Qualitative analysis of psychosocial impact of diagnosis of Chlamydia trachomatis: implications for screening

Disclosure of Sexually Transmitted Infections to Sexual Partners: A Systematic Critical Literature Review

The purpose of this review was to systematically and critically evaluate the STI disclosure literature (excluding HIV disclosure literature), summarize limitations and omissions, and identify opportunities for future research. We used the Health Disclosure Decision-Making Model (DD-MM) as a guiding theoretical framework. Following PRISMA guidelines, database searches using key terms identified 387 possible articles, 32 of which ultimately met inclusion criteria for this review. Findings indicated that individuals with STIs experience a variety of negative feelings and emotions related to the prospect of disclosure. Reasons for disclosure included moral obligation, love for partner, and desire for support, whereas reasons to not disclose included fears about partner's reaction and response, fears of being rejected or broken up with, and beliefs about the lack of obligation. Disclosers used a variety of disclosure strategies, including priming messages, framing, and direct disclosure. Non-disclosers used strategies to pass as uninfected (i.e. passing), withdraw from relationships, and using outbreaks to time sexual activity. Among studies that examined disclosure timing, around half or fewer individuals disclosed or believed they should disclose prior to engaging in sexual activity. The findings indicated that relationship-related factors such as greater levels of commitment, relationship quality, length together, and feelings of closeness were important predictors of disclosure. Finally, some individuals experienced negative partner responses, whereas others experienced positive responses and relationship outcomes. Our review revealed that the experiences of receivers of STI disclosures are not well-represented in the literature. Implications for future research, education, and intervention are specified.

Cyberchondria levels in women with human papilloma virus

AIM

To investigate the level of cyberchondria in patients with high-risk human papilloma virus (HPV) positivity.

METHODS

One hundred and forty women who applied to our clinic between July 2020 and September 2020 and were diagnosed with high-risk HPV positivity or abnormal uterine bleeding (AUB) were included in the study. The Cyberchondria Severity Scale (CSS) was administered face-to-face to the participants. CSS and subscales scores of both groups of patients were evaluated and compared.

RESULTS

The mean score of the patients on the CSS was 78.54 ± 22.09 and the patients with AUB and HPV(+) was 67.43 ± 19.87 and 84.16 ± 21.08, respectively. The mean subscale scores were as follows, compulsion 13.89 ± 6.49, distress 20.07 ± 7.54, excessiveness 22.40 ± 8.18, reassurance 15.07 ± 6.56, and mistrust of medical professionals 7.26 ± 3.62. The mean scores of the CSS and subscales except for the mistrust of medical professional subscale were higher in patients who were HPV-positive than in other patients.

CONCLUSIONS

Women with HPV have higher levels of cyberchondria. Medical professionals can reduce this anxiety by giving information to patients.

Psychological health and well-being in patients with sexually transmitted infections: A prospective cross-sectional study

Background

Patients with sexually transmitted infections (STIs) suffer not only with the physical problems but also with various psychological problems. Majority of bacterial STIs are treatable in a short period, while viral STIs may persist for longer duration or have frequent recurrences.

Aims and Objectives

The aim of the study was To study different aspects of psychological health and well-being in patients with STIs.

Materials and Methods

Study design was a prospective cross-sectional hospital-based study. Data were collected during July 2016-April 2018. STIs were divided into four groups (genital herpes, genital warts, and genital discharge and syphilis). One way analysis of variance and Scheffe Test were used for analysis of the data.

Results

A total of 410 patients were included in the study. Majority of patients were suffering with genital herpes (139), followed by warts (104), discharge (92), and syphilis (75). Genital herpes and genital warts indicated significantly more cognitive affective (CA) depression as compared to the patients suffering with syphilis. Satisfaction with life was more with genital discharge and syphilis in comparison to the patients with genital warts and genital herpes. Genital herpes showed more perceived stress in comparison to genital discharge. Genital warts indicated more somatic depression as compared to syphilis and genital discharge patients while genital herpes showed more somatic depression than in patients suffering with genital discharge. Genital warts and genital herpes indicated significantly more overall depression as compared to the patients suffering with syphilis.

Conclusion

Overall depression was more in patients with genital herpes and warts. The findings provide empirical bases for extended studies on behavioral intervention programs.

The syndemic condition of psychosocial problems related to depression among sexually transmitted infections patients

BACKGROUND

The prevalence of depression in sexually transmitted infections (STIs) patients is much higher than general public. However, studies focusing on comprehensive psychosocial effects on depression among STIs patients are limited. This study aimed to examine association of multiple psychosocial syndemic conditions with depression among STIs patients in Shanghai, China.

METHODS

We conducted a cross-sectional study and recruited 910 STIs patients from Shanghai Skin Disease Hospital. Participants self-reported their demographics and themselves completed the scales of depression, self-esteem, loneliness, social support, entrapment, defeat and interpersonal needs. Logistic regressions were performed to detect the possible contributing psychosocial factors for depression and to verify the syndemic conditions of psychosocial problems.

RESULTS

Of the STIs patient sample, the prevalence of depression was 17.9%. Multivariable analysis showed low-level self-esteem (odds ratio [ORm]: 2.18, 95% CI [1.19-4.00]) and social support (ORm: 2.18, 95% CI [1.37-3.46]), high-level entrapment (ORm: 6.31, 95% CI [3.75-10.62]) and defeat (ORm: 2.60, 95% CI [1.51-4.48]) increased the risk of depression. Psychosocial syndemic conditions magnified effect in fusing depression (adjusted odds ratio [AOR]: 11.94, 95% CI [7.70-18.53]). Participants with more than 4 psychosocial problems were about 22 times more likely to have depression (AOR: 22.12, 95% CI [13.19-37.09]).

CONCLUSIONS

The psychosocial problems syndemic magnifying the risk of depression was confirmed and psychosocial interventions to prevent depression is needed among STIs patients.

Screening for chlamydia and/or gonorrhea in primary health care: systematic reviews on effectiveness and patient preferences

BACKGROUND

We conducted systematic reviews on the benefits and harms of screening compared with no screening or alternative screening approaches for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in non-pregnant sexually active individuals, and on the relative importance patients' place on the relevant outcomes. Findings will inform recommendations by the Canadian Task Force on Preventive Health Care.

METHODS

We searched five databases (to January 24, 2020), trial registries, conference proceedings, and reference lists for English and French literature published since 1996. Screening, study selection, and risk of bias assessments were independently undertaken by two reviewers, with consensus for final decisions. Data extraction was conducted by one reviewer and checked by another for accuracy and completeness. Meta-analysis was conducted where appropriate. We used the GRADE approach to rate the certainty of the evidence. The Task Force and content experts provided input on determining thresholds for important effect sizes and on interpretation of findings.

RESULTS

Of 41 included studies, 17 and 11 reported on benefits and harms of screening, respectively, and 14 reported on patient preferences. Universal screening for CT in general populations 16 to 29 years of age, using population-based or opportunistic approaches achieving low screening rates, may make little-to-no difference for a female's risk of pelvic inflammatory disease (PID) (2 RCTs, n=141,362; 0.3 more in 1000 [7.6 fewer to 11 more]) or ectopic pregnancy (1 RCT, n=15,459; 0.20 more per 1000 [2.2 fewer to 3.9 more]). It may also not make a difference for CT transmission (3 RCTs, n=41,709; 3 fewer per 1000 [11.5 fewer to 6.9 more]). However, benefits may be achieved for reducing PID if screening rates are increased (2 trials, n=30,652; 5.7 fewer per 1000 [10.8 fewer to 1.1 more]), and for reducing CT and NG transmission when intensely screening high-prevalence female populations (2 trials, n=6127; 34.3 fewer per 1000 [4 to 58 fewer]; NNS 29 [17 to 250]). Evidence on infertility in females from CT screening and on transmission of NG in males and both sexes from screening for CT and NG is very uncertain. No evidence was found for cervicitis, chronic pelvic pain, or infertility in males from CT screening, or on any clinical outcomes from NG screening. Undergoing screening, or having a diagnosis of CT, may cause a small-to-moderate number of people to experience some degree of harm, mainly due to feelings of stigmatization and anxiety about future infertility risk. The number of individuals affected in the entire screening-eligible population is likely smaller. Screening may make little-to-no difference for general anxiety, self-esteem, or relationship break-up. Evidence on transmission from studies comparing home versus clinic screening is very uncertain. Four studies on patient preferences found that although utility values for the different consequences of CT and NG infections are probably quite similar, when considering the duration of the health state experiences, infertility and chronic pelvic pain are probably valued much more than PID, ectopic pregnancy, and cervicitis. How patients weigh the potential benefits versus harms of screening is very uncertain (1 survey, 10 qualitative studies); risks to reproductive health and transmission appear to be more important than the (often transient) psychosocial harms.

DISCUSSION

Most of the evidence on screening for CT and/or NG offers low or very low certainty about the benefits and harms. Indirectness from use of comparison groups receiving some screening, incomplete outcome ascertainment, and use of outreach settings was a major contributor to uncertainty. Patient preferences indicate that the potential benefits from screening appear to outweigh the possible harms. Direct evidence about which screening strategies and intervals to use, which age to start and stop screening, and whether screening males in addition to females is necessary to prevent clinical outcomes is scarce, and further research in these areas would be informative. Apart from the evidence in this review, information on factors related to equity, acceptability, implementation, cost/resources, and feasibility will support recommendations made by the Task Force.

SYSTEMATIC REVIEW REGISTRATION

International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42018100733 .

De-Sexualizing Partner Notification: A Qualitative Study on Chinese Young Adults with Chlamydia

Background: Chlamydia is common amongst the sexually active population in Hong Kong. As most cases are asymptomatic, partner notification may be helpful in controlling chlamydia. This study examined attitudes towards partner notification for chlamydia among Hong Kong Chinese youths in order to inform a culturally appropriate, patient-empowering sexual health service. Methods: Sixteen individuals (aged 20 to 31) who received a confirmed diagnosis of chlamydia within the previous twelve months of data collection were recruited from two community-based organizations between June and December 2017. Semi-structured individual interviews were conducted by a health psychologist. Results: Nine participants notified a total of eleven current and ex-partners. Seven participants did not notify their sexual partner(s). Our findings revealed how participants struggled with the discrediting sexual aspect of their infection, and how de-sexualizing the infection and selected disclosure facilitated partner notification and social acceptance. Perceived stigma regarding chlamydia however did not dissipate with their disclosure. Participants did not perceive lasting impact of chlamydia on their well-being as they thought they have much control over whether and how to disclose to their (future) partners. All participants agreed there was a pressing need to raise public awareness on this silent but highly prevalent sexually transmitted infection. Conclusions: Our findings illustrate the complex struggle behind communicating about chlamydia to one’s sexual partner and how strategizing the disclosure process served to circumvent embarrassment and foster testing of sexual partners.

'To be on the safe side': a qualitative study regarding users' beliefs and experiences of internet-based self-sampling for Chlamydia trachomatis and Neisseria gonorrhoeae testing

OBJECTIVES

In Sweden, an increasing number of tests for sexually transmitted infections are conducted. Self-sampling services are provided free of charge at the national eHealth website. Our aim was to obtain a deeper understanding of users' beliefs and experiences of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) self-sampling services.

METHODS

This qualitative study is part of the national project 'Internet-based chlamydia and gonorrhoea self-sampling test', conducted in Sweden. Individuals ordering a CT/NG self-sampling test at home from the eHealth website were invited to participate. Of the 114 individuals who agreed, a purposeful sample including 20 women and men aged 18-49 years (mean, 30.8 years) participated in a telephone interview in 2019.

RESULTS

The test service for CT/NG was highly appreciated by men and women of different ages. Round-the-clock accessibility, avoiding clinical visits, ease of use, confidentiality and a rapid test result were reasons for this appreciation. Language, uncertainty about the correct sampling procedure, unreliable postal services and concerns about handling of personal data were mentioned as barriers. Reasons for testing were checking after unprotected sex, symptoms, checking a partner's fidelity or a regular routine-'to be on the safe side'. Knowledge about the infections and their consequences was limited; some considered them severe, especially if they could threaten fertility, and others were less concerned. Disclosing an infection was described as emotionally stressful. Participants had high self-efficacy in relation to the test and would not hesitate to use the service again, even if it involved a cost.

CONCLUSIONS

Internet-based CT/NG self-sampling at home was highly appreciated and was used for individual health reasons, but also out of concern for others' health and for society as a whole. The benefits seem to outweigh the barriers, and the service may therefore continue to be widely offered.

Guidance on Expedited Partner Therapy: A Content Analysis of Informational Materials for Providers, Pharmacists, Patients, and Partners

BACKGROUND

The rates of sexually transmitted infections have steadily increased in the United States over the last 5 years. The Centers for Disease Control and Prevention has endorsed the use of expedited partner therapy (EPT) as an evidence-based practice to prevent chlamydial reinfection in index patients and lower barriers to treatment for partners. State health departments release guidance on EPT for providers, but it is unclear if information is available for other key stakeholders, for example, pharmacists, patients, and partners. The primary objective of this study was to conduct a review of state and territory health department websites to ascertain the availability, readability, utility, and content of EPT informational materials.

METHODS

A content analysis of 84 EPT informational materials was conducted using validated tools to measure readability, adherence to design standards, and EPT content inclusion. Results were stratified for each target audience.

RESULTS

Only 64% of states where EPT is allowable had informational materials available. The materials targeted providers (51.2%) and partners (35.7%). Little information targeted pharmacists (7.1%) or index patients (4.8%). The average reading level was 11th grade. Mean design score was 9.57 points of a possible 13 points. Most provider and pharmacist materials did not meet the content criteria; index and partner materials did not thoroughly describe cost of EPT, how to communicate with sex partners about EPT/chlamydia, or how to fill an EPT prescription.

CONCLUSIONS

To better support the uptake of EPT, existing resources for EPT should be improved in their design, readability, content, and availability for all target audiences.

Factors associated with condom use during sexual intercourse with a new partner among Scandinavian women

In this population-based, cross-sectional questionnaire study among 18-45-year-old women from Denmark, Sweden, and Norway conducted during 2011-2012 we examine factors associated with using condoms with a new partner. Condom use with a new partner was assessed among 6202 women having had a new partner in the recent six months. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for the associations between sociodemographic and lifestyle factors, and sexual behavior, respectively, and condom use with a new partner using a logistic regression model. Always/almost always ("always") condom use served as the reference category in all analyses and was compared with sometimes/rarely ("sometimes") and never use in two separate analyses. Overall, respectively 36.3%, 26%, and 37.7% reported always, sometimes, or never condom use with a new partner. Married/cohabiting were more likely than single women to never (OR = 2.50, 95% CI: 2.07-3.02) or sometimes (OR = 1.30; 95% CI 1.04-1.62) use condoms with recent new partners. Increasing number of new partners in the recent six months was also associated with condom use with a new partner (never: OR for ≥3 partners = 0.56; 95% CI: 0.47-0.67; sometimes: OR for ≥3 partners = 1.64; 95% CI: 1.38-1.94). Furthermore, women reporting early age at first sexual intercourse, no contraception at first intercourse, or not being vaccinated against human papillomavirus used condoms with new partners less frequently. These findings may suggest that continued awareness about the risk of contracting sexually transmitted infections when practicing condomless sex is important.

Concerns about disclosing a high-risk cervical human papillomavirus (HPV) infection to a sexual partner: a systematic review and thematic synthesis

BACKGROUND

Human papillomavirus (HPV)-based cervical screening is now replacing cytology-based screening in several countries and many women in screening programmes will consequently receive HPV-positive results. Because of the sexually transmitted nature of HPV, receiving an HPV-positive result may raise questions about disclosing the infection to a sexual partner.

OBJECTIVE

To review the quantitative and qualitative literature exploring women's concerns about disclosing a high-risk cervical HPV infection to a sexual partner.

METHODS

We searched MEDLINE, PsycINFO, CINAHL Plus, Web of Science and EMBASE for studies reporting at least one disclosure-related outcome among women with high-risk HPV. We also searched the grey literature and carried out forward/backward citation searches. A narrative synthesis for quantitative studies and a thematic synthesis for qualitative studies were conducted.

RESULTS

Thirteen articles met the inclusion criteria (12 qualitative, 1 quantitative). In the quantitative study, 60% of HPV-positive women felt disclosing an HPV result was 'risky'. Concerns about disclosing HPV to a sexual partner were influenced by the stigma that is associated with having an STI and uncertainty about how their partner would respond. Women questioned how, when and to whom they should disclose their HPV-positive status.

CONCLUSIONS

The studies included in this review provide rich information about the range of concerns women have, the reasons for these concerns, and the questions women have about disclosing HPV to sexual partners. As studies were predominantly qualitative, the prevalence of concerns is unclear.

Using Digital Technology for Sexual and Reproductive Health: Are Programs Adequately Considering Risk?

Digital technologies provide opportunities for advancing sexual and reproductive health and services but also present potential risks. We propose 4 steps to reducing potential harms: (1) consider potential harms during intervention design, (2) mitigate or minimize potential harms during the design phase, (3) measure adverse outcomes during implementation, and (4) plan how to support those reporting adverse outcomes.

Overcoming challenges associated with partner notification following chlamydia and gonorrhoea diagnosis in primary care: a postal survey of doctors and nurses

INTRODUCTION Sexual health guidelines recommend that partner notification and testing for reinfection are undertaken when individuals are diagnosed with bacterial sexually transmitted infections (STIs). AIM To understand factors influencing the effective delivery of partner notification and follow up after diagnosis of STIs in primary care, and to identify strategies that might facilitate these processes. METHODS A postal survey was sent to 216 primary care doctors and nurses working in 72 Wellington primary care settings. Eligible clinicians were identified from laboratory testing data, and included clinicians who had diagnosed relatively high numbers of chlamydia and/or gonorrhoea cases during a 12-month period. Response frequencies were tabulated and chi-squared testing was used to test for significant differences between doctor and nurse responses for selected items. RESULTS In total, 121 surveys were completed (56% response rate) by 78 doctors and 43 nurses, from 55 primary care settings (76% of sites surveyed). Responding health professionals thought that patients were open to partner notification discussion, but appreciated that this sometimes raised difficult issues for patients. Lack of time or resources to follow up, and difficulty getting hold of patients, were cited as key factors that limit assessment of partner notification success. Factors deemed likely to facilitate partner notification included readily available patient resources, training to upskill practice team members, guidance on what to say and record, and access to external advice and assistance. DISCUSSION This study provides insight into provider- and patient-level factors perceived to be hindering successful partner notification. Strategies that could facilitate partner notification were identified, and suggestions made as to how these could be integrated into practice.

Fortitude and resilience in service of the population: a case study of dental professionals striving for health in Sierra Leone

OBJECTIVE

Sierra Leone (SL), with a population of over 7 million people, has a critical health workforce shortage. This research explores the views of key players on population oral health needs and demands, the challenges of oral and dental care delivery, and professional careers in dentistry, in order to inform future capacity building.

MATERIALS AND METHODS

Semi-structured interviews were conducted with a purposive sample of key players in dentistry and healthcare, both in-country and externally. An interpretive phenomenological approach was used in exploring views of key-players on the oral needs and demands of population, challenges in the delivery of oral and dental care, professional careers of dental professionals in SL, and future workforce capacity building based on a topic guide drawn from the available literature. Interviews were audio-recorded, transcribed verbatim, anonymised and analysed using QSR NVivo 10 for data management and reported in accordance to the consolidated criteria for reporting qualitative research.

RESULTS

Twenty-one informants, of whom 18 were male, 17 were in-country and 16 were dental professionals, participated in the research. Dental professionals reported clear consensus on a considerable level of unmet oral health needs, most notably dental caries and periodontal disease, together with life threatening oral conditions such as osteomyelitis, Ludwig's Angina and Burkitt's Lymphoma. Challenges associated with the delivery of dental care revolved around five themes: patients' predisposition for traditional remedies and urgent care; practical hindrances to the delivery of care; professional isolation and weak governance; and place with pressing local crises and lack of political will. An emerging typology of dental professionals included: demonstrating loyalty to their nation and family; exhibiting resilience in challenging circumstances; embracing opportunity most notably amongst expatriates; and striving to serve the needs of the population. There was support for innovative future capacity building developments.

CONCLUSION

This paper provides important insights to the delivery of dental care in a low-income country with significant oral health needs and multiple challenges in the delivery of dental care, whilst also providing a vision for developing, building and retaining future human resources for oral health.

Impact of different educational interventions on psychosocial well-being of women with a positive high-risk human papillomavirus and normal cervical cytology: a randomised trial

INTRODUCTION

The aim of this study was to compare the effect of two educational interventions on the psychosocial well-being of Hong Kong Chinese women who have a positive high-risk human papillomavirus (HPV) test and normal cervical cytology.

METHODS

Participants were randomised into either leaflet group, in which a written HPV factsheet was provided; or counselling group, in which a didactic HPV presentation in person in addition to the factsheet was provided. Women's psychological conditions were assessed by self-administered questionnaires at pre, post (within one week) and 6 months after the educational interventions. Main outcome measures were psychosocial well-being (cervical cancer worry, anxiety and depression, screening-related anxieties, HPV-related shame) and knowledge of cervical screening and HPV.

RESULTS

Data from 121 women (52 in leaflet group; 69 in counselling group) were analysed. There was no significant difference in the psychosocial well-being between the two groups at alltime points. Irrespective of the two educational interventions, cervical cancer worry and anxiety decreased over time. The counselling group had a significantly higher score in knowledge of cervical screening and HPV compared with leaflet group (mean score 4.65 ± 0.19 versus 3.71 ± 0.23, p = 0.002) at post-educational intervention, but there was no significant difference (mean score 4.14 ± 0.22 versus 3.58 ± 0.24, p = 0.084) at 6 months.

DISCUSSION

Both educational interventions were comparable in relieving adverse HPV-related psychosocial effects. Combination of counselling and leaflet were more effective than leaflet only in improving women's knowledge on cervical screening and HPV soon after educational interventions but the benefit was not apparent after 6 months.

Gender differences in the well-being of patients diagnosed with Chlamydia trachomatis: a cross-sectional study

OBJECTIVES

We aimed to investigate how an infection with Chlamydia trachomatis (CT) influenced patients' well-being and whether there were differences due to gender, age or relationship status, in an effort to strengthen preventive measures and provide better healthcare for patients with CT.

METHODS

Patients diagnosed with CT in the county of Västerbotten, Sweden, were asked to fill out a questionnaire about their feelings, thoughts and actions after CT diagnosis. The patients were also asked to fill in the validated questionnaires Hospital Anxiety and Depression Scale and Alcohol Use Disorder Identification Test. Between February 2015 and January 2017, 128 patients (74 women and 54 men) were included in the study.

RESULTS

After being diagnosed with CT, men were generally less worried than women (P<0.001). Women worried more about not being able to have children (P<0.001) and about having other STIs (P=0.001) than men did. Men felt less angry (P=0.001), less bad (P<0.001), less dirty (P<0.001) and less embarrassed (P=0.011) than women did. Nineteen per cent of men and 48% of women reported symptoms of anxiety. The majority of both men (60%) and women (72%) had a risk consumption of alcohol.

CONCLUSION

Women and men reacted differently when diagnosed with CT. Women worried more about complications and more often blamed themselves for being infected. Being aware of these gender differences may be important when planning preventive measures and during counselling of CT-infected patients. Persons working with patients with CT must also be aware of the high frequency of harmful alcohol consumption among their patients.

Stigma Associated with Sexually Transmitted Infections among Patients Attending Suraksha Clinic at a Tertiary Care Hospital in Northern India

CONTEXT

Illnesses affecting sexual organs and its correlation with improper sexual behavior lead to a negative attitude and discriminating behavior towards people affected by such disorders.

AIM

The aim was to study the stigma associated with sexually transmitted infections (STIs) among patients attending Suraksha clinic at a tertiary care hospital in northern India.

SETTINGS AND DESIGN

This was a hospital-based cross-sectional study.

SUBJECTS AND METHODS

The present study was conducted at Suraksha (STI) clinic, King George's Medical University, Uttar Pradesh. A total of 487 STI patients (clinically and/or laboratory-confirmed) were contacted telephonically, of which 49 finally participated in the study. Stigma was assessed using modified and pretested version of India HIV-related stigma scale adapted in context to sexually transmitted diseases.

STATISTICAL ANALYSIS

Quantitative variables were expressed as mean with standard deviation, and independent sample t-test was used to compare the mean values. P < 0.05 was considered statistically significant.

RESULTS

Mean scores of enacted, vicarious, felt normative, and internalized stigma for 49 patients (out 487) who finally participated in the study were 0.04±0.11, 0.55±0.70, 1.21±0.96, and 0.86±0.67, respectively. Unmarried/divorced/separated patients had significantly higher vicarious and felt normative stigma scores as compared to married individuals. Mean score for felt normative stigma was significantly higher among homosexual/bisexuals in comparison to heterosexual individuals.

CONCLUSIONS

Efforts should be directed towards the provision of integrated services through sexual health-oriented campaigns to address the stigma associated with STI in a more comprehensive way.

Human Papillomavirus: A Qualitative Study of Korean American Female College Students' Attitudes Toward Vaccination

BACKGROUND

Human papillomavirus (HPV) vaccines have the potential to reduce Korean American women's high burden of cervical cancer, but information is limited about their awareness of HPV and its vaccine.
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OBJECTIVES

This study aimed to explore Korean American female college students' awareness of and attitudes toward HPV vaccination.
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METHODS

A qualitative descriptive study was used. Five focus group interviews were conducted with 20 Korean American female college students aged 18-26 years from Massachusetts. Data were analyzed using inductive content analysis.
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FINDINGS

Major themes were awareness, misunderstandings, attitudes, social influences, and cultural influence. A critical need exists to develop and implement culturally and linguistically appropriate HPV prevention education programs to promote HPV vaccination in this population.

"Men don't think that far" - Interviewing men in Sweden about chlamydia and HIV testing during pregnancy from a discursive masculinities construction perspective

OBJECTIVES

We used qualitative research design to discursively explore expectant fathers' perceptions of chlamydia and HIV, and their masculinity constructions about testing, and explored how they talked about their potential resistance towards testing and their pre-test emotions.

STUDY DESIGN

Twenty men were offered chlamydia and HIV testing at the beginning of their partner's pregnancy. Those who agreed to be tested were interviewed in-depth; those who declined testing were also interviewed. The interviews were tape recorded and transcribed verbatim. The analysis was inspired by discourse analysis on masculinity.

MAIN OUTCOME

Three discursive themes: Men prefer to suppress their vulnerability to STIs, Body and biology differ between men and women and Men have mixed emotions around STI testing underscore the informants' conversations and sometimes conflicting thoughts about STI testing.

CONCLUSION

The majority of men talked about pregnancy as a feminine territory, raised uncertainties about men's roles in the transmission of STIs, and talked about women's and men's essentially different bodies and biology, where few men realised that they could infect both their partner and the unborn child. This knowledge gap that men have must become apparent to healthcare providers, and policy makers must give men equal access to the reproductive arena.

Measuring Health and Quality of Life for Women Undergoing Testing and Screening for Chlamydia: A Systematic Review

BACKGROUND

Most economic evaluations of interventions to prevent or control curable sexually transmitted infections (STIs), such as chlamydia, have focused on the longer-term health impacts avoided. However, there is a range of qualitative evidence suggesting that those who think that they might have an STI and/or undergo testing can experience impacts on their quality of life (QoL) at the testing and diagnosis stage. A systematic review was undertaken to identify and evaluate studies that have measured QoL and sexual health for women undergoing testing and screening for chlamydia.

METHODS

A systematic review was conducted, with searches of 5 electronic databases up to the end of August 2013. Data on study characteristics, methods, and results were extracted using a standard template, and a narrative synthesis was undertaken.

RESULTS

Eight studies measuring QoL and sexual health were included. The included studies measured a variety of aspects of QoL and sexual health, with a focus on psychosocial well-being. A range of validated tools were used to measure health and QoL, and "bespoke" questions were also developed. Few significant differences were found with comparator groups using generic instruments, but some impacts were found using bespoke questions.

CONCLUSIONS

Although researchers have begun to examine the relationships between QoL and sexual health, there are limitations associated with the evidence available. There is, thus, a need for further research exploring sexual health and QoL for patients undergoing testing and screening for curable STIs, with a focus on analyzing the most appropriate methodological approaches in this context.

Adapting the Get Yourself Tested Campaign to Reach Black and Latino Sexual-Minority Youth

BACKGROUND

Culturally appropriate efforts are needed to increase sexually transmitted disease (STD) testing and care among Black and Latino sexual-minority youth, who are at high risk for STDs. Get Yourself Tested, a national testing campaign, has demonstrated success among youth, but it has yet to be assessed for relevance or impact among this population.

METHOD

This effort included (1) formative and materials-testing research through focus groups; (2) adaptation of existing Get Yourself Tested campaign materials to be more inclusive of Black and Latino sexual-minority youth; (3) a 3-month campaign in four venues of New York City, promoting STD testing at events and through mobile testing and online and social media platforms; (4) process evaluation of outreach activities; and (5) an outcome evaluation of testing at select campaign venues, using a preexperimental design.

RESULTS

During the 3-month campaign period, the number of STD tests conducted at select campaign venues increased from a comparable 3-month baseline period. Although testing uptake through mobile vans remained low in absolute numbers, the van drew a high-prevalence sample, with positivity rates of 26.9% for chlamydia and 11.5% for gonorrhea. This article documents the process and lessons learned from adapting and implementing a local campaign for Black and Latino sexual-minority youth.

The eClinical Care Pathway Framework: a novel structure for creation of online complex clinical care pathways and its application in the management of sexually transmitted infections

BACKGROUND

Despite considerable international eHealth impetus, there is no guidance on the development of online clinical care pathways. Advances in diagnostics now enable self-testing with home diagnosis, to which comprehensive online clinical care could be linked, facilitating completely self-directed, remote care. We describe a new framework for developing complex online clinical care pathways and its application to clinical management of people with genital chlamydia infection, the commonest sexually transmitted infection (STI) in England.

METHODS

Using the existing evidence-base, guidelines and examples from contemporary clinical practice, we developed the eClinical Care Pathway Framework, a nine-step iterative process. Step 1: define the aims of the online pathway; Step 2: define the functional units; Step 3: draft the clinical consultation; Step 4: expert review; Step 5: cognitive testing; Step 6: user-centred interface testing; Step 7: specification development; Step 8: software testing, usability testing and further comprehension testing; Step 9: piloting. We then applied the Framework to create a chlamydia online clinical care pathway (Online Chlamydia Pathway).

RESULTS

Use of the Framework elucidated content and structure of the care pathway and identified the need for significant changes in sequences of care (Traditional: history, diagnosis, information versus Online: diagnosis, information, history) and prescribing safety assessment. The Framework met the needs of complex STI management and enabled development of a multi-faceted, fully-automated consultation.

CONCLUSION

The Framework provides a comprehensive structure on which complex online care pathways such as those needed for STI management, which involve clinical services, public health surveillance functions and third party (sexual partner) management, can be developed to meet national clinical and public health standards. The Online Chlamydia Pathway's standardised method of collecting data on demographics and sexual behaviour, with potential for interoperability with surveillance systems, could be a powerful tool for public health and clinical management.

Health-related quality of life and Chlamydia trachomatis infection in sexually experienced female inner-city students: a community-based cross-sectional study

This cross-sectional study was undertaken to compare health-related quality of life (EQ-5D) in women with and without undiagnosed Chlamydia trachomatis infection. We analysed data from 2401 multi-ethnic sexually active female students aged 16–27 years who were recruited to a randomised controlled trial of chlamydia screening – the prevention of pelvic infection trial in 2004–2006. At recruitment, all participants were asked to provide self-taken vaginal swabs for chlamydia testing and to complete a sexual health questionnaire including quality of life (EQ-5D). Most women (69%) had an EQ-5D of one representing ‘perfect health’ in the five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. We therefore compared the proportion of women with an EQ-5D score < 1 implying ‘less than perfect health’ in women with and without chlamydia infection, and women with symptomatic chlamydia versus the remainder. The proportion of women with EQ-5D score < 1 was similar in women with and without undiagnosed chlamydia: 34% (47/138) versus 31% (697/2263; RR 1.11, 95% CI 0.87 to 1.41). However, more women with symptomatic chlamydia had EQ-5D score < 1 than the remainder: 45% (25/55) versus 31% (714/2319; RR 1.47, CI 1.10 to 1.98). In this community-based study, EQ-5D scores were similar in women with and without undiagnosed chlamydia. However, a higher proportion of women with symptomatic chlamydia infection had ‘less than perfect health’. Undiagnosed chlamydia infection may not have a major short-term effect on health-related quality of life, but EQ-5D may not be the best tool to measure it in this group.

Stigma, Sexually Transmitted Infections and Attendance at the GUM Clinic

A gap in the literature regarding understanding of people's health care seeking behaviours in relation to sexually transmitted infections is identified. Employing both deductive and inductive methods, 10 patients (five female, five male) were interviewed to explore the psychosocial, motivational and attitudinal factors associated with attendance at a Genito-Urinary Medicine (GUM) clinic in a close-knit community in the north of England. Seven stigma-related themes were identified as salient issues surrounding perceptions of sexual health screening and included: (1)prejudice surrounding STIs; (2)fear of exposure; (3)isolation; (4)reluctance to attend; (5)contamination; (6)relationship issues; and (7)perceived invulnerability. Within these themes distinct gender differences were identified. Implications for the theory of planned behaviour (TPB) are discussed against the factors identified.

Self-Reported Impact of Chlamydia Testing on Subsequent Behavior: Results of an Online Survey of Young Adults in England

BACKGROUND

The National Chlamydia Screening Programme performs 1.7 million tests annually among young adults in England. The effect of chlamydia screening on subsequent behavior is unknown. This study examined the self-reported impact of testing on young adults' subsequent health care-seeking and sexual behavior.

METHODS

We conducted a cross-sectional Web-based anonymous survey using an online panel to recruit 1521 young adults aged 16 to 24 years and resident in England. Survey questions were developed using the theory of planned behavior. Multivariate log-binomial regression was used to identify the variables associated with an impact on subsequent behavior after testing.

RESULTS

Most respondents reported that being tested for chlamydia had a positive effect on their subsequent sexual behavior (68.6%; 422/615) or health care-seeking behavior (80.0%; 492/615). In multivariate analysis, being female and having a high level of engagement at last test were both associated with positive impacts on sexual behavior (72.7% [adjusted prevalence ratio {aPR}, 1.19; 95% confidence interval {CI}, 1.07-1.33] and 82.7% [aPR, 1.55; 95% CI, 1.27-1.89], respectively), and health care-seeking behavior (84.4% [aPR, 1.13; 95% Cl, 1.04-1.24] and 86.3% [aPR, 1.23; 95% CI, 1.07-1.41], respectively). Among respondents with minimum level of engagement, 72.4% (76/105) reported an increase in subsequent health care-seeking behavior.

CONCLUSIONS

Chlamydia testing had a positive impact on young adults' self-reported health care-seeking and sexual behavior. This suggests that chlamydia screening has a wider effect on young adults' sexual health beyond that of treatment alone.

Predictors of Chlamydia Trachomatis testing: perceived norms, susceptibility, changes in partner status, and underestimation of own risk

Background

It is hard to convince people to participate in chlamydia screening programs outside the clinical setting. In two earlier studies (BMC Public Health. 2013;13:1091; J Med Internet Res. 2014;16(1):e24), we identified explicit and implicit determinants of chlamydia screening behavior and attempted, unsuccessfully, to improve participation rates by optimizing the recruitment letter. In the present study, we examined the links between a number of social-cognitive determinants (e.g., stereotypical beliefs about a person with chlamydia, intentions, changes in partner status), and self-reported chlamydia testing behavior six months after the initial study.

Methods

The present study is a follow-up to our first study (T0). We assessed self-reported testing behavior 6 months after the first measure by means of an online questionnaire (T1; N = 269). Furthermore, at T1, we measured the social-cognitive determinants in more detail, and explored the influence of stereotypical beliefs and any changes in partner status during this six month period.

Results

In total, 25 (9.1 %) of the participants tested for chlamydia at some point during the six months between baseline (T0) and follow up (T1). Testing behavior was influenced by testing intentions in combination with changes in risk behavior. The higher the participants’ own numbers of partners ever, the higher they estimated the number of partners of the stereotypical person with chlamydia. Testing intentions were most strongly predicted by perceived norms and susceptibility, and having had multiple partners in the last 6 months (R² = .41).

Conclusion

The most relevant determinants for testing intentions and behavior were susceptibility, subjective norms and changes in partner status. We found a systematic tendency for individuals to underestimate their own risk, especially the risk of inconsistent condom use. Future research should focus on more promising alternatives to population-based interventions, such as online interventions, screening in primary care, the rescreening of positives, and clinic-based interventions. This future research should also focus on making testing easier and reducing barriers to testing, as well as using social and sexual networks in order to reach more people.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2689-6) contains supplementary material, which is available to authorized users.

Conceptualising quality of life outcomes for women participating in testing for sexually transmitted infections: A systematic review and meta-synthesis of qualitative research

Many public health interventions have aims which are broader than health alone; this means that there are difficulties in using outcome measures that capture health effects only, such as Quality Adjusted Life Years (QALYs). Sexually Transmitted Infections (STIs) are a major public health concern both in the UK and globally, with Chlamydia trachomatis being the most common bacterial STI worldwide. There is scope for the wider use of qualitative syntheses in health-related research; in this study we highlight their potential value in informing outcome identification, particularly for public health interventions where a broad range of outcomes may need to be considered. This article presents a systematic review and meta-ethnography of qualitative studies that investigated women's experiences of thinking about and participating in testing for chlamydia. The meta-ethnography highlights issues relating to beliefs about STIs and testing, assessing risk and interpreting symptoms, emotional responses to testing, coping with diagnosis, relationship with sex partners(s), informal support, and interaction with health care services. The study findings suggest that women can experience a range of impacts on their health and quality of life. It is important that this range of effects is taken into account within evaluations, to ensure that decision makers are fully informed about the outcomes associated with screening interventions, and ultimately, to make sure that appropriate interventions are available to support women in maintaining good sexual health.

Being diagnosed with a sexually transmitted infection (STI): sources of support for young women

BACKGROUND

Sexually transmitted infections (STIs) are prevalent throughout the world with the rate of these infections increasing on a daily basis. STI acquisition has the ability to cause personal adversity and elicit feelings of stigma and shame.

AIM

The aim of this paper is to report on the sources of support young women who acquired STIs drew on to overcome their associated adversity.

METHODS

This study utilised a feminist qualitative methodology.

FINDINGS

Findings revealed that the women drew on both personal and anonymous sources of support.

CONCLUSION

Nurses and other health-care professionals need to be equipped with knowledge and strategies to promote personal wellbeing and minimise the adversity felt among people having acquired these infections.

Prevalence and associated factors of mental health problems among monogamous Chinese female patients with sexually transmitted diseases in Hong Kong

Sexually transmitted disease (STD) increases risk of HIV infection and has profound psychological consequences. The present study examined the mental health problems (poor emotional well-being, insomnia, probable depression) and their associated factors among monogamous Chinese female STD patients. A total of 537 Chinese female STD patients who self-reported having had only one male sex partner in the last 12 months were recruited from a STD clinic in Hong Kong. They completed a survey including measures of mental health, STD-related history, perceptions, feelings related to STD infection, and perceptions toward condom use. Results showed that 22% had poor emotional well-being, 25.7% had insomnia, and 43% were probable cases of depression. Unemployment, worsened relationship with partners after STD diagnosis, STD history in last three months, finding STD examinations embarrassing, and feelings of helplessness were significant risk factors for poor emotional well-being and insomnia. Also, unemployment, worsened relationships with partners after STD diagnosis, and perceived high chance of STD in the coming six months were significant risk factors for probable depression. Perceived efficacy of condom use for STD prevention was a significant protective factor against poor emotional well-being and probable depression. Findings suggest that interventions are warranted to improve the mental health among this population.

Screening for nonviral sexually transmitted infections in adolescents and young adults

Prevalence rates of many sexually transmitted infections (STIs) are highest among adolescents. If nonviral STIs are detected early, they can be treated, transmission to others can be eliminated, and sequelae can be averted. The US Preventive Services Task Force and the Centers for Disease Control and Prevention have published chlamydia, gonorrhea, and syphilis screening guidelines that recommend screening those at risk on the basis of epidemiologic and clinical outcomes data. This policy statement specifically focuses on these curable, nonviral STIs and reviews the evidence for nonviral STI screening in adolescents, communicates the value of screening, and outlines recommendations for routine nonviral STI screening of adolescents.

Vouchers versus Lotteries: What works best in promoting Chlamydia screening? A cluster randomised controlled trial

In this cluster randomised trial (N=1060), we tested the impact of financial incentives (£5 voucher vs. £200 lottery) framed as a gain or loss to promote Chlamydia screening in students aged 18-24 years, mimicking the standard outreach approach to student in halls of residence. Compared to the control group (1.5%), the lottery increased screening to 2.8% and the voucher increased screening to 22.8%. Incentives framed as gains were marginally more effective (10.5%) that loss-framed incentives (7.1%). This work fundamentally contributes to the literature by testing the predictive validity of Prospect Theory to change health behaviour in the field.

The influence of two different invitation letters on Chlamydia testing participation: randomized controlled trial

Background

In the Netherlands, screening for chlamydia (the most prevalent sexually transmitted infection worldwide) is a relatively simple and free procedure. Via an invitation letter sent by the public health services (PHS), people are asked to visit a website to request a test kit. They can then do a chlamydia test at home, send it anonymously to a laboratory, and, within two weeks, they can review their test results online and be treated by their general practitioner or the PHS. Unfortunately, the participation rates are low and the process is believed to be not (cost-) effective.

Objective

The objective of this study was to assess whether the low participation rate of screening for chlamydia at home, via an invitation letter asking to visit a website and request a test kit, could be improved by optimizing the invitation letter through systematically applied behavior change theories and evidence.

Methods

The original letter and a revised letter were randomly sent out to 13,551 citizens, 16 to 29 years old, in a Dutch municipality. Using behavior change theories, the revised letter sought to increase motivation to conduct chlamydia screening tests. The revised letter was tailored to beliefs that were found in earlier studies: risk perception, advantages and disadvantages (attitude), moral norm, social influence, and response- and self-efficacy. Revisions to the new letter also sought to avoid possible unwanted resistance caused when people feel pressured, and included prompts to trigger the desired behavior.

Results

No significant differences in test package requests were found between the two letters. There were also no differences between the original and revised letters in the rates of returned tests (11.80%, 581/4922 vs 11.07%, 549/4961) or positive test results (4.8%, 23/484 vs 4.1%, 19/460). It is evident that the new letter did not improve participation compared to the original letter.

Conclusions

It is clear that the approach of inviting the target population through a letter does not lead to higher participation rates for chlamydia screening. Other approaches have to be developed and pilot tested.

Non-participation in chlamydia screening in The Netherlands: determinants associated with young people's intention to participate in chlamydia screening

BACKGROUND

In The Netherlands, a national chlamydia screening program started in 2008, but the participation was low and the screening was not cost-effective. This study aimed to explore unconscious and conscious associations with chlamydia screening (16-29 year-olds). In addition, we examined whether information presented in chlamydia screening invitation letters had an effect on the evaluation of these determinants compared to a no-letter group.

METHODS

An Internet survey was conducted that included self-report measures of attitude, susceptibility, severity, unrealistic optimism, subjective, moral, and descriptive norm, perceived behavioral control, outcome expectations, barriers, intention, and a response time measure to assess unconscious associations of chlamydia screening with annoyance, threat and reassurance.

RESULTS

On the unconscious level, participants (N = 713) who received no information letter associated testing for chlamydia with annoyance and threat, but also with reassurance (all p's < .001). On the self-report measures, participants showed a low intention towards chlamydia screening (M = 1.42, range 1-5). Subjective norm, moral norm, perceived susceptibility and attitude were the most important predictors of the intention to screen (R2 = .56). Participants who rated their susceptibility as high also reported more risky behaviors (p < .001).In the groups that received a letter (N = 735), a weaker unconscious association of chlamydia screening with annoyance was found compared with the no-letter group (p < .001), but no differences were found in reassurance or threat. Furthermore, the letters caused a higher intention (p < .001), but intention remained low (M = 1.74). On a conscious level, giving information caused a more positive attitude, higher susceptibility, a higher subjective and moral norm, and more positive outcome expectations (all p's < .001).

CONCLUSION

Subjective norm, moral norm, susceptibility, and attitude towards chlamydia might be crucial targets to increase chlamydia screening behavior among sexually active young people. This study shows that informational invitation letters increase the intention and the intention-predicting variables. More evidence is needed on whether screening behavior can be increased by the use of an alternative information letter adapted to the specific unconscious and conscious determinants revealed in this study, or that we need other, more interactive behavior change methods.

The burden of bacterial vaginosis: women's experience of the physical, emotional, sexual and social impact of living with recurrent bacterial vaginosis

BACKGROUND

Bacterial vaginosis is a common vaginal infection, causing an abnormal vaginal discharge and/or odour in up to 50% of sufferers. Recurrence is common following recommended treatment. There are limited data on women's experience of bacterial vaginosis, and the impact on their self-esteem, sexual relationships and quality of life. The aim of this study was to explore the experiences and impact of recurrent bacterial vaginosis on women.

METHODS

A social constructionist approach was chosen as the framework for the study. Thirty five women with male and/or female partners participated in semi-structured interviews face-to-face or by telephone about their experience of recurrent bacterial vaginosis.

RESULTS

Recurrent bacterial vaginosis impacted on women to varying degrees, with some women reporting it had little impact on their lives but most reporting it had a moderate to severe impact. The degree to which it impacted on women physically, emotionally, sexually and socially often depended on the frequency of episodes and severity of symptoms. Women commonly reported that symptoms of bacterial vaginosis made them feel embarrassed, ashamed, 'dirty' and very concerned others may detect their malodour and abnormal discharge. The biggest impact of recurrent bacterial vaginosis was on women's self-esteem and sex lives, with women regularly avoiding sexual activity, in particular oral sex, as they were too embarrassed and self-conscious of their symptoms to engage in these activities. Women often felt confused about why they were experiencing recurrent bacterial vaginosis and frustrated at their lack of control over recurrence.

CONCLUSION

Women's experience of recurrent bacterial vaginosis varied broadly and significantly in this study. Some women reported little impact on their lives but most reported a moderate to severe impact, mainly on their self-esteem and sex life. Further support and acknowledgement of these impacts are required when managing women with recurrent bacterial vaginosis.

Advances in sampling and screening for chlamydia

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.

Effect of time since exposure to Chlamydia trachomatis on chlamydia antibody detection in women: a cross-sectional study

OBJECTIVES

To investigate what factors influence the detection of Chlamydia trachomatis antibody following genital tract infection.

METHODS

One hundred and sixty-four women with a previous history of C trachomatis infection contributed to an earlier report on the performance of chlamydia antibody ELISA assays. We undertook further analysis to explore how chlamydia antibody assay sensitivity changes with time since infection.

RESULTS

Chlamydia antibody was detected in more women soon after the last detection of chlamydia at the lower genital tract than at later times. This holds true for all tests, but the Anilabsystems IgG EIA, Medac pELISA plus ELISA and the Savyon SeroCT-IgG ELISA were less sensitive than the pgp3 ELISA and the Anilabsystems microimmunofluorescence (MIF) assay at all time points except during current infection. Fall in seropositivity in women generally occurred in the early weeks and months following the last episode of chlamydia infection. There was no clear pattern of further reduction in seropositivity after 6 months. Multiple previous episodes were associated with increased seropositivity in the pgp3 assay (two or more vs one, OR 19, p<0.001) and other tests, but the effect was significantly smaller for the Anilabs, Medac and SeroCT MOMP peptide ELISAs, but not for the MIF assay.

CONCLUSIONS

Chlamydia antibody detection decreases with time since infection and this is most apparent in the first 6 months. In women who have had more than one infection, antibody remained detectable longer for all tests, but this was more marked for the pgp3 ELISA and MIF assay.

A prospective study of the psychosocial impact of a positive Chlamydia trachomatis laboratory test

BACKGROUND

Few data exist on potential harms of chlamydia screening. We assessed the psychosocial impact of receiving a positive Chlamydia trachomatis test result.

METHODS

We prospectively studied women ≥16 years of age undergoing chlamydia testing in 2 Midwestern family planning clinics. We surveyed women at baseline and about 1 month after receiving test results, using 9 validated psychosocial scales/subscales and chlamydia-specific questions. Changes in scale scores were calculated for each woman. Mean percent changes in scores for chlamydia-positive and -negative women were compared using a t test.

RESULTS

We enrolled 1807 women (response rate, 84%). Of the 1688 women with test results, 149 (8.8%) tested positive. At follow-up, chlamydia-positive women (n = 71) had a 75% increase in anxiety about sexual aspects of their life on the Multidimensional Sexual Self-Concept Questionnaire (P < 0.001), significantly greater than the 26% increase among 280 randomly selected chlamydia-negative women (P = 0.02). There were no differences for the other 8 scales/subscales, including general measures of anxiety, depression, and self-esteem. Chlamydia-positive women were more likely than chlamydia-negative women to be "concerned about chlamydia" (80% vs. 40%, P < 0.001) and to report breaking up with a main partner (33% vs. 11%, P < 0.001) at follow-up. Women testing positive reported a range of chlamydia-specific concerns.

CONCLUSIONS

Chlamydia-positive women had significant increases in anxiety about sex and concern about chlamydia, but did not have marked changes in more general measures of psychosocial well-being about 1 month after diagnosis. Chlamydia diagnoses were associated with some disruption of relationships with main partners. Chlamydia-specific concerns may guide counseling messages to minimize psychosocial impact.

Genital chlamydia, genital herpes, Trichomonas vaginalis and gonorrhea prevalence, and risk factors among nearly 70,000 randomly selected women in 4 Nordic countries

BACKGROUND

The aim of this study was to assess the prevalence of women reporting ever having genital chlamydia, genital herpes, Trichomonas vaginalis, and gonorrhea, and to identify factors associated with each of these sexually transmitted infections (STIs).

METHODS

The study was based on a large cross-sectional survey conducted in 2004-2005 among randomly sampled women (18-45 years) from the computerized population registries in Denmark, Iceland, Norway, and Sweden. A total of 69,567 women were included in the study.

RESULTS

The overall prevalence in Denmark, Iceland, Norway, and Sweden was 1.5% for reporting ever having had Trichomonas vaginalis, 1.9% for gonorrhea, 4.8% for genital herpes, and 17.0% for genital chlamydia. The prevalence of each of these STIs varied with birth cohort and country. In addition, they were strongly associated with lifetime number of partners and having a previous diagnosis of another sexually transmitted infection. Moreover, a diagnosis of genital chlamydia or gonorrhea was associated with early age at first intercourse and smoking initiation. Finally, reporting genital chlamydia was associated with early age at drinking initiation, and ever use of hormonal contraceptives and condoms.

CONCLUSION

Genital chlamydia occurs frequently among women in the Nordic countries. Risk-taking behavior, particularly sexual behavior, is strongly associated with STIs, which suggest that further information is needed about STIs and their consequences, targeting high-risk groups. There is also a need for continued monitoring of STIs in order to follow the prevalence and to gain further knowledge about risk factors.

Unveiling the hidden epidemic: a review of stigma associated with sexually transmissible infections

Stigma has long accompanied sexually transmissible infections (STI) and hindered prevention and control efforts. It not only acts as a formidable barrier to STI testing, treatment and disclosure, but has a multitude of consequences for the health and quality of life of infected individuals. This review summarises the literature related to STI stigma and offers practical approaches to counter STI-associated stigma through multi-level efforts. Specifically, it describes the key sources that breed and perpetuate stigma, outlines how STI-associated stigma has been conceptualised and measured in the literature, documents the impact of stigma on infected and uninfected individuals, and summarises the stigma reduction strategies recommended in the literature. Gaps in the literature are identified and areas for further research are suggested, along with practical strategies for moving forward.

Talking therapy services for adult survivors of childhood sexual abuse (CSA) in Scotland: perspectives of service users and professionals

This study aimed to elicit perceptions and experiences of talking therapy services for CSA survivors and professionals utilizing qualitative interviews and analyzing transcripts using Interpretative Phenomenological Analysis. Participants included 13 adult survivors and 31 professionals in statutory and voluntary services in Scotland. Main themes were benefits from and challenges of the therapeutic process. Benefits included a trusting therapeutic relationship, feeling safe to disclose, breaking isolation, enhancing self-esteem and self-worth, contextualizing the abuse, and moving toward recovery. Challenges included trauma-focused work, supportive contact, continuity and consistency of services, accessibility during acute episodes, hearing and managing disclosures, child protection issues, and availability and accessibility of services. The findings support a greater emphasis on relational models, supervision, and training.

Disclosure of STI testing activities by young adults: the influence of emotions and social networks

Thirty young adults (between 18 and 29 years of age) who had sought STI testing were interviewed about their experiences of 'passing' during the STI testing process (keeping their testing practices a secret from other individuals), and also their experiences of disclosing to other individuals the fact that they had sought STI testing. Respondents kept their STI testing practices secret from others in order to preserve their identities as 'normal' individuals. They feared that their identities would become stigmatised if other people were to find out about their testing practices. Keeping their practices a secret was difficult and emotionally draining. Consequently, respondents usually chose to inform a few key individuals about their testing activities. These individuals provided respondents with emotional support and helped them to pass as normal. Healthcare professionals were a particular, valued group to whom respondents disclosed their need for STI testing. A number of respondents reported experiencing stigmatising reactions from healthcare professionals, however, which had deleterious consequences for these respondents' willingness to seek treatment for their STI. Findings are discussed in relation to Goffman's impression management framework (1959, 1963) and develop Goffman's work by highlighting the roles played by emotions and social networks in impression management activities.

"...they should be offering it": a qualitative study to investigate young peoples' attitudes towards chlamydia screening in GP surgeries

BACKGROUND

Despite the known health and healthcare costs of untreated chlamydia infection and the efforts of the National Chlamydia Screening Programme (NCSP) to control chlamydia through early detection and treatment of asymptomatic infection, the rates of screening are well below the 2010-2011 target rate of 35%. General Practitioner (GP) surgeries are a key venue within the NCSP however; previous studies indicate that GP surgery staff are concerned that they may offend their patients by offering a screen. This study aimed to identify the attitudes to, and preferences for, chlamydia screening in 15-24 year old men and women attending GP surgeries (the target group).

METHODS

We undertook 36 interviews in six surgeries of differing screening rates. Our participants were 15-24 year olds attending a consultation with a staff member. Data were analysed thematically.

RESULTS

GP surgeries are acceptable to young people as a venue for opportunistic chlamydia screening and furthermore they think it is the duty of GP surgery staff to offer it. They felt strongly that it is important for surgery staff to have a non-judgmental attitude and they did not want to be singled out as 'needing' a chlamydia screen. Furthermore, our sample reported a strong preference for being offered a screen by staff and providing the sample immediately at the surgery rather than taking home a testing kit. The positive attitude and subjective norms demonstrated by interviewees suggest that young peoples' behaviour would be to accept a screen if it was offered to them.

CONCLUSION

Young people attending GP surgeries have a positive attitude towards chlamydia screening and given the right environment are likely to take up the offer in this setting. The right environment involves normalising screening by offering a chlamydia screen to all 15-24 year olds at every interaction with staff, offering screening with a non-judgmental attitude and minimising barriers to screening such as embarrassment. The GP surgery is the ideal place to screen young people for chlamydia as it is not a threatening place for them and our study has shown that they think it is the normal place to go to discuss health matters.