1
|
Machado LFA, Fonseca RRDS, Queiroz MAF, Oliveira-Filho AB, Cayres-Vallinoto IMV, Vallinoto ACR, Ishak MDOG, Ishak R. The Epidemiological Impact of STIs among General and Vulnerable Populations of the Amazon Region of Brazil: 30 years of Surveillance. Viruses 2021; 13:v13050855. [PMID: 34067165 PMCID: PMC8151421 DOI: 10.3390/v13050855] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/13/2022] Open
Abstract
Sexually transmitted infections (STIs) represent a worldwide public health problem and, although many of them are curable, they continue to be neglected, especially in areas with a low human development index, such as in the northern region of Brazil. This review describes the results of 30 years of studies at the Virus Laboratory at the Federal University of Pará, including the prevalence and molecular epidemiology of HIV-1, HTLV-1/2, HPV, HBV, Treponema pallidum and Chlamydia trachomatis among urban and non-urban populations, and also in vulnerable groups in the Brazilian Amazon. Control strategies and challenges in preventing STIs are discussed considering this immense geographic region, where essential health services are unable to reach the entire population, especially the most vulnerable, such as female sex workers, people who use illicit drugs, remnants of quilombolos and indigenous communities.
Collapse
Affiliation(s)
- Luiz Fernando Almeida Machado
- Laboratório de Virologia, Instituto de Ciências Biológica, Universidade Federal do Pará, Belém 66.075-110, Brazil; (R.R.d.S.F.); (M.A.F.Q.); (I.M.V.C.-V.); (A.C.R.V.); (M.d.O.G.I.); (R.I.)
- Correspondence:
| | - Ricardo Roberto de Souza Fonseca
- Laboratório de Virologia, Instituto de Ciências Biológica, Universidade Federal do Pará, Belém 66.075-110, Brazil; (R.R.d.S.F.); (M.A.F.Q.); (I.M.V.C.-V.); (A.C.R.V.); (M.d.O.G.I.); (R.I.)
| | - Maria Alice Freitas Queiroz
- Laboratório de Virologia, Instituto de Ciências Biológica, Universidade Federal do Pará, Belém 66.075-110, Brazil; (R.R.d.S.F.); (M.A.F.Q.); (I.M.V.C.-V.); (A.C.R.V.); (M.d.O.G.I.); (R.I.)
| | - Aldemir Branco Oliveira-Filho
- Grupo de Estudo e Pesquisa em Populações Vulneráveis, Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança 68.600-000, Brazil;
| | - Izaura Maria Vieira Cayres-Vallinoto
- Laboratório de Virologia, Instituto de Ciências Biológica, Universidade Federal do Pará, Belém 66.075-110, Brazil; (R.R.d.S.F.); (M.A.F.Q.); (I.M.V.C.-V.); (A.C.R.V.); (M.d.O.G.I.); (R.I.)
| | - Antonio Carlos Rosário Vallinoto
- Laboratório de Virologia, Instituto de Ciências Biológica, Universidade Federal do Pará, Belém 66.075-110, Brazil; (R.R.d.S.F.); (M.A.F.Q.); (I.M.V.C.-V.); (A.C.R.V.); (M.d.O.G.I.); (R.I.)
| | - Marluísa de Oliveira Guimarães Ishak
- Laboratório de Virologia, Instituto de Ciências Biológica, Universidade Federal do Pará, Belém 66.075-110, Brazil; (R.R.d.S.F.); (M.A.F.Q.); (I.M.V.C.-V.); (A.C.R.V.); (M.d.O.G.I.); (R.I.)
| | - Ricardo Ishak
- Laboratório de Virologia, Instituto de Ciências Biológica, Universidade Federal do Pará, Belém 66.075-110, Brazil; (R.R.d.S.F.); (M.A.F.Q.); (I.M.V.C.-V.); (A.C.R.V.); (M.d.O.G.I.); (R.I.)
| |
Collapse
|
2
|
Talungchit P, Kwadkweang S, Limsiri P. Mother-role development program and postpartum health-service utilization by adolescent mothers: A randomized, controlled trial. J Obstet Gynaecol Res 2020; 47:653-660. [PMID: 33242918 DOI: 10.1111/jog.14576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/29/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the impact of a mother-role development program on postpartum health-service utilization by adolescent mothers. METHODS A single center, parallel, randomized, controlled, open-label trial using a computer-generated sequence was conducted at Siriraj Hospital. In all, 120 teenage mothers who delivered February 2015-December 2016 were randomized into experimental and control groups. The experimental group participated in a 2-year, mother-role development program at the Young Family Clinic. The two groups' characteristics, pregnancy outcomes and postpartum follow-up details over the 2-year period were compared. The main outcome measure was the utilization of maternal healthcare services (MHS). RESULTS The teenage mothers were randomized into two groups of 60 participants each. Many were progressively lost to follow-up, leaving only 37 (experimental group, 19; control group, 18) for the intention-to-treat analysis. The results demonstrated a higher MHS utilization by the experimental group, but only at the 6-week postpartum follow-up. The usage of long-acting, reversible contraception (birth control implants and intrauterine devices) rose from 53.3% (immediate postpartum) to 95.5% (2 years postpartum). The two groups also had identical repeat pregnancy rates (6.67%; four participants in each), a marked decrease from 20% in a prior study. The breastfeeding rate was consistently higher among the mothers undertaking the mother-role development program. CONCLUSION The program increased both MHS utilization during the initial postpartum period and the breastfeeding duration. Access to immediate postpartum contraception and long-acting, reversible contraception was associated with a reduction in repeat teen pregnancies. Having a multidisciplinary team was key to the health-service improvements.
Collapse
Affiliation(s)
- Pattarawalai Talungchit
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supaporn Kwadkweang
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pattarawan Limsiri
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
3
|
Lobo R, Rayson J, Hallett J, Mak DB. Risk perceptions, misperceptions and sexual behaviours among young heterosexual people with gonorrhoea in Perth, Western Australia. ACTA ACUST UNITED AC 2020; 44. [PMID: 32418513 DOI: 10.33321/cdi.2020.44.41] [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: 11/20/2022]
Abstract
Background Notification rates of gonorrhoea in Australia for heterosexual young adults rose by 63% between 2012 and 2016. In Western Australian major cities, there was a 612% increase among non-Aboriginal females and a 358% increase in non-Aboriginal males in the ten-year period 2007-2016. A qualitative public health investigation was initiated to inform appropriate action. Methods Eighteen semi-structured telephone interviews were conducted with non-Aboriginal heterosexual young adults aged 18-34 years living in Perth, Western Australia, who had recently been notified to the Department of Health with gonorrhoea, to explore the context of their sexual interactions and lifestyles which could have predisposed them to contracting gonorrhoea. Data were thematically analysed. Results Common themes were having several casual sexual partners, limited communication between sexual partners about condom use or sexual history prior to engaging in sexual activity, inconsistent condom use, normalisation of some sexually transmissible infections amongst young people, and poor understandings and assessment of sexually transmissible infection risk. Conclusion The findings support public health interventions that focus on communication between sexual partners and shifting of risk perceptions in sexual health education programs, ensuring accessibility of quality sexual health information, increasing condom accessibility and acceptability, and on strategies for addressing misperceptions of young people in relation to sexually transmitted infections.
Collapse
Affiliation(s)
- Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), School of Public Health, Curtin University, GPO BOX U1987, Bentley, Western Australia, WA 6845
| | - Josephine Rayson
- Communicable Disease Control Directorate, Public and Aboriginal Health Division, Department of Health , CDCD, 189 Royal St, East Perth, Western Australia, WA 6004
| | - Jonathan Hallett
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), School of Public Health, Curtin University, GPO BOX U1987, Bentley, Western Australia, WA 6845
| | - Donna B Mak
- Communicable Disease Control Directorate, Public and Aboriginal Health Division, Department of Health , CDCD, 189 Royal St, East Perth, Western Australia, WA 6004; School of Medicine, Fremantle, University of Notre Dame Australia, PO BOX 1225, Fremantle, Western Australia WA 6959
| |
Collapse
|
4
|
Olson-Chen C, Balaram K, Hackney DN. Chlamydia trachomatis and Adverse Pregnancy Outcomes: Meta-analysis of Patients With and Without Infection. Matern Child Health J 2018; 22:812-821. [DOI: 10.1007/s10995-018-2451-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
5
|
Ong JJ, Chen M, Hocking J, Fairley CK, Carter R, Bulfone L, Hsueh A. Chlamydia screening for pregnant women aged 16-25 years attending an antenatal service: a cost-effectiveness study. BJOG 2015; 123:1194-202. [PMID: 26307516 DOI: 10.1111/1471-0528.13567] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Determine the cost-effectiveness of screening all pregnant women aged 16-25 years for chlamydia compared with selective screening or no screening. DESIGN Cost effectiveness based on a decision model. SETTING Antenatal clinics in Australia. SAMPLE Pregnant women, aged 16-25 years. METHODS Using clinical data from a previous study, and outcomes data from the literature, we modelled the short-term perinatal (12-month time horizon) incremental direct costs and outcomes from a government (as the primary third-party funder) perspective for chlamydia screening. Costs were derived from the Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, and average cost-weights reported for hospitalisations classified according to the Australian refined diagnosis-related groups. MAIN OUTCOME MEASURES Direct costs of screening and managing chlamydia complications, number of chlamydia cases detected and treated, and the incremental cost-effectiveness ratios were estimated and subjected to sensitivity analyses. RESULTS Assuming a chlamydia prevalence rate of 3%, screening all antenatal women aged 16-25 years at their first antenatal visit compared with no screening was $34,931 per quality-adjusted life-years gained. Screening all women could result in cost savings when chlamydia prevalence was higher than 11%. The incremental cost-effectiveness ratios were most sensitive to the assumed prevalence of chlamydia, the probability of pelvic inflammatory disease, the utility weight of a positive chlamydia test and the cost of the chlamydia test and doctor's appointment. CONCLUSION From an Australian government perspective, chlamydia screening of all women aged 16-25 years old during one antenatal visit was likely to be cost-effective compared with no screening or selective screening, especially with increasing chlamydia prevalence. TWEETABLE ABSTRACT Chlamydia screening for all pregnant women aged 16-25 years during an antenatal visit is cost effective.
Collapse
Affiliation(s)
- J J Ong
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.,Melbourne Sexual Health Centre, Carlton, Victoria, Australia
| | - M Chen
- Melbourne Sexual Health Centre, Carlton, Victoria, Australia.,Central Clinical School Monash University, Clayton, Victoria, Australia
| | - J Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - C K Fairley
- Melbourne Sexual Health Centre, Carlton, Victoria, Australia.,Central Clinical School Monash University, Clayton, Victoria, Australia
| | - R Carter
- Deakin Health Economics, Strategic Research Centre-Population Health Deakin University, Burwood, Victoria, Australia
| | - L Bulfone
- Deakin Health Economics, Strategic Research Centre-Population Health Deakin University, Burwood, Victoria, Australia
| | - A Hsueh
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
6
|
Suzuki S, Tanaka M, Matsuda H, Tsukahara Y, Kuribayashi Y, Sekizawa A, Miyazaki R, Nishii O, Nakai A, Mizutani N, Kumamoto Y, Kinoshita K. Current Status of the Screening of Chlamydia trachomatis Infection Among Japanese Pregnant Women. J Clin Med Res 2015; 7:582-4. [PMID: 26015828 PMCID: PMC4432905 DOI: 10.14740/jocmr2137w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Shunji Suzuki
- Japan Association of Obstetricians and Gynecologists, Japan
| | | | - Hideo Matsuda
- Japan Association of Obstetricians and Gynecologists, Japan
| | - Yuki Tsukahara
- Japan Association of Obstetricians and Gynecologists, Japan
| | | | | | | | - Osamu Nishii
- Japan Association of Obstetricians and Gynecologists, Japan
| | - Akihito Nakai
- Japan Association of Obstetricians and Gynecologists, Japan
| | | | | | | |
Collapse
|
7
|
Khryanin AA. Urogenital chlamydia infection in women: patient management tactics according to present-day foreign and Russian recommendations. VESTNIK DERMATOLOGII I VENEROLOGII 2015. [DOI: 10.25208/0042-4609-2015-91-2-101-110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article present data on current approaches to laboratory diagnostics and treatment of urogenital chlamydia infection in women. According to Russian and foreign guidelines, azithromycin, josamycin and doxycycline monohydrate belong to the most efficient antimicrobial drugs for the treatment of urogenital chlamydia infection in non-pregnant women. As for the treatment of pregnant patients suffering from this pathology, azithromycin and josamycin are the most optimal drugs in terms of safety and treatment efficacy according to both Russian and foreign guidelines.
Collapse
|
8
|
Peuchant O, Le Roy C, Desveaux C, Paris A, Asselineau J, Maldonado C, Chêne G, Horovitz J, Dallay D, de Barbeyrac B, Bébéar C. Screening for Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium should it be integrated into routine pregnancy care in French young pregnant women? Diagn Microbiol Infect Dis 2015; 82:14-9. [PMID: 25753079 DOI: 10.1016/j.diagmicrobio.2015.01.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 01/23/2015] [Accepted: 01/27/2015] [Indexed: 12/17/2022]
Abstract
Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium screening during pregnancy is not performed routinely in France. We conducted the first prospective study in 1004 women attending for routine antenatal care to determine the prevalence and risk factors for these bacterial infections. The overall prevalence of C. trachomatis, N. gonorrhoeae, and M. genitalium infections was 2.5%, 0%, and 0.8%, respectively. In patients aged 18-24 years, the prevalence increased to 7.9% for C. trachomatis and to 2.4% for M. genitalium. C. trachomatis infection was associated with age ≤24 years or being single or having more than 5 sexual partners in a lifetime. M. genitalium infection was more frequent in patients aged ≤24 years or who had a history of abortion or their first sexual intercourse after 20 years of age. The high prevalence of C. trachomatis in pregnant women aged ≤24 years, mostly asymptomatic, suggests that systematic screening could be beneficial.
Collapse
Affiliation(s)
- O Peuchant
- Univ. Bordeaux, USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, 33076 Bordeaux, France; INRA, USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, 33076 Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Laboratoire de Bactériologie, 33076 Bordeaux, France.
| | - C Le Roy
- Univ. Bordeaux, USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, 33076 Bordeaux, France; INRA, USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, 33076 Bordeaux, France
| | - C Desveaux
- Centre Hospitalier Universitaire de Bordeaux, Service de Gynécologie Obstétrique, 33076 Bordeaux, France
| | - A Paris
- Centre Hospitalier Universitaire de Bordeaux, Service de Gynécologie Obstétrique, 33076 Bordeaux, France
| | - J Asselineau
- Centre Hospitalier Universitaire de Bordeaux, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique, 33076 Bordeaux, France
| | - C Maldonado
- Centre Hospitalier Universitaire de Bordeaux, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique, 33076 Bordeaux, France
| | - G Chêne
- Centre Hospitalier Universitaire de Bordeaux, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique, 33076 Bordeaux, France
| | - J Horovitz
- Centre Hospitalier Universitaire de Bordeaux, Service de Gynécologie Obstétrique, 33076 Bordeaux, France
| | - D Dallay
- Centre Hospitalier Universitaire de Bordeaux, Service de Gynécologie Obstétrique, 33076 Bordeaux, France
| | - B de Barbeyrac
- Univ. Bordeaux, USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, 33076 Bordeaux, France; INRA, USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, 33076 Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Laboratoire de Bactériologie, 33076 Bordeaux, France
| | - C Bébéar
- Univ. Bordeaux, USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, 33076 Bordeaux, France; INRA, USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, 33076 Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Laboratoire de Bactériologie, 33076 Bordeaux, France
| |
Collapse
|
9
|
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.
Collapse
|
10
|
Samarawickrema NA, Tabrizi SN, Young E, Gunawardena P, Garland SM. Prevalence of Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae and human papillomavirus in a sexual health clinic setting in urban Sri Lanka. Int J STD AIDS 2014; 26:733-9. [PMID: 25258396 DOI: 10.1177/0956462414552813] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/28/2014] [Indexed: 11/15/2022]
Abstract
The prevalences of Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, and human papillomavirus (HPV) in Sri Lanka are not well reported; the objective of this study is to describe the prevalences of these four sexually transmitted infections among attendees of sexual health clinic in an urban setting. Vaginal swabs were collected from consenting women attending a sexual health clinic and tested for the presence of the above sexually transmitted infections using nucleic acid amplification techniques. Basic demographic details were sought from each participant (483 women of age range 14-61, median 30 years, IQR 12 years) via a research assistant-administered questionnaire. Overall, a prevalence of T. vaginalis, C. trachomatis, N. gonorrhoeae and HPV was 2.3%, (95% CI: 1.2-4.1%), 8.2% (95% CI: 5.6-11.4%), 7.6% (95% CI: 5.2-10.8%), and 44.4% (95% CI: 39.8-49.1%), respectively. Among the 197 positive for HPV, HPV6 accounted for 23.1%, HPV16 (12.5%), then HPV11, HPV66 and HPV58 were the commonest. Vaccine-related types (6/11/16/18) were detected in 59.9% of cases (95%CI: 52.7-66.8%). The high prevalence of sexually transmitted infections (45.2%) is a potential risk factor for an increase in HIV infections in the country and the high carriage of HPV supports the need for cervical cancer screening and prevention programmes.
Collapse
Affiliation(s)
- N A Samarawickrema
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC, Australia
| | - S N Tabrizi
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | - E Young
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | - P Gunawardena
- Department of Biochemistry and Clinical Chemistry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - S M Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| |
Collapse
|
11
|
Pereboom MTR, Spelten ER, Manniën J, Rours GIJG, Morré SA, Schellevis FG, Hutton EK. Knowledge and acceptability of Chlamydia trachomatis screening among pregnant women and their partners; a cross-sectional study. BMC Public Health 2014; 14:704. [PMID: 25011479 PMCID: PMC4105044 DOI: 10.1186/1471-2458-14-704] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 06/09/2014] [Indexed: 11/10/2022] Open
Abstract
Background Chlamydia trachomatis infections in pregnancy can cause maternal disease, adverse pregnancy outcomes and neonatal disease, which is why chlamydia screening during pregnancy has been advocated. The effectiveness of a screening program depends on the knowledge of health care professionals, women and partners and the acceptability for screening of the target population. We assessed the knowledge of chlamydia infection among pregnant women and their partners in the Netherlands, their attitudes towards testing, and their experiences of being offered a chlamydia test. In addition, we evaluated the association between participants’ background characteristics and knowledge of chlamydia. Methods Pregnant women aged ≤ 30 years and their partners (regardless of their age) attending one of the participating primary midwifery care practices in the Netherlands were invited to participate. All participants completed a questionnaire, pregnant women provided a vaginal swab and partners provided a urine sample to test for C. trachomatis. Results In total, 383 pregnant women and 282 partners participated in the study of whom 1.9% women and 2.6% partners tested chlamydia positive. Participants had high levels of awareness (92.8%) of chlamydial infection. They were knowledgeable about the risk of chlamydia infection; median knowledge score was 9.0 out of 12.0. Lower knowledge scores were found among partners (p-value <0.001), younger aged (p-value 0.02), non-western origin (p-value <0.001), low educational level (p-value <0.001), and no history of sexually transmitted infections (p-value <0.001). In total, 78% of respondents indicated that when pregnant women are tested for chlamydia, their partners should also be tested; 54% believed that all women should routinely be tested. Pregnant women more often indicated than partners that testing partners for chlamydial infection was not necessary (p-value <0.001). The majority of pregnant women (56.2%) and partners (59.2%) felt satisfied by being offered the test during antenatal care. Conclusion Pregnant women and their partners were knowledgeable about chlamydial infection, found testing, both pregnant women and their partners, for chlamydia acceptable and not stigmatizing.
Collapse
Affiliation(s)
- Monique T R Pereboom
- Department of Midwifery Science, AVAG and the EMGO + Institute for Health and Care Research, VU University Medical Center, P,O, Box 7057, (Room D4,40), Amsterdam, 1007 MB, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
12
|
Developing a predictive model to prioritize human immunodeficiency virus partner notification in North Carolina. Sex Transm Dis 2014; 39:65-71. [PMID: 22183850 DOI: 10.1097/olq.0b013e318239da4e] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Disease intervention specialists (DIS) in North Carolina have less time to conduct partner notification because of competing responsibilities while simultaneously facing increased case loads because of increased human immunodeficiency virus (HIV) testing. We developed a model to predict undiagnosed HIV infection in sexual partners to prioritize DIS interviews. METHODS We abstracted demographic, behavioral, and partnership data from DIS records of HIV-infected persons reported in 2 North Carolina surveillance regions between January 1, 2003 and December 31, 2007. Multiple logistic regression with generalized estimating equations was used to develop a predictive model and risk scores among newly diagnosed persons and their partners. Sensitivities and specificities of the risk scores at different cutoffs were used to examine algorithm performance. RESULTS Five factors predicted a partnership between a person with newly diagnosed HIV infection and an undiagnosed partner--a period of 4 weeks or fewer between HIV diagnosis and DIS interview, no history of crack use, no anonymous sex, fewer total sexual partners reported to DIS, and sexual partnerships between an older index case and younger partner. Using this model, DIS could choose an appropriate cutoff for locating a particular partner by determining the weight of false negatives relative to false positives. CONCLUSIONS Although the overall predictive power of the model is low, it is possible to reduce the number of partners that needs to be located and interviewed while maintaining high sensitivity. If DIS continue to pursue all partners, the model would be useful in identifying partners in whom to invest more resources for locating.
Collapse
|
13
|
Pereboom MTR, Manniën J, Rours GIJG, Spelten ER, Hutton EK, Schellevis FG. Chlamydia trachomatis infection during pregnancy: knowledge, test practices, and attitudes of Dutch midwives. ACTA ACUST UNITED AC 2013; 46:107-13. [PMID: 24350790 DOI: 10.3109/00365548.2013.859391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Chlamydia trachomatis infection in pregnancy may lead to adverse pregnancy outcomes. In the Netherlands, testing for C. trachomatis is based on risk assessment. We assessed midwives' knowledge, test practices, assessment of risk behavior, and attitudes regarding testing for C. trachomatis infection during pregnancy. We evaluated the association between midwives' characteristics and their knowledge of C. trachomatis infection in terms of symptomatology and outcomes. METHODS This was a cross-sectional study among primary care midwives in the Netherlands. Between September and November 2011, midwives from all Dutch primary care midwifery practices were invited to complete a questionnaire about C. trachomatis infection. RESULTS Of the 518 midwives invited to participate in this study, 331 (63.9%) responded. The overall median knowledge score for questions about symptomatology and outcomes was 10 out of a maximum score of 15. The median knowledge score was higher among midwives in urban areas. In total, 239 (72.2%) midwives reported testing pregnant women for C. trachomatis. The primary reason for testing was a request by the woman herself (96.2%), followed by symptoms of infection (89.1%), risk behavior (59.3%), and risk factors for infection (7.3%). Almost 25% of midwives showed positive attitudes towards universal screening for C. trachomatis. CONCLUSIONS Midwives were knowledgeable about symptoms of infection, but less about outcomes. Midwives test pregnant women for C. trachomatis mainly on the women's request. Otherwise, testing is based on symptoms of infection rather than on known risk factors. This may contribute to under-diagnosis and under-treatment, leading to maternal, perinatal, and neonatal morbidity.
Collapse
Affiliation(s)
- Monique T R Pereboom
- From the Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center , Amsterdam , Netherlands
| | | | | | | | | | | |
Collapse
|
14
|
Liu B, Roberts CL, Clarke M, Jorm L, Hunt J, Ward J. Chlamydia and gonorrhoea infections and the risk of adverse obstetric outcomes: a retrospective cohort study. Sex Transm Infect 2013; 89:672-8. [DOI: 10.1136/sextrans-2013-051118] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
15
|
Stephens N, O'Sullivan M, Coleman D, Shaw K. Chlamydia trachomatis in Tasmania 2001-2007: rising notification trends. Aust N Z J Public Health 2013; 34:120-5. [PMID: 23331353 DOI: 10.1111/j.1753-6405.2010.00494.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To investigate trends in notification rates of Chlamydia trachomatis in Tasmania, Australia, by population sub-groups, from 1 January 2001 to 31 December 2007. METHODS An enhanced surveillance dataset was used to supplement case notifications. Rates based on age group were analysed by sex, geographic region, indigenous status, sexual exposure, reason for testing and healthcare provider. RESULTS In all age groups, the notification rate increased steeply. The highest rates were seen in the ages 15-24 years; this age group represented 15% of the population but accounted for 74% of the chlamydial notifications. The increased rates in females aged 15-24 years and males 15-19 years in Tasmania were larger than the increases observed nationally. Rates were consistently higher in urban areas. Females were more likely to have been tested as a result of screening, and males were more likely to have been tested when presenting with symptoms or as a result of contact tracing. The majority of cases reported sexual exposure with opposite sex partners only. CONCLUSIONS This study highlights the increasing significance of chlamydial infection as a public health issue, the gender differences in health-seeking behaviour, and the discrepancies in testing patterns. These findings will assist with the design of health promotion programs.
Collapse
Affiliation(s)
- Nicola Stephens
- Communicable Diseases Prevention Unit, Department of Health and Human Services, Tasmania.
| | | | | | | |
Collapse
|
16
|
Li Z, Chen M, Guy R, Wand H, Oats J, Sullivan EA. Chlamydia screening in pregnancy in Australia: Integration of national guidelines into clinical practice and policy. Aust N Z J Obstet Gynaecol 2013; 53:338-46. [DOI: 10.1111/ajo.12099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 04/16/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Zhuoyang Li
- National Perinatal Epidemiology and Statistics Unit; University of New South Wales; Sydney; New South Wales; Australia
| | | | - Rebecca Guy
- The Kirby Institute University of New South Wales; Sydney; New South Wales; Australia
| | - Handan Wand
- The Kirby Institute University of New South Wales; Sydney; New South Wales; Australia
| | | | | |
Collapse
|
17
|
Walker J, Tabrizi SN, Fairley CK, Chen MY, Bradshaw CS, Twin J, Taylor N, Donovan B, Kaldor JM, McNamee K, Urban E, Walker S, Currie M, Birden H, Bowden F, Gunn J, Pirotta M, Gurrin L, Harindra V, Garland SM, Hocking JS. Chlamydia trachomatis incidence and re-infection among young women--behavioural and microbiological characteristics. PLoS One 2012; 7:e37778. [PMID: 22662220 PMCID: PMC3360595 DOI: 10.1371/journal.pone.0037778] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 04/24/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study aimed to estimate rates of chlamydia incidence and re-infection and to investigate the dynamics of chlamydia organism load in prevalent, incident and re-infections among young Australian women. METHODS 1,116 women aged 16 to 25 years were recruited from primary care clinics in Australia. Vaginal swabs were collected at 3 to 6 month intervals for chlamydia testing. Chlamydia organism load was measured by quantitative PCR. RESULTS There were 47 incident cases of chlamydia diagnosed and 1,056.34 person years of follow up with a rate of 4.4 per 100 person years (95% CI: 3.3, 5.9). Incident infection was associated with being aged 16 to 20 years [RR = 3.7 (95%CI: 1.9, 7.1)], being employed [RR = 2.4 (95%CI: 1.1, 4.9)] and having two or more new sex partners [RR = 5.5 (95%CI: 2.6, 11.7)]. Recent antibiotic use was associated with a reduced incidence [RR:0.1 (95%CI: 0.0, 0.5)]. There were 14 re-infections with a rate of 22.3 per 100 person years (95%CI: 13.2, 37.6). The median time to re-infection was 4.6 months. Organism load was higher for prevalent than incident infections (p<0.01) and for prevalent than re-infections (p<0.01). CONCLUSIONS Chlamydia is common among young women and a high proportion of women are re-infected within a short period of time, highlighting the need for effective partner treatment and repeat testing. The difference in organism load between prevalent and incident infections suggests prevalent infection may be more important for ongoing transmission of chlamydia.
Collapse
Affiliation(s)
- Jennifer Walker
- CERSH Melbourne Medical School, University of Melbourne, Victoria, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Kwan KSH, Giele CM, Combs B, Mak DB. Improvement in antenatal testing for sexually transmissible infections and blood-borne viruses in Western Australian hospitals, 2007 to 2010. Sex Health 2012; 9:349-54. [DOI: 10.1071/sh11151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 01/24/2012] [Indexed: 11/23/2022]
Abstract
Objective Antenatal testing for specified sexually transmissible infections (STIs) and blood-borne viruses (BBVs) is recommended by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). In 2007, the Department of Health, Western Australia (DoHWA) issued an operational directive (OD) recommending universal testing for chlamydia and additional testing for women in the STI endemic regions of Western Australia (WA). To assess adherence to these guidelines, seven WA public hospitals were audited. Design and setting: Demographic details and testing information of the last 200 women who gave birth immediately before 30 June 2007 (baseline audit) and 30 June 2010 (follow-up audit) were obtained from each hospital’s antenatal records. Results: Data from 2718 women who delivered at ≥36 weeks’ gestation were analysed (baselinen = 1353; follow-upn = 1365). Testing at the first antenatal visit in accordance with the guidelines improved over time (RANZCOG: 68–74%; χ2-test = 13.96, d.f. = 1, P < 0.001; DoHWA OD: 12–40%; χ2-test = 279.71, d.f. = 1, P < 0.001). Retesting at 28–36 weeks’ gestation in the STI endemic regions improved for chlamydia (3–10%; χ2-test = 17.40, d.f. = 1, P < 0.001) and gonorrhoea (3–7%; χ2-test = 6.62, d.f. = 1, P < 0.05), but not for syphilis or HIV. Chlamydia prevalence was 3% and 8% among nonAboriginal and Aboriginal women, respectively. Conclusion: The proportion of women delivering in WA public hospitals who had antenatal STI and BBV tests improved after publication and promotion of the OD.
Collapse
|
20
|
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.
Collapse
Affiliation(s)
- Lenka A Vodstrcil
- Melbourne School of Population Health, The University of Melbourne, Vic, Australia
| | | | | | | | | | | | | |
Collapse
|
21
|
Rours GIJG, Duijts L, Moll HA, Arends LR, de Groot R, Jaddoe VW, Hofman A, Steegers EAP, Mackenbach JP, Ott A, Willemse HFM, van der Zwaan EAE, Verkooijen RP, Verbrugh HA. Chlamydia trachomatis infection during pregnancy associated with preterm delivery: a population-based prospective cohort study. Eur J Epidemiol 2011; 26:493-502. [PMID: 21538042 PMCID: PMC3115062 DOI: 10.1007/s10654-011-9586-1] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 04/15/2011] [Indexed: 11/26/2022]
Abstract
Chlamydia trachomatis infection is the most prevalent bacterial sexually transmitted infection and may influence pregnancy outcome. This study was conducted to assess the effect of chlamydial infection during pregnancy on premature delivery and birthweight. Pregnant women attending a participating midwifery practice or antenatal clinic between February 2003 and January 2005 were eligible for the study. From 4,055 women self-administered questionnaires and urine samples, tested by PCR, were analysed for C. trachomatis infection. Pregnancy outcomes were obtained from midwives and hospital registries. Gestational ages and birthweights were analysed for 3,913 newborns. The C. trachomatis prevalence was 3.9%, but varied by age and socio-economic background. Chlamydial infection was, after adjustment for potential confounders, associated with preterm delivery before 32 weeks (OR 4.35 [95% CI 1.3, 15.2]) and 35 weeks gestation (OR 2.66 [95% CI 1.1, 6.5]), but not with low birthweight. Of all deliveries before 32 weeks and 35 weeks gestation 14.9% [95% CI 4.5, 39.5] and 7.4% [95% CI 2.5, 20.1] was attributable to C. trachomatis infection. Chlamydia trachomatis infection contributes significantly to early premature delivery and should be considered a public health problem, especially in young women and others at increased risk of C. trachomatis infection.
Collapse
Affiliation(s)
- G Ingrid J G Rours
- The Generation R Study group, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Bilardi JE, De Guingand DL, Temple-Smith MJ, Garland S, Fairley CK, Grover S, Wallace E, Hocking JS, Tabrizi S, Pirotta M, Chen MY. Young pregnant women's views on the acceptability of screening for chlamydia as part of routine antenatal care. BMC Public Health 2010; 10:505. [PMID: 20723264 PMCID: PMC2933724 DOI: 10.1186/1471-2458-10-505] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 08/19/2010] [Indexed: 12/03/2022] Open
Abstract
Background In pregnancy, untreated chlamydia infection has been associated with adverse outcomes for both mother and infant. Like most women, pregnant women infected with chlamydia do not report genital symptoms, and are therefore unlikely to be aware of their infection. The aim of this study was to determine the acceptability of screening pregnant women aged 16-25 years for chlamydia as part of routine antenatal care. Methods As part of a larger prospective, cross-sectional study of pregnant women aged 16-25 years attending antenatal services across Melbourne, Australia, 100 women were invited to participate in a face-to-face, semi structured interview on the acceptability of screening for chlamydia during pregnancy. Women infected with chlamydia were oversampled (n = 31). Results Women had low levels of awareness of chlamydia before the test, retained relatively little knowledge after the test and commonly had misconceptions around chlamydia transmission, testing and sequelae. Women indicated a high level of acceptance and support for chlamydia screening, expressing their willingness to undertake whatever care was necessary to ensure the health of their baby. There was a strong preference for urine testing over other methods of specimen collection. Women questioned why testing was not already conducted alongside other antenatal STI screening tests, particularly in view of the risks chlamydia poses to the baby. Women who tested positive for chlamydia had mixed reactions, however, most felt relief and gratitude at having had chlamydia detected and reported high levels of partner support. Conclusions Chlamydia screening as part of routine antenatal care was considered highly acceptable among young pregnant women who recognized the benefits of screening and strongly supported its implementation as part of routine antenatal care. The acceptability of screening is important to the uptake of chlamydia screening in future antenatal screening strategies.
Collapse
Affiliation(s)
- Jade E Bilardi
- The University of Melbourne, Carlton, Victoria, Australia.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Screening for Chlamydia trachomatis in pregnancy: a retrospective analysis in a German urban area. Arch Gynecol Obstet 2010; 283:1343-7. [DOI: 10.1007/s00404-010-1537-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 05/31/2010] [Indexed: 11/25/2022]
|
24
|
Silveira MF, Erbelding EJ, Ghanem KG, Johnson HL, Burke AE, Zenilman JM. Risk of Chlamydia trachomatis infection during pregnancy: effectiveness of guidelines-based screening in identifying cases. Int J STD AIDS 2010; 21:367-70. [DOI: 10.1258/ijsa.2010.009559] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Our goal was to define the risk factors for Chlamydia trachomatis (CT) infection among pregnant women at a large urban medical centre. In a retrospective study, clinical records at a US maternity unit from July 2005 through February 2008 were reviewed. The study population included all pregnant women with a singleton newborn of at least 20 weeks gestation and antenatal care information. Logistic regression was used to analyse the association between a positive CT test and demographic, behavioural and prenatal care variables. A total of 2127 women were included in this analysis. The prevalence of CT infection was 4.7%. Cases were more likely to be younger, black and single. Other risk factors included tobacco use and Neisseria gonorrhoeae infection. Our findings suggest that factors other than age may impact upon the diagnosis of CT in pregnant women and that a more comprehensive testing strategy should be considered.
Collapse
Affiliation(s)
- M F Silveira
- Maternal and Child Department, Faculty of Medicine, Federal University of Pelotas, Brazil
| | - E J Erbelding
- Division of Infectious Diseases, Department of Medicine, School of Medicine
| | - K G Ghanem
- Division of Infectious Diseases, Department of Medicine, School of Medicine
| | - H L Johnson
- Department of International Health, Bloomberg School of Public Health
| | - A E Burke
- Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - J M Zenilman
- Division of Infectious Diseases, Department of Medicine, School of Medicine
| |
Collapse
|
25
|
Prediction Model to Maximize Impact of Syphilis Partner Notification—San Francisco, 2004–2008. Sex Transm Dis 2010; 37:109-14. [DOI: 10.1097/olq.0b013e3181bbf985] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
26
|
Kang M, Skinner R, Usherwood T. Interventions for young people in Australia to reduce HIV and sexually transmissible infections: a systematic review. Sex Health 2010; 7:107-28. [DOI: 10.1071/sh09079] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 02/26/2010] [Indexed: 11/23/2022]
Abstract
Background: Like young people in other developed countries, sexually active young Australians can have an increased risk of acquiring sexually transmissible infections (STIs). This paper reviews intervention programs that aim to reduce the incidence and transmission of HIV and STIs among young people in Australia. Methods: Articles were identified from seven databases. Intervention studies conducted in Australia that included young people aged 12–25 years were reviewed. A two-dimensional matrix consisting of ‘setting’ and ‘intervention type’ was developed to categorise each study. Results: Forty-two studies met the inclusion criteria, and the majority were uncontrolled intervention studies. Of these, 23/42 studies measured participation in chlamydia ± other STI testing and found that the highest participation rates took place in non-clinical and non-general practice health care settings. Four studies facilitated access to testing indirectly, through the internet or other media. Ten studies involved the provision of education and measured its impact on factors such as knowledge, attitudes and/or behaviour. Three studies involved novel immunisation strategies for either hepatitis B or human papillomavirus vaccines. Two studies evaluated the impact of enhanced STI surveillance programs on prevalence rates. Conclusions: Proactive STI testing in non-clinical and some health settings appears feasible and achieves higher testing rates than in general practice; however, more evaluation of testing strategies in general practice settings is required. New technologies such as the internet and SMS are useful adjuncts for influencing behaviours such as condom use and STI testing. Media campaigns that promote STI testing can have a positive impact on testing rates.
Collapse
|
27
|
Franklin N, O'Connor CC, Shaw M, Guy R, Grulich A, Fairley CK, Chen MY, Hellard M, Dickson B, Marshall L, Donovan B. Chlamydia at an inner metropolitan sexual health service in Sydney, NSW: Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) Project. Sex Health 2010; 7:478-83. [DOI: 10.1071/sh09125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Accepted: 05/11/2010] [Indexed: 11/23/2022]
Abstract
Background: Australia has a widely dispersed network of public sexual health services that test large numbers of people from high prevalence populations for genital Chlamydia trachomatis infection. These populations include young sexually active heterosexuals, men who have sex with men, sex workers and Aboriginal and Torres Strait Islander people. The Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) Project was established to monitor chlamydia testing rates and positivity rates at a national level, which in turn will help interpret trends in chlamydia diagnoses reported through passive surveillance. The ACCESS Project is the first time that chlamydia-related data including priority population and testing denominators has been collated at a national level. The present paper reports on chlamydia testing and positivity rates in a sexual health service in the inner west of Sydney between 2004 and 2008 and compares these to published national data from the ACCESS Project in sexual health services. Methods: Chlamydia positivity and testing rates at an inner western Sydney sexual health service were compared with aggregate data from the ACCESS Project obtained from 14 sexual health services across Australia. Using a standardised extraction program, retrospective de-identified line-listed demographic and chlamydia testing data on all patients were extracted from patient management systems. Results: Over the 5-year period, 5145 new patients attended the inner-west sexual health service. Almost 66% had a chlamydia test at first visit and there was no significant difference in this testing rate when compared with the ACCESS Project national rate for sexual health services (67.0%; odds ratio [OR] 0.94, 95% confidence intervals 0.88–1.00). The testing rate increased over time from 61% in 2004 to 70% in 2008. There were 281 chlamydia diagnoses at this service, giving an overall chlamydia positivity rate of 9.3%, significantly higher than the ACCESS Project national rate of 8.2% (OR 1.16, 95% confidence intervals 1.02–1.32). Discussion: Testing rates were similar and positivity rates for Chlamydia trachomatis were higher in this sexual health service in Sydney than national trends.
Collapse
|
28
|
Trends in Chlamydia Positivity Over Time Among Women in Melbourne Australia, 2003 to 2007. Sex Transm Dis 2009; 36:763-7. [DOI: 10.1097/olq.0b013e3181b12765] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|