Knowledge of Chlamydia trachomatis genital infection and its consequences in people attending a genitourinary medicine clinic

Readiness of pharmacists and consumers for pharmacy-based chlamydia screening in Australia and Switzerland

OBJECTIVE

To assess chlamydia knowledge, willingness to undertake pharmacy-based chlamydia testing, and facilitators and barriers to such testing in consumers and community pharmacists, in Australia (AUS) and Switzerland (CH).

METHODS

Statements of interest were retrieved from literature and assembled into a 12-item online survey (English and German versions). Survey was disseminated through Facebook, pharmacies' publicly available emails and professional websites (March 2015).

RESULTS

Consumers and pharmacists (AUS: n_cons = 198, n_pharm = 162; CH: n_cons = 209, n_pharm = 223) were predominantly female (>65%). Mean chlamydia knowledge scores (maximum of 8) were higher in Australia in consumers (AUS: 6.8 ± 1.5 vs CH: 4.2 ± 2.4; p < 0.001) and in pharmacists (AUS: 7.1 ± 1.1 vs CH: 6.1 ± 1.4; p < 0.001). High willingness of consumers to seek testing (AUS: 79.3% vs CH: 83.3%, p = 0.3) and of pharmacists to provide testing (AUS: 95.7% vs CH: 80.3%, p < 0.001) was observed. Greatest barrier for consumers was "Embarrassed about asking for a test" (AUS: 47.8% vs CH: 51.2%, p = 0.7) and "No remuneration" for pharmacists (AUS: 40.7% vs CH: 31.8%, p = 0.07).

CONCLUSION

The majority of consumers and pharmacists support pharmacy-based chlamydia testing. There is now emerging evidence that the policy makers in Australia and Switzerland need to develop pharmacy-based chlamydia testing as core business.

Knowledge of sexually transmitted infections and sources of information amongst men

The objective of this study was to investigate menís awareness of sexually transmitted infections (STIs) and sexual health services, together with the best ways of providing information about them.

Information was collated via a self-administered questionnaire, which was answered by 429 men, giving a response rate of 31%.

Men aged 16+ living in two primary care trusts (PCTs) in the north-west of England were accessed through a range of different sources, including social, educational, health, work and religious facilities.

Despite the high rates of STIs in the north-west, approximately one in five men had not heard of herpes, syphilis or chlamydia. One in ten had not heard of gonorrhoea. The majority of men were unaware that many STIs could be asymptomatic. Only 13% knew where their local genitourinary medicine (GUM) clinic was. The main deterrents to accessing the clinic were embarrassment and not knowing where it was.

Menís knowledge of STIs is limited, particularly in relation to the symptoms. The best way of providing information, according to the respondents, was through their general practitioner (GP). However, in practice this might be difficult, as men are reluctant users of GP services in general. Knowledge of the whereabouts of the local GUM clinics is also limited. Although most men thought that they would visit their GP if they thought they might have an STI, this may result from them not knowing the alternatives, rather than having a real choice. More information, targeted wisely, is thus necessary in order to educate men about STIs and service provision.

Young men's views toward the barriers and facilitators of Internet-based Chlamydia trachomatis screening: qualitative study

Background

There is a growing number of Internet-based approaches that offer young people screening for sexually transmitted infections.

Objective

This paper explores young men’s views towards the barriers and facilitators of implementing an Internet-based screening approach. The study sought to consider ways in which the proposed intervention would reach and engage men across ages and socioeconomic backgrounds.

Methods

This qualitative study included 15 focus groups with 60 heterosexual young men (aged 16-24 years) across central Scotland, drawn across age and socioeconomic backgrounds. Focus groups began by obtaining postcode data to allocate participants to a high/low deprivation category. Focus group discussions involved exploration of men’s knowledge of chlamydia, use of technology, and views toward Internet-based screening. Men were shown sample screening invitation letters, test kits, and existing screening websites to facilitate discussions. Transcripts from audio recordings were analyzed with "Framework Analysis".

Results

Men’s Internet and technology use was heterogeneous in terms of individual practices, with greater use among older men (aged 20-24 years) than teenagers and some deprivation-related differences in use. We detail three themes related to barriers to successful implementation: acceptability, confidentiality and privacy concerns, and language, style, and content. These themes identify ways Internet-based screening approaches may fail to engage some men, such as by raising anxiety and failing to convey confidentiality. Men wanted screening websites to frame screening as a serious issue, rather than using humorous images and text. Participants were encouraged to reach a consensus within their groups on their broad design and style preferences for a screening website; this led to a set of common preferences that they believed were likely to engage men across age and deprivation groups and lead to greater screening uptake.

Conclusions

The Internet provides opportunities for re-evaluating how we deliver sexual health promotion and engage young men in screening. Interventions using such technology should focus on uptake by age and socioeconomic background. Young people should be engaged as coproducers of intervention materials and websites to ensure messages and content are framed appropriately within a fast-changing environment. Doing so may go some way to addressing the overall lower levels of testing and screening among men compared with women.

Increasing young adults' condom use intentions and behaviour through changing chlamydia risk and coping appraisals: study protocol for a cluster randomised controlled trial of efficacy

BACKGROUND

Chlamydia is the most commonly diagnosed sexually transmitted infection (STI) in England and has serious public health consequences. Young people carry a disproportionate burden of infection. A number of social cognition models identify risk appraisal as a primary motivator of behaviour suggesting that changing risk appraisals for STIs may be an effective strategy in motivating protective behaviour. Meta-analytic evidence indicates that the relationship between risk appraisal and health behaviour is small, but studies examining this relationship have been criticised for their many conceptual and methodological weaknesses. The effect of risk appraisal on health behaviour may therefore be of larger size. The proposed study aims to examine the efficacy of an intervention to increase condom use intentions and behaviour amongst young people through changing chlamydia risk and coping appraisals. Coping appraisal is targeted to avoid the intervention being counterproductive amongst recipients who do not feel able to perform the behaviour required to reduce the threat. An experimental design with follow-up, a conditional measure of risk appraisal, and analysis which controls for past behaviour, enable the relationship between risk appraisal and protective behaviour to be accurately assessed.

METHODS/DESIGN

The proposed study is a two-arm cluster randomised controlled trial using a waiting-list control design to test the efficacy of the intervention compared to a control group. Participants will be school pupils aged 13-16 years old recruited from approximately ten secondary schools. Schools will be randomised into each arm. Participants will receive their usual teaching on STIs but those in the intervention condition will additionally receive a single-session sex education lesson on chlamydia. Measures will be taken at baseline, post-intervention and at follow-up three months later. The primary outcome measure is intention to use condoms with casual sexual partners.

DISCUSSION

As far as the authors are aware, this is the first controlled trial testing the efficacy of an intervention to increase condom use intentions and behaviour through changing chlamydia risk appraisals. It is one of few experimental studies to accurately test the relationship between risk appraisal and precautionary sexual behaviour using a conditional measure of risk appraisal and controlling for past behaviour.

How do young adults perceive the risk of chlamydia infection? A qualitative study

OBJECTIVES

This study aimed to improve understanding of how young UK genito-urinary medicine (GUM) patients perceive the risk of chlamydia, and identify implications for health education.

DESIGN

A qualitative methodology was chosen.

METHODS

Semi-structured interviews with 27 respondents aged 16-22 years old were conducted. Data were subjected to thematic analysis.

RESULTS

Respondents made assessments of the perceived seriousness of, and their personal susceptibility to, chlamydia infection. Judgements about seriousness were related to beliefs about the controllability of symptoms and the long-term health consequences of infection. Susceptibility estimates were related to beliefs about the extent to which personal exposure put them in contact with chlamydia, and about the prevalence of infection amongst their peer group. This is consistent with the content of illness risk representations proposed by Cameron (2003). Respondents demonstrated some beliefs, which appeared to influence perceptions of seriousness and susceptibility in unhelpful ways.

CONCLUSIONS

Young people may be underestimating their risk of chlamydia infection due to the presence of unhelpful beliefs. Dialogue between health professionals and patients within GUM clinics, or through consultations as part of the National Chlamydia Screening Programme (NCSP), could provide vehicles to deliver health education to target these. Suggested health education includes highlighting false reassurance provided by treatment beliefs and exposing the fallibility of using overt characteristics to judge the likelihood that a potential sexual partner poses a risk of infection.

Knowledge of Chlamydia trachomatis among men and women approached to participate in community-based screening, Scotland, UK

Background

Poor awareness and knowledge of Chlamydia trachomatis could be a barrier to uptake of screening. This study aimed to determine the level of awareness and knowledge of chlamydia among young people who were being approached in a variety of community settings and offered opportunistic screening.

Methods

Men and women aged 16-24 years were approached in education, health and fitness, and workplace settings and invited to complete a self-administered questionnaire then provide a urine sample for chlamydia testing. Follow-up semi-structured interviews with 24 respondents were carried out after test results were received.

Results

363 questionnaires were completed (43.5% from men). Whilst awareness of chlamydia was high, knowledge decreased as questions became increasingly focussed so that around half of respondents were unaware of the asymptomatic nature of chlamydia infections. Men's knowledge of symptoms was consistently lower than women's, with most men failing to identify unusual discharge as a symptom in men (men 58.3%, female 45.8%, p = 0.019); fewer men knew unusual discharge was a symptom among women (men 65.3% female 21.4%, p < 0.001). The asymptomatic nature of the infection resonated with respondents and was the commonest piece of information they picked up from their participation in the study.

Conclusions

Despite scientific gains in understanding chlamydia infection, public understanding remains limited. Greater efforts are required to translate scientific evidence to the public. An improvement in knowledge may maximise gains from interventions to improve detection.

A study of young peoples' attitudes to opportunistic Chlamydia testing in UK general practice

Objective

The objective of this study was to assess young people's perceptions of being offered a chlamydia screening test in United Kingdom (UK) general practice.

Methods

This is qualitative study that uses focus groups and individual interviews with young adults (age 16 – 18) to assess their views.

Results

These young adults were a difficult group to gain access to. Two focus groups, one in a school, the other in a general practice (family practice), and 2 individual interviews were undertaken (total sample 18). Respondents were unfamiliar with Chlamydia, but broadly aware of sexually transmitted infections. General practice (family practice) was perceived as an acceptable place to deliver opportunistic screening, but participants felt that tests should not be initiated by GP receptionists. Novel delivery routes such as schools and "Pub"/Bar dispensing machines were discussed. Issues around stigma and confidentiality were also raised.

Conclusion

Opportunistic Chlamydia screening in UK general practice (family practic seems acceptable to young adults. While this is a difficult group to gain access to for research, attempts need to made to ensure acceptability to users of this programme.

Should asymptomatic men be included in chlamydia screening programs? Cost-effectiveness of chlamydia screening among male and female entrants to a national job training program

OBJECTIVE

To compare the cost-effectiveness of various chlamydia screening strategies within a population of male and female youth entering a national job training program.

STUDY DESIGN

Cost-effectiveness analysis of various chlamydia screening strategies among a cohort of 4000 female and male New England job training students. Strategies for women include (a) no screening, (b) universal endocervical DNA probe screening, (c) universal urine based NAAT screening, and (d) universal endocervical NAAT screening. Strategies for men include (a) no screening, (b) selective urine NAAT screening of leukocyte esterase (LE)-positive urines, and (c) universal urine-based NAAT screening.

RESULTS

Universal endocervical NAAT screening of women and universal urine NAAT screening of men were the most effective and cost-effective strategies individually and in combination. Endocervical NAAT screening of women prevented 23 more cases of PID and saved $27,000 more than endocervical DNA probe screening. Likewise, universal urine NAAT screening of men prevented 21 more cases of PID in their female partners and saved $16,000 more than selective urine NAAT screening of LE positive men.

CONCLUSIONS

Use of a sensitive NAAT to screen both men and women for chlamydia upon entry to a National Job Training Program is cost-effective, cost-saving, and provides a public health opportunity to substantially reduce chlamydia infections among youth at risk for sexually transmitted diseases.

Implementing chlamydia screening: what do women think? A systematic review of the literature

Background

Chlamydia trachomatis is a common sexually transmitted infection that can have serious consequences. It is universally agreed that screening for chlamydia infection should be offered to sexually active young women. We undertook a literature review to document the views, attitudes and opinions of women about being screened, tested and diagnosed with Chlamydia trachomatis.

Methods

Online databases (MEDLINE, Meditext, PsycINFO, Web of Science) and reference lists searched up to August 2005. Search terms: chlamydia, attitude, attitude to health, interview, qualitative, women. Eligibility criteria: about chlamydia, included women, involved interviews/surveys/focus groups, looked at women's views/opinions/attitudes, published in English. Thematic analysis identified the main and recurrent themes emerging from the literature. We compared our thematic analysis with the Theory of Planned Behaviour to provide a model that could assist in planning chlamydia screening programs.

Results

From 561 identified articles, 25 fulfilled inclusion criteria and were reviewed. 22: USA, UK; 3: Holland, Sweden, Australia. Major themes identified: need for knowledge and information, choice and support; concerns about confidentiality, cost, fear, anxiety and stigma. Women are more likely to find chlamydia screening/testing acceptable if they think chlamydia is a serious, common condition which can cause infertility and if they understand that chlamydia infection can be asymptomatic. Women want a range of options for chlamydia testing including urine tests, self-administered swabs, pelvic exams and clinician-collected swabs, home-testing and community-based testing. Tests should be free, easy and quick. Women want support for dealing with the implications of a chlamydia diagnosis, they feel chlamydia diagnoses need to be normalised and destigmatised and they want assistance with partner notification. Women need to know that their confidentiality will be maintained.

Conclusion

Our review found that women from various countries and ethnic backgrounds share similar views regarding chlamydia screening, testing and diagnosis. The acknowledged importance of women's views in planning an effective chlamydia screening program is expanded in this review which details the nature and complexity of such views and considers their likely impact.

Sex in Australia: knowledge about sexually transmissible infections and blood-borne viruses in a representative sample of adults

OBJECTIVE

To describe knowledge related to sexually transmitted infection (STI) and blood-borne virus (BBV) infection in a representative sample of Australian adults.

METHODS

Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The overall response rate was 73.1% (69.4% among men and 77.6% among women). Respondents were read a series of statements about STIs and BBVs and asked to say if they believed they were true or false. Predictors of knowledge were examined.

RESULTS

Respondents were more likely to answer correctly questions about hepatitis C than questions about herpes, gonorrhoea, genital warts and chlamydia. Women had better knowledge than men. Other predictors of better knowledge included speaking English at home, homosexual or bisexual identity, higher educational levels, higher income, higher occupational level and a previous STI diagnosis.

CONCLUSION

Knowledge of transmission routes and health consequences of the most common STIs was poor. Although knowledge is only one prerequisite for effective disease prevention, the findings suggest that improving public knowledge of STIs is an urgent task in reducing the morbidity associated with these common infections.

IMPLICATIONS

Education campaigns to increase knowledge of the transmission and health consequences of STIs are urgently required if the substantial morbidity associated with these common infections is to be reduced.

Choosing and using services for sexual health: a qualitative study of women's views

OBJECTIVE

To explore women's accounts of choosing and using specialist services for sexual health.

METHODS

A qualitative study involving semistructured interviews with 37 women screened for Chlamydia trachomatis attending genitourinary medicine and family planning clinics in an East Midlands health authority.

RESULTS

In making the decision to seek help, women act on a range of specific prompts, including lay ideas about the significance of symptoms; their own behaviour; their partner's symptoms or behaviour; contact tracing; and health promotion. Some women do not seek help specifically in relation to sexual health but are identified as being at risk of sexually transmitted infections (STIs) during routine consultations. Important influences on women's choice of services include the lay referral system, "insider" knowledge of health services, referral by health professionals, and need to have alternatives to general practice care. Women's willingness to access services is mediated by psychosocial factors such as embarrassment. They may use smear tests as a legitimate opportunity to raise questions about sexual health. Women's priorities for services are that their feelings of stigma and embarrassment are managed appropriately; that staff communicate well and are sensitive to their emotions and comfort during tests and procedures; that they are "in control" when obtaining test results; and that confidentiality is preserved.

CONCLUSIONS

A detailed understanding of both lay people's response to symptoms or behaviour that indicates risk of an STI and their needs when using services should inform interventions aimed at encouraging secondary prevention of STIs.

Knowledge of genital Chlamydia trachomatis infection in family planning clinic attenders

The purpose of this study was to determine the level of awareness of genital Chlamydia infection and level of knowledge related to this infection in family planning (FP) clinic attenders. Clients attending FP clinics during a 3 month study period were invited to complete an anonymous self-administered questionnaire. Five hundred and sixteen questionnaires from female attenders were analysed. Results showed that 54% of respondents had heard of Chlamydia. Subjective knowledge assessment for Chlamydia was low compared to that for other infections. Mean knowledge scores relating to genital chlamydial infection were low. There was no significant age-related trend in knowledge scores. The implications of these findings are discussed in relation to increased Chlamydia screening activity in FP clinics.