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Chlamydia trachomatis as a Current Health Problem: Challenges and Opportunities. Diagnostics (Basel) 2022; 12:diagnostics12081795. [PMID: 35892506 PMCID: PMC9331119 DOI: 10.3390/diagnostics12081795] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Chlamydia is one of the most common sexually transmitted bacterial infections (STIs) worldwide. It is caused by Chlamydia trachomatis (CT), which is an obligate intracellular bacterium. In some cases, it can occur in coinfection with other parasites, increasing the pathologic potential of the infection. The treatment is based on antibiotic prescription; notwithstanding, the infection is mostly asymptomatic, which increases the risk of transmission. Therefore, some countries have implemented Chlamydia Screening Programs in order to detect undiagnosed infections. However, in Portugal, there is no CT screening plan within the National Health Service. There is no awareness in the general healthcare about the true magnitude of this issue because most of the methods used are not Nucleic Acid Amplification Technology-based and, therefore, lack sensitivity, resulting in underreporting infection cases. CT infections are also associated with possible long-term severe injuries. In detail, persistent infection triggers an inflammatory milieu and can be related to severe sequels, such as infertility. This infection could also trigger gynecologic tumors in women, evidencing the urgent need for cost-effective screening programs worldwide in order to detect and treat these individuals adequately. In this review, we have focused on the success of an implemented screening program that has been reported in the literature, the efforts made concerning the vaccine discovery, and what is known regarding CT infection. This review supports the need for further fundamental studies in this area in order to eradicate this infection and we also suggest the implementation of a Chlamydia Screening Program in Portugal.
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Stoecker C, Monnette A, Qu Z, Schmidt N, Craig-Kuhn MC, Kissinger PJ. Cost-effectiveness of Check It: A Novel Community-Based Chlamydia Screening and Expedited Treatment Program for Young Black Men. Clin Infect Dis 2021; 74:2166-2172. [PMID: 34864944 PMCID: PMC9258938 DOI: 10.1093/cid/ciab818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 11/16/2022] Open
Abstract
Background We assessed the cost-effectiveness of the Check It program, a novel community-based chlamydia screening and expedited partner treatment program for young Black men conducted in New Orleans since 2017. Methods We implemented a probabilistic cost-effectiveness model using a synthetic cohort of 16 181 men and 13 419 women intended to simulate the size of the Black, sexually active population in New Orleans ages 15–24 years. Results The Check It program cost $196 838 (95% confidence interval [CI]: $117 320–$287 555) to implement, saved 10.2 quality-adjusted life-years (QALYs; 95% CI: 7.7–12.7 QALYs), and saved $140 950 (95% CI: −$197 018 to −$105 620) in medical costs per year. The program cost $5468 (95% CI: cost saving, $16 717) per QALY gained. All iterations of the probabilistic model returned cost-effectiveness ratios less than $50 000 per QALY gained. Conclusions The Check It program (a bundled seek, test, and treat chlamydia prevention program for young Black men) is cost-effective under base case assumptions. Communities where Chlamydia trachomatis rates have not declined could consider implementing a similar program.
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Affiliation(s)
- Charles Stoecker
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | | | - Zhuolin Qu
- Department of Mathematics, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Norine Schmidt
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Megan Clare Craig-Kuhn
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Patricia J Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Diesel J, Peterson A, Peterman T. Reported Chlamydia and Gonorrhea Are Decreasing Among Young Black Women: Good News or Bad News? A Narrative Review. Sex Transm Dis 2021; 48:e228-e235. [PMID: 34091582 PMCID: PMC10308433 DOI: 10.1097/olq.0000000000001491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Since 2010, reported chlamydia and gonorrhea rates decreased among Black women aged 15 to 19 years and were stable for Black women aged 20 to 24 years in the United States. Rates increased for older Black women aged 25 to 39 years and all White women. The Black/White rate ratio decreased across age groups. We examined whether trends in reported rates reflected changing prevalence or changing screening. We analyzed trends in reported chlamydia and gonorrhea rates from 2010 to 2018 among women in the United States aged 15 to 39 years by age and race/ethnicity subgroup, state, and reporting source. Most jurisdictions reported decreased chlamydia and gonorrhea rates among Black teens and increased rates among White teens and older women. Between 2010 and 2018, public clinics reported fewer cases, especially among young Black women, that were not restored by increases elsewhere. We reviewed literature on trends in screening, prevalence, and sequelae. Family planning clinics annual reports showed chlamydia tests among women younger than 25 years decreased by 541,573 tests (-38%) in 2018 compared with 2010 and the number of women visiting sexually transmitted disease clinics had decreased 50% by 2016 compared with 2010. Prevalence of chlamydia in a sentinel population (Job Corps) was unchanged for Black women younger than 25 years and increased for Whites aged 20 to 24 years. Sequelae trends using data from a large all-payer emergency department database were mixed: pelvic inflammatory disease decreased, whereas ectopic pregnancy increased. Decreases in testing at public clinics likely missed diagnoses among young Black women, a group traditionally at highest risk and in need of more testing. Innovative approaches to screening are needed.
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Affiliation(s)
- Jill Diesel
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention, Atlanta, GA
- Michigan Department of Health and Human Services, Detroit, MI
| | - Amy Peterson
- Michigan Department of Health and Human Services, Detroit, MI
| | - Thomas Peterman
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention, Atlanta, GA
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Prevalence of leukocyturia in a cohort of French asymptomatic aircrews. Clin Microbiol Infect 2021; 28:141.e1-141.e4. [PMID: 34607000 DOI: 10.1016/j.cmi.2021.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/01/2021] [Accepted: 09/23/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Sexually transmitted infections (STIs) can cause leukocyturia. We aimed to estimate the prevalence of leukocyturia in asymptomatic aircrews and the proportion of STIs in those presenting leukocyturia. METHODS The LEUCO survey was a prospective cohort study conducted among aircrews between 14th October 2019 and 13th March 2020 at the Toulon aeromedical centre in France. All participants performed a dipstick urinalysis. Those positive for leukocyturia were offered STI screening by nucleic acid amplification test (NAAT) for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis. RESULTS Among the 2236 included asymptomatic participants (1912 men and 324 women), 127 (36 men and 91 women) were positive for leukocyturia. The prevalence of leukocyturia was 1.9% (1.3-2.6) in men and 28.1% (23.3-33.3) in women (p < 0.001). In men positive for leukocyturia, the NAAT positivity rate for C. trachomatis, N. gonorrhoeae, M. genitalium and T. vaginalis was 28.6% (3.7-71.0) in the age group 18-24, 20.0% (0.5-71.6) in the age group 25-34, and zero in the older age group (p 0.65). In women positive for leukocyturia it was 16.7% (4.7-37.4) in the age group 18-24, 18.2% (2.3-51.8) in the age group 25-34, and zero in the older age group (p 0.16). CONCLUSIONS In asymptomatic individuals, leukocyturia is rare in men and more common in women. In asymptomatic adults under 35 years of age with leukocyturia, multiplex NAAT shows a high proportion of STIs and might be useful in improving STI detection.
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Ahmadi SJ, Farhadifar F, Sharami SRY, Zare S, Rezaei M, Soofizadeh N, Babaei E, Moradi G, Ahmadi A. The role of Chlamydia trachomatis in preterm delivery: a case-control study in Besat Hospital, Sanandaj, Iran (2018-2019). IRANIAN JOURNAL OF MICROBIOLOGY 2020; 12:325-330. [PMID: 32994904 PMCID: PMC7502151 DOI: 10.18502/ijm.v12i4.3936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background and Objectives: Preterm delivery is an important subject in gynecology, obstetrics and pediatrics. It is defined as regular uterine contractions every five to eight minutes or less, lasting for 30 seconds. It is associated with progressive changes in the cervix, resulting in delivery after 22 weeks and before 37 weeks of gestation. This study aimed to evaluate the role of Chlamydia trachomatis infection in women with preterm delivery. Materials and Methods: This case-control study was performed on 75 women with preterm delivery (case group) and 75 women with term delivery (control group). The research tools included a questionnaire, polymerase chain reaction (PCR) assay of cervical swab samples and ELISA assay of umbilical cord blood samples. Fisher’s exact test and t test were also performed to compare qualitative variables between the two groups. Results: In this study, the mean age of subjects was 26.55 ± 0.53 years in the control group and 26.76 ± 0.56 years in the case group. The prevalence of C. trachomatis in the cervical swab samples was 7 (9.33%) in the control group and 2 (2.67%) in the case group. There was no C. trachomatis IgM antibody in either of the groups, while there was 1 (1.33%) C. trachomatis IgG antibody in both groups. Conclusion: The results of the present study showed that there was no significant relationship between C. trachomatis infection and preterm delivery.
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Affiliation(s)
- Seyedeh Jahan Ahmadi
- Department of Obstetrics & Gynecology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Fariba Farhadifar
- Department of Obstetrics & Gynecology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.,Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | - Shamsi Zare
- Department of Obstetrics & Gynecology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Masomeh Rezaei
- Department of Obstetrics & Gynecology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Nasrin Soofizadeh
- Department of Obstetrics & Gynecology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Erfan Babaei
- Department of Immunology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Amjad Ahmadi
- Department of Microbiology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.,Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Huai P, Li F, Chu T, Liu D, Liu J, Zhang F. Prevalence of genital Chlamydia trachomatis infection in the general population: a meta-analysis. BMC Infect Dis 2020; 20:589. [PMID: 32770958 PMCID: PMC7414538 DOI: 10.1186/s12879-020-05307-w] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 07/28/2020] [Indexed: 12/11/2022] Open
Abstract
Background Estimating prevalence of Chlamydia trachomatis (CT) worldwide is necessary in designing control programs and allocating health resources. We performed a meta-analysis to calculate the prevalence of CT in the general population. Methods The Pubmed and Embase databases were searched for eligible population-based studies from its inception through June 5, 2019. Q test and I2 statistic were used to calculate the heterogeneity between studies. Random effects models were used to pool the prevalence of CT. Meta regression was performed to explore the possible sources of heterogeneity. Publication bias was evaluated using a funnel plot and “trim and fill” method. Results Twenty nine studies that reported prevalence of CT infection from 24 countries were identified, including a total population of 89,886 persons. The pooled prevalence of CT among the general population was 2.9% (95% CI, 2.4–3.5%), and females had a higher CT prevalence (3.1, 95% CI, 2.5–3.8%) than males (2.6, 95% CI, 2.0–3.2%) (χ2 = 10.38, P < 0.01). Prevalence of CT was highest in region of America (4.5, 95% CI, 3.1–5.9%), especially in Latin America (6.7, 95% CI, 5.0–8.4%), followed by females in region of Africa (3.8, 95% CI, 0.7–6.9%), while South-East Asia had a lowest CT prevalence 0.8% (95% CI, 0.3–1.3%). Conclusions This study provided the updated prevalence of CT among general population worldwide. General population from Latin America, especially females, and women in Africa should be given priority by WHO when design and delivery CT control programs.
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Affiliation(s)
- Pengcheng Huai
- Shandong Provincial Hospital for Skin Disease, Shandong First Medical University, Jinan, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, China
| | - Furong Li
- Shandong Provincial Hospital for Skin Disease, Shandong First Medical University, Jinan, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, China
| | - Tongsheng Chu
- Shandong Provincial Hospital for Skin Disease, Shandong First Medical University, Jinan, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, China
| | - Dianchang Liu
- Shandong Provincial Hospital for Skin Disease, Shandong First Medical University, Jinan, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, China
| | - Jian Liu
- Shandong Provincial Hospital for Skin Disease, Shandong First Medical University, Jinan, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, China
| | - Furen Zhang
- Shandong Provincial Hospital for Skin Disease, Shandong First Medical University, Jinan, China. .,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, China.
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Chang SX, Chen KK, Liu XT, Xia N, Xiong PS, Cai YM. Cross-sectional study of asymptomatic Neisseria gonorrhoeae and Chlamydia trachomatis infections in sexually transmitted disease related clinics in Shenzhen, China. PLoS One 2020; 15:e0234261. [PMID: 32516318 PMCID: PMC7282648 DOI: 10.1371/journal.pone.0234261] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/21/2020] [Indexed: 02/05/2023] Open
Abstract
The aims of this study were to investigate the prevalence and proportion of laboratory-confirmed urethral Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections that were asymptomatic among individuals presenting to clinics in Shenzhen and the risk factors related to asymptomatic CT infection. In a cross-sectional study, eligible individuals were invited to participate in the questionnaire, and urine specimens were collected to identify CT and NG infections using a nucleic acid amplification test (NAAT). Considering the differences in the presentation of symptoms between men and women, this study was stratified by gender. Corresponding outcomes were analyzed by Chi-square test and multivariate logistic regression. A total of 2,871 participants were asymptomatic and included in our analyses: 1120 (39.0%) men and 1751 (61.0%) women. The prevalence of asymptomatic NG and CT infections was 0.9% and 6.2% in men, and 0.4% and 7.9% in women, respectively. The proportion of asymptomatic urethral CT among men with urethral CT was 28.3%; for women, it was 34.2%. For asymptomatic men with CT, 3 independent risk factors were identified: (1) men under the age of 30 (aOR, 1.83; 95% CI, 1.11-3.03); (2) being employed in the commercial service work (2.82; 1.36-5.84); and (3) being recruited through the urological department (2.12; 1.19-3.79). For asymptomatic women with urethral CT, age less than 30 years was a risk factor. In conclusion, a substantial prevalence of asymptomatic CT infections was found among men and women presenting to clinics in Shenzhen. The significant correlation between asymptomatic CT infection and these risk factors could help identify high-risk populations and guide screening.
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Affiliation(s)
- Shu-Xia Chang
- Shenzhen Longgang Center for Chronic Disease Control, Shenzhen, China
| | - Kang-Kang Chen
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Xiao-Ting Liu
- Department of Nursing, Shantou University Medical College, Shantou, China
| | - Nan Xia
- Department of Preventive Medicine, Central South University, Changsha, China
| | - Pei-Sheng Xiong
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Yu-Mao Cai
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
- * E-mail:
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Mao X, Zhao R, Yao R, Guo S, Bao L, Gao Y, Sun J, Bao Y, Shi Y, Cui X. Chinese Herbal Formula Feilin Vaginal Gel Prevents the Cervicitis in Mouse Model. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:4168126. [PMID: 30733810 PMCID: PMC6348856 DOI: 10.1155/2019/4168126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/25/2018] [Indexed: 11/28/2022]
Abstract
Cervicitis is a common sexually transmitted disease. In recent years, the abuse of antibiotic in the treatment of cervicitis results in the emergence of antibiotic-resistant bacteria; alternative strategies are needed to be developed. In this research, we investigated the effects of Feilin Vaginal Gel (FVG), a Chinese herbal formula, on the treatment of cervicitis. Two cervicitis models were optimized using BALB/c mouse; one in vitro model was established in HeLa cells. In Chlamydia trachomatis-induced cervicitis model, the high level of bacterial loads, the inflammation in tissue, and the cytokines in serum could be observed. With the administration of FVG, the bacterial loads in cervical mucus and cervix tissue could be significantly inhibited in dose-dependent manners. The pathological injury of cervix and vagina, as well as the levels of IL-2, IL-17, and MCP-1 in serum, could be mitigated by FVG. FVG reduced the number of inclusion induced by C. trachomatis in HeLa cells. In addition, the histological damage in Escherichia coli and Staphylococcus aureus-induced cervicitis model could be reduced by FVG. These results suggest that FVG is capable of treating cervicitis through the inhibition of pathogens and the regulation of host immune responses. FVG may contribute as an alternative agent for the treatment of cervicitis.
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Affiliation(s)
- Xin Mao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Ronghua Zhao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Rongmei Yao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
- College of Traditional Chinese Medicine, North China University of Sciences and Technology, Hebei 063210, China
| | - Shanshan Guo
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Lei Bao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yingjie Gao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Jing Sun
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yanyan Bao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yujing Shi
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Xiaolan Cui
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
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Huai P, Li F, Li Z, Sun L, Fu X, Pan Q, Yu G, Chai Z, Chu T, Mi Z, Bao F, Wang H, Zhou B, Wang C, Sun Y, Niu G, Zhang Y, Fu F, Lang X, Wang X, Zhao H, Liu D, Liu H, Liu D, Liu J, Xu A, Zhang F. Prevalence, risk factors, and medical costs of Chlamydia trachomatis infections in Shandong Province, China: a population-based, cross-sectional study. BMC Infect Dis 2018; 18:534. [PMID: 30367605 PMCID: PMC6204023 DOI: 10.1186/s12879-018-3432-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 10/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background A population-based study of Chlamydia trachomatis (CT) infections is essential in designing a specific control program; however, no large investigation of CT infections among the general population in mainland China has been conducted since 2000. We aimed to determine the prevalence, risk factors, and associated medical costs of CT among residents, 18–49 years of age, in Shandong, China. Methods From May to August 2016, a multistage probability sampling survey involving 8074 individuals was distributed. Data were collected via face-to-face interviews, followed by self-administered questionnaire surveys. First-void urines were collected and tested for CT and Neisseria gonorrhoeae (NG) using nucleic acid amplification. Results The weighted prevalence of CT infection was 2.3% (95% confidence interval [CI], 1.5–3.2) in females and 2.7% (1.6–3.8) in males. Women, 30–34 years of age, had the highest prevalence of CT infections (3.5%, 2.6–4.4), while the highest prevalence of CT infections in males was in those 18–24 years of age (4.3%, 0.0–8.8). Neisseria gonorrhoeae infection had a prevalence of 0.1% (0.0–0.3) in women and 0.03% (0.0–0.1) in men. Risk factors for CT infections among females included being unmarried, divorced, or widowed (odds ratio [OR], 95% CI 3.57, 1.54–8.24) and having two or more lifetime sex partners (3.72, 1.14–12.16). Among males, first intercourse before 20 years of age (1.83, 1.10–3.02) and having two or more lifetime sex partners (1.85, 1.14–3.02) were associated with CT infections. The estimated lifetime cost of CT infections in patients 18–49 years of age in Shandong was 273 million (range, 172–374 million) China Renminbi in 2016. Conclusions This study demonstrated a high burden of CT infections among females < 35 years of age and males < 25 years of age in Shandong. Thus, a CT infection control program should focus on this population, as well as others with identified risk factors. Electronic supplementary material The online version of this article (10.1186/s12879-018-3432-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pengcheng Huai
- Shandong Provincial Hospital for Skin Disease, Shandong University, Jinan, China.,Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
| | - Furong Li
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China
| | - Zhen Li
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China
| | - Lele Sun
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Xi'an Fu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Qing Pan
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Gongqi Yu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Zemin Chai
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Tongsheng Chu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China
| | - Zihao Mi
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Fangfang Bao
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Honglei Wang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Bingni Zhou
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Chuan Wang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Yonghu Sun
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Guiye Niu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Yuan Zhang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Fanghui Fu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Xiaoqiao Lang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Xiaoling Wang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Hui Zhao
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Daina Liu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Hong Liu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China
| | - Dianchang Liu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China
| | - Jian Liu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China
| | - Aiqiang Xu
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China.,Shandong Center for Disease Control and Prevention, Jinan, China
| | - Furen Zhang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China. .,Shandong Provincial Key Laboratory for Dermatovenereology, Jinan, China.
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10
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Ridpath A, Chesson H, Marcus JL, Kirkcaldy RD, Torrone E, Aral SO, Bernstein KT. Screening Peter to Save Paul: The Population-Level Effects of Screening Men Who Have Sex With Men for Gonorrhea and Chlamydia. Sex Transm Dis 2018; 45:623-625. [PMID: 29994935 PMCID: PMC6086737 DOI: 10.1097/olq.0000000000000892] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Alison Ridpath
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Harrell Chesson
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Robert D Kirkcaldy
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elizabeth Torrone
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sevgi O Aral
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kyle T Bernstein
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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11
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Sethi S, Roy A, Garg S, Venkatesan LS, Bagga R. Detection of Chlamydia trachomatis infections by polymerase chain reaction in asymptomatic pregnant women with special reference to the utility of the pooling of urine specimens. Indian J Med Res 2018; 146:S59-S63. [PMID: 29205197 PMCID: PMC5735572 DOI: 10.4103/ijmr.ijmr_981_15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND & OBJECTIVES Genital Chlamydia trachomatis (CT) infections are one of the most prevalent sexually transmitted infections across the world. In pregnant women, if not detected and treated early, these may result in poor pregnancy outcomes and complications. The present study was aimed to screen CT infections from first void urine (FVU) samples of asymptomatic pregnant women using molecular methods. The secondary objective was to evaluate cost-effectiveness in pooling FVU samples for their diagnostic application. METHODS FVU samples were collected from 1000 asymptomatic pregnant women over a period of three years. Pooling was done by including five specimens in one pool in the amount of 10 μl and subjected to polymerase chain reaction (PCR) and further confirmed by direct fluorescent antibody assay (DFA). RESULTS The age of study participants ranged from 18 to 43 yr with the median±standard deviation of 26±3.84 yr. Majority of positive participants were younger than 25 years. A total of 200 pools were prepared and 20 of these were PCR positive. When individual specimen in 20 positive pools was tested, 20 PCR-positive specimens were identified from 19 pools, of which 16 were positive by DFA. Thus, CT was detected in 1.6 per cent asymptomatic pregnant women in India and pooling strategy resulted in 70 per cent reduction in a number of tests performed. INTERPRETATION & CONCLUSIONS Our study detected C. trachomatis infection in 1.6 per cent asymptomatic pregnant women, and pooling of FVU specimens for PCR testing was found to be a cost-saving strategy in comparison to testing individual samples. Further evaluation and studies on the bigger sample size are warranted to validate these results.
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Affiliation(s)
- Sunil Sethi
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Amit Roy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Shubha Garg
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Lakshmi Sree Venkatesan
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Rashmi Bagga
- Department of Obstetrics & Gynaecology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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12
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Luo ZZ, Li W, Wu QH, Zhang L, Tian LS, Liu LL, Ding Y, Yuan J, Chen ZW, Lan LN, Wu XB, Cai YM, Hong FC, Feng TJ, Zhang M, Chen XS. Population-based study of chlamydial and gonococcal infections among women in Shenzhen, China: Implications for programme planning. PLoS One 2018; 13:e0196516. [PMID: 29715319 PMCID: PMC5929501 DOI: 10.1371/journal.pone.0196516] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/14/2018] [Indexed: 01/04/2023] Open
Abstract
This study was aimed to estimate the prevalences of chlamydia (CT) and gonococcal (NG) infections and explore risk factors associated with the CT infection among women in Shenzhen, China. We collected socio-demographic and clinical data from women (aged 20–60) and determined positivity of CT or NG by nucleic acid amplification test (NAAT) with self-collected urine specimens. We estimated prevalence of CT and NG and determined risk factors associated with CT infection. Among 9,207 participants, 4.12% (95% confidence interval [CI], 3.71%-4.53%) tested positive for CT and 0.17% (95% CIs, 0.09%-0.25%) for NG. Factors significantly associated with CT infection included being an ethnic minority (ethnicity other than Han China) (Adjusted odds ratio [AOR], 1.9; 95% CI, 1.2–3.0), using methods other than condom for contraception (AOR, 1.5; 95% CI, 1.2–1.8), having a history of adverse pregnancy outcomes (AOR, 1.4; 95% CI, 1.1–1.8), and experiencing reproductive tract symptoms in the past three months (AOR, 1.3; 95% CI, 1.0–1.7). we found that CT infection is prevalent among women in Shenzhen, China and associated with both demographic and behavioral factors. A comprehensive CT screening, surveillance and treatment programme targeting this population is warranted.
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Affiliation(s)
- Zhen-Zhou Luo
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Wu Li
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Qiu-Hong Wu
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Li Zhang
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Li-Shan Tian
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Lan-Lan Liu
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Yi Ding
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Jun Yuan
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Zhong-Wei Chen
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Li-Na Lan
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Xiao-Bing Wu
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Yu-Mao Cai
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Fu-Chang Hong
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Tie-Jian Feng
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Min Zhang
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
- * E-mail: (MZ); (XSC)
| | - Xiang-Sheng Chen
- Chinese Academy of Medical Sciences & Peking Union Medical College Institute of Dermatology, Nanjing, China
- National Center for STD Control, Nanjing, China
- * E-mail: (MZ); (XSC)
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13
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Prevalence and risk factors of chlamydia infection in Hong Kong: A population-based geospatial household survey and testing. PLoS One 2017; 12:e0172561. [PMID: 28225805 PMCID: PMC5321413 DOI: 10.1371/journal.pone.0172561] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 02/07/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Chlamydia causes infertility and increases risk of HIV infection, and population-based studies provide essential information for effective infection control and prevention. This study examined Chlamydia trachomatis prevalence and risk factors among a representative sample of 18-49-year-old residents in Hong Kong. METHODS Census boundary map of 412 constituency areas was used as primary sampling units to construct the sampling frame and, residential buildings and units were randomly selected using geospatial modelling. A questionnaire on sexual practice and health was conducted, and polymerase chain reaction was used to test the urine for genital chlamydial infection. Invitation letters were sent to the selected households and a team of interviewers were sent to recruit one subject per household. Prevalence data was weighted according to the 2011 census and risk factors identified through logistic regression. RESULTS Among 881 participants (response rate of 24.5%), the overall Chlamydia trachomatis prevalence was low at 1.4% (95%CI 0.8-2.5%) but sexually active young (18-26 years) women had relatively high prevalence (5.8%, 95%CI 1.7-18.2%) in Hong Kong. A unique U-shape disease burden was observed with peaks in younger and older (40-49 years) women. Amongst the sexually active women, the risk factors of Chlamydia trachomatis infection were: younger age (aOR = 25.4, 95% CI 2.81-230); living alone (aOR = 8.99, 95% CI 1.46-55.40); and, among all the sexually active participants, males (including the male partners of the female participants) who had travelled out of Hong Kong in the previous 12 months had higher risks of infection (aOR = 5.35; 95% CI 1.25-22.8). A core-peripheral geographical distribution of Chlamydia trachomatis prevalence was also observed. CONCLUSION Young and older sexually active women in Hong Kong have high prevalence of chlamydia. Routine screening for sexually active women and young men should be considered. Further research on testing feasibility and linkage-to-care are urgently needed to control the infection.
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14
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Ditkowsky J, Shah KH, Hammerschlag MR, Kohlhoff S, Smith-Norowitz TA. Cost-benefit analysis of Chlamydia trachomatis screening in pregnant women in a high burden setting in the United States. BMC Infect Dis 2017; 17:155. [PMID: 28214469 PMCID: PMC5316151 DOI: 10.1186/s12879-017-2248-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 02/07/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis is the most common bacterial sexually transmitted infection (STI) in the United States (U.S.) [1] and remains a major public health problem. We determined the cost- benefit of screening all pregnant women aged 15-24 for Chlamydia trachomatis infection compared with no screening. METHODS We developed a decision analysis model to estimate costs and health-related effects of screening pregnant women for C. trachomatis in a high burden setting (Brooklyn, NY). Outcome data was from literature for pregnant women in the 2015 US population. A virtual cohort of 6,444,686 pregnant women, followed for 1 year was utilized. Using outcomes data from the literature, we predicted the number of C. trachomatis cases, associated morbidity, and related costs. Two comparison arms were developed: pregnant women who received chlamydia screening, and those who did not. Costs and morbidity of a pregnant woman-infant pair with C. trachomatis were calculated and compared. RESULTS Cost and benefit of screening relied on the prevalence of C. trachomatis; when rates are above 16.9%, screening was proven to offer net cost savings. At a pre-screening era prevalence of 8%, a screening program has an increased expense of $124.65 million ($19.34/individual), with 328 thousand more cases of chlamydia treated, and significant reduction in morbidity. At a current estimate of prevalence, 6.7%, net expenditure for screening is $249.08 million ($38.65/individual), with 204.63 thousand cases of treated chlamydia and reduced morbidity. CONCLUSIONS Considering a high prevalence region, prenatal screening for C. trachomatis resulted in increased expenditure, with a significant reduction in morbidity to woman-infant pairs. Screening programs are appropriate if the cost per individual is deemed acceptable to prevent the morbidity associated with C. trachomatis.
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Affiliation(s)
- Jared Ditkowsky
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Khushal H Shah
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Margaret R Hammerschlag
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Stephan Kohlhoff
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Tamar A Smith-Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave, Brooklyn, NY, 11203, USA.
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15
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Lallemand A, Bremer V, Jansen K, Nielsen S, Münstermann D, Lucht A, Tiemann C. Prevalence of Chlamydia trachomatis infection in women, heterosexual men and MSM visiting HIV counselling institutions in North Rhine-Westphalia, Germany - should Chlamydia testing be scaled up? BMC Infect Dis 2016; 16:610. [PMID: 27784280 PMCID: PMC5080774 DOI: 10.1186/s12879-016-1915-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 10/11/2016] [Indexed: 11/24/2022] Open
Abstract
Background Patients asking for a free anonymous HIV test may have contracted other sexually transmitted infections (STIs) such as Chlamydia trachomatis, yet Chlamydia prevalence in that population is unknown. This study aimed to assess the prevalence and factors associated with Chlamydia infection in patients seeking HIV testing at local public health authorities (LPHA) in order to evaluate whether Chlamydia testing should be routinely offered to them. Methods We conducted a cross-sectional study among patients (≥18 years) attending 18 LPHA in North Rhine-Westphalia from November 2012 to September 2013. LPHA collected information on participants’ socio-demographic characteristics, sexual and HIV testing behaviours, previous STI history and clinical symptoms. Self-collected vaginal swabs and urine (men) were analysed by Transcription-Mediated Amplification. We assessed overall and age-stratified Chlamydia prevalence and 95 % confidence intervals (95 % CI). Using univariate and multivariable binomial regression, we estimated adjusted prevalence ratios (aPR) to identify factors associated with Chlamydia infection. Results The study population comprised 1144 (40.5 %) women, 1134 (40.1 %) heterosexual men and 549 (19.4 %) men who have sex with men (MSM); median age was 30 years. Chlamydia prevalence was 5.3 % (95 % CI: 4.1–6.8 %) among women, 3.2 % (95 % CI: 2.2–4.4) in heterosexual men and 3.5 % (95 % CI: 2.1–5.4) in MSM. Prevalence was highest among 18–24 year-old women (9 %; 95 % CI: 5.8–13) and heterosexual men (5.7 %; 95 % CI: 3.0–9.8 %), respectively. Among MSM, the prevalence was highest among 30–39 year-olds (4.4 %; 95 % CI: 1.9–8.5 %). Among those who tested positive, 76.7 % of women, 75.0 % of heterosexual men and 84.2 % of MSM were asymptomatic. Among women, factors associated with Chlamydia infection were young age (18–24 years versus ≥ 40 years, aPR: 3.0, 95 % CI: 1.2–7.8), having had more than 2 partners over the past 6 months (ref.: one partner, aPR: 2.1, 95 % CI: 1.1–4.0) and being born abroad (aPR: 1.9, 95 % CI: 1.0–3.5). Among heterosexual men, young age was associated with Chlamydia infection (18–24 years versus ≥ 40 years, aPR: 4.1, 95 % CI: 1.3–13). Among MSM, none of the variables were associated with Chlamydia infection. Conclusions LPHA offering HIV tests should consider offering routine Chlamydia testing to women under 30 years. Women with multiple partners and those born abroad may also be considered for routine testing. Our results also suggest offering routine Chlamydia testing to heterosexual men under 25 years old. For MSM, we cannot draw specific recommendations based on our study as we estimated the prevalence of urethral Chlamydia infection, leaving out rectal and pharyngeal infections.
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Affiliation(s)
- Anne Lallemand
- Robert Koch Institute, Berlin, Germany. .,European Programme for Intervention Epidemiology Training (EPIET), ECDC, Stockholm, Sweden.
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16
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Matteelli A, Capelli M, Sulis G, Toninelli G, Carvalho ACC, Pecorelli S, Caruso A, Bonfanti C, Gargiulo F, Donato F. Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infection in adolescents in Northern Italy: an observational school-based study. BMC Public Health 2016; 16:200. [PMID: 26927226 PMCID: PMC4772514 DOI: 10.1186/s12889-016-2839-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 02/05/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We carried out a study to evaluate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae genital infections in school-based adolescents in Northern Italy. METHODS Systematic screening for C. trachomatis and N. gonorrhoeae genital infection was performed in 13th grade students in the province of Brescia, an industrialized area in Northern Italy. Student filled in a questionnaire on sexual behaviour and provided a urine sample for microbiological testing. RESULTS A total of 2,718 students (mean age: 18.4 years; 59.1% females) provided complete data (62.2% of those eligible). Overall 2,059 students (75.8%) were sexually active (i.e. had had at least one partner), and the mean age at sexual debut was 16.1 years (SD: 1.4). Only 27.5% of the sexually active students reported regular condom use during the previous 6 months, with higher frequency in males than in females (33.8% vs 24.2%). No case of N. gonorrhoeae infection was detected, while C. trachomatis was found in 36 adolescents, with a prevalence of 1.7% (95% CI: 1.2-2.4) among sexually active students, and no statistical difference between females and males (1.9 and 1.4%, respectively). Inconsistent condom use (odds ratio, OR = 5.5) and having had more than one sexual partner during the previous 6 months (OR = 6.8) were associated with an increased risk of Chlamydia infection at multivariate analysis. CONCLUSION The prevalence of C. trachomatis infection among sexually active adolescents in Northern Italy was low, despite a high proportion of students who engage in risky sexual behaviour. No cases of N. gonorrhoeae infection were identified.
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Affiliation(s)
- Alberto Matteelli
- />University Department of Infectious and TropicalDiseases, University of Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy
| | - Michela Capelli
- />Post-graduate school of Public Health, University of Brescia, Brescia, Italy
| | - Giorgia Sulis
- />University Department of Infectious and TropicalDiseases, University of Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy
| | - Giuseppe Toninelli
- />Post-graduate school of Public Health, University of Brescia, Brescia, Italy
| | - Anna Cristina C. Carvalho
- />University Department of Infectious and TropicalDiseases, University of Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy
- />Laboratory of Innovations in Therapies, Education and Bioproducts (LITEB), Oswaldo Cruz Institute (IOC), FioCruz, Rio de Janeiro, Brazil
| | - Sergio Pecorelli
- />Clinic of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
| | - Arnaldo Caruso
- />Laboratory of Microbiology, Spedali Civili General Hospital, Brescia, Italy
| | - Carlo Bonfanti
- />Laboratory of Microbiology, Spedali Civili General Hospital, Brescia, Italy
| | - Franco Gargiulo
- />Laboratory of Microbiology, Spedali Civili General Hospital, Brescia, Italy
| | - Francesco Donato
- />Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy
| | - (on behalf of the Clamigon Study Group)
- />University Department of Infectious and TropicalDiseases, University of Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy
- />Post-graduate school of Public Health, University of Brescia, Brescia, Italy
- />Laboratory of Innovations in Therapies, Education and Bioproducts (LITEB), Oswaldo Cruz Institute (IOC), FioCruz, Rio de Janeiro, Brazil
- />Clinic of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
- />Laboratory of Microbiology, Spedali Civili General Hospital, Brescia, Italy
- />Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy
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17
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Lewis FMT, Dittus P, Salmon ME, Nsuami MJ. School-Based Sexually Transmitted Disease Screening: Review and Programmatic Guidance. Sex Transm Dis 2016; 43:S18-27. [PMID: 26779684 PMCID: PMC6747663 DOI: 10.1097/olq.0000000000000283] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
School-based sexually transmitted disease (STD) screening (SBSS) was designed to provide chlamydia and gonorrhea testing, treatment, and counseling to adolescents in a school setting to overcome some of the difficulties of screening in this population. To inform STD control programs and other entities on decision making about potentially implementing this intervention, we reviewed existing published and gray literature on SBSS from 1998 to 2014. Although they are work-intensive to establish, school-based STD screening programs are a feasible and cost-effective way of testing large numbers of male and female adolescents for chlamydia and gonorrhea, and to provide counseling and treatment to almost all those who are found infected. School-based STD screening programs do not seem to reduce prevalence in either the school or the general adolescent population, although there are currently relatively few studies on large-scale SBSS. More research in this field is needed.
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Affiliation(s)
- Felicia M T Lewis
- From the *Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA; †Philadelphia Department of Public Health, Philadelphia, PA; and ‡Louisiana State University Health Sciences Center, New Orleans, LA
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18
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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.
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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
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Bellaminutti S, Seraceni S, De Seta F, Gheit T, Tommasino M, Comar M. HPV and Chlamydia trachomatis co-detection in young asymptomatic women from high incidence area for cervical cancer. J Med Virol 2014; 86:1920-5. [PMID: 25132162 DOI: 10.1002/jmv.24041] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2014] [Indexed: 11/10/2022]
Abstract
Chlamydia trachomatis causing chronic inflammatory diseases has investigated as possible human papillomavirus (HPV) cofactor in cervical cancer. The aim of this study is to evaluate the prevalence of Chlamydia trachomatis and HPV co-infection in different cohorts of asymptomatic women from a Northern Italy area at high incidence for cervical cancer. Cervical samples from 441 females were collected from Cervical Cancer Screening Program, Sexually Transmitted Infectious and Assisted Reproductive Technology centres. HPV and Chlamydia trachomatis were detected simultaneously and genotyped using a highly sensitive bead based assay. The overall prevalence of Chlamydia trachomatis was estimated 9.7%, in contrast with the reported national data of 2.3%, and co-infection with HPV was diagnosed in the 17% of the samples. In females ≤ 25 years of age, the infection reached a peak of 22% and co-infection with HPV of 45.8% (P < 0.001). Of note, in young females diagnosed with low grade cervical lesions, no significant difference between Chlamydia trachomatis and HPV distribution was observed, while differently, HPV co-infection was found significantly associated to the presence of intraepithelial lesions when compared to older females (20% vs. 1%; P < 0.001). In this study, the use of a high sensitive molecular technique exhibited higher analytical sensitivity than the referred assays for the diagnosis of Chlamydia trachomatis and HPV co-infection in asymptomatic females, leading to reduction of the potential to identify incorrectly the infection status. An active screening for timely treatment of Chlamydia trachomatis infection is suggested in young females to evaluate a possible decrease in incidence of pre-cancer intraepithelial lesions.
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Dimech W, Lim MSC, Van Gemert C, Guy R, Boyle D, Donovan B, Hellard M. Analysis of laboratory testing results collected in an enhanced chlamydia surveillance system in Australia, 2008-2010. BMC Infect Dis 2014; 14:325. [PMID: 24920016 PMCID: PMC4061452 DOI: 10.1186/1471-2334-14-325] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 06/06/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Chlamydial infection is the most common notifiable disease in Australia, Europe and the US. Australian notifications of chlamydia rose four-fold from 20,274 cases in 2002 to 80,846 cases in 2011; the majority of cases were among young people aged less than 29 years. Along with test positivity rates, an understanding of the number of tests performed and the demographics of individuals being tested are key epidemiological indicators. The ACCESS Laboratory Network was established in 2008 to address this issue. METHODS The ACCESS Laboratory Network collected chlamydia testing data from 15 laboratories around Australia over a three-year period using data extraction software. All chlamydia testing data from participating laboratories were extracted from the laboratory information system; patient identifiers converted to a unique, non-reversible code and de-identified data sent to a single database. Analysis of data by anatomical site included all specimens, but in age and sex specific analysis, only one testing episode was counted. RESULTS From 2008 to 2010 a total of 628,295 chlamydia tests were referred to the 15 laboratories. Of the 592,626 individual episodes presenting for testing, 70% were from female and 30% from male patients. In female patients, chlamydia positivity rate was 6.4% overall; the highest rate in 14 year olds (14.3%). In male patients, the chlamydia positivity rate was 9.4% overall; the highest in 19 year olds (16.5%). The most common sample type was urine (57%). In 3.2% of testing episodes, multiple anatomical sites were sampled. Urethral swabs gave the highest positivity rate for all anatomical sites in both female (7.7%) and male patients (14%), followed by urine (7.6% and 9.4%, respectively) and eye (6.3% and 7.9%, respectively). CONCLUSIONS The ACCESS Laboratory Network data are unique in both number and scope and are representative of chlamydia testing in both general practice and high-risk clinics. The findings from these data highlight much lower levels of testing in young people aged 20 years or less; in particular female patients aged less than 16 years, despite being the group with the highest positivity rate. Strategies are needed to increase the uptake of testing in this high-risk group.
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Affiliation(s)
- Wayne Dimech
- NRL, 4th Floor Healy Building, 41 Victoria Parade, Fitzroy 3065, Australia
| | - Megan SC Lim
- Burnet Institute, Centre for Population Health, 85 Commercial Road, Melbourne, Victoria 3004, Australia
- Monash University, School of Population Health and Preventive Medicine, 99 Commercial Rd, Melbourne 3004, Australia
| | - Caroline Van Gemert
- Burnet Institute, Centre for Population Health, 85 Commercial Road, Melbourne, Victoria 3004, Australia
- Monash University, School of Population Health and Preventive Medicine, 99 Commercial Rd, Melbourne 3004, Australia
| | - Rebecca Guy
- The Kirby Institute, Sexual Health Program, University of New South Wales, Sydney, NSW 2052, Australia
| | - Douglas Boyle
- GRHANITE Health Informatics Unit, Rural Health Academic Centre, Melbourne Medical School, University of Melbourne, 49 Graham Street, Shepparton, Victoria 3630, Australia
| | - Basil Donovan
- The Kirby Institute, Sexual Health Program, University of New South Wales, Sydney, NSW 2052, Australia
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW 2000, Australia
| | - Margaret Hellard
- Burnet Institute, Centre for Population Health, 85 Commercial Road, Melbourne, Victoria 3004, Australia
- Monash University, School of Population Health and Preventive Medicine, 99 Commercial Rd, Melbourne 3004, Australia
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Trichomonas vaginalis in selected U.S. sexually transmitted disease clinics: testing, screening, and prevalence. Sex Transm Dis 2014; 40:865-9. [PMID: 24113409 DOI: 10.1097/olq.0000000000000038] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trichomonas vaginalis is the most prevalent nonviral sexually transmitted infection in the United States, affecting 3.1% of women of reproductive age. Infection is associated with HIV acquisition and pelvic inflammatory disease. In the United States, Centers for Disease Control and Prevention guidelines recommend testing all women with vaginal discharge for T. vaginalis, but except for HIV-infected women, there are no national guidelines for screening asymptomatic persons. The objective of this analysis is to assess testing and screening practices for T. vaginalis among symptomatic and asymptomatic women in the sexually transmitted disease (STD) clinic setting. METHODS We analyzed data on demographics, clinical presentation, and laboratory testing for all women visiting a clinician in 2010 to 2011 at any of 15 STD clinics participating in the STD Surveillance Network. Prevalence of laboratory-confirmed T. vaginalis infection was calculated among symptomatic women tested and among asymptomatic women screened. RESULTS A total of 59,176 women visited STD clinicians: 39,979 were considered symptomatic and 19,197 were considered asymptomatic for T. vaginalis infection, whereas 211 were HIV-infected. Diagnostic practices varied by jurisdiction: 4.0% to 96.1% of women were tested or screened for T. vaginalis using any laboratory test. Among 17,952 symptomatic women tested, prevalence was 26.2%. Among 3909 asymptomatic women screened, prevalence was 6.5%. Among 92 HIV-infected women tested/screened, prevalence was 29.3%. CONCLUSIONS Trichomoniasis is common among STD clinic patients. In this analysis, most STD clinics tested symptomatic women seeking care, in accordance with national guidelines. All HIV-infected women should be screened annually. Additional evidence and national guidance are needed regarding potential benefits of T. vaginalis screening in other asymptomatic women.
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Mohamed-Noriega K, Mohamed-Noriega J, Valdés-Navarro MA, Cuervo-Lozano EE, Fernández-Espinosa MC, Mohamed-Hamsho J. Conjunctival infection with Chlamydia trachomatis in sexual partners of patients with adult inclusion conjunctivitis. Int Ophthalmol 2014; 35:179-85. [DOI: 10.1007/s10792-014-9930-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 02/28/2014] [Indexed: 10/25/2022]
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Jackson LJ, Auguste P, Low N, Roberts TE. Valuing the health states associated with Chlamydia trachomatis infections and their sequelae: a systematic review of economic evaluations and primary studies. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:116-130. [PMID: 24438725 DOI: 10.1016/j.jval.2013.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 10/10/2013] [Accepted: 10/22/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Economic evaluations of interventions to prevent and control sexually transmitted infections such as Chlamydia trachomatis are increasingly required to present their outcomes in terms of quality-adjusted life-years using preference-based measurements of relevant health states. The objectives of this study were to critically evaluate how published cost-effectiveness studies have conceptualized and valued health states associated with chlamydia and to examine the primary evidence available to inform health state utility values (HSUVs). METHODS A systematic review was conducted, with searches of six electronic databases up to December 2012. Data on study characteristics, methods, and main results were extracted by using a standard template. RESULTS Nineteen economic evaluations of relevant interventions were included. Individual studies considered different health states and assigned different values and durations. Eleven studies cited the same source for HSUVs. Only five primary studies valued relevant health states. The methods and viewpoints adopted varied, and different values for health states were generated. CONCLUSIONS Limitations in the information available about HSUVs associated with chlamydia and its complications have implications for the robustness of economic evaluations in this area. None of the primary studies could be used without reservation to inform cost-effectiveness analyses in the United Kingdom. Future debate should consider appropriate methods for valuing health states for infectious diseases, because recommended approaches may not be suitable. Unless we adequately tackle the challenges associated with measuring and valuing health-related quality of life for patients with chlamydia and other infectious diseases, evaluating the cost-effectiveness of interventions in this area will remain problematic.
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Affiliation(s)
- Louise J Jackson
- Health Economics Unit, University of Birmingham, Edgbaston, Birmingham, UK
| | - Peter Auguste
- Warwick Evidence, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Tracy E Roberts
- Health Economics Unit, University of Birmingham, Edgbaston, Birmingham, UK.
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Fernández-Benítez C, Mejuto-López P, Otero-Guerra L, Margolles-Martins MJ, Suárez-Leiva P, Vazquez F. Prevalence of genital Chlamydia trachomatis infection among young men and women in Spain. BMC Infect Dis 2013; 13:388. [PMID: 23968487 PMCID: PMC3765329 DOI: 10.1186/1471-2334-13-388] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 08/16/2013] [Indexed: 11/24/2022] Open
Abstract
Background There are no accurate data regarding the real prevalence of Chlamydia trachomatis infection in Spain. Our aim was to determine the prevalence of C. trachomatis infections and the risk factors for acquiring them among 1,048 young (15–24 years old) inhabitants of Laviana. Methods The study was completed in the period between 1st November 2010 and 31st December 2011. We conducted a capture strategy in the whole population, instead of only in a sample group, with a capture conducted in schools, in the local health centre, by post and by phone as a last resort. The design was based on the model used by Shafer to increase screening rates. C. trachomatis was identified by RT-PCR in urine samples. Results A total of 487 sexually active people underwent the test, which implies a response rate of 59.8% of the sexually active people (target population). The prevalence was 4.1% (CI 95%: 3.1-5.8): women: 4% ( CI 95%; 2.8-6.4) and men: 4.3% (CI 95%: 2.9-7.2). The circulating genotype was the E genotype. There was an increase in the risk of C. trachomatis infection when barrier contraceptives were not routinely used OR: 4.76 (CI 95%:1.30-17.36) p<0.05. Conclusions In our study the prevalence in women resembles those found in other countries in Europe and the prevalence in men is similar to that in women. Screening for C. trachomatis infection in women would be cost-effective in Spain given the prevalence of C. trachomatis measured by this study. The use of a condom is the best preventative measure for avoiding STIs in sexually active people.
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Pediatric emergency department provider perceptions of universal sexually transmitted infection screening. Adv Emerg Nurs J 2013; 35:76-86. [PMID: 23364408 DOI: 10.1097/tme.0b013e31827eabe5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to describe the perceptions of pediatric emergency care providers in relation to implementing a universal sexually transmitted infection screening process for adolescent female patients in a pediatric emergency department. A descriptive qualitative design was used with a convenience sample of pediatric emergency physicians and nurses working in a large urban, pediatric teaching hospital. Participants were individually interviewed using a standard interview guide. Verbatim transcripts were analyzed using a modified constant comparative analysis method. Three overriding themes were identified that describe the perceptions of providers in relation to a universal screening process in a pediatric emergency department: Attitudes, Barriers, and Solutions. Universal sexually transmitted infection screening is one strategy that may help with early identification and treatment of adolescent female patients with undiagnosed sexually transmitted infections, and the pediatric emergency department is a potential site for such screening.
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Fairley SJ, Singh SR, Yilma AN, Waffo AB, Subbarayan P, Dixit S, Taha MA, Cambridge CD, Dennis VA. Chlamydia trachomatis recombinant MOMP encapsulated in PLGA nanoparticles triggers primarily T helper 1 cellular and antibody immune responses in mice: a desirable candidate nanovaccine. Int J Nanomedicine 2013; 8:2085-99. [PMID: 23785233 PMCID: PMC3682632 DOI: 10.2147/ijn.s44155] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Indexed: 11/23/2022] Open
Abstract
We recently demonstrated by in vitro experiments that PLGA (poly D, L-lactide-co-glycolide)
potentiates T helper 1 (Th1) immune responses induced by a peptide derived from the recombinant
major outer membrane protein (rMOMP) of Chlamydia trachomatis, and may be a
promising vaccine delivery system. Herein we evaluated the immune-potentiating potential of PLGA by
encapsulating the full-length rMOMP (PLGA-rMOMP), characterizing it in vitro, and investigating its
immunogenicity in vivo. Our hypothesis was that PLGA-rMOMP triggers Th1 immune responses in mice,
which are desirable prerequisites for a C. trachomatis candidate nanovaccine.
Physical-structural characterizations of PLGA-rMOMP revealed its size (approximately 272 nm), zeta
potential (−14.30 mV), apparent spherical smooth morphology, and continuous slow release
pattern. PLGA potentiated the ability of encapsulated rMOMP to trigger production of cytokines and
chemokines by mouse J774 macrophages. Flow cytometric analyses revealed that spleen cells from
BALB/c mice immunized with PLGA-rMOMP had elevated numbers of CD4+ and CD8+ T cell
subsets, and secreted more rMOMP-specific interferon-gamma (Th1) and interleukin (IL)-12p40
(Th1/Th17) than IL-4 and IL-10 (Th2) cytokines. PLGA-rMOMP-immunized mice produced higher serum
immunoglobulin (Ig)G and IgG2a (Th1) than IgG1 (Th2) rMOMP-specific antibodies. Notably, sera from
PLGA-rMOMP-immunized mice had a 64-fold higher Th1 than Th2 antibody titer, whereas mice immunized
with rMOMP in Freund’s adjuvant had only a four-fold higher Th1 than Th2 antibody titer,
suggesting primarily induction of a Th1 antibody response in PLGA-rMOMP-immunized mice. Our data
underscore PLGA as an effective delivery system for a C. trachomatis vaccine. The
capacity of PLGA-rMOMP to trigger primarily Th1 immune responses in mice promotes it as a highly
desirable candidate nanovaccine against C. trachomatis.
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Affiliation(s)
- Stacie J Fairley
- Center for NanoBiotechnology Research, Alabama State University, Montgomery, AL 36104, USA
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Yeganeh O, Jeddi-Tehrani M, Yaghmaie F, Kamali K, Heidari-Vala H, Zeraati H, Shakhssalim N, Zarei S, Chamani-Tabriz L. A survey on the prevalence of Chlamydia trachomatis and Mycoplasma genitalium infections in symptomatic and asymptomatic men referring to urology clinic of labbafinejad hospital, tehran, iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:340-4. [PMID: 24083010 PMCID: PMC3785911 DOI: 10.5812/ircmj.8600] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 01/02/2013] [Indexed: 11/16/2022]
Abstract
Background Chlamydia trachomatis and Mycoplasma genitalium infections are the most prevalent sexually transmitted bacterial infections in the world that cause urogenital infections in both men and women. It appears that infertility is a complication of these infections. Objective This study was designed to estimate the prevalence of Chlamydia trachomatis and Mycoplasma genitalium in symptomatic and asymptomatic men and to assess risk factors associated with infection. Patients and Methods Urine specimens were collected from 200 men; 100 of them were symptomatic and 100 asymptomatic. Samples were examined by PCR to detect the infections. Results C. trachomatis was detected in 20% of symptomatic and in 4% of asymptomatic men (P < 0.001). The prevalence of M. genitalium was revealed to be 12% and 2% in symptomatic and asymptomatic men, respectively (P < 0.01). Four of 100 men in the symptomatic group were infected with both organisms. C. trachomatis infection was associated with dysuria, urethral discharge, testicular swelling, and genital ulcer (P < 0.05). M. genitalium infection was related with dysuria, testis inflammation, pelvic pain and low educational level (P < 0.05). Furthermore, the prevalence of infections at ages 30-39 years was more than other ages. Conclusions Considering the role of these bacteria in urogenital infections, a screening test is recommended. Since the PCR assay is a highly sensitive and specific assay for the detection of these bacteria in male urine specimens, it provides a noninvasive technique for routine screening.
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Affiliation(s)
- Omid Yeganeh
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, IR Iran
| | - Mahmood Jeddi-Tehrani
- Monoclonal Antibody Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research (ACECR), Tehran, IR Iran
| | - Farhad Yaghmaie
- Reproductive Biotechnology Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research (ACECR), Tehran, IR Iran
| | - Kourosh Kamali
- Reproductive Biotechnology Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research (ACECR), Tehran, IR Iran
| | - Hamed Heidari-Vala
- Reproductive Biotechnology Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research (ACECR), Tehran, IR Iran
| | - Hojjat Zeraati
- Epidemiology and Biostatistics Department, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Nasser Shakhssalim
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Science, Tehran, IR Iran
| | - Saeed Zarei
- Reproductive Immunology Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research (ACECR), Tehran, IR Iran
| | - Leili Chamani-Tabriz
- Reproductive Biotechnology Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research (ACECR), Tehran, IR Iran
- Corresponding author: Leili Chamani-Tabriz, Reproductive Biotechnology Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research (ACECR), P.O.: 19615-1177, Tehran, IR Iran. Tel: +98-2122432020, Fax: +98-2122432021, E-mail:
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Christianson M, Boman J, Essén B. ‘Let men into the pregnancy’—Men's perceptions about being tested for Chlamydia and HIV during pregnancy. Midwifery 2013; 29:351-8. [DOI: 10.1016/j.midw.2012.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 01/12/2012] [Accepted: 02/05/2012] [Indexed: 11/29/2022]
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Screening for Chlamydia trachomatis Using Self-Collected Vaginal Swabs at a Public Pregnancy Termination Clinic in France. Sex Transm Dis 2012; 39:622-7. [DOI: 10.1097/olq.0b013e318254ca6f] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Female genital Chlamydia trachomatis infection: where are we heading? Arch Gynecol Obstet 2012; 285:1271-85. [PMID: 22350326 DOI: 10.1007/s00404-012-2240-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 01/23/2012] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Urogenital infection by Chlamydia trachomatis is the most common bacterial sexually transmitted disease in the world. C. trachomatis is the etiologic agent of several common genital tract syndromes such as urethritis, cervicitis, and pelvic inflammatory disease in women. MATERIALS AND METHODS In this review, the pathophysiology of a chlamydial infection as well as diagnosis, therapy and prevention strategies regarding female chlamydial infection are reviewed. RESULTS A chlamydial infection results in minimal or even no symptoms in approximately two-thirds of women, remaining therefore clinically apparent and undiagnosed. C. trachomatis infections are of great socioeconomic and public health concern due to the potential for severe long-term consequences in women, including an increased risk of ectopic pregnancy, tubal infertility and chronic pelvic pain. Moreover, if the bacterium is transmitted during labor to a newborn, it can cause ophthalmia neonatorum and atypical neonatal pneumonia. Due to the documented increased risk of morbidity, several national guidelines are available, including a routine screening for young women and screening during pregnancy that is recommended in several countries. DISCUSSION A routine screening for young women and screening during pregnancy is recommended in several countries. However, additional prospective studies of the effectiveness of chlamydia screening are warranted and might be feasible within established screening programs. Moreover, the transition from cervicitis to infertility should be also evaluated in future controlled studies to underline the existing evidence. Additionally, there is an urgent need to educate and inform health-care providers about implementation of screening programs to reduce the spread of chlamydial infection. Moreover, awareness and use of screening programs by the public is needed, which requires informational campaigns for the general public using different media. For improved screening strategies and public awareness, novel approaches have to be developed and evaluated. Finally, guidelines should be actively disseminated to all medical practitioners to increase their use in daily practice. Although the major socioeconomic and public health concerns of C. trachomatis infection are recognized, several considerations and additional measures for addressing this increasingly urgent health problem remain.
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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.
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Screening of Oropharynx and Anorectum Increases Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae Infection in Female STD Clinic Visitors. Sex Transm Dis 2011; 38:783-7. [DOI: 10.1097/olq.0b013e31821890e9] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Peters RPH, Verweij SP, Nijsten N, Ouburg S, Mutsaers J, Jansen CL, van Leeuwen AP, Morré SA. Evaluation of sexual history-based screening of anatomic sites for chlamydia trachomatis and neisseria gonorrhoeae infection in men having sex with men in routine practice. BMC Infect Dis 2011; 11:203. [PMID: 21791061 PMCID: PMC3162902 DOI: 10.1186/1471-2334-11-203] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 07/26/2011] [Indexed: 11/28/2022] Open
Abstract
Background Sexually transmitted infection (STI) screening programmes are implemented in many countries to decrease burden of STI and to improve sexual health. Screening for Chlamydia trachomatis and Neisseria gonorrhoeae has a prominent role in these protocols. Most of the screening programmes concerning men having sex with men (MSM) are based on opportunistic urethral testing. In The Netherlands, a history-based approach is used. The aim of this study is to evaluate the protocol of screening anatomic sites for C. trachomatis and N. gonorrhoeae infection based on sexual history in MSM in routine practice in The Netherlands. Methods All MSM visiting the clinic for STI in The Hague are routinely asked about their sexual practice during consulting. As per protocol, tests for urogenital, oropharyngeal and anorectal infection are obtained based on reported site(s) of sexual contact. All consultations are entered into a database as part of the national STI monitoring system. Data of an 18 months period were retrieved from this database and analysed. Results A total of 1455 consultations in MSM were registered during the study period. The prevalence of C. trachomatis and N. gonorrhoeae per anatomic site was: urethral infection 4.0% respectively and 2.8%, oropharynx 1.5% and 4.2%, and anorectum 8.2% and 6.0%. The majority of chlamydia cases (72%) involved a single anatomic site, which was especially manifest for anorectal infections (79%), while 42% of gonorrhoea cases were single site. Twenty-six percent of MSM with anorectal chlamydia and 17% with anorectal gonorrhoea reported symptoms of proctitis; none of the oropharyngeal infections were symptomatic. Most cases of anorectal infection (83%) and oropharyngeal infection (100%) would have remained undiagnosed with a symptom-based protocol. Conclusions The current strategy of sexual-history based screening of multiple anatomic sites for chlamydia and gonorrhoea in MSM is a useful and valid guideline which is to be preferred over a symptom-based screening protocol.
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Affiliation(s)
- Remco P H Peters
- The Hague Municipal Health Services, STI clinic, The Hague, The Netherlands.
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Shaw K, Coleman D, O’Sullivan M, Stephens N. Public health policies and management strategies for genital Chlamydia trachomatis infection. Risk Manag Healthc Policy 2011; 4:57-65. [PMID: 22312228 PMCID: PMC3270924 DOI: 10.2147/rmhp.s12710] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Genital Chlamydia trachomatis is a sexually transmissible bacterial infection that is asymptomatic in the majority of infected individuals and is associated with significant short-term and long-term morbidity. The population prevalence of the infection appears to be increasing. C. trachomatis is of public health significance because of the impacts of untreated disease on reproductive outcomes, transmission of other sexually acquired infections, and the costs to health systems. At the individual level, C. trachomatis infection is readily treatable with antibiotics, although antibiotic resistance appears to be increasing. At the population level, public health control of spread of infection is more problematic. Approaches to control include primary preventive activities, increased access to testing and treatment for people with or at risk of infection, partner notification and treatment, and screening either opportunistically or as part of an organized population screening program. A combination of all of the above approaches is likely to be required to have a significant effect on the burden of disease associated with genital chlamdyia infection and to reduce population prevalence. The development of a vaccine for genital chlamydia infection could significantly reduce the public health burden associated with infection; however a vaccine is not expected to be available in the near future.
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Affiliation(s)
- Kelly Shaw
- Department of Health and Human Services, Hobart, Tasmania, Australia
- Health and Wellbeing Research Cluster, Southern Cross University, New South Wales, Australia
| | - David Coleman
- Department of Health and Human Services, Hobart, Tasmania, Australia
| | - Maree O’Sullivan
- Department of Health and Human Services, Hobart, Tasmania, Australia
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Kouyoumdjian FG, Main C, Calzavara LM, Kiefer L. Prevalence and predictors of urethral chlamydia and gonorrhea infection in male inmates in an Ontario correctional facility. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2011; 102:220-224. [PMID: 21714323 PMCID: PMC6974176 DOI: 10.1007/bf03404901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 11/22/2010] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To determine the prevalence of urethral chlamydia and gonorrhea in males in a correctional facility in Ontario, Canada, and to explore risk factors for infection. METHODS Between June and December, 2009, 500 adult males who had been newly admitted at a correctional facility in southern Ontario completed a survey of risk factors and provided a urine sample for testing. Those who tested positive were treated and their names were provided to the local public health unit for follow-up including contact tracing. Prevalence and 95% confidence intervals were calculated for infection with chlamydia and gonorrhea, respectively, and a multivariable model was used to look at risk factors for infection. RESULTS The study population reported high levels of sexual risk behaviours and drug use. The overall chlamydia prevalence was 2.9% (95% CI 1.6-4.8) and the overall gonorrhea prevalence was 0.6% (95% CI 0.1-1.8). Rates were particularly high for chlamydia in younger males, at 16% (95% CI 4.5-36) in 18-19 year olds and 3.7% (95% CI 1.0-9.3) in 20-24 year olds, and for gonorrhea in males aged 20-24 at 1.9% (95% CI 0.2-6.6). A multivariable logistic regression model revealed that though not statistically significant, younger age was associated with infection. CONCLUSION The relatively high prevalence of chlamydia and gonorrhea found in this study suggests that primary and secondary prevention programs should be instituted for males in correctional facilities, in particular among younger inmates. Further research is required to ensure internal and external generalizability of these results, as well as to determine the cost-effectiveness of potential interventions.
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Affiliation(s)
- Fiona G Kouyoumdjian
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7.
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Reduction in Unnecessary Chlamydia Screening Among Older Women at Title X-Funded Family Planning Sites Following a Structural Intervention—San Francisco, 2009. Sex Transm Dis 2011; 38:127-9. [DOI: 10.1097/olq.0b013e3182027994] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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MOORING CE, O’ROURKE PK, KIMBLE RMN. Large loop excision of transformation zone procedures used in the management of cytological abnormalities of the cervix. Aust N Z J Obstet Gynaecol 2011; 51:109-13. [DOI: 10.1111/j.1479-828x.2010.01265.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Lehmusvuori A, Juntunen E, Tapio AH, Rantakokko-Jalava K, Soukka T, Lövgren T. Rapid homogeneous PCR assay for the detection of Chlamydia trachomatis in urine samples. J Microbiol Methods 2010; 83:302-6. [PMID: 20888867 DOI: 10.1016/j.mimet.2010.09.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 09/21/2010] [Accepted: 09/24/2010] [Indexed: 11/15/2022]
Abstract
Chlamydia trachomatis infection is the most common bacterial sexually transmitted disease and a major public health problem worldwide. Fast and sensitive point-of-care diagnostics including non-invasive sample collection would be of value for the prevention of C. trachomatis transmission. The aim of this study was to develop a fast, reliable, non-invasive and easy-to-use homogenous PCR assay for the detection of C. trachomatis. Bacteria were concentrated from urine by a simple and fast centrifugation-based urine pretreatment method. Novel automated GenomEra technology was utilized for the rapid closed-tube PCR including time-resolved fluorometric detection of the target using lanthanide chelate labeled probes. We have developed a rapid C. trachomatis assay which provides qualitative results in 1 h with diagnostic sensitivity and specificity of 98.7% and 97.3%, respectively. The novel assay can be performed with minimal laboratory expertise and without sophisticated DNA-extraction devices and has performance comparable to current gold standard assays.
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Affiliation(s)
- Ari Lehmusvuori
- Department of Biotechnology, University of Turku, Tykistökatu 6A, 20520 Turku, Finland.
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Owusu-Edusei K, Gift TL. Assessing the impact of state insurance policies on chlamydia screening: A panel data analysis. Health Policy 2010; 96:231-8. [PMID: 20207440 DOI: 10.1016/j.healthpol.2010.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 02/04/2010] [Accepted: 02/04/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In the late 1990s, three Southern states (Maryland (MD), Georgia (GA) and Tennessee (TN)) enacted laws that required health plans to reimburse for chlamydia screening for the populations at risk. We assessed the impact of the laws on chlamydia screening rates for Georgia (GA) and Tennessee (TN). METHODS We extracted monthly chlamydia screening rates on employer-sponsored privately insured women and used a panel regression analysis to conduct an intervention analysis that compared changes in screening rates in Georgia and Tennessee to ten southern states, based on the dates that the laws were enacted in the two states. Maryland was excluded due to non-specificity of the law and insufficient data. RESULTS Although there were substantial increases in screening rates in both GA and TN after the enactment of the laws, data from the other ten states showed similar increases over the same period. Thus, there was no significant difference in the increase in screening rates between Georgia and Tennessee and the other states. CONCLUSION Because this analysis was restricted to privately insured patients, additional studies are needed to assess the effectiveness (or the lack thereof) of the laws for other populations, such as those covered by Medicaid, within the individual states.
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Affiliation(s)
- Kwame Owusu-Edusei
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, United States.
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Carey AJ, Beagley KW. Chlamydia trachomatis, a hidden epidemic: effects on female reproduction and options for treatment. Am J Reprod Immunol 2010; 63:576-86. [PMID: 20192953 DOI: 10.1111/j.1600-0897.2010.00819.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The number of genital tract Chlamydia trachomatis infections is steadily increasing worldwide, with approximately 50-70% of infections asymptomatic. There is currently no uniform screening practice, current antibiotic treatment has failed to prevent the increased incidence, and there is no vaccine available. We examined studies on the epidemiology of C. trachomatis infections, the effects infections have on the female reproductive tract and subsequent reproductive health and what measures are being taken to reduce these problems. Undetected or multiple infections in women can lead to the development of severe reproductive sequelae, including pelvic inflammatory disease and tubal infertility. There are two possible paradigms of chlamydial pathogenesis, the cellular and immunological paradigms. While many vaccine candidates are being extensively tested in animal models, they are still years from clinical trials. With no vaccine available and antibiotic treatment unable to halt the increased incidence, infection rates will continue to increase and cause a significant burden on health care systems.
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Affiliation(s)
- Alison J Carey
- Institute of Health & Biomedical Innovation, School of Life Sciences, Faculty of Science, Queensland University of Technology, Brisbane, Qld, Australia
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Gallo Vaulet L, Entrocassi C, Corominas AI, Rodríguez Fermepin M. Distribution study of Chlamydia trachomatis genotypes in symptomatic patients in Buenos Aires, Argentina: association between genotype E and neonatal conjunctivitis. BMC Res Notes 2010; 3:34. [PMID: 20181127 PMCID: PMC2831911 DOI: 10.1186/1756-0500-3-34] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Accepted: 02/09/2010] [Indexed: 11/30/2022] Open
Abstract
Background Chlamydia trachomatis infections are the most prevalent sexually transmitted bacterial infections in the world. There is scarce data available referring to the distribution of C. trachomatis genotypes in Argentina. The aim of this study was to identify the genotypes of C. trachomatis circulating in the metropolitan area of Buenos Aires (Argentina) associated with ophthalmia neonatorum and genital infections. Findings From 2001 to 2006, 199 positive samples for C. trachomatis infection from symptomatic adult patients and neonates with ophthalmia neonatorum from two public hospitals were studied. C. trachomatis genotypes were determined by PCR-RFLP of an ompA fragment. Genotype E was the most prevalent regardless of the sample origin (46.3% 57/123 in adults and 72.4% 55/76 in neonates), followed by genotype D (19.5% 24/123) and F (14.6% 18/123) in adults, and G (9.2% 7/76) and D (7.9% 6/76) in neonates. We detected a significantly higher frequency of genotype E (p < 0.001, OR = 3.03 (1.57<OR<5.90)) in ophthalmia neonatorum than in genital specimens. Genotype D was associated with genital localization (p < 0.05, OR = 2.83 (1.03<OR<8.18)). Conclusion We found a particularly increased frequency of C. trachomatis genotype E in neonatal conjunctivitis, which may indicate an epidemiological association between this genotype and the newborn population. The present study also contributed to increase the knowledge on genotype distribution of Chlamydia trachomatis in symptomatic adult patients in Buenos Aires, Argentina, in which genotypes E, D and F were the predominant ones.
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Affiliation(s)
- Lucía Gallo Vaulet
- Inmunología Clínica, Departamento de Bioquímica Clínica, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Argentina.
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Economic burden of sexually transmitted infections: incidence and direct medical cost of Chlamydia, gonorrhea, and syphilis among Illinois adolescents and young adults, 2005-2006. Sex Transm Dis 2010; 36:629-36. [PMID: 19955874 DOI: 10.1097/olq.0b013e3181a96d23] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Local assessment of sexually transmitted infections (STI) magnitude and economic burden can aid in targeting resources and prevention programs. METHODS Reported cases of Chlamydia, gonorrhea, and primary and secondary syphilis (obtained from the Illinois Department of Public Health) were used to estimate the number of incident cases among persons aged 15 to 24 years, accounting for the proportion of undiagnosed and unreported cases, and sexually active population. STI costs were obtained from the published literature, and multiplied by the estimated incident cases of STIs in 2005 and 2006 to determine direct medical costs of incident infections. Incident rates per 100,000 population and costs in 2007 US dollars are estimated by age, gender, race, and county. RESULTS Chlamydia incidence and cost were estimated at 5030 infections per 100,000 population and $27,576,686 in 2005, and 5259 infections per 100,000 population and $28,779,734 in 2006. Gonorrhea incidence and cost were estimated at 1740 infections per 100,000 population and $7,698,135 in 2005, and 1704 infections per 100,000 population and $7,546,500 in 2006. Syphilis incidence and cost were estimated at 9.4 per 100,000 and $59,940 in 2005, and 10.4 per 100,000 population and $66,333 in 2006. Incidence and costs of all STIs were highest among women and blacks. Ten counties accounted for >80% of the estimated statewide morbidity and costs. CONCLUSIONS Estimates of STI incidence and costs are conservative, yet represent a significant economic burden in Illinois. Focusing prevention efforts on locales with the highest STI rates may maximize effectiveness in terms of disease prevention and cost reduction.
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O'Connell E, Brennan W, Cormican M, Glacken M, O'Donovan D, Vellinga A, Cahill N, Lysaght F, O'Donnell J. Chlamydia trachomatis infection and sexual behaviour among female students attending higher education in the Republic of Ireland. BMC Public Health 2009; 9:397. [PMID: 19874584 PMCID: PMC2774694 DOI: 10.1186/1471-2458-9-397] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Accepted: 10/29/2009] [Indexed: 11/13/2022] Open
Abstract
Background There are no prevalence data on Chlamydia trachomatis relating to female students attending higher education available for the Republic of Ireland. This information is required to guide on the necessity for Chlamydia screening programmes in higher education settings. This research aimed to determine the prevalence of and predictive risk factors for Chlamydia trachomatis genital infection among female higher education students in Ireland. Methods All females presenting during one-day periods at Student Health Units in three higher education institutions in two cities in the Republic of Ireland were invited to participate. Participants completed a questionnaire on lifestyle and socio-demographic factors and provided a urine sample. Samples were tested for C. trachomatis DNA by a PCR based technique (Cobas Amplicor, Roche). To examine possible associations between a positive test and demographic and lifestyle risk factors, a univariate analysis was performed. All associations with a p value < 0.05 were included in a multivariate logistic regression analysis. Results Of the 460 sexually active participants 22 tested positive (prevalence 4.8%; 95% CI 3.0 to 7.1%). Variables associated with significantly increased risk were current suggestive symptoms, two or more one-night stands and three or more lifetime sexual partners. The students displayed high-risk sexual behaviour. Conclusion The prevalence of C. trachomatis infection and the lack of awareness of the significance of suggestive symptoms among sexually experienced female students demonstrate the need for a programme to test asymptomatic or non-presenting higher education students. The risk factors identified by multivariate analysis may be useful in identifying those who are most likely to benefit from screening. Alcohol abuse, condom use, sexual behaviour (at home and abroad) and, knowledge of sexually transmitted infections (STIs) (including asymptomatic nature or relevant symptoms) were identified as target areas for health promotion strategies. These strategies are needed in view of the high-risk sexual activity identified.
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Affiliation(s)
- Emer O'Connell
- Department of Public Health, Health Service Executive, Western Area, Galway, Ireland.
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Land JA, Van Bergen JEAM, Morré SA, Postma MJ. Epidemiology of Chlamydia trachomatis infection in women and the cost-effectiveness of screening. Hum Reprod Update 2009; 16:189-204. [PMID: 19828674 DOI: 10.1093/humupd/dmp035] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The majority of Chlamydia trachomatis infections in women are asymptomatic, but may give rise to pelvic inflammatory disease (PID) and tubal infertility. Screening programmes aim at reducing morbidity in individuals by early detection and treatment, and at decreasing the overall prevalence of infection in the population. A number of modelling studies have tried to calculate the threshold prevalence of chlamydia lower genital tract infection above which screening becomes cost-effective. There is considerable debate over the exact complication rates after chlamydia infections, and more precise estimates of PID and tubal infertility are needed, for instance to be inserted in economic models. METHODS With reference to key studies and systematic reviews, an overview is provided focusing on the epidemiology of chlamydia infection and the risk-estimates of its late complications. RESULTS In the literature, the generally assumed risk of developing PID after lower genital tract chlamydia infection varies considerably, and is up to 30%. For developing tubal infertility after PID the risks are 10-20%. This implies that the risk of test-positive women of developing tubal infertility would range between 0.1 and 6%. We included chlamydia IgG antibody testing in a model and estimated a risk of tubal infertility up to 4.6%. CONCLUSION The risk of developing late complications after chlamydia lower genital tract infection appears low. High quality RCTs dealing with the transition from cervicitis to infertility are needed to broaden the evidence. In screening programmes, chlamydia antibody testing, as an intermediate marker for potential adverse sequelae, might enable more precise estimates.
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Affiliation(s)
- J A Land
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, The Netherlands.
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Mehta SD. Gonorrhea and chlamydia in emergency departments: Screening, diagnosis, and treatment. Curr Infect Dis Rep 2009; 9:134-42. [PMID: 17324351 DOI: 10.1007/s11908-007-0009-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Failure to screen sexually active adolescents and adults for gonorrhea and chlamydia at the time of acute care visits to urban emergency departments (ED) results in missed treatment opportunities for 38% to 82% of infected persons. The prevalence of gonorrhea and chlamydia infections among ED patients presenting with genitourinary or pregnancy-related complaints or providing urine specimens as part of routine medical care ranges from 4.3% to 16.4%. Notably, prevalence among general ED patients is similar (9.7%-14.3%). Due to the asymptomatic or nonspecific presentation of these infections, expanded screening is recommended to increase detection, treatment, and partner notification. A lower threshold of empiric treatment in the ED setting is recommended due to the difficulty and incompleteness of follow-up subsequent to ED discharge. Specific recommendations to improve the quality of ED care for sexually transmitted infections and to expand detection are provided.
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Affiliation(s)
- Supriya D Mehta
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, 958 SPHPI, M/C 923, 1603 West Taylor Street, Chicago, IL 60612, USA.
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Kucinskiene V, Juseviciute V, Valiukeviciene S, Milasauskiene Z, Unemo M, Domeika M. Home sampling and pooling of vaginal samples are effective tools for genetic screening of Chlamydia trachomatis among high school female students in Lithuania. ACTA ACUST UNITED AC 2009; 40:88-93. [PMID: 17852902 DOI: 10.1080/00365540701587002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aims were 1) to estimate the prevalence of C. trachomatis infection among sexually active female students in Kaunas, Lithuania; 2) to investigate the usefulness of personal invitation, self-sampling, and pooling of samples for screening; and 3) to evaluate the costs of the approaches used. A cross-sectional study inviting 795 female students (18-31 y of age) from 7 high schools and 1 college in Kaunas was performed. The response rate was 67% (533/795). Self-obtained vaginal samples were analysed, individually and pooled (n = 3), using Digene Hybrid Capture II CT/NG Test. The overall prevalence of C. trachomatis infection was 5.6%. Among the sexually active female students 20-24 y of age (n = 424), the prevalence was 7.1%; however, the prevalence varied from 0% to 14.2% at the different schools. For estimation of the population prevalence based solely on identification of C. trachomatis positive pools, the pooling strategy reduced the costs by 85%. For estimation of population prevalence and for diagnosis of each individual sample, pooling reduced the costs by 70%. Targeted screening, using pooling to reduce the expenses, mainly of 3rd and 4th y Lithuanian female students could be recommended. By extended personal contact and internet-based communication, increased participation rates may be attained.
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Affiliation(s)
- Vesta Kucinskiene
- Department of Skin and Venereal Diseases, Kaunas University of Medicine, Kaunas, Lithuania
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Miller JM, Maupin RT, Nsuami M. Initial and repeat testing for chlamydia during pregnancy. J Matern Fetal Neonatal Med 2009; 18:231-5. [PMID: 16318972 DOI: 10.1080/14767050500223630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study was done to evaluate the prevalence of chlamydia in late pregnancy after an initial negative test. METHODS This retrospective cohort study reports prenatal patients entering care between January 1998 and May 2000 at an inner city community based clinic (n = 752). Patients were evaluated if results of initial and late tests (34 weeks gestational age) for chlamydia were known. Charts were abstracted for demographic and pregnancy-related factors. Analysis for categorized data was by chi-squares and odds ratios. Continuous data were analyzed by t-test. Significance was accepted if p < 0.05. RESULTS The prevalence of chlamydia was 17.8%, with 3.9% having only the second test positive. Treatment failure and/or reinfection were found in 13.3%. Factors correlated with chlamydial carriage include: age 19 years (p < 0.001), gonorrheal carriage (p < 0.001), lower gravidity (p < 0.01), lower parity (p < 0.05), and never having married (p < 0.001). Logistic regression identified gonorrheal carriage and age 19 years as important for both initial and late chlamydial cervicitis. Marital status was important for initial tests only. CONCLUSIONS In our high-risk population, repeat testing for chlamydia in late pregnancy was found appropriate.
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Affiliation(s)
- Joseph M Miller
- Department of Obstetrics, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
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León SR, Konda KA, Klausner JD, Jones FR, Cáceres CF, Coates TJ. Chlamydia trachomatis infection and associated risk factors in a low-income marginalized urban population in coastal Peru. Rev Panam Salud Publica 2009; 26:39-45. [PMID: 19814880 PMCID: PMC2849276 DOI: 10.1590/s1020-49892009000700006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To estimate Chlamydia trachomatis (CT) infection prevalence and associated risk factors among a low-income marginalized urban population in Peru. METHODS Between April 2003 and April 2005, men and women at high-risk for sexually transmitted infections (STIs) were recruited from low-income urban areas in three coastal cities in Peru (Chiclayo, Lima, and Trujillo). Consenting participants were studied using a sero-epidemiologic survey. Urine and vaginal swabs collected from men and women were evaluated using polymerase chain reaction (PCR) (COBAS AMPLICOR (CT/NG) Test, Roche Molecular Diagnostics, Branchburg, NJ, USA) for CT. RESULTS Among the 2 440 participants recruited for the study (2 145 men and 295 women), overall prevalence of CT infection was 6.6% (95% CI, 5.6-7.6%): 5.5% (95% CI, 4.5-6.5%) in men and 14.9% (95% CI, 11.7-27.1%) in women. Chlamydial infection was inversely associated with age and positively associated with HIV infection and dysuria in men. Among women, chlamydial infection was inversely associated with age and positively associated with number of sex partners. CONCLUSIONS CT infection was common among high-risk men and women in urban coastal Peru. Because chlamydial infection is associated with complications related to female reproduction, including infertility and ectopic pregnancy, interventions to prevent and treat infection and studies to determine the feasibility of population-based screening for CT should be conducted among the high-risk female population.
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Kong FYS, Hocking JS, Link CK, Chen MY, Hellard ME. Sex and sport: chlamydia screening in rural sporting clubs. BMC Infect Dis 2009; 9:73. [PMID: 19470183 PMCID: PMC2695469 DOI: 10.1186/1471-2334-9-73] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 05/27/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis is the most common notifiable disease in Australia, mainly affecting those aged 15 to 29 years. Testing rates are low in Australia and considerably lower in rural areas, with access and confidentiality of sexual health services being problematic in rural and regional areas. This study aimed to determine the feasibility of establishing a pilot chlamydia testing outreach program among 16-25 year old males and females in rural Victoria (Australia) undertaken at local sporting clubs and to determine the prevalence of chlamydia and acceptability of the program in this population. METHODS We aimed to recruit young people from the Loddon Mallee region of Victoria, Australia between May and September 2007. After a night of sporting practice, participants provided a first pass urine sample, completed a brief questionnaire regarding risk taking behaviour and were then provided with condoms and health promotion materials about sexually transmitted infections (STIs). Those positive for chlamydia were managed by telephone consultation with a practitioner from Melbourne Sexual Health Centre. RESULTS A total of 709 young people participated (77% male, 23% female), 77% being sexually active. All provided a urine sample and completed the questionnaire. Participation rate on recruitment nights was over 95%. Overall chlamydia prevalence in those sexually active was 5.1% (95%CI: 3.4-7.3), 7.4% in females (95%CI: 3.5-13.6) and 4.5% in males (95%CI: 2.7-6.9). CONCLUSION Sporting clubs represent a feasible, acceptable and innovative community based setting to screen, treat and educate young people in a rural and regional setting, especially for males.
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Affiliation(s)
- Fabian YS Kong
- Centre for Population Health, The Macfarlane Burnet Institute for Medical Research and Public Health, 85 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Jane S Hocking
- Key Centre for Women's Health in Society, University of Melbourne, 305 Cardigan Street, Carlton, Victoria 3053, Australia
| | - Chris K Link
- Women's Health Loddon Mallee, 47 Myers Street Bendigo, Victoria 3550, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, Victoria 3053, Australia
| | - Margaret E Hellard
- Centre for Population Health, The Macfarlane Burnet Institute for Medical Research and Public Health, 85 Commercial Rd, Melbourne, Victoria 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, 89 Commercial Rd, Melbourne, Victoria 3004, Australia
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Keegan H, Ryan F, Malkin A, Griffin M, Lambkin H. Chlamydia trachomatisdetection in cervical PreservCyt specimens from an Irish urban female population. Cytopathology 2009; 20:111-6. [DOI: 10.1111/j.1365-2303.2007.00534.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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