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Callander D, McManus H, Gray RT, Grulich AE, Carr A, Hoy J, Donovan B, Fairley CK, Holt M, Templeton DJ, Liaw ST, McMahon JH, Asselin J, Petoumenos K, Hellard M, Pedrana A, Elliott J, Keen P, Costello J, Keane R, Kaldor J, Stoové M, Guy R. HIV treatment-as-prevention and its effect on incidence of HIV among cisgender gay, bisexual, and other men who have sex with men in Australia: a 10-year longitudinal cohort study. Lancet HIV 2023; 10:e385-e393. [PMID: 37068498 DOI: 10.1016/s2352-3018(23)00050-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 02/04/2023] [Accepted: 02/10/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Although HIV treatment-as-prevention reduces individual-level HIV transmission, population-level effects are unclear. We aimed to investigate whether treatment-as-prevention could achieve population-level reductions in HIV incidence among gay, bisexual, and other men who have sex with men (GBM) in Australia's most populous states, New South Wales and Victoria. METHODS TAIPAN was a longitudinal cohort study using routine health record data extracted from 69 health services that provide HIV diagnosis and care to GBM in New South Wales and Victoria, Australia. Data from Jan 1, 2010, to Dec 31, 2019, were linked within and between services and over time. TAIPAN collected data from all cisgender GBM who attended participating services, resided in New South Wales or Victoria, and were 16 years or older. Two cohorts were established: one included HIV-positive patients, and the other included HIV-negative patients. Population prevalence of viral suppression (plasma HIV viral load <200 RNA copies per μL) was calculated by combining direct measures of viral load among the HIV-positive cohort with estimates for undiagnosed GBM. The primary outcome of HIV incidence was measured directly via repeat testing in the HIV-negative cohort. Poisson regression analyses with generalised estimating equations assessed temporal associations between population prevalence of viral suppression and HIV incidence among the subsample of HIV-negative GBM with multiple instances of HIV testing. FINDINGS At baseline, the final sample (n=101 772) included 90 304 HIV-negative and 11 468 HIV-positive GBM. 59 234 patients in the HIV-negative cohort had two or more instances of HIV testing and were included in the primary analysis. Over the study period, population prevalence of viral suppression increased from 69·27% (95% CI 66·41-71·96) to 88·31% (86·37-90·35), while HIV incidence decreased from 0·64 per 100 person-years (95% CI 0·55-0·76) to 0·22 per 100 person-years (0·17-0·28). Adjusting for sociodemographic characteristics and HIV pre-exposure prophylaxis (PrEP) use, treatment-as-prevention achieved significant population-level reductions in HIV incidence among GBM: a 1% increase in population prevalence of viral suppression corresponded with a 6% decrease in HIV incidence (incidence rate ratio [IRR] 0·94, 95% CI 0·93-0·96; p<0·0001). PrEP was introduced in 2016 with 17·60% uptake among GBM that year, which increased to 36·38% in 2019. The relationship between population prevalence of viral suppression and HIV incidence was observed before the availability of PrEP (IRR 0·98, 95% CI 0·96-0·99; p<0·0001) and was even stronger after the introduction of PrEP (0·80, 0·70-0·93; p=0·0030). INTERPRETATION Our results suggest that further investment in HIV treatment, especially alongside PrEP, can improve public health by reducing HIV incidence among GBM. FUNDING National Health and Medical Research Council of Australia.
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Affiliation(s)
- Denton Callander
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Hamish McManus
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Richard T Gray
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Andrew Carr
- HIV and Immunology Unit, St Vincent's Hospital, Sydney, NSW, Australia
| | - Jennifer Hoy
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
| | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia
| | - Christopher K Fairley
- Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Melbourne, VIC, Australia
| | - Martin Holt
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - David J Templeton
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Department of Sexual Health Medicine, Sydney Local Health District, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Positive Life New South Wales, Sydney, NSW, Australia
| | - Siaw-Teng Liaw
- School of Population Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - James H McMahon
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
| | | | - Kathy Petoumenos
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Margaret Hellard
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia; The Burnet Institute, Melbourne, VIC, Australia
| | | | - Julian Elliott
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
| | - Phillip Keen
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jane Costello
- Positive Life New South Wales, Sydney, NSW, Australia
| | | | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mark Stoové
- The Burnet Institute, Melbourne, VIC, Australia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Prevalence of sexually transmitted infections among cervical cancer suspected women at University of Gondar Comprehensive Specialized Hospital, North-west Ethiopia. BMC Infect Dis 2021; 21:378. [PMID: 33888090 PMCID: PMC8063310 DOI: 10.1186/s12879-021-06074-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
Background Sexually transmitted infections (STIs) such as Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Syphilis have continued a significant public health problem, especially in areas with substandard infection prevention and control programs. It is known that STIs are largely associated with the increased occurrence of cervical cancer. To date, little is known about the burden of STIs among cervical cancer suspected women in Ethiopia. Objectives To assess the seroprevalence of STIs and associated risk factors among cervical cancer suspected women with special emphasis on HIV, HBV, HCV, and Syphilis. Methods A hospital-based cross-sectional study was conducted among cervical cancer suspected women at the University of Gondar Comprehensive Specialized Hospital from February to April 2017. A pre-tested and structured questionnaire was used to collect data on patients’ characteristics. The patient’s serum or plasma samples were tested for HIV, HBV, HCV, and syphilis using enzyme-linked immunosorbent assay. In all aspects, the standard operational procedure was strictly followed. Data were analyzed using SPSS version 20 software and presented using tables. Statistical associations were measured using bivariate and multivariable logistic regression. A p-value of below 0.05 was considered statistically significant. Result A total of 403 cervical cancer suspected women with the mean age of 42.54 (SD + 11. 24) years were enrolled in the study. The overall prevalence of STIs was 16.6% (67/403) and the prevalence of HIV, HBV, HCV, and syphilis was 36/403 (8.9%), 10/403 (2.5%), 4/403 (1%), and 29/403 (7.2%) respectively. History of multiple sexual partners (Adjusted OR = 3.02, 95%CI 1.57–5.79, P = 0.001), alcohol addiction (Adjusted OR = 2.2, 95%CI 1.07–4.5, P = 0.031), history of STI (Adjusted OR = 3.38; 95% CI: 1.76–6.47, P = 0.00) and not use of condom (Adjusted OR = 4.99; 95% CI: 1.5–16.16, P = 0.007) were significantly associated with STIs. Conclusion The prevalence of STIs was generally higher among cervical cancer suspected patients. Health education is encouraged to promote awareness about the prevention of STIs.
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Should Asymptomatic Men Who Have Sex With Men Be Screened for Oropharyngeal Chlamydia? Clinical Outcomes From a Cross-Sectional Study. Sex Transm Dis 2019; 45:103-106. [PMID: 29329179 DOI: 10.1097/olq.0000000000000718] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To help inform screening guidelines, we estimated the proportion of asymptomatic men who have sex with men (MSM) with oropharyngeal chlamydia. STUDY DESIGN An audit of asymptomatic MSM attending a sexual health service from March 2015 to April 2016 was conducted. They each had an oropharyngeal swab that was tested for Chlamydia trachomatis by transcription-mediated nucleic acid amplification. In addition, a random sample of 17 swabs that initially tested positive had confirmatory testing to determine the likelihood of true positivity. RESULTS We collected 4877 oropharyngeal swabs: 72 (1.5%; 95% confidence interval [CI], 1.2-1.9) were diagnosed positive for chlamydia. Most (n = 56 [78%]; 95% CI, 67-86) only had oropharyngeal chlamydia detected (i.e., no concurrent extraoropharyngeal chlamydia and/or gonorrhea). Of the 17 samples that underwent confirmation, all confirmed positive (100%; 95% CI, 82-100). CONCLUSIONS Although oropharyngeal chlamydia prevalence was low among asymptomatic MSM, most oropharyngeal chlamydia cases had no chlamydia at other sites, and these cases would have been missed and not treated if routine oropharyngeal chlamydia testing was not done.
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Rawre J, Agrawal S, Dhawan B. Sexually transmitted infections: Need for extragenital screening. Indian J Med Microbiol 2018; 36:1-7. [PMID: 29735819 DOI: 10.4103/ijmm.ijmm_18_46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Extragenital infections can occur concurrently with simultaneous urogenital infections. Extragenital sites are believed to serve as hidden reservoirs and play a critical role in their transmission. The etiological relationship of the most widespread Sexually transmitted diseases (STD) pathogen to reproductive tract has long been established, but the distribution to extragenital sites appears to be infrequent and its correlation with the sexual practice still requires to be investigated. Optimal-screening strategies for extragenital infections are largely unknown. However, there is a lack of data on clinical outcomes and optimal treatment regimens for rectal and pharyngeal extragenital infections. Further studies are needed in settings other than reproductive health and STD clinics, especially in primary care clinics and resource-limited settings.
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Affiliation(s)
- Jyoti Rawre
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sonu Agrawal
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Benu Dhawan
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Hinkan S, Chuerduangphui J, Ekalaksananan T, Budkaew J, Proyrungroj K, Pimson C, Chumworathayi B, Hanond T, Pientong C. Anatomical site distribution and genotypes of Chlamydia trachomatis infecting asymptomatic men who have sex with men in northeast Thailand. Int J STD AIDS 2018. [PMID: 29514561 DOI: 10.1177/0956462418760659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chlamydia trachomatis is a common agent of sexually transmitted infection, especially in asymptomatic extra-genital sites among men who have sex with men (MSM). This study aims to investigate anatomical site distribution and genotypes of C. trachomatis from asymptomatic MSM in northeast Thailand. Specimens were collected using swabs from anorectal, oropharyngeal, and urethral sites in 346 asymptomatic MSM. C. trachomatis infection was determined by real-time polymerase chain reaction and genotyping was based on sequences of the ompA gene. The results showed that infection by C. trachomatis was most common at the urethral site (29.1%, 101/346) followed by oropharyngeal (17.6%, 61/346) and anorectal site (17.0%, 59/346). In addition, C. trachomatis infection was significantly associated with absence of condom use (odds ratio = 1.909, 95%CI = 1.054-3.457, P = 0.033) at the urethral site. Overall 49.4% (171/346) of individuals were infected in at least one site. Infection at only the anorectum, oropharynx, or urethra was seen in 9.0, 9.3, and 18.5% of participants, respectively. Concurrent infections at anorectum/oropharynx, anorectum/urethra, oropharynx/urethra, and all three sites were 2.0, 4.3, 4.6, and 1.7%, respectively. Genotype D predominated at the anorectal and urethral sites among asymptomatic MSM in northeast Thailand. Concurrent infection in two or three anatomical sites occurred. C. trachomatis screening at all three sites in asymptomatic MSM is important and should be considered for proper treatment and prevention of transmission.
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Affiliation(s)
- Saowarop Hinkan
- 1 Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,2 HPV & EBV and Carcinogenesis Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Jureeporn Chuerduangphui
- 1 Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,2 HPV & EBV and Carcinogenesis Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Tipaya Ekalaksananan
- 1 Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,2 HPV & EBV and Carcinogenesis Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Jiratha Budkaew
- 3 Department of Social Medicine, Khon Kaen Center Hospital, Khon Kaen, Thailand
| | - Kanisara Proyrungroj
- 1 Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,2 HPV & EBV and Carcinogenesis Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Charinya Pimson
- 2 HPV & EBV and Carcinogenesis Research Group, Khon Kaen University, Khon Kaen, Thailand.,4 Department of Animal Health Science, Faculty of Agro-Industrial Technology, Kalasin University, Kalasin, Thailand
| | - Bandit Chumworathayi
- 2 HPV & EBV and Carcinogenesis Research Group, Khon Kaen University, Khon Kaen, Thailand.,5 Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Tanyaporn Hanond
- 1 Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chamsai Pientong
- 1 Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,2 HPV & EBV and Carcinogenesis Research Group, Khon Kaen University, Khon Kaen, Thailand
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Extragenital Infections Caused by Chlamydia trachomatis and Neisseria gonorrhoeae: A Review of the Literature. Infect Dis Obstet Gynecol 2016; 2016:5758387. [PMID: 27366021 PMCID: PMC4913006 DOI: 10.1155/2016/5758387] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 04/12/2016] [Accepted: 04/20/2016] [Indexed: 12/30/2022] Open
Abstract
In the United States, sexually transmitted diseases due to Chlamydia trachomatis and Neisseria gonorrhoeae continue to be a major public health burden. Screening of extragenital sites including the oropharynx and rectum is an emerging practice based on recent studies highlighting the prevalence of infection at these sites. We reviewed studies reporting the prevalence of extragenital infections in women, men who have sex with men (MSM), and men who have sex only with women (MSW), including distribution by anatomical site. Among women, prevalence was found to be 0.6–35.8% for rectal gonorrhea (median reported prevalence 1.9%), 0–29.6% for pharyngeal gonorrhea (median 2.1%), 2.0–77.3% for rectal chlamydia (median 8.7%), and 0.2–3.2% for pharyngeal chlamydia (median 1.7%). Among MSM, prevalence was found to be 0.2–24.0% for rectal gonorrhea (median 5.9%), 0.5–16.5% for pharyngeal gonorrhea (median 4.6%), 2.1–23.0% for rectal chlamydia (median 8.9%), and 0–3.6% for pharyngeal chlamydia (median 1.7%). Among MSW, the prevalence was found to be 0–5.7% for rectal gonorrhea (median 3.4%), 0.4–15.5% for pharyngeal gonorrhea (median 2.2%), 0–11.8% for rectal chlamydia (median 7.7%), and 0–22.0% for pharyngeal chlamydia (median 1.6%). Extragenital infections are often asymptomatic and found in the absence of reported risk behaviors, such as receptive anal and oral intercourse. We discuss current clinical recommendations and future directions for research.
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Martinez O, Roth AM, Kelle G, Downs M, Rhodes SD. Adaptation and implementation of HoMBReS: a community-level, evidence-based HIV behavioral intervention for heterosexual Latino men in the midwestern United States. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2014; 26:68-80. [PMID: 24450279 PMCID: PMC3987858 DOI: 10.1521/aeap.2014.26.1.68] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Over the past decade, the midwestern United States has witnessed a dramatic increase in its Latino population. The lack of culturally and linguistically congruent resources coupled with high incidence and prevalence rates of HIV among Latinos living in the Midwest merits attention. HoMBReS: Hombres Manteniendo Bienestar y Relaciones Saludables (Men Maintaining Wellbeing and Healthy Relationships) is a community-level social network intervention designed for Latino men. We describe the adaptation and implementation of HoMBReS for Latino men living in Indianapolis, Indiana, the second largest city in the Midwest. Five Navegantes (lay health educators) were trained; they provided a total of 34 educational charlas (small group didactic sessions). A total of 270 Latino men attended the charlas and were offered no-cost screening for HIV and sexually transmitted infections (STI). Three participants tested HIV positive and 15 screened positive for STI. The charlas coupled with the testing initiative, served as a successful method to increase sexual health knowledge among Latino men and to link newly-diagnosed HIV/STI-positive individuals to treatment and care. The adaptation and implementation of HoMBReS respond to the CDC and NIH call to increase HIV testing and service provision among vulnerable populations.
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Physical Barrier Methods. Sex Transm Dis 2013. [DOI: 10.1016/b978-0-12-391059-2.00008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Lewis D, Newton DC, Guy RJ, Ali H, Chen MY, Fairley CK, Hocking JS. The prevalence of Chlamydia trachomatis infection in Australia: a systematic review and meta-analysis. BMC Infect Dis 2012; 12:113. [PMID: 22583480 PMCID: PMC3462140 DOI: 10.1186/1471-2334-12-113] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 04/03/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis is a common sexually transmitted infection in Australia. This report aims to measure the burden of chlamydia infection by systematically reviewing reports on prevalence in Australian populations. METHODS Electronic databases and conference websites were searched from 1997-2011 using the terms 'Chlamydia trachomatis' OR 'chlamydia' AND 'prevalence' OR 'epidemiology' AND 'Australia'. Reference lists were checked and researchers contacted for additional literature. Studies were categorised by setting and participants, and meta-analysis conducted to determine pooled prevalence estimates for each category. RESULTS Seventy-six studies met the inclusion criteria for the review. There was a high level of heterogeneity between studies; however, there was a trend towards higher chlamydia prevalence in younger populations, Indigenous Australians, and those attending sexual health centres. In community or general practice settings, pooled prevalence for women <25 years in studies conducted post-2005 was 5.0% (95% CI: 3.1, 6.9; five studies), and for men <30 years over the entire review period was 3.9% (95% CI: 2.7, 5.1; six studies). For young Australians aged <25 years attending sexual health, family planning or youth clinics, estimated prevalence was 6.2% (95% CI: 5.1, 7.4; 10 studies) for women and 10.2% (95% CI: 9.5, 10.9; five studies) for men. Other key findings include pooled prevalence estimates of 22.1% (95% CI: 19.0, 25.3; three studies) for Indigenous women <25 years, 14.6% (95% CI: 11.5, 17.8; three studies) for Indigenous men <25 years, and 5.6% (95% CI: 4.8, 6.3; 11 studies) for rectal infection in men who have sex with men. Several studies failed to report basic demographic details such as sex and age, and were therefore excluded from the analysis. CONCLUSIONS Chlamydia trachomatis infections are a significant health burden in Australia; however, accurate estimation of chlamydia prevalence in Australian sub-populations is limited by heterogeneity within surveyed populations, and variations in sampling methodologies and data reporting. There is a need for more large, population-based studies and prospective cohort studies to compliment mandatory notification data.
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Affiliation(s)
- Dyani Lewis
- School of Population Health, University of Melbourne, Carlton, Victoria, Australia
| | - Danielle C Newton
- School of Population Health, University of Melbourne, Carlton, Victoria, Australia
| | - Rebecca J Guy
- The Kirby Institute, University of New South Wales, Darlinghurst, New South Wales, Australia
| | - Hammad Ali
- The Kirby Institute, University of New South Wales, Darlinghurst, New South Wales, Australia
| | - Marcus Y Chen
- School of Population Health, University of Melbourne, Carlton, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Hospital, Carlton, Victoria, Australia
| | - Christopher K Fairley
- School of Population Health, University of Melbourne, Carlton, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Hospital, Carlton, Victoria, Australia
| | - Jane S Hocking
- School of Population Health, University of Melbourne, Carlton, Victoria, Australia
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Lim MSC, Goller JL, Guy R, Gold J, Stoove M, Hocking JS, Fairley CK, Henning D, McNamee K, Owen L, Sheehan P, Hellard ME. Correlates of Chlamydia trachomatis infection in a primary care sentinel surveillance network. Sex Health 2012; 9:247-53. [DOI: 10.1071/sh11019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 07/28/2011] [Indexed: 11/23/2022]
Abstract
Background
Chlamydia is the most commonly notified infection in Australia. Prevention strategies should be informed by routine data on at-risk populations. Methods: We calculated chlamydia positivity and correlates of infection using multivariable logistic regression for data collected between April 2006 and June 2009. Results: Chlamydia positivity was 5.6% in 12 233 females, 7.7% in 10 316 heterosexual males and 6.2% in 7872 men who have sex with men (MSM). Correlates of chlamydia positivity among females included younger age (odds ratio (OR) 2.27, 95% confidence interval (CI) 1.92–2.69), being born overseas (OR 1.50, 95% CI 1.25–1.82), multiple sex partners in the past year (OR 1.72, 95% CI 1.40–2.11) and inconsistent condom use with regular sex partners (OR 3.44 ,95% CI 1.65–7.20). Sex work was protective for females (OR 0.68, 95% CI 0.53–0.86). Among heterosexual males, correlates of positivity were younger age (OR 1.87, 95% CI 1.62–2.17), being born overseas (OR 1.35, 95% CI 1.16–1.58), symptoms at the time of testing (OR 1.64, 95% CI 1.40–1.92) and multiple sex partners in the past year (OR 1.83, 95% CI 1.46–2.30). Correlates of positivity among MSM were being born overseas (OR 1.23, 95% CI 1.00–1.51), being HIV-positive (OR 1.80, 95%CI 1.32–2.47), and reporting six or more anal sex partners in the past 6 months (OR 4.45, 95% CI 1.37–14.5). Conclusions: Our analysis identified subgroups at the highest risk of chlamydia in Victoria. These estimates will provide important baseline information to measure the impact of chlamydia control strategies.
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Marrazzo JM, Cates W. Interventions to prevent sexually transmitted infections, including HIV infection. Clin Infect Dis 2011; 53 Suppl 3:S64-78. [PMID: 22080271 PMCID: PMC3213401 DOI: 10.1093/cid/cir695] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The Centers for Disease Control and Prevention (CDC) Sexually Transmitted Disease (STD) Treatment Guidelines were last updated in 2006. To update the "Clinical Guide to Prevention Services" section of the 2010 CDC STD Treatment Guidelines, we reviewed the recent science with reference to interventions designed to prevent acquisition of STDs, including human immunodeficiency virus (HIV) infection. Major interval developments include (1) licensure and uptake of immunization against genital human papillomavirus, (2) validation of male circumcision as a potent prevention tool against acquisition of HIV and some other sexually transmitted infections (STIs), (3) failure of a promising HIV vaccine candidate to afford protection against HIV acquisition, (4) encouragement about the use of antiretroviral agents as preexposure prophylaxis to reduce risk of HIV and herpes simplex virus acquisition, (5) enhanced emphasis on expedited partner management and rescreening for persons infected with Chlamydia trachomatis and Neisseria gonorrhoeae, (6) recognition that behavioral interventions will be needed to address a new trend of sexually transmitted hepatitis C among men who have sex with men, and (7) the availability of a modified female condom. A range of preventive interventions is needed to reduce the risks of acquiring STI, including HIV infection, among sexually active people, and a flexible approach targeted to specific populations should integrate combinations of biomedical, behavioral, and structural interventions. These would ideally involve an array of prevention contexts, including (1) communications and practices among sexual partners, (2) transactions between individual clients and their healthcare providers, and (3) comprehensive population-level strategies for prioritizing prevention research, ensuring accurate outcome assessment, and formulating health policy.
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Affiliation(s)
- Jeanne M Marrazzo
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Seattle, WA 98104, USA.
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Karlsson A, Österlund A, Forssén A. Pharyngeal Chlamydia trachomatis is not uncommon any more. ACTA ACUST UNITED AC 2011; 43:344-8. [DOI: 10.3109/00365548.2011.553243] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tinmouth J, Gilmour MW, Kovacs C, Kropp R, Mitterni L, Rachlis A, Richards S, Salit I, Sikri R, Valencia GR, Wesson T, Wong T, Wood H. Is there a reservoir of sub-clinical lymphogranuloma venereum and non-LGV Chlamydia trachomatis infection in men who have sex with men? Int J STD AIDS 2009; 19:805-9. [PMID: 19050208 DOI: 10.1258/ijsa.2008.008260] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
SUMMARY The aim of this study was to determine if a reservoir of sub-clinical LGV infection exists in men who have sex with men (MSM), as this finding might account for the recent rise in lymphogranuloma venereum (LGV) Chlamydia trachomatis infections among MSM in Canada. MSM without proctitis were enrolled between January and August 2006 in a cross-sectional study. Rectal, urine, serology and pharyngeal specimens were tested for specific C. trachomatis serovars. The median age of the 253 participants was 43 years; 53% were HIV+. We found no active cases of LGV infection; but 20 (8%) participants had positive serology. Thirteen participants (5%) had non-LGV C. trachomatis infections. Unprotected anopenetrative intercourse, rectal enema and drug use were associated with non-LGV C. trachomatis infection. Sub-clinical rectal non-LGV C. trachomatis infection was relatively common but LGV was not identified in our sample. Further studies of screening for non-LGV chlamydia infection in MSM are needed.
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Affiliation(s)
- J Tinmouth
- Department of Medicine Sunnybrook Health Sciences Centre, Division of Gastroenterology, Toronto, Ontario, Canada.
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Chibber K, Kaplan R, Padian N, Anderson S, Ling P, Acharya N, Van Dyke C, Krishnan S. A common pathway toward women's health. Glob Public Health 2008; 3:26-38. [DOI: 10.1080/17441690701523226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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