL/6 and BALB/c mice were infected orally and genitally and treated with azithromycin (Az) orally (20, 40, or 80 mg/kg of body weight), and the numbers of chlamydiae were determined from cervix and cecal tissues. The Az concentration in the cecum and cervix was measured by high-performance liquid chromatography with electrochemical detection (HPLC-ECD). Az treatment cleared genital infection in both C57BL/6 and BALB/c mice; however, GI infection was not cleared with the same doses. HPLC data showed the presence of Az at both sites of infection, and significant amounts of Az were measured in treatment groups. However, no significant difference in Az levels between the cecum and the cervix was observed, indicating similar levels of Az reaching both sites of infection. These data indicate that antibiotic levels that are sufficient to cure genital infection are ineffectual against GI infection. The results suggest a reevaluation of antibiotic therapy for chlamydial infection.
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Rizzo A, Carratelli CR, Losacco A, Iovene MR. Antimicrobial effect of natural polyphenols with or without antibiotics on Chlamydia pneumoniae infection in vitro. Microb Drug Resist 2013; 20:1-10. [PMID: 23952319 DOI: 10.1089/mdr.2013.0024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Chlamydia pneumoniae is a human pathogen that causes multiple diseases worldwide. Despite appropriate therapy with antichlamydial antibiotics, chronic exacerbated diseases often occur and lead to serious sequelae. The use of the macrolide clarithromycin and the fluoroquinolone ofloxacin has improved the treatment of chlamydial infection, but therapy failure is still a major problem. In this work, we studied the pretreatment with natural polyphenols and subsequent treatment with clarithromycin or ofloxacin. The phenolic compounds resveratrol and quercetin improved the antichlamydial effect of clarithromycin and ofloxacin. In particular, resveratrol at 40 μM and quercetin at 20 μM exhibited significant growth inhibition on C. pneumoniae in presence of clarithromycin or ofloxacin compared to controls. In addition, we demonstrated that both resveratrol and quercetin decreased IL-17 and IL-23 production in a time-dependent manner in C. pneumoniae-infected cells. The results showed a particularly strong inhibition of the IL-23 levels released with combined treatment of resveratrol or quercetin and ofloxacin or clarithromycin, suggesting that the combined treatment may afford a synergistic effect in controlling Chlamydia infections.
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Affiliation(s)
- Antonietta Rizzo
- Section of Microbiology and Clinical Microbiology, Department of Experimental Medicine, Faculty of Medicine and Surgery, Second University of Naples , Naples, Italy
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Reid AE, Magriples U, Niccolai LM, Gordon DM, Divney AA, Kershaw TS. Associations of a sexually transmitted disease diagnosis during a relationship with condom use and psychosocial outcomes: (short) windows of opportunity. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2013; 51:510-519. [PMID: 23321987 PMCID: PMC3834616 DOI: 10.1007/s10464-012-9567-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Few studies have examined whether and how receiving an sexually transmitted disease (STD) diagnosis while in a romantic relationship relates to condom use and psychosocial sexual outcomes. Using dyadic data, we examined associations of a personal or a partner's STD diagnosis during a relationship with condom use, monogamy intentions, condom intentions and attitudes, and STD susceptibility and communication. Because beliefs about how the STD was acquired may shape associations with behavior and cognitions, gender and suspecting that one's partner had other sexual partners (i.e., partner concurrency) were examined as moderators. Participants were 592 individuals in 296 couples expecting a baby; 108 individuals had been diagnosed with an STD during the relationship. Personal STD diagnosis was unrelated to outcomes or was associated with increased risk. A partner's diagnosis related to more positive condom intentions and attitudes. Among men who suspected concurrency, both a personal and a partner's STD diagnosis were associated with less condom use. Receiving the STD diagnosis during pregnancy was associated with greater susceptibility and marginally greater condom use. Results suggest potential benefits of enhancing communication and encouraging joint risk reduction counseling among couples, engaging men more fully in preventive efforts, and capitalizing on the short window during which risk reduction occurs.
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Affiliation(s)
- Allecia E Reid
- Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, New Haven, CT 06510, USA.
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Yu YY, Frasure-Williams JA, Dunne EF, Bolan G, Markowitz L, Bauer HM. Chlamydia partner services for females in California family planning clinics. Sex Transm Dis 2013; 38:913-8. [PMID: 21934563 DOI: 10.1097/olq.0b013e3182240366] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prompt treatment of exposed partners is critical for preventing further transmission of chlamydia, reinfection, and sequelae among females. Patient-delivered partner therapy (PDPT) has been allowable in California since 2001; however, few data are available regarding PDPT use and treatment outcomes. METHODS Eight family planning clinics participated in a partner services evaluation from 2005 to 2006. Females aged 16 to 35 years with chlamydia were interviewed to determine the partner service received and partner treatment outcomes; a subset of partners was also interviewed. Determinants of reported partner treatment were assessed using multivariate logistic regression. Selected medical records were reviewed to assess reinfection rates. RESULTS Overall, 743 female patients disclosed 952 partners; 58% of whom were identified as steady partners. Reported partner services included concurrent patient-partner treatment visits (15% of partners), PDPT (19%), patient referral (55%), health department referral (0.1%), and no partner management (11%). On the basis of patient report, 82% of partners were notified and 54% received treatment. Of the 166 (17%) partners interviewed, 139 (84%) reported that they had received treatment, which correlated well with patient report. Reported partner treatment was higher for concurrent treatment visits and PDPT (79% and 80%, respectively) compared to patient referral (44%, P < 0.0001). Adjusted for clinic and relationship status, partners managed with concurrent treatment visits or PDPT were more likely to receive treatment compared with partners managed with patient referral (adjusted odds ratios, 3.5; 95% confidence interval, 2.1-5.8 and adjusted odds ratios, 4.3; 95% confidence interval, 2.6-7.2, respectively). Among the patients retested within 6 months after treatment, 18% were reinfected; reinfection rates did not differ by type of partner service. CONCLUSIONS Although overall rates of reported partner treatment were low, concurrent patient-partner treatment visits and PDPT were associated with significantly higher rates of partner treatment. However, these methods may be underutilized in California family planning settings.
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Affiliation(s)
- Ying-Ying Yu
- California Department of Public Health, Center for Infectious Diseases, Division of Communicable Disease Control, Sexually Transmitted Disease Control Branch, Richmond, CA 94804, USA
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Carr S, Espey E. Intrauterine devices and pelvic inflammatory disease among adolescents. J Adolesc Health 2013; 52:S22-8. [PMID: 23535053 DOI: 10.1016/j.jadohealth.2013.01.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 01/25/2013] [Accepted: 01/31/2013] [Indexed: 02/02/2023]
Abstract
Adolescents may be ideal candidates for intrauterine device (IUD) use, given high rates of unintended pregnancy and less successful use of short-acting contraceptive methods. Concerns about elevated risks of pelvic inflammatory disease in adolescents, with the consequences of infertility, ectopic pregnancy, and pelvic pain, prevent many clinicians from inserting IUDs in adolescents. The body of evidence examining risks of pelvic infection related to IUD use specifically in adolescents is limited, but is reassuring that the absolute risk of pelvic infection is small and that the benefits of IUD use likely outweigh the risks.
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Affiliation(s)
- Shannon Carr
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131, USA
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Park IU, Amey A, Creegan L, Barandas A, Bauer HM. Retesting for repeat chlamydial infection: family planning provider knowledge, attitudes, and practices. J Womens Health (Larchmt) 2012; 19:1139-44. [PMID: 20482236 DOI: 10.1089/jwh.2009.1648] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Repeated genital infections with Chlamydia trachomatis are common and associated with serious adverse reproductive sequelae in women such as infertility, ectopic pregnancy, and chronic pelvic pain. Retesting for repeat chlamydial infection is recommended 3 months after treatment for an initial infection; however, retesting rates in various settings are low. In order to design interventions to increase retesting rates, understanding provider barriers and practices around retesting is crucial. Therefore, in this survey of family planning providers we sought to describe: (1) knowledge about retesting for chlamydia; (2) attitudes and barriers toward retesting; (3) practices currently utilized to ensure retesting, and predictors associated with their use. METHODS We conducted a cross-sectional, self-administered, Internet-based survey of a convenience sample of family planning providers in California inquiring about strategies utilized to ensure retesting in their practice setting. High-intensity strategies included chart flagging, tickler (reminder) systems, follow-up appointments, and phone/mail reminders. RESULTS Of 268 respondents, 82% of providers reported at least 1 barrier to retesting, and only 44% utilized high-intensity interventions to ensure that patients returned. Predictors associated with use of high-intensity interventions included existence of clinic-level retesting policies (OR 3.95, 95% CI 1.98-7.88), and perception of a high/moderate level of clinic priority toward retesting (OR 3.75, 95% CI 2.12-.6.63). CONCLUSION Emphasizing the importance of retesting to providers through adoption of clinic policies will likely be an important component of a multimodal strategy to ensure that patients are retested and that provider/clinic staff take advantage of opportunities to retest patients. Innovative approaches such as home-based retesting with self-collected vaginal swabs and use of cost-effective technologies to generate patient reminders should also be considered.
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Affiliation(s)
- Ina U Park
- Program Development and Evaluation Section, California Department of Public Health STD Control Branch, Richmond, California 94804, USA.
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Hoover KW, Tao G, Nye MB, Body BA. Suboptimal Adherence to Repeat Testing Recommendations for Men and Women With Positive Chlamydia Tests in the United States, 2008–2010. Clin Infect Dis 2012; 56:51-7. [DOI: 10.1093/cid/cis771] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mmeje O, Coleman JS. Concurrent patient-partner treatment in pregnancy: an alternative to expedited partner therapy? Sex Transm Dis 2012; 39:665-70. [PMID: 22902661 DOI: 10.1097/olq.0b013e318259f5a4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Concurrent patient-partner treatment (CPPT) is the provision of treatment to the index patient and their sexual partner(s) and appears to be an effective method of preventing repeat sexually transmitted infections. The objectives of the study were to determine whether CPPT reduces the prevalence of a positive test of cure (TOC) for chlamydia and/or gonorrhea infection in pregnant women. METHODS We conducted an observational cohort study of 241 pregnant women aged 15 to 40 years diagnosed with chlamydia and/or gonorrhea receiving prenatal care at an urban teaching hospital. Pregnant women and their sexual partner(s) received CPPT consisting of azithromycin and/or cefpodoxime for treatment of chlamydia and/or gonorrhea infection, respectively, or patient referral consisting of an antibiotic prescription to the pregnant woman and advice for partner screening and therapy. Odds ratios (ORs) and survival estimates were calculated by χ or Fisher exact test, multivariable logistic regression, and Kaplan-Meier. RESULTS Forty-five pregnant women with chlamydia and/or gonorrhea received CPPT and were less likely to have a positive TOC (OR = 0; P < 0.001) and repeat positive chlamydia infection (OR = 0; P = 0.12) compared with 196 women that were treated and counseled on the patient referral treatment strategy for their sexual partners. CPPT shortened the median time to cure (4.4 weeks, standard deviation = 2.3) versus standard patient referral (5.1 weeks, standard deviation = 5.2). There were no repeat positive chlamydia infections in the CPPT group compared with 19 (18.1%) in the patient referral group. CONCLUSIONS CPPT decreased the prevalence of a positive TOC for chlamydia infection among pregnant women.
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Affiliation(s)
- Okeoma Mmeje
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA 94105, USA.
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Ong JBS, Fu X, Lee GKK, Chen MIC. Comparability of results from pair and classical model formulations for different sexually transmitted infections. PLoS One 2012; 7:e39575. [PMID: 22761828 PMCID: PMC3384672 DOI: 10.1371/journal.pone.0039575] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 05/27/2012] [Indexed: 11/19/2022] Open
Abstract
The "classical model" for sexually transmitted infections treats partnerships as instantaneous events summarized by partner change rates, while individual-based and pair models explicitly account for time within partnerships and gaps between partnerships. We compared predictions from the classical and pair models over a range of partnership and gap combinations. While the former predicted similar or marginally higher prevalence at the shortest partnership lengths, the latter predicted self-sustaining transmission for gonorrhoea (GC) and Chlamydia (CT) over much broader partnership and gap combinations. Predictions on the critical level of condom use (C(c)) required to prevent transmission also differed substantially when using the same parameters. When calibrated to give the same disease prevalence as the pair model by adjusting the infectious duration for GC and CT, and by adjusting transmission probabilities for HIV, the classical model then predicted much higher C(c) values for GC and CT, while C(c) predictions for HIV were fairly close. In conclusion, the two approaches give different predictions over potentially important combinations of partnership and gap lengths. Assuming that it is more correct to explicitly model partnerships and gaps, then pair or individual-based models may be needed for GC and CT since model calibration does not resolve the differences.
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Affiliation(s)
- Jimmy Boon Som Ong
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore.
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Jones HE, Pressman EJ, Bell DL, Kerns JL, Lykes ST, Garth J, Westhoff CL. Managing chlamydia infections in young men: results from an audit of a public men's clinic in New York City. Int J STD AIDS 2011; 22:581-4. [DOI: 10.1258/ijsa.2011.010462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Research on management of Chlamydia trachomatis (CT) among men has largely been neglected. Findings from an audit of 284 CT-infected men from 2004 to 2005 attending a young men's clinic primarily serving Latino men in New York City, NY, USA, are presented. Ninety-nine percent received treatment, with 81% treated within 14 days of a positive test. Three percent reported no partner in the last three months, 17% were referred by a CT-positive partner and 24% were missing partner information. Among the rest, 18% received expedited partner therapy, 4% directly observed therapy, 12% partner referral and 65% did not receive documented partner management. Of the 34% who had a post-treatment visit at least three months after their index visit, only 36% received a test for re-infection. Among primarily Latino men in an urban clinic in New York City, a high proportion of CT cases were treated in a timely manner. However, documentation of partner management was often lacking and few CT cases received tests for re-infection.
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Affiliation(s)
- H E Jones
- Department of Obstetrics and Gynecology, Columbia University Medical Center
- Biostatistics and Epidemiology Program, CUNY School of Public Health, Hunter College
| | - E J Pressman
- Department of Obstetrics and Gynecology, Columbia University Medical Center
- Heilbrunn Department of Population and Family Health, Columbia University
| | - D L Bell
- Heilbrunn Department of Population and Family Health, Columbia University
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - J L Kerns
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA
| | - S T Lykes
- Heilbrunn Department of Population and Family Health, Columbia University
| | - J Garth
- New York Presbyterian Hospital, New York, NY, USA
| | - C L Westhoff
- Department of Obstetrics and Gynecology, Columbia University Medical Center
- Heilbrunn Department of Population and Family Health, Columbia University
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Stein MD, Caviness CM, Anderson BJ. Incidence of sexually transmitted infections among hazardously drinking women after incarceration. Womens Health Issues 2011; 22:e1-7. [PMID: 21835632 DOI: 10.1016/j.whi.2011.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 05/24/2011] [Accepted: 05/24/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND BACKGROUND At the time of incarceration, women have a high prevalence of sexually transmitted infections (STI). In the months after community release, women remain at high risk for new infections. This study assessed the rates and predictors of incident chlamydia, gonorrhea, and trichomoniasis in a sample of hazardously drinking women after incarceration. METHODS Self-reported behavioral data were collected from 245 incarcerated women. Vaginal swabs were collected at baseline, and 3- and 6-month time points and tested for chlamydia, gonorrhea, and trichomoniasis. Treatment was provided for all positive tests. RESULTS Participants' mean age was 34.1 years of age; 175 (71.4%) were Caucasian, 47 (19.2%) were African American, 17 (6.9%) were Hispanic, and 6 (2.4%) were of other ethnic origins. The STI incidence rate was estimated to be 30.5 (95% confidence interval, 21.3-43.5) new infections per 100 person-years. Number of male sex partners reported during follow-up was a significant (z = 2.16; p = .03) predictor of STI; each additional male sex partner increased the estimated hazard of STI by 1.26. CONCLUSION Incarcerated women who are hazardous drinkers are at high risk for STI in the months after their return to the community. In addition to testing and treatment during incarceration, post-release rescreening, education, partner treatment, and follow-up are recommended.
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Use of Home-Obtained Vaginal Swabs to Facilitate Rescreening for Chlamydia trachomatis Infections. Obstet Gynecol 2011; 118:231-239. [DOI: 10.1097/aog.0b013e3182246a83] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Implementation of Expedited Partner Therapy Among Women With Chlamydia Infection at an Urban Family Planning Clinic. Sex Transm Dis 2011; 38:722-6. [DOI: 10.1097/olq.0b013e318214bb83] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Graseck AS, Shih SL, Peipert JF. Home versus clinic-based specimen collection for Chlamydia trachomatis and Neisseria gonorrhoeae. Expert Rev Anti Infect Ther 2011; 9:183-94. [PMID: 21342066 DOI: 10.1586/eri.10.164] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sexually transmitted infections (STIs) are a major public health concern that must be addressed with innovative screening methods to supplement traditional approaches. Home-based screening with self-collected urine or vaginal specimens is a highly feasible and acceptable method, and shows promise in improving STI screening rates in both men and women. Home collection kits have been offered in a variety of settings, with results ranging from very modest improvements in screening rates to 100-fold increases beyond the rates observed with clinic-based screening. This article describes and evaluates the effectiveness and limitations of various home screening strategies used for the detection of STIs.
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Affiliation(s)
- Anna S Graseck
- Washington University in St Louis School of Medicine, Division of Clinical Research, Department of Obstetrics and Gynecology, Campus Box 8219, 4533 Clayton Avenue, St Louis, MO 63110, USA
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Niccolai LM, Livingston KA, Laufer AS, Pettigrew MM. Behavioural sources of repeat Chlamydia trachomatis infections: importance of different sex partners. Sex Transm Infect 2011; 87:248-53. [PMID: 21212380 PMCID: PMC5438152 DOI: 10.1136/sti.2010.045484] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To examine sources of repeat Chlamydia trachomatis infections using behavioural and molecular methods. METHODS Women with C. trachomatis had baseline and 4-month follow-up visits consisting of behavioural surveys and genotyping of C. trachomatis. Frequencies and population-attributable risk percentages (PAR%) were estimated for possible sources of repeat infections including sex partners not known to be treated, new sex partners, and sex partners not known to be monogamous. Women with different genotypes at baseline and follow-up were classified as different partner sources of infection. RESULTS The cumulative incidence of repeat infections in the sample (n=183) was 13% (95% CI 8% to 18%). Predictors of repeat infections included younger age and continued sex with a partner not known to be treated. Frequencies of having partners not known to be treated, new partners, or partners not known to be monogamous at follow-up were 21% (95% CI 15% to 27%), 37% (95% CI 30% to 44%) and 33% (95% CI 28% to 41%), respectively. The PAR% for having a partner not known to be treated was 26% (95% CI 3% to 49%) and for having a new sex partner was 21% (95% CI 0% to 50%). Among eight patients with available genotypes at baseline and follow-up, five had different genotypes and were classified as having a different partner source of infection. CONCLUSIONS Different sex partner sources of repeat C. trachomatis infections other than untreated sex partners may contribute substantially to the burden of repeat infections.
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Affiliation(s)
- Linda M Niccolai
- Yale School of Public Health, 60 College Street, New Haven, CT 06520, USA.
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Walker J, Fairley CK, Urban E, Chen MY, Bradshaw C, Walker SM, Donovan B, Tabrizi SN, McNamee K, Currie M, Pirotta M, Kaldor J, Gurrin LC, Birden H, Harindra V, Bowden FJ, Garland S, Gunn JM, Hocking JS. Maximising retention in a longitudinal study of genital Chlamydia trachomatis among young women in Australia. BMC Public Health 2011; 11:156. [PMID: 21385471 PMCID: PMC3061916 DOI: 10.1186/1471-2458-11-156] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 03/09/2011] [Indexed: 11/12/2022] Open
Abstract
Background Cohort studies are an important study design however they are difficult to implement, often suffer from poor retention, low participation and bias. The aims of this paper are to describe the methods used to recruit and retain young women in a longitudinal study and to explore factors associated with loss to follow up. Methods The Chlamydia Incidence and Re-infection Rates Study (CIRIS) was a longitudinal study of Australian women aged 16 to 25 years recruited from primary health care clinics. They were followed up via the post at three-monthly intervals and required to return questionnaires and self collected vaginal swabs for chlamydia testing. The protocol was designed to maximise retention in the study and included using recruiting staff independent of the clinic staff, recruiting in private, regular communication with study staff, making the follow up as straightforward as possible and providing incentives and small gifts to engender good will. Results The study recruited 66% of eligible women. Despite the nature of the study (sexual health) and the mobility of the women (35% moved address at least once), 79% of the women completed the final stage of the study after 12 months. Loss to follow up bias was associated with lower education level [adjusted hazard ratio (AHR): 0.7 (95% Confidence Interval (CI): 0.5, 1.0)], recruitment from a sexual health centre as opposed to a general practice clinic [AHR: 1.6 (95% CI: 1.0, 2.7)] and previously testing positive for chlamydia [AHR: 0.8 (95% CI: 0.5, 1.0)]. No other factors such as age, numbers of sexual partners were associated with loss to follow up. Conclusions The methods used were considered effective for recruiting and retaining women in the study. Further research is needed to improve participation from less well-educated women.
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Affiliation(s)
- Jennifer Walker
- Centre for Women's Health, Gender and Society, School of Population Health, University of Melbourne, Victoria 3010, Australia.
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Upsurge of chlamydial reinfection in a large Canadian city: an indication of suboptimal chlamydia screening practices? Canadian Journal of Public Health 2011. [PMID: 21214060 DOI: 10.1007/bf03404865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Given the limited knowledge on chlamydial reinfection (CR) in Canada, we examined the extent and predictors of CR in Montréal, a large Canadian city. METHODS We retrospectively studied all Montréal residents aged > or =10 years for whom > or =1 laboratory-confirmed chlamydial infection was reported to the public health department between 1988 and 2007 (n = 44,580). Each person was passively followed for two years after baseline infection or until reinfection. Socio-demographic factors and histories of other notifiable diseases were examined as potential predictors. Cox multivariate regression was used to model the time to CR. Survival analyses were stratified by age group (<25 vs. > or =25 years). RESULTS We estimated an overall two-year CR rate of 6.4%, an incidence density of 3.5 per 100 person-years, and a median time to reinfection of nine months. CR significantly increased over time. Among persons <25 years, reinfection was significantly more likely among females [adjusted hazard ratio (AHR): 1.58] and younger participants (10-14 years: AHR: 2.98; 15-19 years: AHR: 1.81). Residing within the South Central sector was deleterious for six months following initial infection after which it became protective. Among persons > or =25 years, a history of sexually transmitted infections increased the risk of reinfection (AHR: 1.79). CONCLUSION CR is a significant and growing problem in Montreal. The current recommendation for a single repeat screening six months posttreatment might be usefully complemented with additional screenings. Our results also underscore the importance of screening high-risk populations, particularly young women.
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Patient Preference for Patient-Delivered Partner Therapy: Exploratory Findings From Three Sexually Transmitted Disease Clinics. Sex Transm Dis 2011; 38:148-9. [DOI: 10.1097/olq.0b013e3182036d45] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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