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den Heijer CDJ, Hoebe CJPA, Driessen JHM, Wolffs P, van den Broek IVF, Hoenderboom BM, Williams R, de Vries F, Dukers-Muijrers NHTM. Chlamydia trachomatis and the Risk of Pelvic Inflammatory Disease, Ectopic Pregnancy, and Female Infertility: A Retrospective Cohort Study Among Primary Care Patients. Clin Infect Dis 2020; 69:1517-1525. [PMID: 31504315 PMCID: PMC6792126 DOI: 10.1093/cid/ciz429] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/27/2019] [Indexed: 11/24/2022] Open
Abstract
Background We evaluated the risk of pelvic inflammatory disease (PID), ectopic pregnancy, and infertility in women with a previous Chlamydia trachomatis (CT) diagnosis compared with women who tested negative for CT and CT untested women, considering both targeted and incidental (ie, prescribed for another indication) use of CT-effective antibiotics. Methods This was a retrospective study of women aged 12–25 years at start of follow-up within the Clinical Practice Research Datalink GOLD database linked to index of multiple deprivation quintiles, 2000–2013. CT test status and antibiotic use were determined in a time-dependent manner. Risk of PID, ectopic pregnancy, or female infertility were evaluated using of Cox proportional hazard models. Results We studied 857 324 women, contributing 6 457 060 person-years. Compared with women who tested CT-negative, women who tested CT-positive had an increased risk of PID (adjusted hazard ratio [aHR], 2.36; 95% confidence interval [CI], 2.01–2.79), ectopic pregnancy (aHR, 1.87; 95% CI, 1.38–2.54), and infertility (aHR, 1.85; 95% CI, 1.27–2.68). The PID risk was higher for women with 2 or more positive CT tests than those with 1 positive test. PID risk increased with the number of previous antibiotic prescriptions, regardless of CT test status. Conclusions We showed an association between CT-positive tests and 3 adverse reproductive health outcomes. Moreover, this risk increased with repeat CT infections. CT-effective antibiotic use showed no decreased risks of subsequent PID regardless of CT history. Our results confirm the reproductive health burden of CT, which requires adequate public health interventions.
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Affiliation(s)
- Casper D J den Heijer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Heerlen.,Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Heerlen
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Heerlen.,Department of Medical Microbiology,Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+ (MUMC+), Maastricht
| | - Johanna H M Driessen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Heerlen.,Department of Clinical Pharmacy and Toxicology CAPHRI, School for Nutrition and Translational Research in Metabolism, MUMC+, Maastricht
| | - Petra Wolffs
- Department of Medical Microbiology,Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+ (MUMC+), Maastricht
| | - Ingrid V F van den Broek
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Bernice M Hoenderboom
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Rachael Williams
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, United Kingdom
| | - Frank de Vries
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Heerlen.,Department of Clinical Pharmacy and Toxicology CAPHRI, School for Nutrition and Translational Research in Metabolism, MUMC+, Maastricht
| | - Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Heerlen.,Department of Medical Microbiology,Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+ (MUMC+), Maastricht
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Reekie J, Donovan B, Guy R, Hocking JS, Kaldor JM, Mak DB, Pearson S, Preen D, Wand H, Ward J, Liu B. Trends in chlamydia and gonorrhoea testing and positivity in Western Australian Aboriginal and non-Aboriginal women 2001-2013: a population-based cohort study. Sex Health 2019. [PMID: 28648150 DOI: 10.1071/sh16207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study aimed to examine trends in chlamydia and gonorrhoea testing and positivity in Aboriginal and non-Aboriginal women of reproductive age. METHODS A cohort of 318002 women, born between 1974 and 1995, residing in Western Australia (WA) was determined from birth registrations and the 2014 electoral roll. This cohort was then probabilistically linked to all records of chlamydia and gonorrhoea nucleic acid amplification tests conducted by two large WA pathology laboratories between 1 January 2001 and 31 December 2013. Trends in chlamydia and gonorrhoea testing and positivity were investigated over time and stratified by Aboriginality and age group. RESULTS The proportion of women tested annually for chlamydia increased significantly between 2001 and 2013 from 24.5% to 36.6% in Aboriginal and 4.0% to 8.5% in non-Aboriginal women (both P-values <0.001). Concurrent testing was high (>80%) and so patterns of gonorrhoea testing were similar. Chlamydia and gonorrhoea positivity were substantially higher in Aboriginal compared with non-Aboriginal women; age-, region- and year-adjusted incidence rate ratios were 1.52 (95% confidence interval (CI) 1.50-1.69, P<0.001) and 11.80 (95% CI 10.77-12.91, P<0.001) respectively. Chlamydia positivity increased significantly in non-Aboriginal women aged 15-19 peaking in 2011 at 13.3% (95% CI 12.5-14.2%); trends were less consistent among 15-19-year-old Aboriginal women but positivity also peaked in 2011 at 18.5% (95% CI 16.9-20.2%). Gonorrhoea positivity was 9.7% (95% CI 9.3-10.1%), 6.7% (95% CI 6.4-7.0%), 4.7% (4.4-5.0%), and 3.1% (2.8-3.4%) among Aboriginal women aged respectively 15-19, 20-24, 25-29 and ≥30 years, compared with <1% in all age groups in non-Aboriginal women. Over time, gonorrhoea positivity declined in all age groups among Aboriginal and non-Aboriginal women. CONCLUSION Between 2001 and 2013 in WA chlamydia and gonorrhoea positivity remained highest in young Aboriginal women despite chlamydia positivity increasing among young non-Aboriginal women. More effective prevention strategies, particularly for young Aboriginal women, are needed to address these disparities.
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Affiliation(s)
- Joanne Reekie
- Kirby Institute, UNSW Sydney, High Street, Sydney, NSW 2052, Australia
| | - Basil Donovan
- Kirby Institute, UNSW Sydney, High Street, Sydney, NSW 2052, Australia
| | - Rebecca Guy
- Kirby Institute, UNSW Sydney, High Street, Sydney, NSW 2052, Australia
| | - Jane S Hocking
- School of Population and Global Health, University of Melbourne, Bouverie Street, Melbourne, Vic. 3053, Australia
| | - John M Kaldor
- Kirby Institute, UNSW Sydney, High Street, Sydney, NSW 2052, Australia
| | - Donna B Mak
- School of Medicine, The University of Notre Dame, Henry Street, Fremantle, WA 6160, Australia
| | - Sallie Pearson
- Faculty of Pharmacy and School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - David Preen
- Centre for Health Services Research, Stirling Highway, University of Western Australia, Perth, WA 6009, Australia
| | - Handan Wand
- Kirby Institute, UNSW Sydney, High Street, Sydney, NSW 2052, Australia
| | - James Ward
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia
| | - Bette Liu
- School of Public Health and Community Medicine, UNSW Sydney, Samuels Avenue, Sydney, NSW 2052, Australia
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Yan RL, Ye YF, Fan QY, Huang YH, Wen GC, Li LM, Cai YM, Feng TJ, Huang ZM. Chlamydia trachomatis infection among patients attending sexual and reproductive health clinics: A cross-sectional study in Bao'an District, Shenzhen, China. PLoS One 2019; 14:e0212292. [PMID: 30779755 PMCID: PMC6380618 DOI: 10.1371/journal.pone.0212292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/30/2019] [Indexed: 11/26/2022] Open
Abstract
This study aimed to estimate the prevalence of chlamydial trachomatis (CT) infection and explore its risk factors among patients attending sexual and reproductive health clinics in Shenzhen, China. We collected demographic and clinical information from attendees (aged 18–49). CT and Neisseria gonorrhoeae (NG) infection was determined by nucleic acid amplification test (NAAT) on self-collected urine specimens. Of 1,938 participants recruited, 10.3% (95% confidence interval [CI]: 9.6%-11.0%) tested positive for CT. Prevalence was similar between men (10.6% [85/804]; 95% CI, 9.5%–11.7%) and women (10.1% [115/1134]; 95% CI: 9.2%–11.0%). Being 18–25 years old (adjusted odds ratio [aOR] = 2.52; 95%CI:1.35–4.71), never tested for CT before (aOR = 2.42; 95%CI: 1.05–5.61) and infected with NG(aOR = 3.87; 95%CI: 2.10–7.10) were independently associated with CT infection. We found that CT infection is prevalent among patients attending sexual and reproductive health clinics in Shenzhen, China. A comprehensive program including CT screening, surveillance and treatment is urgently needed.
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Affiliation(s)
- Rui-Lin Yan
- Shenzhen Baoan Center for Chronic Disease Control, Shenzhen, China
| | - Yun-Feng Ye
- Shenzhen Baoan Center for Chronic Disease Control, Shenzhen, China
| | - Qin-Ying Fan
- Shenzhen Baoan Center for Chronic Disease Control, Shenzhen, China
| | - Yan-Hui Huang
- Shenzhen Baoan Center for Chronic Disease Control, Shenzhen, China
| | - Gui-Chun Wen
- Shenzhen Baoan Center for Chronic Disease Control, Shenzhen, China
| | - Li-Mei Li
- Shenzhen Baoan Center for Chronic Disease Control, Shenzhen, China
| | - Yu-Mao Cai
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Tie-Jian Feng
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Zhi-Ming Huang
- Shenzhen Baoan Center for Chronic Disease Control, Shenzhen, China
- * E-mail:
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Douglass CH, Vella AM, Hellard ME, Lim MSC. Correlates of sexually transmissible infection testing among a sample of at-risk young Australians. Aust J Prim Health 2017; 23:272-277. [PMID: 28424143 DOI: 10.1071/py16115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/03/2017] [Indexed: 11/23/2022]
Abstract
Annual chlamydia testing is recommended for all sexually active Australians aged 15-29 years; however, the testing rate is below recommended levels. Three surveys at a Melbourne music festival were conducted over 2012-14 to identify correlates of sexually transmissible infection (STI) testing among young people at risk of STIs. In total, 3588 participants were recruited; 72% reported having sex in the past year. Based on sexual behaviours, 38% of sexually active participants were classified as at risk of contracting STIs. In the past year, at-risk participants had significantly higher odds of reporting a STI test (37%) than participants classified as not at risk (24%) (OR=1.9; CI=1.6-2.3). Among at-risk participants, correlates of STI testing in the past year included being aged 20-24 years, visiting a GP, higher knowledge levels, earlier sexual debut and reporting more than five lifetime partners. Testing rates in our sample did not meet levels required to reduce chlamydia prevalence. However, the testing rate was higher in at-risk participants than participants who were not at risk. Future programs aiming to increase chlamydia testing should improve knowledge and promote the importance of testing after risk exposure, particularly among 16- to 19-year-olds.
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Affiliation(s)
- Caitlin H Douglass
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Alyce M Vella
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Margaret E Hellard
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Megan S C Lim
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
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Kridin K, Khamaisi M, Rishpon S, Grifat R. Striking ethnic variations in the epidemiology of Chlamydia trachomatis in Haifa District, Israel, throughout the years 2001-2015. Int J STD AIDS 2017; 28:1389-1396. [PMID: 28497706 DOI: 10.1177/0956462417706857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our objectives were to examine trends in the incidence of chlamydia over an extended period and compare the epidemiology of the infection between two distinct ethnic groups in Israel: Jews and Arabs. We examined the incidence rate of Chlamydia trachomatis infection among residents of Haifa District, northern Israel from 2001 to 2015, by reviewing archives of the Department of Epidemiology, Ministry of Health. Notified cases were stratified by age group, gender, and ethnic group. The overall incidence rate of Chlamydia was 10.8 cases per 100,000 population per year. The annual rate increased dramatically from 5.1 per 100,000 population in 2001, to an all-time high of 18.5 cases per 100,000 population in 2015 (P < 0.001), representing an increase of 362.7%. The most affected age group was 25-34 years of age. The estimated rate among Jewish inhabitants was ninefold higher than among Arabs. Only 3% recurrent episodes of Chlamydia were registered. The prevalence of HIV positivity among Chlamydia-infected patients was similar to that of the general population. In conclusion, Chlamydia in Haifa has been continuously increasing since 2001 and the infection is much more prevalent among patients of Jewish ethnicity, mainly due to more hazardous sexual practices in this population.
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Affiliation(s)
- Khalaf Kridin
- 1 Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
| | - Mogher Khamaisi
- 2 Institute of Endocrinology, Diabetes and Metabolism and Internal Medicine D, Rambam Health Care Campus, Haifa, Israel.,3 Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shmuel Rishpon
- 4 Haifa District Office, Ministry of Health, Haifa, Israel
| | - Rami Grifat
- 4 Haifa District Office, Ministry of Health, Haifa, Israel
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Stephens N, Coleman D, Shaw K, O'Sullivan M, Vally H, Venn A. Exploration of testing practices and population characteristics support an increase in chlamydia positivity in Tasmania between 2001 and 2010. Aust N Z J Public Health 2015; 40:362-7. [PMID: 26713515 DOI: 10.1111/1753-6405.12502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/01/2015] [Accepted: 10/01/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The proportion of positive chlamydia tests in young people in Tasmania increased significantly between 2001 and 2010. While female positivity rates increased steadily, male positivity rose steeply to 2005 then stabilised. Crude positivity rates can be influenced by a variety of factors making interpretation difficult. Unique Tasmanian datasets were used to explore whether symptom status, reason for testing or sexual exposure could explain the observed positivity trends. METHODS Population-level chlamydia positivity rates in Tasmania over a 10-year period were compared with surveillance data collected on people aged 15 to 29 years notified with chlamydia. RESULTS The proportion of asymptomatic chlamydia cases increased, with the largest increase in males aged 15 to 19 years (28%). Opportunistic testing of cases increased (greatest in males, range 17-32%). Sexual exposure remained consistent. CONCLUSIONS After allowing for any changes in sexual exposure, symptom status and reason for testing, an increase in chlamydia positivity occurred over the 10 years. Healthcare providers have increased chlamydia testing in high-risk groups. IMPLICATIONS Monitoring chlamydia testing patterns and positivity rates at a population level is a step forward in surveillance practices. Targeted surveys provide valuable information to supplement routine surveillance data.
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Affiliation(s)
- Nicola Stephens
- Communicable Disease Epidemiology and Surveillance, Department of Health and Human Services Victoria.,Menzies Institute for Medical Research, University of Tasmania
| | - David Coleman
- Communicable Disease Epidemiology and Surveillance, Department of Health and Human Services Victoria
| | - Kelly Shaw
- Population Epidemiology, Department of Health and Human Services Tasmania
| | | | - Hassan Vally
- Faculty of Health Sciences, La Trobe University, Victoria
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania
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7
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Antibiotic use before chlamydia and gonorrhea genital and extragenital screening in the sexually transmitted infection clinical setting. Antimicrob Agents Chemother 2014; 59:121-8. [PMID: 25313220 DOI: 10.1128/aac.03932-14] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background antibiotic use (i.e., administration of antibiotics not directly related to Chlamydia trachomatis or Neisseria gonorrhoeae infections) has been associated with a lower prevalence of genital C. trachomatis infection in a clinical setting. Associations with specific antibiotic types or with N. gonorrhoeae are lacking. Here, we assessed the prevalence of antibiotic use, the different classes and agents used, and their association with a subsequent sexually transmitted infection (STI) clinic C. trachomatis and N. gonorrhoeae test result. At our STI clinic, we systematically registered whether antibiotics were used in the past month (in 29% of the cases, the specific antibiotic agent was named). Patients were screened for urogenital C. trachomatis and N. gonorrhoeae; a third of them were also screened for anorectal and oropharyngeal C. trachomatis and N. gonorrhoeae. The proportion of antibiotics used and their association with C. trachomatis and N. gonorrhoeae prevalence were assessed for heterosexual men, men who have sex with men (MSM), and women. During 14,775 clinic consultations, antibiotic use was reported by 12.2% (95% confidence interval [CI], 11.7% to 12.7%), i.e., 14.8% of women, 8.6% of heterosexual men, and 11.6% of MSM. The most reported antibiotics were penicillins, tetracyclines, and macrolides, respectively. The prevalence was 11.0% (95% CI, 10.3% to 11.3%) for C. trachomatis and 1.9% (95% CI, 1.7% to 2.1%) for N. gonorrhoeae. Only tetracycline use was associated with a lower C. trachomatis prevalence (3%). Overall antibiotic use was associated with lower anorectal C. trachomatis prevalence in MSM only (odds ratio, 0.4; 95% CI, 0.2 to 0.8). STI clinic visitors commonly report recent antibiotic use. Even in a country with low antibiotic consumption, tetracycline use impacted C. trachomatis prevalence, while there was a notable absence of association with azithromycin.
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Dimech W, Lim MSC, Van Gemert C, Guy R, Boyle D, Donovan B, Hellard M. Analysis of laboratory testing results collected in an enhanced chlamydia surveillance system in Australia, 2008-2010. BMC Infect Dis 2014; 14:325. [PMID: 24920016 PMCID: PMC4061452 DOI: 10.1186/1471-2334-14-325] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 06/06/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Chlamydial infection is the most common notifiable disease in Australia, Europe and the US. Australian notifications of chlamydia rose four-fold from 20,274 cases in 2002 to 80,846 cases in 2011; the majority of cases were among young people aged less than 29 years. Along with test positivity rates, an understanding of the number of tests performed and the demographics of individuals being tested are key epidemiological indicators. The ACCESS Laboratory Network was established in 2008 to address this issue. METHODS The ACCESS Laboratory Network collected chlamydia testing data from 15 laboratories around Australia over a three-year period using data extraction software. All chlamydia testing data from participating laboratories were extracted from the laboratory information system; patient identifiers converted to a unique, non-reversible code and de-identified data sent to a single database. Analysis of data by anatomical site included all specimens, but in age and sex specific analysis, only one testing episode was counted. RESULTS From 2008 to 2010 a total of 628,295 chlamydia tests were referred to the 15 laboratories. Of the 592,626 individual episodes presenting for testing, 70% were from female and 30% from male patients. In female patients, chlamydia positivity rate was 6.4% overall; the highest rate in 14 year olds (14.3%). In male patients, the chlamydia positivity rate was 9.4% overall; the highest in 19 year olds (16.5%). The most common sample type was urine (57%). In 3.2% of testing episodes, multiple anatomical sites were sampled. Urethral swabs gave the highest positivity rate for all anatomical sites in both female (7.7%) and male patients (14%), followed by urine (7.6% and 9.4%, respectively) and eye (6.3% and 7.9%, respectively). CONCLUSIONS The ACCESS Laboratory Network data are unique in both number and scope and are representative of chlamydia testing in both general practice and high-risk clinics. The findings from these data highlight much lower levels of testing in young people aged 20 years or less; in particular female patients aged less than 16 years, despite being the group with the highest positivity rate. Strategies are needed to increase the uptake of testing in this high-risk group.
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Affiliation(s)
- Wayne Dimech
- NRL, 4th Floor Healy Building, 41 Victoria Parade, Fitzroy 3065, Australia
| | - Megan SC Lim
- Burnet Institute, Centre for Population Health, 85 Commercial Road, Melbourne, Victoria 3004, Australia
- Monash University, School of Population Health and Preventive Medicine, 99 Commercial Rd, Melbourne 3004, Australia
| | - Caroline Van Gemert
- Burnet Institute, Centre for Population Health, 85 Commercial Road, Melbourne, Victoria 3004, Australia
- Monash University, School of Population Health and Preventive Medicine, 99 Commercial Rd, Melbourne 3004, Australia
| | - Rebecca Guy
- The Kirby Institute, Sexual Health Program, University of New South Wales, Sydney, NSW 2052, Australia
| | - Douglas Boyle
- GRHANITE Health Informatics Unit, Rural Health Academic Centre, Melbourne Medical School, University of Melbourne, 49 Graham Street, Shepparton, Victoria 3630, Australia
| | - Basil Donovan
- The Kirby Institute, Sexual Health Program, University of New South Wales, Sydney, NSW 2052, Australia
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW 2000, Australia
| | - Margaret Hellard
- Burnet Institute, Centre for Population Health, 85 Commercial Road, Melbourne, Victoria 3004, Australia
- Monash University, School of Population Health and Preventive Medicine, 99 Commercial Rd, Melbourne 3004, Australia
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9
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Lim MSC, El‐Hayek C, Goller JL, Fairley CK, Nguyen PLT, Hamilton RA, Henning DJ, McNamee KM, Hellard ME, Stoove MA. Trends in chlamydia positivity among heterosexual patients from the Victorian Primary Care Network for Sentinel Surveillance, 2007–2011. Med J Aust 2014; 200:166-9. [DOI: 10.5694/mja13.10108] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 08/22/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Megan S C Lim
- Centre for Population Health, Burnet Institute, Melbourne, VIC
| | - Carol El‐Hayek
- Centre for Population Health, Burnet Institute, Melbourne, VIC
| | - Jane L Goller
- Centre for Population Health, Burnet Institute, Melbourne, VIC
| | - Christopher K Fairley
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
- Melbourne Sexual Health Centre, Melbourne, VIC
| | | | | | - Dorothy J Henning
- Young People's Health Service, Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC
| | - Kathleen M McNamee
- Family Planning Victoria, Melbourne, VIC
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC
| | | | - Mark A Stoove
- Centre for Population Health, Burnet Institute, Melbourne, VIC
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10
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Forcey DS, Hocking JS, Tabrizi SN, Bradshaw CS, Chen MY, Fehler G, Nash JL, Fairley CK. Chlamydia detection during the menstrual cycle: a cross-sectional study of women attending a sexual health service. PLoS One 2014; 9:e85263. [PMID: 24475042 PMCID: PMC3903481 DOI: 10.1371/journal.pone.0085263] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/25/2013] [Indexed: 12/03/2022] Open
Abstract
Background We investigated the detection of chlamydia at different stages of the menstrual cycle. Methods Electronic medical records for women attending Melbourne Sexual Health Centre between March 2011 and 31st December 2012, who were tested for chlamydia by nucleic acid amplification of high vaginal, cervical, or urinary samples, and who recorded a date of last normal menstrual period (LNMP) between 0–28 days were included in the analysis. Logistic regression was used to calculate adjusted odds ratio (aOR) and 95% confidence intervals (CI) for the association of chlamydia with menstrual cycle adjusted by demographics and behavioural variables. Chlamydia and beta globin load were determined on those with stored samples. Results Of the 10,017 consultations that included a test for chlamydia and a valid LNMP, there were 417 in which chlamydia was detected. The proportion of samples with chlamydia was greater in the luteal phase (4.8%, 184/3831) than in the follicular phase (3.4%, 233/6816) both in the crude (OR 1.29 95%CI 1.1–1.6, p = 0.01) and adjusted odds ratio (aOR) 1.4 (95%CI 1.1–1.8, p = 0.004). Among women using hormonal contraception, there was no significant association with the luteal phase of the menstrual cycle (aOR 1.3, 95%CI 0.9, 1.8, p = 0.18). Among women not using hormonal contraception, there was a significant association with the luteal phase (aOR 1.6, (95% CI 1.1–2.3, p = 0.007). The chlamydia load was not significantly different in the 329 positive stored samples in weeks 3 and 4 vs weeks 1 and 2 for any site (P>0.12). Conclusions The higher detection of chlamydia detection in the luteal phase of the menstrual cycle in only those not taking hormonal contraception suggest that hormonal factors influence chlamydia detection. The absence of a significantly highly chlamydia load in women during the luteal phase raises questions about the mechanism.
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Affiliation(s)
- Dana S. Forcey
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane S. Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sepehr N. Tabrizi
- Department of Clinical Microbiology and Infectious Diseases, Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Catriona S. Bradshaw
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Marcus Y. Chen
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Glenda Fehler
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jessica L. Nash
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- * E-mail:
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11
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Hocking JS, Guy R, Walker J, Tabrizi SN. Advances in sampling and screening for chlamydia. Future Microbiol 2013; 8:367-86. [PMID: 23464373 DOI: 10.2217/fmb.13.3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chlamydia is the most commonly diagnosed bacterial sexually transmitted infection in the developed world, with diagnosis rates continuing to increase each year. As chlamydia is largely asymptomatic, screening and treatment is the main way to detect cases and reduce transmission. Recent advances in self-collected specimens and laboratory tests has made chlamydia screening easier to implement as well as possible in nonclinical settings. This review will discuss new approaches to specimen collection and how these have expanded opportunities for reaching target populations for chlamydia screening. Furthermore, it will discuss how advanced molecular microbiological methods can be used with self-collected specimens to further our knowledge of the epidemiology of chlamydia and the dynamics of transmission.
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Affiliation(s)
- Jane S Hocking
- Centre for Women's Health, Gender & Society, University of Melbourne, Victoria, Australia
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Al-Thani A, Abdul-Rahim H, Alabsi E, Bsaisu HN, Haddad P, Mumtaz GR, Abu-Raddad LJ. Prevalence of Chlamydia trachomatis infection in the general population of women in Qatar. Sex Transm Infect 2013; 89 Suppl 3:iii57-60. [PMID: 23863874 PMCID: PMC3841785 DOI: 10.1136/sextrans-2013-051169] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objectives The Arabian Gulf region has limited epidemiological data related to sexually transmitted infections. The objective of this study was to estimate the prevalence of Chlamydia trachomatis infection among general population women in Doha, Qatar. Methods Endocervical swabs were collected from healthy women attending primary healthcare centres in Doha, June–December 2008. The specimens were tested for C trachomatis by a commercially available PCR-based assay. Data on basic socio-demographic characteristics, medical history and sexual behaviour were obtained using self-administered questionnaires. The prevalence of C trachomatis and of background variables were stratified by nationality, Qatari nationals versus non-Qatari residents. Results A total of 377 women were enrolled in the study, out of whom 351 (37.9% Qataris, 62.1% non-Qataris) were tested for the presence of C trachomatis in their specimens. The mean age of participants was 41.2 years, and the vast majority (93%, 95% CI 90.3 to 95.7) were married. The mean age at sexual debut was significantly lower among Qatari women compared with non-Qatari women (19.2 vs 22.2 years, respectively p<0.001), but the mean number of reported lifetime sexual partners (1.1 partner) was nearly the same in both groups (p=0.110). The prevalence of C trachomatis infection was 5.3% among Qatari women and 5.5% among non-Qatari women, with no statistically significant difference between both groups (p=0.923). Conclusions The prevalence of C trachomatis among women was higher than expected, with no significant difference between Qatari nationals and expatriate residents. The higher prevalence may reflect, in part, the limited access to and use of chlamydia screening and management.
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Affiliation(s)
- Asma Al-Thani
- Department of Health Sciences, College of Arts and Sciences, Qatar University, , Doha, Qatar
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Ali H, Donovan B, Liu B, Hocking JS, Agius P, Ward J, Bourne C, Kaldor JM, Guy RJ. Chlamydia prevention indicators for Australia: review of the evidence from New South Wales. Sex Health 2013; 9:399-406. [PMID: 22950949 DOI: 10.1071/sh11183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 03/19/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Annual notifications of chlamydia (Chlamydia trachomatis) diagnoses have increased steadily in Australia in the last decade. To guide public health programs, we developed 10 national chlamydia prevention indicators and report on each indicator for New South Wales (NSW). METHODS Using systematic methods, we reviewed the literature to report on the 10 health and behaviour indicators for 15- to 29-year-old heterosexuals in NSW from 2000. We included data with two or more time points. RESULTS Chlamydia notification rates (Indicator 1) in 15- to 29-year-olds have increased by 299%, from 237 per 100000 population in 2001 to 946 per 100000 population in 2010; and the percent of 15- to 34-year-olds with an annual Medicare-rebated chlamydia test (Indicator 2) increased by 326%, from 1.9% in 2001 to 8.1% in 2010. Since 2004, sentinel surveillance showed a 28% increase in chlamydia prevalence (Indicator 3) in 15- to 29-year-old females tested at their first sexual health service visit (from 8.5% in 2004 to 10.9% in 2010) but no significant increase in males. No NSW-specific chlamydia incidence (Indicator 4) was available. Pelvic inflammatory disease hospitalisation separations rate decreased from 0.58 per 1000 in 2001 to 0.44 per 1000 in 2010 in 15- to 29-year-old females (Indicator 5).Secondary school surveys in 2002 and 2008 showed chlamydia knowledge increased in males. The sexual risk-taking behaviour of young people remained unchanged (Indicators 6-10). CONCLUSIONS Although notifications have risen steeply, the modest increase in chlamydia prevalence maybe a more realistic reflection of transmission rates. Strategies are needed to increase testing and to modify sexual risk behaviour. Crucial gaps in epidemiological data were identified.
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Affiliation(s)
- Hammad Ali
- The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia.
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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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Aubin F. Vaccination contre le papillomavirus humain : état des lieux. Ann Dermatol Venereol 2012; 139:339-43. [DOI: 10.1016/j.annder.2012.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Su JY, Condon JR. Trends in testing and notification for genital gonorrhoea in a northern Australian district, 2004 - 2008. Sex Health 2012; 9:384-8. [DOI: 10.1071/sh11113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 02/07/2012] [Indexed: 11/23/2022]
Abstract
Background The study aimed to examine the trends in notification and testing for genital gonorrhoea (Neisseria gonorrhoeae) in the Darwin Remote District of Northern Territory, Australia, between 2004 and 2008. Methods: Using laboratory testing data and notification data, we calculated the annual sex- and age-specific notification rates, testing rates and positivity rates, and examined their trends. A deterministic matching method was used to identify unique individuals tested in order to estimate the number of years out of five in which each individual was tested. The correlation between testing rates and notification rates was calculated. Results: The notification rates for the 15–24 year age group increased sharply from 2004 to 2005, and then trended downwards between 2005 and 2008, with a decrease of 48.2% in females and 59.9% in males. No evident trends were found in testing rates. The positivity rates for this age group decreased by 46.3% in females (from 8.9% to 4.8%), and by 70.4% in males (from 10.8% to 3.2%) between 2004 and 2008. Over 76% of the population in this age-group had been tested at least once during the study period. A moderate correlation was found between notification rates and testing rates in both sexes. Conclusions: There was a significant decreasing trend in the notification rate of gonorrhoea between 2005 and 2008, which was most probably due to a decrease in prevalence. This study demonstrates the importance and utility of population-level testing data in understanding the epidemiology of common bacterial sexually transmissible infections such as gonorrhoea.
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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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Vodstrcil LA, Fairley CK, Fehler G, Leslie D, Walker J, Bradshaw CS, Hocking JS. Trends in chlamydia and gonorrhea positivity among heterosexual men and men who have sex with men attending a large urban sexual health service in Australia, 2002-2009. BMC Infect Dis 2011; 11:158. [PMID: 21639943 PMCID: PMC3138447 DOI: 10.1186/1471-2334-11-158] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 06/05/2011] [Indexed: 11/11/2022] Open
Abstract
Background To determine whether chlamydia positivity among heterosexual men (MSW) and chlamydia and gonorrhea positivity among men who have sex with men (MSM), are changing. Methods Computerized records for men attending a large sexual health clinic between 2002 and 2009 were analyzed. Chlamydia and gonorrhea positivity were calculated and logistic regression used to assess changes over time. Results 17769 MSW and 8328 MSM tested for chlamydia and 7133 MSM tested for gonorrhea. In MSW, 7.37% (95% CI: 6.99-7.77) were chlamydia positive; the odds of chlamydia positivity increased by 4% per year (OR = 1.04; 95% CI: 1.01-1.07; p = 0.02) after main risk factors were adjusted for. In MSM, 3.70% (95% CI: 3.30-4.14) were urethral chlamydia positive and 5.36% (95% CI: 4.82-5.96) were anal chlamydia positive; positivity could not be shown to have changed over time. In MSM, 3.05% (95% CI: 2.63-3.53) tested anal gonorrhea positive and 1.83% (95% CI: 1.53-2.18) tested pharyngeal gonorrhea positive. Univariate analysis found the odds of anal gonorrhea positivity had decreased (OR = 0.93; 95% CI: 0.87-1.00; p = 0.05), but adjusting for main risk factors resulted in no change. Urethral gonorrhea cases in MSM as a percentage of all MSM tested for gonorrhea also fell (p < 0.001). Conclusions These data suggest that chlamydia prevalence in MSW is rising and chlamydia and gonorrhea prevalence among MSM is stable or declining. High STI testing rates among MSM in Australia may explain differences in STI trends between MSM and MSW.
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Affiliation(s)
- Lenka A Vodstrcil
- Melbourne School of Population Health, The University of Melbourne, Vic, Australia
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Yeung A, Bush M, Cummings R, Bradshaw CS, Chen M, Williams H, Denham I, Fairley CK. Use of computerized medical records to determine the feasibility of testing for chlamydia without patients seeing a practitioner. Int J STD AIDS 2011; 21:755-7. [PMID: 21187357 DOI: 10.1258/ijsa.2010.010220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The proportion of clinically important diagnoses in a low-risk, asymptomatic population who use a computer-assisted self-interview (CASI) to assess risk was needed to determine optimal health service delivery. Medical records were retrospectively analysed between July 2008 and June 2009 for risk characteristics and diagnoses. A total of 7733 new patients completed a CASI, of whom 1060 were asymptomatic heterosexuals. From this low-risk group, 26 diagnoses were made on the day of presentation, including 22 cases of genital warts (2.08% [95% confidence interval (CI) 1.22-2.93]), three cases of genital herpes (0.28% [95% CI 0.055-0.82]) and one case of unintended pregnancy (0.094% [95% CI 0.0061-0.52]). Additionally, there were 54 cases of chlamydia detected (5.09% [95% CI 3.77-6.42]). As chlamydia is effectively diagnosed and managed from self-collected samples, patient review is not always required. This study provides evidence for an express testing service for chlamydia to streamline the screening of low-risk, asymptomatic heterosexual patients as identified by CASI without the need to for a traditional face-to-face consultation.
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Affiliation(s)
- A Yeung
- Sexual Health Unit, School of Population Health, The University of Melbourne, Australia
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