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Liu S, Ouyang Y, Tang Q, Mei B, Li C. Prevalence of Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum among outpatients in central China: A retrospective study. Diagn Microbiol Infect Dis 2024; 110:116394. [PMID: 38850689 DOI: 10.1016/j.diagmicrobio.2024.116394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/20/2024] [Accepted: 06/04/2024] [Indexed: 06/10/2024]
Abstract
Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Ureaplasma urealyticum (UU) are the common sexually transmitted pathogens and lead to genital diseases, highly prevalent all around the world. The objective of this study was to analyze the prevalence of NG, CT and UU among outpatients in central China. A total of 2186 urogenital swabs were collected from the patients and the NG, CT and UU pathogens were testing with RT-PCR method, meanwhile the medical records were obtained from the hospital information system. The overall infection rates of NG, CT and UU were 4.57 %, 6.63 % and 48.81 % respectively, showed the prevalence of UU was higher than NG and CT. The younger people had the highest infection rate of NG (10.81 %), CT (20.54 %) and UU (54.59 %). Single infection (89.09 %) was significant higher than co-infection (10.91 %), and the CT-UU co-infection was the prominent pattern (66.41 %). There were an obvious sex difference, the prevalence of NG and CT were significant higher in male, whereas UU was higher in female. Our study could contributed a better understanding of the prevalence of NG, CT and UU, facilitating to the development of effective screening, prevention and treatment policies.
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Affiliation(s)
- Shun Liu
- Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, People's Republic of China
| | - Yaoling Ouyang
- Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, People's Republic of China
| | - Quan Tang
- Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, People's Republic of China
| | - Bing Mei
- Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, People's Republic of China
| | - Chengbin Li
- Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, People's Republic of China.
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Campaner AB, de Castro MA, Lucarelli AP. Chlamydia trachomatis prevalence in females in São Paulo, Brazil: 11 years' surveillance of the infection. Braz J Microbiol 2023; 54:151-158. [PMID: 36574206 PMCID: PMC9944148 DOI: 10.1007/s42770-022-00865-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 10/29/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis (CT) infection is the most prevalent sexually transmitted bacterial disease worldwide whose greatest impact is on the female reproductive system. The objective was to assess the prevalence of Chlamydia infection in a large population of female patients from a private health service in São Paulo (Brazil), identifying the main age groups affected by the agent and the evolution of the prevalence. METHODS A cross-sectional study was conducted based on the results of all molecular biology tests. The tests were carried out between January 2005 and December 2015. The positivity of test results was determined by year and age group. RESULTS A total of 85,292 patients who performed 103,576 tests for Chlamydia were considered eligible for the statistical data. The overall prevalence of C. trachomatis infection in the study population was 2.2% (95% CI: 2.07-2.25). A higher prevalence of infection was observed in the ≤ 25 years and ≤ 30 years age groups, with rates of 6.0% (95% CI: 5.59-6.35) and 4.4% (95% CI: 4.08-4.50), respectively. There was a significant increase in the positivity of the exams over time, especially in the ≤ 35 years age group. The prevalence at 26-30 years was 3.1% (95% CI: 2.82-3.30); 31-35 years 1.7% (95% CI: 1.50-1.82); 36-40 years 1.0% (95% CI: 0.86-1.16); 41-60 years 0.6% (95% CI: 0.50-0.70) and the prevalence at ≥ 61 years was 0.4% (95% CI: 0.11-0.75). CONCLUSION The screening of asymptomatic young women would have the potential to reduce infection, transmission, and sequelae of infection by this agent.
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Affiliation(s)
- Adriana Bittencourt Campaner
- Department of Gynecology and Obstetrics, Santa Casa de São Paulo Medical School, Rua Dr Cesário Mota Jr, 112 - Vila Buarque, São Paulo, 01221- 020 Brazil
| | - Marco Antonio de Castro
- Department of Gynecology and Obstetrics, Santa Casa de São Paulo Medical School, Rua Dr Cesário Mota Jr, 112 - Vila Buarque, São Paulo, 01221- 020 Brazil
| | - Adrienne Pratti Lucarelli
- Department of Gynecology and Obstetrics, Santa Casa de São Paulo Medical School, Rua Dr Cesário Mota Jr, 112 - Vila Buarque, São Paulo, 01221- 020 Brazil
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High Prevalence of Sexually Transmitted and Reproductive Tract Infections (STI/RTIs) among Patients Attending STI/Outpatient Department Clinics in Tanzania. Trop Med Infect Dis 2023; 8:tropicalmed8010062. [PMID: 36668969 PMCID: PMC9863565 DOI: 10.3390/tropicalmed8010062] [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: 11/14/2022] [Revised: 12/30/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023] Open
Abstract
We determined the prevalence and reported risk factors associated with sexually transmitted and reproductive tract infections (STI/RTIs) among patients who presented with genital symptoms in STI/outpatient department (OPD) clinics in two regional referral hospitals and six health centres in six regions in Tanzania. Methods: The patients were consecutively recruited, and the data collection was conducted in eight health care facilities from 2014 to 2016. Genital swabs were collected for the detection of the aetiological pathogens of STI/RTIs. Results: A total of 1243 participants were recruited in the study; the majority (1073, 86%) were women. The overall median age was 27.8. The prevalence of Neisseria gonorrhoeae was 25.7% (319/1243), with proportions of 50.9 and 21.5% for men and women, respectively, of Chlamydia trachomatis 12.9% (160/1241) and Mycoplasma genitalium 4.7% (53/1134). Unmarried men were more often likely to be infected with gonococcal infections as compared to their women counterparts (57.9 vs. 24.1%) p < 0.001. The majority presented with genital discharge syndrome (GDS) 93.6% (1163/1243), genital ulcer disease (GUD) 13.0% (162/1243) and GDS + GUD 9.6% (119/1243). GDS was more common in the health centres, 96.1% (1195/1243), vs. the regional referral hospitals, 92.2% (1146/1243) (p = 0.01), but those reported to the regional referral hospitals were more likely to be infected with N. gonorrhoeae (OR = 2.5) and C. trachomatis (OR = 2.1) than those from the health centres (p < 0.001). The prevalence of bacterial vaginosis (BV) and vaginal candidiasis (VC) was 24.1 and 10.4%, respectively. Interestingly, unmarried and BV-positive women were less likely to be infected with VC (p = 0.03), though VC was strongly inversely associated with an N. gonorrhoeae infection (p < 0.001). High proportions of N. gonorrhoeae (51.1%) and C. trachomatis (23.3%) were found in the Dodoma and Dar es Salaam regions, respectively. M. genitalium (7.6%) was found to be the highest in Mwanza. Conclusion: We reported a high prevalence of STI/RTIs. The findings suggest that these infections are common and prevalent in STI/OPD clinics in six regions of Tanzania. We recommend surveillance to be conducted regularly to elucidate the true burden of emerging and classical STI/RTIs by employing modern and advanced laboratory techniques for the detection and monitoring of STI/RTIs in low- and high-risk populations, including the community settings.
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Khosropour CM, Soge OO, Golden MR, Hughes JP, Barbee LA. Incidence and Duration of Pharyngeal Chlamydia Among a Cohort of Men Who Have Sex With Men. Clin Infect Dis 2022; 75:875-881. [PMID: 34893806 PMCID: PMC9477446 DOI: 10.1093/cid/ciab1022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The prevalence of pharyngeal chlamydia is low, but its incidence and duration are unknown. A high incidence or duration may support the role of pharyngeal chlamydia in sustaining chlamydia transmission. METHODS From March 2016 to December 2018, we enrolled men who have sex with men (MSM) in a 48-week cohort study in Seattle, Washington. Participants self-collected pharyngeal specimens weekly. We tested specimens using nucleic acid amplification testing at the conclusion of the study. In primary analyses, we defined incident pharyngeal chlamydia as >2 consecutive weeks of a positive pharyngeal specimen. In sensitivity analyses, we defined incident chlamydia as >1 week of a positive specimen. We estimated duration of pharyngeal chlamydia, censoring at loss to follow-up, receipt of antibiotics, or end of study. RESULTS A total of 140 participants contributed 70.5 person-years (PY); 1.4% had pharyngeal chlamydia at enrollment. In primary analyses, there were 8 pharyngeal chlamydia cases among 6 MSM (incidence = 11.4 per 100 PY; 95% confidence interval [CI]: 6.0-21.9). In sensitivity analysis, there were 19 cases among 16 MSM (incidence = 27.1 per 100 PY; 95% CI: 18.5-39.8). The median duration was 6.0 weeks (95% CI: 2.0-undefined) in primary analysis and 2.0 weeks (95% CI: 1.1-6.0) in sensitivity analysis. Duration was shorter for those with a history of chlamydia compared with those without (3.6 vs 8.7 weeks; P = .02). CONCLUSIONS Pharyngeal chlamydia has a low incidence and duration relative to other extragenital sexually transmitted infections. Its contribution to population-level transmission remains unclear.
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Affiliation(s)
| | - Olusegun O Soge
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Matthew R Golden
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Public Health–Seattle & King County HIV/STD Program, Seattle, Washington, USAand
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Lindley A Barbee
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Public Health–Seattle & King County HIV/STD Program, Seattle, Washington, USAand
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Reyes-Lacalle A, Carnicer-Pont D, Masvidal MG, Montero-Pons L, Cabedo-Ferreiro R, Falguera-Puig G. Prevalence and Characterization of Undiagnosed Youths at Risk of Chlamydia trachomatis Infection: A Cross-sectional Study. J Low Genit Tract Dis 2022; 26:223-228. [PMID: 35584026 PMCID: PMC9232277 DOI: 10.1097/lgt.0000000000000682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the prevalence of Chlamydia trachomatis infection in undiagnosed young people aged between 15 and 24 years. MATERIALS AND METHODS A convenience sample of 623 youths, with a mean (SD) age of 20.1 (2.2) years, was recruited from key spaces in the North Metropolitan area of Barcelona in Catalonia, Spain. Participants completed a 21-item questionnaire and provided a urine sample or vaginal swab for testing. RESULTS The most common age at the first sexual intercourse was 16 years (24.6%), followed by 15 years (21.3%). Only 32.6% reported always use of condoms, 49.2% sometimes, and 15.6% never. A positive test for chlamydia was found in 34 participants (5.5%; 95% CI, 3.8-7.5), with no difference by sex. A positive test was significantly more common among the participants who were working, who had been diagnosed with a sexually transmitted disease (STD) at some point in their life, and who used web pages/apps to find new sexual partners more than once a month. In the multivariate analysis, working status was an independent factor associated with chlamydial infection (adjusted odds ratio[OR], 8.88; 95% CI, 1.71-46.17), whereas not having been previously diagnosed with an STD (OR, 0.34; 95% CI, 0.07-1.49) and never using the Internet to find sexual partners (OR, 0.16; 95% CI, 0.03-080) were protective factors against chlamydial infection. CONCLUSIONS The prevalence of C. trachomatis infection was 5.5%. Working status, a previous diagnosis of STD, and use of the Internet to find new sexual partners were associated with chlamydial test positivity.
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Affiliation(s)
- Azahara Reyes-Lacalle
- Atenció a la Salut Sexual I Reproductiva Sabadell, Direcció d'Atenció Primària Metropolitana Nord, Institut Catalá de la Salut (ICS), Barcelona, Spain
- Research Group Atenció a la Salut Sexual i Reproductiva (GRASSIR), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Dolors Carnicer-Pont
- Research Group Atenció a la Salut Sexual i Reproductiva (GRASSIR), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Programa de Prevenció i Control del Cancer, Institut Catalá d'Oncologia/WHO Collaborating Center for Tobacco Control, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Miriam Gómez Masvidal
- Research Group Atenció a la Salut Sexual i Reproductiva (GRASSIR), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Atenció a la Salut Sexual I Reproductiva Mataról, Direcció d'Atenció Primària Metropolitana Nord, Institut Catalá de la Salut (ICS), Barcelona, Spain
| | - Laura Montero-Pons
- Research Group Atenció a la Salut Sexual i Reproductiva (GRASSIR), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Atenció a la Salut Sexual I Reproductiva Santa Coloma de Grameenet, Direcció d'Atenció Primària Metropolitana Nord, Institut Catalá de la Salut (ICS), Barcelona, Spain
| | - Rosa Cabedo-Ferreiro
- Research Group Atenció a la Salut Sexual i Reproductiva (GRASSIR), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Atenció a la Salut Sexual I Reproductiva Granollers, Direcció d'Atenció Primària Metropolitana Nord, Institut Catalá de la Salut (ICS), Barcelona, Spain
| | - Gemma Falguera-Puig
- Research Group Atenció a la Salut Sexual i Reproductiva (GRASSIR), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Responsable Atenció a la Salut Sexual I Reproductiva, Direcció d'Atenció Primària Metropolitana Nord, Institut Catalá de la Salut (ICS), Barcelona, Spain
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Vallejo-Ortega MT, Gaitán Duarte H, Mello MB, Caffe S, Perez F. A systematic review of the prevalence of selected sexually transmitted infections in young people in Latin America. Rev Panam Salud Publica 2022; 46:e73. [PMID: 35747471 PMCID: PMC9211030 DOI: 10.26633/rpsp.2022.73] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To estimate the burden of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (TP), and human papillomavirus (HPV) infections among people aged 10 to 25 in Latin America and the Caribbean. Methods The MEDLINE, EMBASE, and LILACS databases were searched, as well as documents from regional organizations or national health Institutions. Population-based studies that reported prevalence or incidence of CT, NG, TP, and HPV detected through confirmatory tests in adolescents and young people were included. Two reviewers independently selected studies and extracted data. The quality of studies was assessed using the Newcastle-Ottawa Scale. Pooled estimators were calculated in cases where heterogeneity was <70%; when not feasible, prevalence ranges were reported. Results Out of a total of 3 583 references, 15 prevalence studies complied with the inclusion criteria. Due to substantial heterogeneity (>70%), it was not possible to pool frequency estimators. Among the general population, the prevalence of CT infection ranged between 2.1% and 30.1% (9 studies, 5 670 participants); for NG, prevalence ranged between 0% and 2.9% (8 studies, 5 855 participants); for TP, prevalence varied between 0% and 0.7% (3 studies, 11 208 participants), and for HPV infection, prevalence ranged between 25.1% and 55.6% (8 studies, 3 831 participants). Conclusions Reliable, population-based data on sexually transmitted infections (STIs) in adolescents and youth in Latin America and the Caribbean are limited. Additional studies are needed to better understand the burden of STIs in this population. However, given the substantial prevalence of STIs detected, countries need public health policies for prevention, early diagnosis, and treatment of STIs in young people.
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Affiliation(s)
| | - Hernando Gaitán Duarte
- Universidad Nacional de Colombia Bogotá Colombia Universidad Nacional de Colombia, Bogotá, Colombia
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Kazemian H, Zarandi MK, Zargoush Z, Ghafourian S, Sadeghifard N, Jalilian A, Shafieian M, Pakzad I. The prevalence of gonococcal and non-gonococcal infections in women referred to obstetrics and gynecology clinics. LE INFEZIONI IN MEDICINA 2022; 30:247-253. [PMID: 35693060 PMCID: PMC9177188 DOI: 10.53854/liim-3002-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/30/2022] [Indexed: 06/15/2023]
Abstract
Bacterial vaginosis is a condition caused by changes in the vaginal microbial ecosystem and increases the risk of preterm delivery, premature rupture of membranes, endometritis, and weight loss of the baby. This study aimed to evaluate the frequency of gonococcal and non-gonococcal genital infections in women referred to clinics in Ilam, Iran. Two swab samples were taken from each patient using a sterile swab, one swab was placed in a THB medium for the culture of Streptococcus agalactiae and the other in PBS buffer for PCR. PCR method was conducted for the identification of the other bacterial agents such as Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, and also S. agalactiae. Sampling was performed on 169 women with symptomatic vaginosis. The frequency of S. agalactiae by culture and PCR methods was 4.7% (8 samples) and 13.6% (23 samples) respectively. Also, 6.5% (11 samples), 3.5% (6 samples), 4.1% (7 samples), 1.2% (2 samples), and 0% of the samples were positive for N. gonorrhoeae, M. genitalium, M. hominis, U. urealyticum and C. trachomatis by PCR method. Except for a significant association between S. agalactiae colonization and abortion, there was no significant correlation between the prevalence of these bacteria and the patient's age, age of marriage, number of deliveries, and number of abortions. Overall, the prevalence of gonococcal and non-gonococcal infection in women referred to clinics in Ilam is similar to the other parts of Iran.
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Affiliation(s)
- Hossein Kazemian
- Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Morteza Karami Zarandi
- Department of Microbiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Zeinab Zargoush
- Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Sobhan Ghafourian
- Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Nourkhoda Sadeghifard
- Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Anahita Jalilian
- Department of Obstetrics and Gynecology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Mahnaz Shafieian
- Department of Midwifery, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Iraj Pakzad
- Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
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Kebbi-Beghdadi C, Aeby S, Baud D, Greub G. Evaluation of a Multiplex Real-Time PCR Assay for Detecting Chlamydia trachomatis in Vaginal Samples. Diagnostics (Basel) 2022; 12:diagnostics12051141. [PMID: 35626297 PMCID: PMC9139926 DOI: 10.3390/diagnostics12051141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 02/04/2023] Open
Abstract
Chlamydia trachomatis is an important cause of sexually transmitted infections (STI) in Western countries. It is often asymptomatic, and thus, left untreated, and can have severe negative consequences, such as tubal infertility or adverse pregnancy outcomes. Other sexually transmitted microorganisms, such as Neisseria gonorrhoeae and Trichomonas vaginalis, as well as normal residents of the vaginal flora, such as genital mycoplasmas, also negatively impact human sexual and reproductive health. We evaluated the reliability of the Seegene Allplex STI Essential Assay for C. trachomatis detection using the real-time qPCR routinely used in our diagnostic laboratories as the gold standard. The Seegene assay displayed a sensitivity of 97.8% and a specificity of 98.9%. As this assay can also detect six other urogenital pathogens, we applied it to 404 samples from women who attended Lausanne University Maternity Hospital and obtained the following prevalence rates: 2.5% for C. trachomatis, 3.5% for Mycoplasma hominis, 6.3% for Ureaplasma urealyticum, and 27.7% for Ureaplasma parvum. Two samples were positive for Trichomonas vaginalis, and one sample was positive for Mycoplasma genitalium. Bacterial vaginosis was present in 4.5% of the cases and was strongly associated with M. hominis. Finally, we confirmed the association between C. trachomatis infection and pre-term birth (p = 0.03) but could not detect any association of this condition with other urogenital pathogens (Mycoplasma/Ureaplasma). In conclusion, given its high sensitivity and specificity for C. trachomatis DNA detection as well as its multiplex format, which simultaneously provides results for six other urogenital pathogens, the Seegene Allplex™ STI Essential Assay represents an appealing diagnostic tool in modern microbiology laboratories.
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Affiliation(s)
- Carole Kebbi-Beghdadi
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland; (C.K.-B.); (S.A.)
| | - Sebastien Aeby
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland; (C.K.-B.); (S.A.)
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, CH-1011 Lausanne, Switzerland;
| | - Gilbert Greub
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland; (C.K.-B.); (S.A.)
- Correspondence: ; Tel.: +41-21-314-4979; Fax: +41-21-314-4060
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Causer L, Liu B, Watts C, McManus H, Donovan B, Ward J, Guy R. Hospitalisations for pelvic inflammatory disease in young Aboriginal women living in remote Australia: the role of chlamydia and gonorrhoea. Sex Transm Infect 2021; 98:445-447. [PMID: 34887352 DOI: 10.1136/sextrans-2021-055242] [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: 08/02/2021] [Accepted: 11/21/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Aboriginal women living in remote Australia experience a high burden of both chlamydia and gonorrhoea infections and disproportionately high rates of pelvic inflammatory disease (PID). We estimated for the first time the fraction of PID attributable to these infections in young Aboriginal women living in these settings. METHODS Using published data from two large Australian studies (2002-2013; 2010-2014), we calculated the fraction of emergency department presentations and hospitalisations for PID attributable to chlamydia and/or gonorrhoea infection in Aboriginal women aged 16-29 years living in remote Australia. We used a Monte Carlo simulation to estimate the mean and 95% CIs for the assumed prevalence and population attributable fractions for PID for infection stratifications (chlamydia only, gonorrhoea only and dual infection) as well as for any infection (chlamydia and/or gonorrhoea). Additional outputs were calculated for chlamydia infection with/without gonorrhoea coinfection, and vice versa. RESULTS The prevalence of chlamydia only was 12.9% (95% CI: 11.6% to 14.2%), gonorrhoea only was 7.8% (95% CI: 6.6% to 8.9%) and dual infection was 6.5% (95% CI: 5.8% to 7.2%); rate ratios of PID were 1.9 (95% CI: 1.5 to 2.3), 5.2 (95% CI: 4.3 to 6.4) and 4.6 (95% CI: 3.8 to 5.5), respectively. The overall fraction of PID attributable to chlamydia and/or gonorrhoea was 40.2% (95% CI: 36.0% to 44.4%); any gonorrhoea was 33.4% (95% CI: 29.2% to 37.8%) and any chlamydia was 20.6% (95% CI: 16.9% to 24.6%). CONCLUSION Our study demonstrates the importance of calculating the fraction of PID related to chlamydia and gonorrhoea in the local context, demonstrating the major contribution gonorrhoea makes to PID hospitalisations among Australian Aboriginal women living in remote settings. To significantly and sustainably reduce the unacceptable rate of PID in this population, strategies are urgently needed to improve timely testing and treatment and recognition and management of PID in primary care.
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Affiliation(s)
- Louise Causer
- Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Bette Liu
- School of Population Health, UNSW, Sydney, New South Wales, Australia
| | - Caroline Watts
- Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Hamish McManus
- Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Basil Donovan
- Kirby Institute, UNSW, Sydney, New South Wales, Australia.,Sydney Sexual Health Centre, Sydney, New South Wales, Australia
| | - James Ward
- Poche Centre for Indigenous Health, The University of Queensland-Saint Lucia Campus, Saint Lucia, Queensland, Australia
| | - Rebecca Guy
- Kirby Institute, UNSW, Sydney, New South Wales, Australia
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Li C, Tang W, Ho HC, Ong JJ, Zheng X, Sun X, Li X, Liu L, Wang Y, Zhao P, Xiong M, Zheng H, Wang C, Yang B. Prevalence of Chlamydia trachomatis Among Pregnant Women, Gynecology Clinic Attendees, and Subfertile Women in Guangdong, China: A Cross-sectional Survey. Open Forum Infect Dis 2021; 8:ofab206. [PMID: 34235228 PMCID: PMC8253043 DOI: 10.1093/ofid/ofab206] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/21/2021] [Indexed: 11/22/2022] Open
Abstract
Background Chlamydia trachomatis (CT) is a major cause of infertility
and adverse birth outcomes, but its epidemiology among childbearing-age
women remains unclear in China. This study investigated the prevalence of CT
and associated factors among Chinese women aged 16–44 years who were either
(1) pregnant, (2) attending gynecology clinics, or (3) subfertile. Methods We conducted a cross-sectional survey and recruited participants from
obstetrics, gynecology, and infertility clinics in Guangdong between March
and December 2019. We collected information on individuals’ sociodemographic
characteristics, previous medical conditions, and sexual behaviors.
First-pass urine and cervical swabs were tested using nucleic acid
amplification testing. We calculated the prevalence in each population and
subgroup by age, education, and age at first sex. Multivariable binomial
regression models were used to identify factors associated with CT. Results We recruited 881 pregnant women, 595 gynecology clinic attendees, and 254
subfertile women. The prevalence of CT was 6.7% (95% CI, 5.2%–8.5%), 8.2%
(95% CI, 6.2%–10.7%), and 5.9% (95% CI, 3.5%–9.3%) for the above 3
populations, respectively. The subgroup-specific prevalence was highest
among those who first had sex before age 25 years and older pregnant women
(>35 years). The proportion of asymptomatic CT was 84.8%, 40.0%, and
60.0% among pregnant women, gynecology clinic attendees, and subfertile
women, respectively. Age at first sex (<25 years), multipara, and ever
having more than 1 partner increased the risk of CT. Conclusions Childbearing-age women in China have a high prevalence of CT. As most women
with CT were asymptomatic, more optimal prevention strategies are urgently
needed in China.
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Affiliation(s)
- Changchang Li
- Department of Sexually Transmitted Disease Prevention and Control, Dermatology Hospital of Southern Medical University, Guangzhou, China.,Institute for Global Health and Sexually Transmitted Infections, Southern Medical University, Guangzhou, China
| | - Weiming Tang
- Department of Sexually Transmitted Disease Prevention and Control, Dermatology Hospital of Southern Medical University, Guangzhou, China.,Institute for Global Health and Sexually Transmitted Infections, Southern Medical University, Guangzhou, China.,University of North Carolina Project-China, Guangzhou, China
| | - Hung Chak Ho
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong, China.,Centre of Urban Studies and Urban Planning, The University of Hong Kong, Hong Kong, China
| | - Jason J Ong
- Sexual Health Physician, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,London School of Hygiene and Tropical Medicine, London, UK.,Central Clinical School, Monash University, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Xiaojing Zheng
- Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Xuewan Sun
- Department of Sexually Transmitted Disease Prevention and Control, Dermatology Hospital of Southern Medical University, Guangzhou, China.,Institute for Global Health and Sexually Transmitted Infections, Southern Medical University, Guangzhou, China.,University of North Carolina Project-China, Guangzhou, China
| | - Xia Li
- Department of Sexually Transmitted Disease Prevention and Control, Dermatology Hospital of Southern Medical University, Guangzhou, China.,Institute for Global Health and Sexually Transmitted Infections, Southern Medical University, Guangzhou, China
| | - Lijun Liu
- Department of Sexually Transmitted Disease Prevention and Control, Dermatology Hospital of Southern Medical University, Guangzhou, China.,Institute for Global Health and Sexually Transmitted Infections, Southern Medical University, Guangzhou, China
| | - Yajie Wang
- Department of Sexually Transmitted Disease Prevention and Control, Dermatology Hospital of Southern Medical University, Guangzhou, China.,Institute for Global Health and Sexually Transmitted Infections, Southern Medical University, Guangzhou, China
| | - Peizhen Zhao
- Department of Sexually Transmitted Disease Prevention and Control, Dermatology Hospital of Southern Medical University, Guangzhou, China.,Institute for Global Health and Sexually Transmitted Infections, Southern Medical University, Guangzhou, China
| | - Mingzhou Xiong
- Department of Sexually Transmitted Disease Prevention and Control, Dermatology Hospital of Southern Medical University, Guangzhou, China.,Institute for Global Health and Sexually Transmitted Infections, Southern Medical University, Guangzhou, China
| | - Heping Zheng
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Institute for Global Health and Sexually Transmitted Infections, Southern Medical University, Guangzhou, China
| | - Cheng Wang
- Department of Sexually Transmitted Disease Prevention and Control, Dermatology Hospital of Southern Medical University, Guangzhou, China.,Institute for Global Health and Sexually Transmitted Infections, Southern Medical University, Guangzhou, China
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Institute for Global Health and Sexually Transmitted Infections, Southern Medical University, Guangzhou, China
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11
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Pillay J, Wingert A, MacGregor T, Gates M, Vandermeer B, Hartling L. Screening for chlamydia and/or gonorrhea in primary health care: systematic reviews on effectiveness and patient preferences. Syst Rev 2021; 10:118. [PMID: 33879251 PMCID: PMC8056106 DOI: 10.1186/s13643-021-01658-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We conducted systematic reviews on the benefits and harms of screening compared with no screening or alternative screening approaches for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in non-pregnant sexually active individuals, and on the relative importance patients' place on the relevant outcomes. Findings will inform recommendations by the Canadian Task Force on Preventive Health Care. METHODS We searched five databases (to January 24, 2020), trial registries, conference proceedings, and reference lists for English and French literature published since 1996. Screening, study selection, and risk of bias assessments were independently undertaken by two reviewers, with consensus for final decisions. Data extraction was conducted by one reviewer and checked by another for accuracy and completeness. Meta-analysis was conducted where appropriate. We used the GRADE approach to rate the certainty of the evidence. The Task Force and content experts provided input on determining thresholds for important effect sizes and on interpretation of findings. RESULTS Of 41 included studies, 17 and 11 reported on benefits and harms of screening, respectively, and 14 reported on patient preferences. Universal screening for CT in general populations 16 to 29 years of age, using population-based or opportunistic approaches achieving low screening rates, may make little-to-no difference for a female's risk of pelvic inflammatory disease (PID) (2 RCTs, n=141,362; 0.3 more in 1000 [7.6 fewer to 11 more]) or ectopic pregnancy (1 RCT, n=15,459; 0.20 more per 1000 [2.2 fewer to 3.9 more]). It may also not make a difference for CT transmission (3 RCTs, n=41,709; 3 fewer per 1000 [11.5 fewer to 6.9 more]). However, benefits may be achieved for reducing PID if screening rates are increased (2 trials, n=30,652; 5.7 fewer per 1000 [10.8 fewer to 1.1 more]), and for reducing CT and NG transmission when intensely screening high-prevalence female populations (2 trials, n=6127; 34.3 fewer per 1000 [4 to 58 fewer]; NNS 29 [17 to 250]). Evidence on infertility in females from CT screening and on transmission of NG in males and both sexes from screening for CT and NG is very uncertain. No evidence was found for cervicitis, chronic pelvic pain, or infertility in males from CT screening, or on any clinical outcomes from NG screening. Undergoing screening, or having a diagnosis of CT, may cause a small-to-moderate number of people to experience some degree of harm, mainly due to feelings of stigmatization and anxiety about future infertility risk. The number of individuals affected in the entire screening-eligible population is likely smaller. Screening may make little-to-no difference for general anxiety, self-esteem, or relationship break-up. Evidence on transmission from studies comparing home versus clinic screening is very uncertain. Four studies on patient preferences found that although utility values for the different consequences of CT and NG infections are probably quite similar, when considering the duration of the health state experiences, infertility and chronic pelvic pain are probably valued much more than PID, ectopic pregnancy, and cervicitis. How patients weigh the potential benefits versus harms of screening is very uncertain (1 survey, 10 qualitative studies); risks to reproductive health and transmission appear to be more important than the (often transient) psychosocial harms. DISCUSSION Most of the evidence on screening for CT and/or NG offers low or very low certainty about the benefits and harms. Indirectness from use of comparison groups receiving some screening, incomplete outcome ascertainment, and use of outreach settings was a major contributor to uncertainty. Patient preferences indicate that the potential benefits from screening appear to outweigh the possible harms. Direct evidence about which screening strategies and intervals to use, which age to start and stop screening, and whether screening males in addition to females is necessary to prevent clinical outcomes is scarce, and further research in these areas would be informative. Apart from the evidence in this review, information on factors related to equity, acceptability, implementation, cost/resources, and feasibility will support recommendations made by the Task Force. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42018100733 .
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Affiliation(s)
- Jennifer Pillay
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Aireen Wingert
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Tara MacGregor
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Michelle Gates
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
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12
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Chlamydia trachomatis transmission between the oropharynx, urethra and anorectum in men who have sex with men: a mathematical model. BMC Med 2020; 18:326. [PMID: 33198750 PMCID: PMC7670797 DOI: 10.1186/s12916-020-01796-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/24/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND It has been presumed that Chlamydia trachomatis is transmitted between men only through anal or oral sex, but no mathematical models have tested this presumption. METHODS To test this presumption, we created 20 compartmental mathematical models of different sexual practices that included both oral and anal sex and calibrated these models to the observed rates of Chlamydia trachomatis infection at three anatomical sites from 4888 men who have sex with men (MSM) in Melbourne Sexual Health Centre during 2018-2019. RESULTS A model that included only oral and anal sex could replicate the observed rates of single-site infection at the oropharynx, urethra and rectum alone, but could not replicate infection at more than one of these sites (multisite). However, if we included transmission from sexual practices that followed one another in the same sexual episode (e.g. saliva contamination of the penis from oral sex transmitting chlamydia to the rectum by anal sex), we significantly improved the calibration of multisite infection rates substantially. CONCLUSIONS Our modelling study suggests that transmission routes other than just oral and anal sex are necessary to explain the high rate of Chlamydia trachomatis infection at more than one site.
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13
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Elliott SR, Betts S, Hobbs K, Wand H, Rumbold AR, Ward J, Johnson DR. Analysis of diagnostic data for sexually transmissible infections in South Australian Aboriginal Community Controlled Health Services (2008-16). Sex Health 2020; 16:566-573. [PMID: 31623703 DOI: 10.1071/sh18189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/22/2019] [Indexed: 11/23/2022]
Abstract
Australian Aboriginal communities experience a high burden of sexually transmissible infections (STIs). Since 2009, a comprehensive sexual health program has been implemented at nine Aboriginal Community Controlled Health Services in South Australia. This study assessed trends in STI testing and positivity using deidentified diagnostic data from this period (2008-16). METHODS Testing data for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) from one urban, three regional and five remote Aboriginal health services were analysed using logistic regression. RESULTS From 2008 to 2016, testing increased for CT (twofold), NG (threefold) and TV (sixfold). On average, 30% of testing occurred during an annual 6-week screen. Fewer males were tested (range 27-38% annually). Mean annual STI testing coverage was 28% for 16- to 30-year-old clients attending regional or remote services (2013-16). Positivity at first testing episode for all three infections declined during the study period. From 2013 to 2016, when testing was stable and changes in positivity were more likely to indicate changes in prevalence, there were significant reductions in CT positivity (adjusted odds ratio (aOR) 0.4; 95% confidence interval (CI) 0.2-0.5) and TV positivity (aOR 0.6, 95% CI 0.4-0.9), although declines were statistically significant for females only. There was no significant decrease in NG positivity (aOR 0.9; 95% CI 0.5-1.5). CONCLUSIONS Since the sexual health program began, STI testing increased and STI positivity declined, but significant reductions observed in CT and TV positivity were confined to females. These findings suggest evidence of benefit from sustained, comprehensive sexual health programs in Aboriginal communities with a high STI prevalence, but highlight the need to increase STI testing among men in these communities.
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Affiliation(s)
- Salenna R Elliott
- Aboriginal Health Council of South Australia, Adelaide, SA 5000, Australia; and South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; and Flinders University, Bedford Park, SA 5042, Australia; and SA Health, Adelaide, SA 5000, Australia; and Corresponding author.
| | - Sarah Betts
- Aboriginal Health Council of South Australia, Adelaide, SA 5000, Australia
| | - Katie Hobbs
- Aboriginal Health Council of South Australia, Adelaide, SA 5000, Australia; and SA Health, Adelaide, SA 5000, Australia
| | - Handan Wand
- The Kirby Institute, UNSW, Sydney, NSW 2052, Australia
| | - Alice R Rumbold
- The Robinson Research Institute, University of Adelaide, North Adelaide, SA 5006, Australia
| | - James Ward
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5000, Australia; and Flinders University, Bedford Park, SA 5042, Australia
| | - David R Johnson
- Aboriginal Health Council of South Australia, Adelaide, SA 5000, Australia
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14
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Ribeiro AA, Saddi VA, Carneiro MA, Figueiredo-Alves RR, da Silva Barros NK, de Almeida Carvalho KP, do Nascimento Tavares SB, de Araújo Teles S, D'Alessandro WB, Rabelo-Santos SH. Human papillomavirus and Chlamydia trachomatis infections in adolescents and young women: Prevalence and risk factors. Diagn Cytopathol 2020; 48:736-744. [PMID: 32379403 DOI: 10.1002/dc.24460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND The objective of this study was to estimate the prevalence of Human papillomavirus (HPV) genotypes and Chlamydia trachomatis (CT) infections among adolescents and young adult women and to identify the risk factors associated. METHODS This study included 276 sexually active participants, classified as adolescents (15-19 years) and young adult women (20-24 years) that realized conventional cytology and were tested for 27 HPV genotypes and for CT. Bivariate and multivariate analyses were performed to evaluate the factors associated with both infections. RESULTS The prevalence of HPV infection was 50.7% in adolescents and 43.0% in young adult women. The HPV-16 was the most prevalent (27.7%), followed by HPV-68 (6.9%), HPV-52 (6.2%), HPV-39 (4.6%), and HPV-73 (4.6%). The prevalence of CT infection was 11.5% among adolescents and 6.2% among young adult women. Cytological abnormalities were found in 14.2% among adolescents, of which 80.9% were positive for HPV and 10% of young adult women of which 84.6% were positive for HPV infection. HPV16 and HPV 68 were detected in 35.7% and 32.1% of cases with cytological abnormalities. Factors independently associated with HPV infection obtained by multivariate analysis were unmarried or divorced marital status and the presence of cytological abnormalities. The same variables were analyzed for the association with CT infection, and the association with cytological abnormalities remained significant. CONCLUSION HPV and CT infections are very prevalent in adolescent and young adult women; these findings reinforce the need of early vaccination, prior to the onset of sexual activity, and justify implementation of molecular screening tests.
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Affiliation(s)
- Andrea Alves Ribeiro
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | | | | | | | | | | | | | - Sheila de Araújo Teles
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | | | - Silvia Helena Rabelo-Santos
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil.,School of Pharmacy, Federal University of Goiás, Goiânia, Brazil
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15
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Ward JS, Hengel B, Ah Chee D, Havnen O, Boffa JD. Setting the record straight: sexually transmissible infections and sexual abuse in Aboriginal and Torres Strait Islander communities. Med J Aust 2020; 212:205-207.e1. [PMID: 32062855 DOI: 10.5694/mja2.50492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- James S Ward
- University of Queensland, Brisbane, QLD.,Poche Centre for Indigenous Health, University of Queensland, Brisbane, QLD
| | | | - Donna Ah Chee
- Central Australian Aboriginal Congress, Alice Springs, NT
| | | | - John D Boffa
- Central Australian Aboriginal Congress, Alice Springs, NT
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16
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Rob F, Jůzlová K, Kružicová Z, Vaňousová D, Lásiková Š, Sýkorová B, Machala L, Rozsypal H, Veselý D, Zákoucká H, Hercogová J. Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae co-infections among patients with newly diagnosed syphilis: a single-centre, cross-sectional study. Cent Eur J Public Health 2020; 27:285-291. [PMID: 31951687 DOI: 10.21101/cejph.a5142] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of the study was to determine the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae co-infections among patients with newly diagnosed syphilis. METHODS In patients with any stage of newly diagnosed syphilis swabs were performed from urethra, rectum, pharynx and cervix according to the gender and type of sexual intercourse. From these smears standard validated nucleic acid amplification tests (NAATs) for Chlamydia trachomatis and Neisseria gonorrhoeae infections were done. RESULTS From 548 (488 men, 60 women) screened patients co-infection was detected in 15.9% of the cases. The majority of the co-infections (86.2%) were asymptomatic. The overall prevalence of chlamydial infection was 11.1% and 8.8% for gonococcal infections. In men who have sex with men (MSM) the prevalence of co-infections was significantly higher (20.0%) than in heterosexual men and women (4.2%) (p < 0.001). In MSM patients the presence of co-infection was significantly associated with HIV infection (p < 0.001). Among MSM 9.6% of the tests detected infection in anorectal site, while prevalence in urethral (2.8%) and pharyngeal (2.4%) localization was significantly lower. In heterosexual patients prevalence was less than 2.0% in all anatomic sites. CONCLUSIONS The implementation of screening tests in case of sexually transmitted infections in patients with newly diagnosed syphilis is an important part in the management of this disease. These results suggest that screening of asymptomatic heterosexual patients leads to detection of minimum co-infections, but in MSM (especially HIV positive) should always be performed at least in anorectal site, where asymptomatic co-infections are common.
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Affiliation(s)
- Filip Rob
- Department of Dermatovenerology, Second Faculty of Medicine, Charles University, Na Bulovce Hospital, Prague, Czech Republic
| | - Kateřina Jůzlová
- Department of Dermatovenerology, Second Faculty of Medicine, Charles University, Na Bulovce Hospital, Prague, Czech Republic
| | - Zuzana Kružicová
- Department of Dermatovenerology, Second Faculty of Medicine, Charles University, Na Bulovce Hospital, Prague, Czech Republic
| | - Daniela Vaňousová
- Department of Dermatovenerology, Second Faculty of Medicine, Charles University, Na Bulovce Hospital, Prague, Czech Republic
| | - Šárka Lásiková
- Department of Microbiology, Na Bulovce Hospital, Prague, Czech Republic
| | - Blanka Sýkorová
- Department of Microbiology, Na Bulovce Hospital, Prague, Czech Republic
| | - Ladislav Machala
- Department of Infectious Diseases, Third Faculty of Medicine, Charles University, Na Bulovce Hospital, Prague, Czech Republic
| | - Hanuš Rozsypal
- Department of Infectious and Tropical Diseases, First Faculty of Medicine, Charles University, Na Bulovce Hospital, Prague, Czech Republic
| | - Dan Veselý
- Department of Infectious Diseases, Second Faculty of Medicine, Charles University, Na Bulovce Hospital, Prague, Czech Republic
| | - Hana Zákoucká
- National Reference Laboratory for Diagnostics of Syphilis, National Institute of Public Health, Prague, Czech Republic
| | - Jana Hercogová
- Department of Dermatovenerology, Second Faculty of Medicine, Charles University, Na Bulovce Hospital, Prague, Czech Republic
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17
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Garland SM, Subasinghe AK, Ahmed N, Jayasinghe Y, Marceglia A. Long-term trends of Chlamydia trachomatis in a clinic population at the Royal Women's Hospital, Melbourne. Aust N Z J Obstet Gynaecol 2019; 60:149-153. [PMID: 31881110 DOI: 10.1111/ajo.13106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/06/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chlamydia trachomatis (C. trachomatis) prevalence has been reported to be increasing. Whether this is a true increase over time or confounded by increases in testing and/or use of more sensitive assays is to be determined. MATERIALS AND METHODS One laboratory service has been detecting C. trachomatis for the past 30 years within the Royal Women's Hospital Melbourne. We conducted a retrospective audit of records over the period 1986-2016 from a clinic population routinely offered chlamydia screening. These were women presenting for family planning advice (termination of pregnancy, intrauterine device insertion or considered at high risk), who underwent chlamydia testing in the context of various diagnostic assays used over this time period. Assays utilised included culture, enzyme immunoassay (EIA), DNA probe, and nucleic acid amplification testing (NAAT). Non-parametric test for trend was used to determine significant differences between prevalence estimates across ordered groups. Least squares regression was conducted to describe a linear trend matching known data points. RESULTS Overall, there was no significant change for chlamydia prevalence which was 2.2%, in the 30-year study period (P = 0.7). Over time diagnostic assays changed from culture, to EIA, DNA probe, to the more sensitive NAAT. The bulk of the positives were in women under 25 years of age (57%). CONCLUSION Chlamydia prevalence has been stable over 30 years, remaining a problem in young women. Screening for those at risk needs underscoring in a national sexual health program.
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Affiliation(s)
- Suzanne Marie Garland
- Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Infection & Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Asvini Kokila Subasinghe
- Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Infection & Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Navera Ahmed
- Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Yasmin Jayasinghe
- Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Department of Gynaecology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Alex Marceglia
- Sexual Health and Rapid Access Service, The Royal Women's Hospital, Melbourne, Victoria, Australia
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18
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Chow EPF, Fairley CK. The role of saliva in gonorrhoea and chlamydia transmission to extragenital sites among men who have sex with men: new insights into transmission. J Int AIDS Soc 2019; 22 Suppl 6:e25354. [PMID: 31468730 PMCID: PMC6715946 DOI: 10.1002/jia2.25354] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/26/2019] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Gonorrhoea and chlamydia cases have been rising among gay, bisexual and other men who have sex with men (MSM) over the last decade. The majority of cases are extragenital and occur at the oropharynx and anorectum. The aim of this narrative review was to review the risk factors and mode of transmission for gonorrhoea and chlamydia at the oropharynx and anorectum among MSM. RESULTS AND DISCUSSION New evidence suggests that oropharyngeal gonorrhoea can be transmitted by kissing in addition to through the established route of condomless oral sex; and anorectal gonorrhoea can be acquired when saliva is used as a lubricant for anal sex and rimming in addition to the established route of condomless penile-anal sex in MSM. In contrast, condomless penile-anal sex remains the major route for chlamydia transmission. CONCLUSIONS Substantial transmission of gonorrhoea may occur with practices other than the established routes of condomless oral and/or anal sex and hence condoms may not be effective in preventing gonorrhoea transmission to extragenital sites. In contrast, condoms are effective for chlamydia control because it is mainly transmitted through condomless penile-anal sex. Novel interventions for gonorrhoea that reduce the risk of transmission at extragenital site are required.
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Affiliation(s)
- Eric PF Chow
- Melbourne Sexual Health CentreAlfred HealthCarltonVICAustralia
- Central Clinical SchoolMonash UniversityMelbourneVICAustralia
| | - Christopher K Fairley
- Melbourne Sexual Health CentreAlfred HealthCarltonVICAustralia
- Central Clinical SchoolMonash UniversityMelbourneVICAustralia
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19
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Thompson KN, Betts J, Jovev M, Nyathi Y, McDougall E, Chanen AM. Sexuality and sexual health among female youth with borderline personality disorder pathology. Early Interv Psychiatry 2019; 13:502-508. [PMID: 29076247 DOI: 10.1111/eip.12510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/12/2017] [Accepted: 08/20/2017] [Indexed: 11/26/2022]
Abstract
AIM Borderline personality disorder (BPD) is a severe mental disorder that is characterized by unstable relationships, impulsive behaviours and identity disturbance. BPD usually has its onset between puberty and young adulthood and presents disproportionately among females in clinical settings. Taken together, this makes young women with BPD a particularly vulnerable group with regard to healthy psychosexual development. It was hypothesized that female youth with BPD pathology would be more likely to score worse on measures of sexual health and safety, and to show greater uncertainty in sexual identity formation. METHODS Fifty 15 to 24 yr-old females with 3 or more Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-IV) BPD criteria were compared with 204 females from a nationally representative sample. Both groups were interviewed using a comprehensive interview for sexual health and relationships. The patient group completed a structured diagnostic interview. RESULTS Young women with borderline personality pathology engaged in sexual relationships at a younger age, with more sexual partners in the previous year, in more casual relationships. They were more likely to practice unsafe sex for their first sexual experience, to be coerced into unwanted sexual activity, to be unclear about their sexual identity or their sexual attraction, and to report worse overall health status. CONCLUSIONS BPD pathology in youth is associated with poor sexual health and safety, and uncertainty in sexual identity formation. These findings support the need for assessment of the sexuality and sexual health of youth with BPD, along with the need for routine screening in sexual health services for BPD features among high-risk youth.
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Affiliation(s)
- Katherine N Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer Betts
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Martina Jovev
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.,Orygen Youth Health, Parkville, Victoria, Australia
| | - Yolanda Nyathi
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Emma McDougall
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.,Orygen Youth Health, Parkville, Victoria, Australia
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20
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Evolving patterns of reactive arthritis. Clin Rheumatol 2019; 38:2083-2088. [PMID: 30919146 DOI: 10.1007/s10067-019-04522-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/08/2019] [Accepted: 03/15/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To characterize rheumatologists' perspectives on evolving trends of reactive arthritis (ReA). METHODS After ethics approval, 548 members of the Canadian Rheumatology Association were surveyed with 37 questions covering their demographic information, subspecialty, level of experience, practice setting and opinions on prevalence, treatment, and causes of ReA. Results were analyzed with descriptive statistics. RESULTS Ninety-seven responded to the survey (18% response rate); 66 fully completed it. Nearly half of respondents believed that the incidence of ReA is declining and causes of ReA may be changing. Physicians reported that most of the ReA cases in their practices were caused by an unknown organism, sexually transmitted, or gastrointestinal infection. Full triad ReA increased the chance of recurrence according to their impressions. Common investigations in ReA included inflammatory markers, HLA-B27, chlamydia and gonorrhea testing, stool cultures, synovial fluid analyses, SI joint imaging. ReA treatment included NSAIDs, intra-articular corticosteroid injections, and DMARDs. Two-thirds said they used TNF alpha inhibitors in chronic ReA occasionally or more frequently. CONCLUSION ReA may be decreasing in frequency and severity in Canada. Changes could be due to less food borne illness, cleaner water, or more rapid treatment of sexually transmitted infections. The cause is often unknown in clinical practice.Key Points• Reactive arthritis (ReA) is likely decreasing in prevalence and severity.• Patients with classic trial of arthritis, urethritis, and conjunctivitis are more likely to have recurrent and/or chronic ReA.• The causal organisms are often not detected and seem to be changing over time.
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Pillay J, Moore A, Rahman P, Lewin G, Reynolds D, Riva J, Thériault G, Thombs B, Wilson B, Robinson J, Ramdyal A, Cadieux G, Featherstone R, Burchell AN, Dillon JA, Singh A, Wong T, Doull M, Traversy G, Courage S, MacGregor T, Johnson C, Vandermeer B, Hartling L. Screening for chlamydia and/or gonorrhea in primary health care: protocol for systematic review. Syst Rev 2018; 7:248. [PMID: 30587234 PMCID: PMC6307186 DOI: 10.1186/s13643-018-0904-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 12/05/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis and Neisseria gonorrhoeae are the most commonly reported sexually transmitted infections in Canada. Existing national guidance on screening for these infections was not based on a systematic review, and recommendations as well as implementation considerations (e.g., population groups, testing and case management) should be explicit and reflect the quality of evidence. The aim of this systematic review is to synthesize research on screening for these infections in sexually active individuals within primary care. We will also review evidence on how people weigh the relative importance of the potential outcomes from screening, rated as most important by the Canadian Task Force on Preventive Health Care (CTFPHC) with input from patients and stakeholders. METHODS We have developed a peer-reviewed strategy to comprehensively search MEDLINE, Embase, Cochrane Library, CINAHL, and PsycINFO for English and French literature published 1996 onwards. We will also search trial registries and conference proceedings, and mine references lists. Screening, study selection, risk of bias assessments, and quality of findings across studies (for each outcome) will be independently undertaken by two reviewers with consensus for final decisions. Data extraction will be conducted by one reviewer and checked by another for accuracy and completeness. The CTFPHC and content experts will provide input for decisions on study design (i.e., when and whether to include uncontrolled studies for screening effectiveness) and for interpretation of the findings. DISCUSSION The results section of the review will include a description of all studies, results of all analyses, including planned subgroup and sensitivity analyses, and evidence profiles and summary of findings tables incorporating assessment based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods to communicate our confidence in the estimates of effect. We will compare our findings to others and discuss limitations of the review and available literature. The findings will be used by the CTFPHC-supplemented by consultations with patients and stakeholders and from other sources on issues of feasibility, acceptability, costs/resources, and equity-to inform recommendations on screening to support primary health care providers in delivering preventive care. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42018100733.
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Affiliation(s)
- Jennifer Pillay
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue, Edmonton, Alberta T6G 1C9 Canada
| | - Ainsley Moore
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Prinon Rahman
- Global Health and Guidelines Division, Public Health Agency of Canada, Edmonton, Canada
| | - Gabriel Lewin
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Donna Reynolds
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - John Riva
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | | | - Brett Thombs
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Brenda Wilson
- Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Canada
| | - Joan Robinson
- Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Amanda Ramdyal
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | | | - Robin Featherstone
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue, Edmonton, Alberta T6G 1C9 Canada
| | - Anne N. Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jo-Anne Dillon
- Department of Microbiology and Immunology, University of Saskatchewan, Saskatoon, Canada
| | - Ameeta Singh
- Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Tom Wong
- Public Health Agency of Canada, Edmonton, Canada
| | - Marion Doull
- Global Health and Guidelines Division, Public Health Agency of Canada, Edmonton, Canada
| | - Greg Traversy
- Global Health and Guidelines Division, Public Health Agency of Canada, Edmonton, Canada
| | - Susan Courage
- Global Health and Guidelines Division, Public Health Agency of Canada, Edmonton, Canada
| | - Tara MacGregor
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue, Edmonton, Alberta T6G 1C9 Canada
| | - Cydney Johnson
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue, Edmonton, Alberta T6G 1C9 Canada
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue, Edmonton, Alberta T6G 1C9 Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue, Edmonton, Alberta T6G 1C9 Canada
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22
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Prevalence of chlamydia trachomatis infection among reproductive age women in sub Saharan Africa: a systematic review and meta-analysis. BMC Infect Dis 2018; 18:596. [PMID: 30477441 PMCID: PMC6258386 DOI: 10.1186/s12879-018-3477-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 10/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis is the most common curable sexual transmitted bacterial infection in the world, including Sub-Saharan Africa. There is nil systematic review and meta-analysis on Chlamydia trachomatis infection in Sub-Saharan Africa among reproductive age women. Therefore, this study was carried out to determine the pooled prevalence of chlamydia trachomatis infection in Sub-Saharan Africa among reproductive age women. METHODS A comprehensive literature search was conducted from biomedical data bases: Medline, PubMed, EMBASE, Google scholar, HINARI and Cochrane Library using a special index search terms (medical subject headings (MeSH), title and abstract. The Cochrane Q test and I2 statistics was used to test heterogeneity and publication bias was assessed using Begg's and Egger's tests. Results were presented in tables, figures and funnel plot. Data were pooled in a meta-analysis using a random effects model. RESULTS Twenty-four studies were included in this meta-analysis. There was a high level of heterogeneity among studies. The pooled prevalence of Chlamydia trachomatis infection in Sub-Saharan Africa among reproductive age women was 7.8% (95% CI: 5.6-10.6). CONCLUSION This review showed that Chlamydia trachomatis infection is high in Sub-Saharan Africa among reproductive age group women. This evidence suggests that governmental and non-governmental organization shall give attention for primary prevention of this infection. Likewise, in resource limited countries policy makers, stakeholders and health care providers' due attention for Chlamydia trachomatis specific and rapid diagnostic test, treatment in any medical out and in patient clinics for reproductive age women.
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23
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Li B, Hocking JS, Bi P, Bell C, Fairley CK. The efficacy of azithromycin and doxycycline treatment for rectal chlamydial infection: a retrospective cohort study in South Australia. Intern Med J 2018; 48:259-264. [PMID: 28967178 DOI: 10.1111/imj.13624] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 08/14/2017] [Accepted: 09/15/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are ongoing concerns about treatment failure with azithromycin for the treatment of rectal chlamydia. AIM To investigate treatment efficacy of two treatments for rectal chlamydial infection. METHODS We performed a retrospective analysis of all patients diagnosed with rectal chlamydial infection between 2009 and 2015 in Adelaide, Australia. Patients were treated with either azithromycin (1 g single dose) or doxycycline (100 mg twice a day for 10 days) and returned for repeat testing 14-180 days after treatment commenced. Log-binomial models were used to estimate the relative risk (RR) of recurrent rectal chlamydia associated with the treatment with azithromycin versus doxycycline. RESULTS In men, rectal chlamydia prevalence was 6.7%, and in women, it was 8.1%. Of the 526 patients diagnosed with rectal chlamydial infections, 419 (79.7%), 93 (17.7%) and 14 (2.6%) patients were treated with doxycycline, azithromycin or other medication respectively. Of these patients, 173 (41.3%) of 419 doxycycline-treated patients and 31 (33.3%) of 93 azithromycin-treated patients were retested between 14 and 180 days after treatment commenced (P = 0.16). Among these patients, the repeat rectal chlamydia test was less commonly positive in those treated with doxycycline (5.8%; 95% confidence interval (CI) 0.03-0.10) compared with those treated with azithromycin (19.4%; 95% CI 0.09-0.36) and (P = 0.01). In the multivariate analysis, azithromycin-treated patients had a significantly higher risk of a positive test in the 14 and 180 days after treatment commenced (adjusted relative risk (aRR) 2.96, 95% CI 1.16-7.57). CONCLUSION The findings suggest that doxycycline may be more effective than azithromycin in treating rectal chlamydial infections.
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Affiliation(s)
- Bin Li
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia.,STI Services (Clinic 275), Infectious Disease Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Charlotte Bell
- STI Services (Clinic 275), Infectious Disease Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher K Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
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24
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Graham S, Smith LW, Fairley CK, Hocking J. Prevalence of chlamydia, gonorrhoea, syphilis and trichomonas in Aboriginal and Torres Strait Islander Australians: a systematic review and meta-analysis. Sex Health 2018; 13:99-113. [PMID: 26775118 DOI: 10.1071/sh15171] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/05/2015] [Indexed: 11/23/2022]
Abstract
Higher notification rates of sexually transmissible infections (STIs) are reported among Aboriginal and Torres Strait Islander (Aboriginal) compared with non-Aboriginal people in Australia. The aim of this study is to estimate the pooled prevalence of chlamydia, gonorrhoea, syphilis and trichomonas among Aboriginal people in Australia by sex, age-group, setting (clinic vs population/community-based) and population group [adults, pregnant females, young people (12-29 years) and prisoners]. The databases Medline, PubMed and Web of Science were searched in May 2015. A meta-analysis was conducted to estimate the pooled prevalence of the four STIs in Aboriginal people and if possible, by gender, age-group, setting and population group. A total of 46 studies were included. The pooled prevalence was 11.2% (95%CI: 9.4-13.0%) for chlamydia (36 studies), 12.5% (95%CI: 10.5-14.6%) for gonorrhoea (28 studies), 16.8% (95%CI: 11.0-22.6%) for syphilis (13 studies) and 22.6% (95%CI: 18.5-26.7%) for trichomonas (11 studies); however, there was significant heterogeneity between studies (I(2) <97.5%, P<0.01). In the subgroup analysis, a higher pooled prevalence occurred in females than males for chlamydia (12.7% vs 7.7%) and gonorrhoea (10.7% vs 8.1%). The prevalence of chlamydia was 12.4% in clinic-based compared with 4.3% in population-based studies. The highest pooled prevalence by population group was among pregnant females (16.8%) and young people (16.2%) for chlamydia, pregnant females (25.2%) for trichomonas; and young people for gonorrhoea (11.9%). This review highlights the need to decrease the prevalence of STIs among Aboriginal people through community-based programs that target asymptomatic young people.
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Affiliation(s)
- Simon Graham
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3052, Australia
| | | | - Christopher K Fairley
- Melbourne Sexual Health Centre and Central Clinical School, Monash University, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Jane Hocking
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3052, Australia
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Roshani D, Ramazanzadeh R, Farhadifar F, Ahmadi A, Derakhshan S, Rouhi S, Zarea S, Zandvakili F. A PRISMA systematic review and meta-analysis on Chlamydia trachomatis infections in Iranian women (1986-2015). Medicine (Baltimore) 2018; 97:e0335. [PMID: 29668583 PMCID: PMC5916690 DOI: 10.1097/md.0000000000010335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 03/10/2018] [Accepted: 03/15/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis (CT) is the cause of genital tract infections in women. Some evidence has shown the role of this infection with CT in spontaneous abortions. The purpose of this study is to study the frequency of CT infection in Iranian women. METHODS This study was performed based on PRISMA guidelines. A total of 75 articles published in Google Scholar, PubMed, ISI Web of Science, Biological abs, Iranmedex, SID, and Scopus databases were found (1986-2015) using the following keywords: CT in women, CT and Iranian women, CT and infection in Iran, CT and pregnancy in Iran, CT and preterm delivery in Iran, CT and preterm labor in Iran, CT and fertility in Iran, CT and infertility in Iran, and CT and abortion in Iran. Finally, 40 studies from different regions of Iran were included. Statistical analyses were performed using R3 and STATA 12. RESULTS From 1986 to 2015, the lowest rate of prevalence was from 2010 to 2011 (3.9%) and the highest prevalence rate was in 2009 (69.39%) in northern Iran. Fixed effects for different parts of Iran (North, South, East, and West) were Pooled proportion: 0.13 (95% confidence interval [CI] = 0.12-0.14) and for samples (cervical, vaginal, urine, and blood) the pooled proportion was = 0.14 (95% CI = 0.12-0.14). CONCLUSION CT infection in this study was prevalent in urine samples and the rate of CT was observed from culture methods in comparison to other methods. Because women with CT play an important role because of sexual activity for transmission and untreated women are at risk of developing sequels. Also, most studies in Iran use sensitive polymerase chain reaction tests for the detection of genital CT infections.
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Affiliation(s)
- Daem Roshani
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences
| | - Rashid Ramazanzadeh
- Cellular and Molecular Research Center, Kurdistan University of Medical Sciences
- Department of Microbiology, Faculty of Medicine, Kurdistan University of Medical Sciences
| | - Fariba Farhadifar
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kurdistan University of Medical Sciences
| | - Amjad Ahmadi
- Cellular and Molecular Research Center, Kurdistan University of Medical Sciences
- Department of Microbiology, Faculty of Medicine, Kurdistan University of Medical Sciences
| | - Safoura Derakhshan
- Liver and Digestive Research Center, Kurdistan University of Medical Sciences
| | - Samaneh Rouhi
- Cellular and Molecular Research Center, Kurdistan University of Medical Sciences
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Shamsi Zarea
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kurdistan University of Medical Sciences
| | - Farnaz Zandvakili
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kurdistan University of Medical Sciences
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26
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Arnet I, Gudka S, Salter S, Hersberger KE, Clifford R. Readiness of pharmacists and consumers for pharmacy-based chlamydia screening in Australia and Switzerland. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 16:138-153. [PMID: 29804758 DOI: 10.1016/j.srhc.2018.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 02/21/2018] [Accepted: 03/27/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess chlamydia knowledge, willingness to undertake pharmacy-based chlamydia testing, and facilitators and barriers to such testing in consumers and community pharmacists, in Australia (AUS) and Switzerland (CH). METHODS Statements of interest were retrieved from literature and assembled into a 12-item online survey (English and German versions). Survey was disseminated through Facebook, pharmacies' publicly available emails and professional websites (March 2015). RESULTS Consumers and pharmacists (AUS: ncons = 198, npharm = 162; CH: ncons = 209, npharm = 223) were predominantly female (>65%). Mean chlamydia knowledge scores (maximum of 8) were higher in Australia in consumers (AUS: 6.8 ± 1.5 vs CH: 4.2 ± 2.4; p < 0.001) and in pharmacists (AUS: 7.1 ± 1.1 vs CH: 6.1 ± 1.4; p < 0.001). High willingness of consumers to seek testing (AUS: 79.3% vs CH: 83.3%, p = 0.3) and of pharmacists to provide testing (AUS: 95.7% vs CH: 80.3%, p < 0.001) was observed. Greatest barrier for consumers was "Embarrassed about asking for a test" (AUS: 47.8% vs CH: 51.2%, p = 0.7) and "No remuneration" for pharmacists (AUS: 40.7% vs CH: 31.8%, p = 0.07). CONCLUSION The majority of consumers and pharmacists support pharmacy-based chlamydia testing. There is now emerging evidence that the policy makers in Australia and Switzerland need to develop pharmacy-based chlamydia testing as core business.
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Affiliation(s)
- Isabelle Arnet
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland.
| | - Sajni Gudka
- School of Allied Health, M315 Pharmacy, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.
| | - Sandra Salter
- School of Allied Health, M315 Pharmacy, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.
| | - Kurt E Hersberger
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland.
| | - Rhonda Clifford
- School of Allied Health, M315 Pharmacy, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.
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Bowring AL, Wright CJC, Douglass C, Gold J, Lim MSC. Features of successful sexual health promotion programs for young people: findings from a review of systematic reviews. Health Promot J Austr 2018; 29:46-57. [PMID: 29700941 DOI: 10.1002/hpja.3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 06/22/2017] [Indexed: 11/11/2022] Open
Abstract
ISSUE ADDRESSED Young people have a high burden of sexual and reproductive health (SRH) problems, and it is important to reach this group through health promotion initiatives. We conducted a systematic review of reviews to identify successful elements of health promotion programs for improving SRH of young people. METHODS We identified and collated systematic reviews published in 2005-2015 which focused on young people (10-24 years), reported on SRH outcomes (pregnancy, sexually transmissible infections, condoms/contraceptive use, risky sexual behaviour, sexual healthcare access or intimate partner violence), and included primary studies predominantly conducted in high-income countries. This report focuses on features of successful SRH programs identified in the interpretation and discussion of included systematic reviews. RESULTS We identified 66 systematic reviews, of which 37 reported on program features which were anecdotally or statistically associated with improved program effectiveness and success. Common features of effective interventions were: longer term or repeated implementation; multi-setting and multi-component; parental involvement; culturally/gender/age appropriate; and inclusion of skills-building. SO WHAT?: There is marked consistency of features improving SRH program effectiveness for young people despite the wide variation in interventions reviewed. There is a need to better implement this knowledge in future programs, and our findings provide useful guidance for optimising the design of SRH interventions for young people.
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Affiliation(s)
| | - Cassandra J C Wright
- Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Caitlin Douglass
- Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Judy Gold
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Megan S C Lim
- Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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28
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Karim S, Souho T, Benlemlih M, Bennani B. Cervical Cancer Induction Enhancement Potential of Chlamydia Trachomatis: A Systematic Review. Curr Microbiol 2018; 75:1667-1674. [PMID: 29356877 DOI: 10.1007/s00284-018-1439-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/16/2018] [Indexed: 01/15/2023]
Abstract
Human papillomavirus (HPV) persistent infection is the necessary but not sufficient cause of cervical cancer. Other co-factors are required to induce cell transformation that will evolve to malignant cervical cancer. These co-factors include physical elements, other sexually transmitted infections, and immune response. Chlamydia trachomatis the most common bacterial sexually transmitted infection is often asymptomatic but causes various syndromes such as cervicitis, endometritis, pelvic inflammatory disease, and infertility. It is established that this bacterium is involved in cell proliferation process and inhibit apoptosis. Furthermore, C. trachomatis may induce chronic inflammation, interfere with immune response by decreasing the number of antigen presenting cells, and reduce the cell-mediated immunity allowing the persistence of HPV. However, it is unclear whether this bacterium plays a particular role in cervical cancer induction. We therefore aimed at enlightening the actual knowledge about the relationship between C. trachomatis and cervical cancer or precursor lesions through a systematic literature review. We summarized and analyzed the epidemiological data on C. trachomatis and its co-infection with HPV and their association to cervical cancer.
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Affiliation(s)
- Safae Karim
- Laboratory of Microbiology and Molecular Biology, Faculty of Medicine and Pharmacy of Fez (FMPF), Sidi Mohammed Ben Abdellah University (USMBA), Fez, Morocco
- Laboratory of Biotechnologies, Faculty of Sciences Dhar El Mahraz, USMBA, Fez, Morocco
| | - Tiatou Souho
- Faculty of Science and Technology, University of Kara, Kara, Togo
| | - Mohamed Benlemlih
- Laboratory of Biotechnologies, Faculty of Sciences Dhar El Mahraz, USMBA, Fez, Morocco
| | - Bahia Bennani
- Laboratory of Microbiology and Molecular Biology, Faculty of Medicine and Pharmacy of Fez (FMPF), Sidi Mohammed Ben Abdellah University (USMBA), Fez, Morocco.
- Team of Microorganisms, Genomic and Oncogene Factors, Laboratory of Human Pathology, Biomedicine and Environmental, FMP, USMBA, Fez, Morocco.
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29
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Unemo M, Bradshaw CS, Hocking JS, de Vries HJC, Francis SC, Mabey D, Marrazzo JM, Sonder GJB, Schwebke JR, Hoornenborg E, Peeling RW, Philip SS, Low N, Fairley CK. Sexually transmitted infections: challenges ahead. THE LANCET. INFECTIOUS DISEASES 2017; 17:e235-e279. [PMID: 28701272 DOI: 10.1016/s1473-3099(17)30310-9] [Citation(s) in RCA: 455] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 03/13/2017] [Accepted: 03/30/2017] [Indexed: 12/30/2022]
Abstract
WHO estimated that nearly 1 million people become infected every day with any of four curable sexually transmitted infections (STIs): chlamydia, gonorrhoea, syphilis, and trichomoniasis. Despite their high global incidence, STIs remain a neglected area of research. In this Commission, we have prioritised five areas that represent particular challenges in STI treatment and control. Chlamydia remains the most commonly diagnosed bacterial STI in high-income countries despite widespread testing recommendations, sensitive and specific non-invasive testing techniques, and cheap effective therapy. We discuss the challenges for chlamydia control and evidence to support a shift from the current focus on infection-based screening to improved management of diagnosed cases and of chlamydial morbidity, such as pelvic inflammatory disease. The emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae is globally recognised. We review current and potential future control and treatment strategies, with a focus on novel antimicrobials. Bacterial vaginosis is the most common vaginal disorder in women, but current treatments are associated with frequent recurrence. Recurrence after treatment might relate to evidence that suggests sexual transmission is integral to the pathogenesis of bacterial vaginosis, which has substantial implications for the development of effective management approaches. STIs disproportionately affect low-income and middle-income countries. We review strategies for case management, focusing on point-of-care tests that hold considerable potential for improving STI control. Lastly, STIs in men who have sex with men have increased since the late 1990s. We discuss the contribution of new biomedical HIV prevention strategies and risk compensation. Overall, this Commission aims to enhance the understanding of some of the key challenges facing the field of STIs, and outlines new approaches to improve the clinical management of STIs and public health.
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Affiliation(s)
- Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Catriona S Bradshaw
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Henry J C de Vries
- STI Outpatient Clinic, Public Health Service of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Infection and Immunity, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Suzanna C Francis
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - David Mabey
- Clinical Research Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Jeanne M Marrazzo
- Department of Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Gerard J B Sonder
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands; Division of Infectious Diseases, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jane R Schwebke
- Department of Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Elske Hoornenborg
- STI Outpatient Clinic, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Rosanna W Peeling
- Clinical Research Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Susan S Philip
- Disease Prevention and Control Population Health Division, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia.
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Belozorov A, Fedets O, Chastii T, Milutina E, Sokol O, Grigorova R, Unuchko S. Chlamydia trachomatis infection positivity rates determined by nucleic acid amplification test in patients of hospitals in the northeastern region of Ukraine. Int J STD AIDS 2017; 28:1405-1409. [PMID: 28583015 DOI: 10.1177/0956462417709831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There are no accurate data regarding the prevalence of Chlamydia trachomatis infection in Ukraine. This study aims to estimate the prevalence in the northeastern region of the country through reviewing nucleic acid amplification test results in patients of medical institutions in the Kharkov region during 2014-2016. Samples from 6920 patients (5028 women and 1892 men) aged 12-76 years were tested. The overall positivity rate was 4.5% (95% CI 4.0-5.0): 3.9% (95% CI 3.4-4.5) in women and 6.1% (95% CI 5.1-7.3) in men. The highest prevalence was found in the 16-20 (8.5%, CI 6.3-11.4) and 21-25 (8.0%, CI 6.7-9.4) year age groups. The prevalence in men was higher than in women in all investigated groups. The results show the need for more attention to the prevention, diagnosis, and treatment of chlamydial infection in these age groups of women and men in this region.
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Affiliation(s)
- Alexei Belozorov
- 1 SE 'Institute of Dermatology and Venerology of the National Academy of Medical Sciences of Ukraine,' Kharkiv, Ukraine
| | - Olga Fedets
- 2 Medical Laboratory 'Analytica,' Institute of Hygiene and Professional Pathology, Kharkiv, Ukraine
| | - Tatjana Chastii
- 1 SE 'Institute of Dermatology and Venerology of the National Academy of Medical Sciences of Ukraine,' Kharkiv, Ukraine
| | - Elena Milutina
- 1 SE 'Institute of Dermatology and Venerology of the National Academy of Medical Sciences of Ukraine,' Kharkiv, Ukraine
| | - Oksana Sokol
- 1 SE 'Institute of Dermatology and Venerology of the National Academy of Medical Sciences of Ukraine,' Kharkiv, Ukraine
| | - Ritsa Grigorova
- 1 SE 'Institute of Dermatology and Venerology of the National Academy of Medical Sciences of Ukraine,' Kharkiv, Ukraine
| | - Sergey Unuchko
- 1 SE 'Institute of Dermatology and Venerology of the National Academy of Medical Sciences of Ukraine,' Kharkiv, Ukraine
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Akosile W, McDermott BM. Prevalence and clinical correlates of chlamydia infection in youth who use drugs and alcohol: a good opportunity for early intervention. Australas Psychiatry 2017; 25:146-149. [PMID: 28124943 DOI: 10.1177/1039856216689536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS This study estimates the prevalence of chlamydia infection amongst teenage substance users aged 14-18years and investigates risk factors associated with a positive diagnosis of chlamydia infection. METHODS Data was collected from the medical files of adolescents who attended a statewide drug and alcohol treatment facility during a three-year period commencing June 2011. RESULTS The highest rate of chlamydia detection (18.0%) was found in the group with a reported history of abuse, a non-substance use psychiatric diagnosis, and individuals who did not complete year 10 education. CONCLUSION Adolescents attending a detoxification facility are a suitable group for targeted chlamydia infection screening and early treatment.
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Affiliation(s)
- Wole Akosile
- Addiction Psychiatrist, Senior Lecturer, University of Queensland, Brisbane, QLD, Australia
| | - Brett M McDermott
- Professor of Psychiatry, Townsville Clinical School, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
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Kong FYS, Rupasinghe TW, Simpson JA, Vodstrcil LA, Fairley CK, McConville MJ, Hocking JS. Pharmacokinetics of a single 1g dose of azithromycin in rectal tissue in men. PLoS One 2017; 12:e0174372. [PMID: 28350806 PMCID: PMC5370104 DOI: 10.1371/journal.pone.0174372] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/08/2017] [Indexed: 11/18/2022] Open
Abstract
Chlamydia is the most common bacterial sexually transmitted infection among men who have sex with men. Repeat infection following treatment with 1g azithromycin is common and treatment failure of up to 22% has been reported. This study measured the pharmacokinetics of azithromycin in rectal tissue in men following a single 1g dose to assess whether azithromycin reaches the rectal site in adequate concentrations to kill chlamydia. Ten healthy men took a single oral dose of 1g azithromycin and provided nine self-collected swabs and one blood sample over 14 days. Participant demographics, medications, sexual behaviour, treatment side effects, lubricant use and douching practices were recorded with each swab. Drug concentration over time was determined using liquid chromatography-mass spectrometry and total exposure (AUC0-∞) was estimated from the concentration-time profiles. Following 1g of azithromycin, rectal concentrations peaked after a median of 24 hours (median 133mcg/g) and remained above the minimum inhibitory concentration for chlamydia (0.125mcg/mL) for at least 14 days in all men. AUC0-∞ was the highest ever reported in human tissue (13103((mcg/g).hr)). Tissue concentrations were not associated with weight (mg/kg), but data suggest that increased gastric pH could increase azithromycin levels and diarrhoea or use of water-based lubricants could decrease concentrations. High and sustained concentrations of azithromycin were found in rectal tissue following a single 1g dose suggesting that inadequate concentrations are unlikely to cause treatment failure. Factors effecting absorption (pH and diarrhoea) or drug depletion (douching and water-based lubricants) may be more important determinants of concentrations in situ.
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Affiliation(s)
- Fabian Y. S. Kong
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Thusitha W. Rupasinghe
- Metabolomics Australia, School of BioSciences, University of Melbourne, Melbourne, Australia
| | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Lenka A. Vodstrcil
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Monash University Central Clinical School and Melbourne Sexual Health Centre, Melbourne, Australia
| | - Christopher K. Fairley
- Monash University Central Clinical School and Melbourne Sexual Health Centre, Melbourne, Australia
| | - Malcolm J. McConville
- Metabolomics Australia, Bio21 Institute for Molecular Science and Biotechnology, University of Melbourne, Melbourne, Australia
| | - Jane S. Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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33
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Danielewski JA, Phillips S, Kong FYS, Smith KS, Hocking JS, Guy R, Fairley CK, Garland SM, Tabrizi SN. A snapshot of Chlamydia trachomatis genetic diversity using multilocus sequence type analysis in an Australian metropolitan setting. Eur J Clin Microbiol Infect Dis 2017; 36:1297-1303. [PMID: 28220321 DOI: 10.1007/s10096-017-2935-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 02/02/2017] [Indexed: 12/01/2022]
Abstract
High-resolution screening methodologies which enable the differentiation of Chlamydia trachomatis at the strain level, directly from clinical samples, can provide the detailed information required for epidemiological questions such as the dynamics of treatment failure. In addition, they give a detailed snapshot of circulating C. trachomatis genetic variation, data which are currently lacking for the Australian population. In the context of two Australian clinical trials, we assessed the genetic diversity of C. trachomatis and compared these to strains circulating globally. We used high-resolution multilocus sequence typing (MLST) of five highly variable genetic regions of C. trachomatis to examine variation in Australia. Samples with established genovars were drawn from a pool of 880 C. trachomatis-positive samples from two clinical studies, whereby 76 sample pairs which remained C. trachomatis-positive for the same genovar after treatment underwent MLST analysis to distinguish between treatment failure and reinfection. MLST analysis revealed a total of 25 sequence types (STs), six new allele variants and seven new STs not described anywhere else in the world, when compared to those in the international C. trachomatis MLST database. Of the eight most common global STs, seven were found in Australia (four derived from men who have sex with men (MSM) and three from heterosexuals). Newly identified STs were predominantly found in samples from the MSM population. In conclusion, MLST provided a diverse C. trachomatis strain profile, with novel circulating STs, and could be used to identify local sexual networks to focus on interventions such as testing and partner notification to prevent reinfection.
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Affiliation(s)
- J A Danielewski
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Locked Bag 300, Parkville, 3052, VIC, Australia. .,Murdoch Childrens Research Institute, Melbourne, VIC, Australia.
| | - S Phillips
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Locked Bag 300, Parkville, 3052, VIC, Australia.,Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - F Y S Kong
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - K S Smith
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - J S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - R Guy
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - C K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - S M Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Locked Bag 300, Parkville, 3052, VIC, Australia.,Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
| | - S N Tabrizi
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Locked Bag 300, Parkville, 3052, VIC, Australia.,Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
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34
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Javanmard D, Behravan M, Ghannadkafi M, Salehabadi A, Ziaee M, Namaei MH. Detection of Chlamydia trachomatis in Pap Smear Samples from South Khorasan Province of Iran. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2017; 12:31-36. [PMID: 29334204 PMCID: PMC5767929 DOI: 10.22074/ijfs.2018.5064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 06/20/2017] [Indexed: 11/04/2022]
Abstract
Background Chlamydia trachomatis (CT), the most common bacterial sexually transmitted infection (STI), leads to pelvic inflammatory disease, infertility and chronic pelvic pain in women as well as an increased risk of vertical transmission, conjunctivitis and pneumonitis in infants. It may also be a co-factor along with human papillomavirus (HPV) in cervical cancer progression. We aimed to determine the prevalence of CT genotypes in genital specimens of women from South Khorasan, Iran and to test the association between CT and cytology statistics. MATERIALS AND METHODS This was a cross-sectional study on 248 Pap smear samples from women who visited a gynecologist for routine Pap smear testing in South Khorasan province. Nested polymerase chain reaction (PCR) was used to test the residual fluids of Pap smears for CT-DNA after cytological examination. Direct sequencing, alignment and phylogenic analyses were performed on eight samples to identify their genotypes. RESULTS The mean age of patients was 37.54 ± 5.21 years. Most samples had a normal cytology (214 cases, 86.29%). Overall, 31 samples were positive for CT infection (12.5%) of which 20 (9.34%) were normal and 11 (32.35%) were abnormal, with the frequency difference being significant (P=0.022). The co-infection of CT/HPV in total was identified in 14 cases (5.6%). The results of sequencing eight samples out of the 31 CT positive samples revealed the detection of genotypes D and E, each with four cases. CONCLUSION We show that a high prevalence of genital CT infection is present in women with both normal and abnormal cytology; however, the higher prevalence among women in the abnormal group may indicate its involvement in cervical neoplasia.
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Affiliation(s)
- Davod Javanmard
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Mahmoodreza Behravan
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Malaknaz Ghannadkafi
- Faulty of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran
| | - Alireza Salehabadi
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran.
| | - Masood Ziaee
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Mohammad Hasan Namaei
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran.
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35
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Lau A, Kong F, Fairley CK, Donovan B, Chen M, Bradshaw C, Boyd M, Amin J, Timms P, Tabrizi S, Regan DG, Lewis DA, McNulty A, Hocking JS. Treatment efficacy of azithromycin 1 g single dose versus doxycycline 100 mg twice daily for 7 days for the treatment of rectal chlamydia among men who have sex with men - a double-blind randomised controlled trial protocol. BMC Infect Dis 2017; 17:35. [PMID: 28061753 PMCID: PMC5217553 DOI: 10.1186/s12879-016-2125-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/14/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Rectal infection with Chlamydia trachomatis is one of the most common bacterial sexually transmissible infections among men who have sex with men (MSM) with diagnosis rates continuing to rise. Current treatment guidelines recommend either azithromycin 1 g single dose or doxycycline 100 mg twice daily for 7 days. However, there are increasing concerns about treatment failure with azithromycin. We are conducting the first randomised controlled trial (RCT) to compare treatment efficacy of azithromycin versus doxycycline for the treatment of rectal chlamydia in MSM. METHODS/DESIGN The Rectal Treatment Study will recruit 700 MSM attending Australian sexual health clinics for the treatment of rectal chlamydia. Participants will be asked to provide rectal swabs and will be randomised to either azithromycin 1 g single dose or doxycycline 100 mg twice daily for 7 days. Participants will be asked to complete questionnaires about adverse drug reactions, sexual behaviour and drug adherence via short message service and online survey. The primary outcome is the treatment efficacy as determined by a negative chlamydia nucleic acid amplification test at 4 weeks post treatment. Secondary outcomes will utilise whole genome sequencing and mRNA assay to differentiate between treatment failure, reinfection or false positive results. DISCUSSION Rectal chlamydia is an increasing public health concern as use of pre-exposure prophylaxis against HIV becomes commonplace. Optimal, evidence-based treatment is critical to halting ongoing transmission. This study will provide the first RCT evidence comparing azithromycin and doxycycline for the treatment of rectal chlamydia. The results of this trial will establish which treatment is more efficacious and inform international management guidelines. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12614001125617.
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Affiliation(s)
- Andrew Lau
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, 3053 VIC Australia
| | - Fabian Kong
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, 3053 VIC Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston St, Carlton, 3053 VIC Australia
- Central Clinical School, Monash University, Clayton, 3800 VIC Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Australia, Kensington, 2052 NSW Australia
| | - Marcus Chen
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston St, Carlton, 3053 VIC Australia
- Central Clinical School, Monash University, Clayton, 3800 VIC Australia
| | - Catriona Bradshaw
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, 3053 VIC Australia
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston St, Carlton, 3053 VIC Australia
- Central Clinical School, Monash University, Clayton, 3800 VIC Australia
| | - Mark Boyd
- The Kirby Institute, UNSW Australia, Kensington, 2052 NSW Australia
| | - Janaki Amin
- The Kirby Institute, UNSW Australia, Kensington, 2052 NSW Australia
| | - Peter Timms
- University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, 4556 QLD Australia
| | - Sepehr Tabrizi
- Division of Laboratory Services, Department of Microbiology, University of Melbourne, Carlton, 3053 VIC Australia
| | - David G. Regan
- The Kirby Institute, UNSW Australia, Kensington, 2052 NSW Australia
| | - David A. Lewis
- Western Sydney Sexual Health Centre, 162 Marsden St, Parramatta, 2150 NSW Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity & Sydney Medical School-Westmead, University of Sydney, Sydney, 2000 NSW Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Level 3 Nightingale Wing, Sydney Hospital, Macquarie St, Sydney, 2000 NSW Australia
| | - Jane S. Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, 3053 VIC Australia
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston St, Carlton, 3053 VIC Australia
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36
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Debattista J, Hayes M, Marshall P, Pouchkareff N, Gordon R, Priddle A. A trial of pharmacy-based testing forChlamydia trachomatisusing postal specimen kits. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2016. [DOI: 10.1002/jppr.1221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Joseph Debattista
- Metro North Public Health Unit; Metro North Hospital & Health Service; Brisbane Queensland Australia
| | - Meghan Hayes
- The Pharmacy Guild of Australia (QLD Branch); Brisbane Queensland Australia
| | - Penelope Marshall
- Metro North Public Health Unit; Metro North Hospital & Health Service; Brisbane Queensland Australia
| | - Nickolas Pouchkareff
- Children's Health Queensland Hospital and Health Service; Brisbane Queensland Australia
| | - Rose Gordon
- Sexual Health Services; Townsville Hospital & Health Service; Townsville Queensland Australia
| | - Alannah Priddle
- The Pharmacy Guild of Australia (QLD Branch); Brisbane Queensland Australia
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37
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Menon S, Stansfield SH, Walsh M, Hope E, Isaia L, Righarts AA, Niupulusu T, Temese SVA, Iosefa-Siitia L, Auvaa L, Tapelu SA, Motu MF, Suaalii-Sauni T, Timms P, Hill PC, Huston WM. Sero-epidemiological assessment of Chlamydia trachomatis infection and sub-fertility in Samoan women. BMC Infect Dis 2016; 16:175. [PMID: 27102989 PMCID: PMC4839085 DOI: 10.1186/s12879-016-1508-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 04/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background In our recent village-based cross-sectional study, the prevalence of nucleic acid amplification technique (NAAT) diagnosed Chlamydia trachomatis (CT) in sexually active Samoan women was very high (36 %), and test positivity was associated with sub-fertility. We conducted a serological and epidemiological analysis in these participants to identify if serological data can provide further insight into the potential contribution of CT to sub-fertility in this population. Methods Serological prediction of CT associated sub-fertility was conducted using a series of commercial tests. The correlation between fertility or sub-fertility, behavioral factors, and serologically predicted CT associated sub-fertility was determined. Results A positive antibody reaction against the Chlamydia Major Outer Membrane Protein (MOMP) was significantly associated with sub-fertility, with 50 % of infertile women being positive. Serum IgG and IgA antibodies against MOMP correlated with current infection measured by urine NAAT, suggesting longer term infections are common in this population. Chlamydia pneumoniae antibodies were frequently detected in this population (84 %), and unexpectedly, were significantly associated with sub-fertility. Conclusions The high prevalence of chlamydial infection and of positive chlamydial sub-fertility results suggests that CT is an important and frequent contributory factor to sub-fertility in this population.
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Affiliation(s)
- S Menon
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - S H Stansfield
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - M Walsh
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - E Hope
- National University of Samoa, Apia, Samoa
| | - L Isaia
- National Health Service Laboratory Division, Apia, Samoa
| | - A A Righarts
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - T Niupulusu
- Samoa Family Health Association, Apia, Samoa
| | - S V A Temese
- Centre for Samoan Studies, National University of Samoa, Apia, Samoa
| | | | - L Auvaa
- National University of Samoa, Apia, Samoa
| | | | - M F Motu
- Samoa National Council of Churches, Apia, Samoa
| | | | - P Timms
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore, Australia
| | - P C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - W M Huston
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia. .,School of Life Sciences, Faculty of Science, University of Technology Sydney, Broadway, Sydney, NSW, Australia. .,School of Life Sciences, University of Technology Sydney, PO BOX 123, Broadway, Sydney, NSW, 2007, Australia.
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38
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Blondeel K, Say L, Chou D, Toskin I, Khosla R, Scolaro E, Temmerman M. Evidence and knowledge gaps on the disease burden in sexual and gender minorities: a review of systematic reviews. Int J Equity Health 2016; 15:16. [PMID: 26800682 PMCID: PMC4724086 DOI: 10.1186/s12939-016-0304-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 01/13/2016] [Indexed: 01/19/2023] Open
Abstract
Sexual and gender minorities (SGM) include individuals with a wide range of sexual orientations, physical characteristics, and gender identities and expressions. Data suggest that people in this group face a significant and poorly understood set of additional health risks and bear a higher burden of some diseases compared to the general population. A large amount of data is available on HIV/AIDS, but far less on other health problems. In this review we aimed to synthesize the knowledge on the burden of communicable and non-communicable diseases, mental health conditions and violence experienced by SGM, based on available systematic reviews. We conducted a global review of systematic reviews, including searching the Cochrane and the Campbell Collaboration libraries, as well as PubMed, using a range of search terms describing the populations of interest, without time or language restrictions. Google Scholar was also scanned for unpublished literature, and references of all selected reviews were checked to identify further relevant articles. We found 30 systematic reviews, all originally written in English. Nine reviews provided data on HIV, 12 on other sexually transmitted infections (STIs), 4 on cancer, 4 on violence and 3 on mental health and substance use. A quantitative meta-analysis was not possible. The findings are presented in a narrative format. Our review primarily showed that there is a high burden of disease for certain subpopulations of SGM in HIV, STIs, STI-related cancers and mental health conditions, and that they also face high rates of violence. Secondly, our review revealed many knowledge gaps. Those gaps partly stem from a lack of original research, but there is an equally urgent need to conduct systematic and literature reviews to assess what we already know on the disease burden in SGM. Additional reviews are needed on the non-biological factors that could contribute to the higher disease burden. In addition, to provide universal access to health-care for all, more information is needed on the barriers that SGM face in accessing health services, including the attitudes of health-care providers. Understanding these barriers and the additional health risks they impose is crucial to improving the health status of SGM.
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Affiliation(s)
| | - Lale Say
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Doris Chou
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
| | - Rajat Khosla
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Elisa Scolaro
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Marleen Temmerman
- Ghent University, Ghent, Belgium.
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
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Stephens N, Coleman D, Shaw K, O'Sullivan M, Vally H, Venn A. Exploration of testing practices and population characteristics support an increase in chlamydia positivity in Tasmania between 2001 and 2010. Aust N Z J Public Health 2015; 40:362-7. [PMID: 26713515 DOI: 10.1111/1753-6405.12502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/01/2015] [Accepted: 10/01/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The proportion of positive chlamydia tests in young people in Tasmania increased significantly between 2001 and 2010. While female positivity rates increased steadily, male positivity rose steeply to 2005 then stabilised. Crude positivity rates can be influenced by a variety of factors making interpretation difficult. Unique Tasmanian datasets were used to explore whether symptom status, reason for testing or sexual exposure could explain the observed positivity trends. METHODS Population-level chlamydia positivity rates in Tasmania over a 10-year period were compared with surveillance data collected on people aged 15 to 29 years notified with chlamydia. RESULTS The proportion of asymptomatic chlamydia cases increased, with the largest increase in males aged 15 to 19 years (28%). Opportunistic testing of cases increased (greatest in males, range 17-32%). Sexual exposure remained consistent. CONCLUSIONS After allowing for any changes in sexual exposure, symptom status and reason for testing, an increase in chlamydia positivity occurred over the 10 years. Healthcare providers have increased chlamydia testing in high-risk groups. IMPLICATIONS Monitoring chlamydia testing patterns and positivity rates at a population level is a step forward in surveillance practices. Targeted surveys provide valuable information to supplement routine surveillance data.
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Affiliation(s)
- Nicola Stephens
- Communicable Disease Epidemiology and Surveillance, Department of Health and Human Services Victoria.,Menzies Institute for Medical Research, University of Tasmania
| | - David Coleman
- Communicable Disease Epidemiology and Surveillance, Department of Health and Human Services Victoria
| | - Kelly Shaw
- Population Epidemiology, Department of Health and Human Services Tasmania
| | | | - Hassan Vally
- Faculty of Health Sciences, La Trobe University, Victoria
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania
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40
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Scott N, McBryde E, Kirwan A, Stoové M. Modelling the Impact of Condom Distribution on the Incidence and Prevalence of Sexually Transmitted Infections in an Adult Male Prison System. PLoS One 2015; 10:e0144869. [PMID: 26658518 PMCID: PMC4691199 DOI: 10.1371/journal.pone.0144869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 11/24/2015] [Indexed: 11/18/2022] Open
Abstract
Aims To determine the effects of 1) a condom distribution program and 2) a condom distribution program combined with opt-out sexually transmitted infection (STI) screening on the transmission and prevalence of STIs in a prison system. Methods Using data from an implementation evaluation of a state-wide prison condom program and parameter estimates from available literature, a deterministic model was developed to quantify the incidence and prevalence of sexually transmitted HIV, hepatitis B, chlamydia, syphilis and gonorrhoea across 14 Victorian prisons. The model included individual prison populations (by longer (>2 years) or shorter sentence lengths) and monthly prisoner transfers. For each STI, simulations were compared: without any intervention; with a condom distribution program; and with a combined condom and opt-out STI screening at prison reception intervention program. Results Condoms reduced the annual incidence of syphilis by 99% (N = 66 averted cases); gonorrhoea by 98% (N = 113 cases); hepatitis B by 71% (N = 5 cases); chlamydia by 27% (N = 196 cases); and HIV by 50% (N = 2 cases every 10 years). Condom availability changed the in-prison epidemiology of gonorrhoea and syphilis from self-sustaining to levels unlikely to result in infection outbreaks; however, condoms did not reduce chlamydia prevalence below a self-sustaining level due to its high infectiousness, high prevalence and low detection rate. When combined with a screening intervention program, condoms reduced chlamydia prevalence further, but not below a self-sustaining level. The low prevalence of HIV and hepatitis B in Australian prisons meant the effects of condoms were predicted to be small. Conclusion Condoms are predicted to effectively reduce the incidence of STIs in prison and are predicted to control syphilis and gonorrhoea transmission, however even combined with a screening on arrival program may be insufficient to reduce chlamydia prevalence below self-sustaining levels. To control chlamydia transmission additional screening of the existing prison population would be required.
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Affiliation(s)
- Nick Scott
- Centre for Population Health, Burnet Institute, Melbourne, VIC 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC 3008, Australia
- * E-mail:
| | - Emma McBryde
- Centre for Population Health, Burnet Institute, Melbourne, VIC 3004, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia
- Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia
| | - Amy Kirwan
- Centre for Population Health, Burnet Institute, Melbourne, VIC 3004, Australia
| | - Mark Stoové
- Centre for Population Health, Burnet Institute, Melbourne, VIC 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC 3008, Australia
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Human and Pathogen Factors Associated with Chlamydia trachomatis-Related Infertility in Women. Clin Microbiol Rev 2015; 28:969-85. [PMID: 26310245 DOI: 10.1128/cmr.00035-15] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Chlamydia trachomatis is the most common bacterial sexually transmitted pathogen worldwide. Infection can result in serious reproductive pathologies, including pelvic inflammatory disease, ectopic pregnancy, and infertility, in women. However, the processes that result in these reproductive pathologies have not been well defined. Here we review the evidence for the human disease burden of these chlamydial reproductive pathologies. We then review human-based evidence that links Chlamydia with reproductive pathologies in women. We present data supporting the idea that host, immunological, epidemiological, and pathogen factors may all contribute to the development of infertility. Specifically, we review the existing evidence that host and pathogen genotypes, host hormone status, age of sexual debut, sexual behavior, coinfections, and repeat infections are all likely to be contributory factors in development of infertility. Pathogen factors such as infectious burden, treatment failure, and tissue tropisms or ascension capacity are also potential contributory factors. We present four possible processes of pathology development and how these processes are supported by the published data. We highlight the limitations of the evidence and propose future studies that could improve our understanding of how chlamydial infertility in women occurs and possible future interventions to reduce this disease burden.
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Mason E, Wray L, Foster R, Jamil MS, Guy R, McNulty A, Donovan B. Reactive arthritis at the Sydney Sexual Health Centre 1992-2012: declining despite increasing chlamydia diagnoses. Int J STD AIDS 2015; 27:882-9. [PMID: 26378192 DOI: 10.1177/0956462415598251] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/01/2015] [Indexed: 01/21/2023]
Abstract
Reactive arthritis is an under-studied complication of genital Chlamydia trachomatis infection (chlamydia). We assessed trends and risk factors for reactive arthritis in a large urban sexual health clinic. Using a case-control design, data on reactive arthritis cases and controls at the Sydney Sexual Health Centre over the period 1992-2012 were extracted and multivariate analyses were performed. Trend analyses were performed on reactive arthritis diagnoses. Over the 1992-2012 study period, 85 reactive arthritis cases were diagnosed at Sydney Sexual Health Centre. The rate of reactive arthritis diagnoses decreased over time (23 in 1992-1996 to one in 2007-2011 and none in 2012), while chlamydia diagnoses increased (770 in 1992-1996 to 2257 in 2007-2011). In multivariate analysis, factors independently associated with a reactive arthritis diagnosis were: being male (adjusted odds ratio [aOR] 3.27; 95% confidence interval [CI] 1.04-10.32; p = 0.043) or born overseas (aOR 2.69; 95% CI 1.27-5.70; p = 0.010), while a past sexually transmitted infection other than chlamydia or non-gonococcal urethritis was protective (aOR 0.21; 95% CI 0.10-0.45; p < 0.001). Reactive arthritis was not associated with current or recent chlamydia infection (p = 0.184) but was marginally associated with past non-gonococcal urethritis (p = 0.080). This study found a decline in reactive arthritis diagnoses despite an increase in chlamydia diagnoses.
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Affiliation(s)
- E Mason
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia
| | - L Wray
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia School of Women's and Children's Health, UNSW Australia, Sydney, NSW, Australia
| | - R Foster
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - M S Jamil
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - R Guy
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - A McNulty
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia
| | - B Donovan
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
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Corsenac P, Noël M, Rouchon B, Hoy D, Roth A. Prevalence and sociodemographic risk factors of chlamydia, gonorrhoea and syphilis: a national multicentre STI survey in New Caledonia, 2012. BMJ Open 2015; 5:e007691. [PMID: 26353867 PMCID: PMC4567678 DOI: 10.1136/bmjopen-2015-007691] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To estimate prevalence and identify sociodemographic risk factors for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) and Treponema pallidum infections in New Caledonia. METHOD A national cross-sectional survey was undertaken using a three-stage random sampling of general practice surgeries and public dispensaries. Participants were included through opportunistic screening and using a systematic step for selection. The study sample was weighted to the general population aged 18-49 years. Prevalence and risk factors were calculated by logistic regression. RESULTS CT was the most common sexually transmitted infection, with a prevalence of 9% (95% CI 6.6% to %11.4), followed by NG 3.5% (95% CI 1.9% to 5.1%), previous or latent syphilis 3% (95% CI 1.7% to 4.3%), NG and CT co-infection 2.1% (95% CI 0.8% to 3.3%) and active syphilis 0.4% (95% CI 0.0% to 0.9%). Being from a young age group (18-25 years), being single, having a low level of education and province of residence were all associated with higher prevalence of all three STIs. Being of Melanesian origin was associated with higher prevalence of both CT and NG. There was a significant interaction between ethnic group and province of residence for prevalence of CT. Female gender was associated with higher prevalence of CT. CONCLUSIONS The prevalence of CT was similar to estimates from other healthcare-based surveys from the Pacific, but higher for NG and lower for active syphilis infection. All sexually transmitted infections estimates were much higher than those found in population-based surveys from Europe and the USA. The sociodemographic risk factors identified in this study will help guide targeted prevention and control strategies in New Caledonia.
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Affiliation(s)
- Philippe Corsenac
- Department of Epidemiology, Agence Sanitaire et Sociale de la Nouvelle-Calédonie (ASSNC), Noumea, New Caledonia
| | - Martine Noël
- New Caledonia Health and Social Affairs Service, Noumea, New Caledonia
| | - Bernard Rouchon
- Department of Epidemiology, Agence Sanitaire et Sociale de la Nouvelle-Calédonie (ASSNC), Noumea, New Caledonia
| | - Damian Hoy
- Research Evidence and Information Programme, Public Health Division, Secretariat of the Pacific Community, Noumea, New Caledonia
| | - Adam Roth
- Research Evidence and Information Programme, Public Health Division, Secretariat of the Pacific Community, Noumea, New Caledonia
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Ahmadi MH, Mirsalehian A, Bahador A. Prevalence of genital Chlamydia trachomatis in Iran: a systematic review and meta-analysis. Pathog Glob Health 2015; 109:290-9. [PMID: 26343285 DOI: 10.1179/2047773215y.0000000033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To determine the overall prevalence of Chlamydia trachomatis in Iranian males and females and to find out the effect of this bacterium on fertility potential and its association with urogenital symptoms. METHODS We searched both English and Persian electronic databases using keywords 'Chlamydia', 'Chlamydia trachomatis', 'prevalence', 'incidence', 'frequency', 'epidemiology' and 'Iran'. Finally, after some exclusion, 34 studies from different regions of Iran were included in our study, and a meta-analysis was performed to determine pooled prevalence estimates for each group. RESULTS C. trachomatis prevalence for women and men was high and ranged from 0 to 32.7% and 0 to 23.3%, respectively (95% CI). The pooled prevalence of the bacterium in the female population was 12.3% (95% CI: 10.6-14.2%) and in men was 10.9% (95% CI: 7.6-15.4%). A high level of heterogeneity was seen for both men (I(2) = 77.4%; P < 0.001) and women (I(2) = 77.5%; P < 0.001); but in men and not in women, some evidence for publication bias was observed [Egger's test (two-tailed P = 0.013); Begg's test (two-tailed P = 0.025)]. In females analysis of symptomatic/infertile group with asymptomatic/fertile group in females, the overall OR was above 1 and the overall P-value was below zero. CONCLUSIONS This bacterium may play a role in female infertility or be associated with clinical manifestations; thus, planning national programmes for adequate diagnosis of genital infections caused by this pathogen is necessary. Furthermore, screening strategies, particularly for asymptomatic individuals, and treatment of infected people can reduce consequent complications.
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Huffam S, Chow EPF, Fairley CK, Hocking J, Peel J, Chen M. Chlamydia infection in individuals reporting contact with sexual partners with chlamydia: a cross-sectional study of sexual health clinic attendees. Sex Transm Infect 2015; 91:434-9. [PMID: 26056390 DOI: 10.1136/sextrans-2015-052068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/20/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We aimed to ascertain the proportion of positive, and predictive factors of chlamydia infection among females, heterosexual males and men who have sex with men (MSM) presenting to a sexual health service reporting contact with a chlamydia infected sexual partner. METHODS A cross-sectional analysis of patients attending the Melbourne Sexual Health Centre from October 2010 to September 2013. Behavioural data obtained using computer assisted self-interview were analysed to determine factors predictive of chlamydia. RESULTS Of the 491 female, 808 heterosexual male, and 268 MSM chlamydia contacts, the proportion diagnosed with chlamydia were 39.9% (95% CI 35.7% to 44.3%), 36.1% (95% CI 32.9% to 39.9%) and 23.5% (95% CI 18.8% to 29.0%), respectively. Female chlamydia contacts were more likely to have chlamydia if age <25 (adjusted OR (AOR) 1.86, 95% CI 1.12 to 3.10) or if they reported inconsistent condom use during vaginal sex with a regular male partner (AOR 2.5, 95% CI 1.12 to 6.14). Heterosexual male contacts were more likely to have chlamydia if age <25 (AOR 1.69, 95% CI 1.25 to 2.28) or if they had a regular female sexual partner (AOR 1.38, 95% CI 1.03 to 1.85). In MSM urethral chlamydia was diagnosed in 8.8%, rectal chlamydia in 20.2%, and 3.9% at both sites. MSM were more likely to have chlamydia if they had a regular male sexual partner (OR 2.12, 95% CI 1.18 to 3.81). CONCLUSIONS This study of female, heterosexual male, and MSM presentations with self-reported chlamydia contact provides insight into the likelihood and predictive factors of infection. The data may inform policy and individual clinical decision making regarding presumptive treatment of chlamydia contacts.
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Affiliation(s)
- Sarah Huffam
- Department of Alfred Health, Melbourne Sexual Health Centre, Melbourne, Victoria, Australia Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Department of Alfred Health, Melbourne Sexual Health Centre, Melbourne, Victoria, Australia Faculty of Medicine, Department of Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Department of Alfred Health, Melbourne Sexual Health Centre, Melbourne, Victoria, Australia Faculty of Medicine, Department of Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jane Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Joanne Peel
- Department of Alfred Health, Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
| | - Marcus Chen
- Department of Alfred Health, Melbourne Sexual Health Centre, Melbourne, Victoria, Australia Faculty of Medicine, Department of Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Parker RM, Bell A, Currie MJ, Deeks LS, Cooper G, Martin SJ, Del Rosario R, Hocking JS, Bowden FJ. 'Catching chlamydia': combining cash incentives and community pharmacy access for increased chlamydia screening, the view of young people. Aust J Prim Health 2015; 21:79-83. [PMID: 24139788 DOI: 10.1071/py12135] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 08/05/2013] [Indexed: 11/23/2022]
Abstract
In Australia and elsewhere, chlamydia screening rates for those aged between 16 and 30 years continue to be low. Innovative, age-appropriate approaches are necessary to increase chlamydia screening among this target group to prevent short- and long-term consequences of the infection such as pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy and infertility. Studies have demonstrated that offering chlamydia screening in community pharmacies may be a useful adjunct to current screening services. Approximately 90% of Australians visit a pharmacy at least once a year. Chlamydia screening and education in community pharmacies with remuneration may provide another option for opportunistic testing as part of a national chlamydia screening scheme. Compensation is an accepted practice in the field of research and has been demonstrated to improve adherence to health promotion activities. In 2011, a cross-sectional study of community pharmacy-based chlamydia screening offered in conjunction with an A$10 cash incentive to participate was conducted in the Australian Capital Territory. As part of this study young people were asked about their experience of, and views about, pharmacy-based chlamydia screening. The views of consented participants were collected using the one-page questionnaire consisting of 10 closed questions and one open-ended question. Participants completed the questionnaire when they returned their urine sample and before being given the cash incentive. Overall participants were highly satisfied with the pharmacy-based chlamydia screening service. Over 60% of questionnaire respondents felt that the payment did affect their decision to have the chlamydia test, and 23% stated that it made no difference. Young people reported that pharmacy-based screening is acceptable and convenient. Accessibility and the small cash incentive played significant roles in increasing participation.
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Affiliation(s)
- Rhian M Parker
- Centre for Research and Action in Public Health, Faculty of Health, University of Canberra, ACT 2601, Australia
| | - Allison Bell
- Australian Primary Health Care Research Institute, The Australian National University, Acton, ACT 0200, Australia
| | - Marian J Currie
- Academic Unit of Internal Medicine, The Australian National University Medical School, Building 4, Level 2, Canberra Hospital, PO Box 11, Woden, ACT 2606, Australia
| | - Louise S Deeks
- Academic Unit of Internal Medicine, The Australian National University Medical School, Building 4, Level 2, Canberra Hospital, PO Box 11, Woden, ACT 2606, Australia
| | - Gabrielle Cooper
- Discipline of Pharmacy, Faculty of Health, University of Canberra, ACT 2601, Australia
| | - Sarah J Martin
- Academic Unit of Internal Medicine, The Australian National University Medical School, Building 4, Level 2, Canberra Hospital, PO Box 11, Woden, ACT 2606, Australia
| | - Rendry Del Rosario
- Canberra Sexual Health Centre, Canberra Hospital, PO Box 11, Woden, ACT 2606, Australia
| | - Jane S Hocking
- Centre for Women's Health, Gender and Society, Melbourne School of Population Health, University of Melbourne, Level 3/207 Bouverie Street, Carlton, Vic. 3053, Australia
| | - Francis J Bowden
- Academic Unit of Internal Medicine, The Australian National University Medical School, Building 4, Level 2, Canberra Hospital, PO Box 11, Woden, ACT 2606, Australia
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Musil K, Currie M, Sherley M, Martin S. Rectal chlamydia infection in women at high risk of chlamydia attending Canberra Sexual Health Centre. Int J STD AIDS 2015; 27:526-30. [PMID: 25957326 DOI: 10.1177/0956462415586317] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 04/20/2015] [Indexed: 11/15/2022]
Abstract
Chlamydia is the most commonly notified sexually transmitted infection in Australia. Australian guidelines recommend urogenital screening in asymptomatic men and women, and rectal screening in men who have sex with men or women reporting anal sex/symptoms. International studies describe a rectal chlamydia prevalence in women of 5% to 21%. We found that in women at high risk of chlamydia, 57% (32/56) tested positive for rectal chlamydia. Of these, 97% (31/32) had concurrent urogenital chlamydia. Women with urogenital chlamydia were significantly more likely to have a positive rectal result (χ(2), p = 0.000). Neither anal symptoms nor reported anal sex were associated with a positive rectal chlamydia test. The recommended treatment of rectal chlamydia differs substantially from that of urogenital chlamydia, raising the possibility that Australian women are being regularly undertreated due to a lack of rectal testing. Untreated rectal chlamydia may increase the risk of persistent infection, reproductive tract reinfection, complications and transmission. Further work is needed to determine the optimal management of chlamydia in women.
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Affiliation(s)
- Kate Musil
- Australian National University, ANU Medical School, Canberra, ACT, Australia
| | - Marian Currie
- University of Canberra/ Australian National University/ Canberra Hospital, Canberra, ACT, Australia
| | - Miranda Sherley
- Canberra Hospital, Canberra Sexual Health Centre, Canberra, ACT, Australia
| | - Sarah Martin
- Australian National University, ANU Medical School, Canberra, ACT, Australia Canberra Hospital, Canberra Sexual Health Centre, Canberra, ACT, Australia
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Abstract
The use of meta-analysis in microbiology may facilitate decision-making that impacts public health policy. Directed at clinicians and researchers in microbiology, this review outlines the steps in performing this statistical technique, addresses its biases and describes its value in this discipline. The survey to estimate extent of the use of meta-analyses in microbiology shows the remarkable growth in the use of this research methodology, from a minimal Asian output to a level comparable with those of Europe and North America in the last 7 years.
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Affiliation(s)
| | - H Jarjanazi
- Saint Louis University, Baguio, Philippines, Environmental Monitoring and Reporting Branch,Ontario Ministry of the Environment , Toronto, Ontario, Canada
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Kong FYS, Tabrizi SN, Fairley CK, Vodstrcil LA, Huston WM, Chen M, Bradshaw C, Hocking JS. The efficacy of azithromycin and doxycycline for the treatment of rectal chlamydia infection: a systematic review and meta-analysis. J Antimicrob Chemother 2015; 70:1290-7. [PMID: 25637520 DOI: 10.1093/jac/dku574] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 12/25/2014] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND There are increasing concerns about treatment failure following treatment for rectal chlamydia with 1 g of azithromycin. A systematic review and meta-analysis was conducted to investigate the efficacy of 1 g of azithromycin as a single dose or 100 mg of doxycycline twice daily for 7 days for the treatment of rectal chlamydia. METHODS Medline, Embase, PubMed, Cochrane Controlled Trials Register, Australia New Zealand Clinical Trial Register and ClinicalTrials.gov were searched to the end of April 2014. Studies using 1 g of azithromycin or 7 days of doxycycline for the treatment of rectal chlamydia were eligible. Gender, diagnostic test, serovar, symptomatic status, other sexually transmitted infections, follow-up time, attrition and microbial cure were extracted. Meta-analysis was used to calculate pooled (i) azithromycin and doxycycline efficacy and (ii) efficacy difference. RESULTS All eight included studies were observational. The random-effects pooled efficacy for azithromycin (based on eight studies) was 82.9% (95% CI 76.0%-89.8%; I(2) = 71.0%; P < 0.01) and for doxycycline (based on five studies) was 99.6% (95% CI 98.6%-100%; I(2) = 0%; P = 0.571), resulting in a random-effects pooled efficacy difference (based on five studies) of 19.9% (95% CI 11.4%-28.3%; I(2) = 48.5%; P = 0.101) in favour of doxycycline. CONCLUSIONS The efficacy of single-dose azithromycin may be considerably lower than 1 week of doxycycline for treating rectal chlamydia. However, the available evidence is very poor. Robust randomized controlled trials are urgently required.
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Affiliation(s)
- Fabian Yuh Shiong Kong
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 3/207 Bouverie St, Melbourne 3004, Australia
| | - Sepehr N Tabrizi
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville 3052, Australia Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, 20 Flemington Road, Parkville 3052, Australia
| | - Christopher Kincaid Fairley
- Monash University, Central Clinical School, 580 Swanston St, Melbourne 3053, Australia Melbourne Sexual Health Centre, 580 Swanston St, Melbourne 3053, Australia
| | - Lenka A Vodstrcil
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 3/207 Bouverie St, Melbourne 3004, Australia Murdoch Children's Research Institute, 50 Flemington Rd, Parkville 3052, Australia Melbourne Sexual Health Centre, 580 Swanston St, Melbourne 3053, Australia
| | - Wilhelmina M Huston
- School of Biomedical Sciences, Queensland University of Technology, 2 George St, Brisbane 4000, Australia
| | - Marcus Chen
- Melbourne Sexual Health Centre, 580 Swanston St, Melbourne 3053, Australia
| | - Catriona Bradshaw
- Melbourne Sexual Health Centre, 580 Swanston St, Melbourne 3053, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 3/207 Bouverie St, Melbourne 3004, Australia
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Natoli L, Guy RJ, Shephard M, Donovan B, Fairley CK, Ward J, Regan DG, Hengel B, Maher L. Chlamydia and gonorrhoea point-of-care testing in Australia: where should it be used? Sex Health 2015; 12:51-8. [DOI: 10.1071/sh14213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 12/05/2014] [Indexed: 11/23/2022]
Abstract
Background Diagnoses of chlamydia and gonorrhoea have increased steadily in Australia over the past decade. Testing and treatment is central to prevention and control but in some settings treatment may be delayed. Testing at the point of care has the potential to reduce these delays. We explored the potential utility of newly available accurate point-of-care tests in various clinical settings in Australia. Methods: In-depth qualitative interviews were conducted with a purposively selected group of 18 key informants with sexual health, primary care, remote Aboriginal health and laboratory expertise. Results: Participants reported that point-of-care testing would have greatest benefit in remote Aboriginal communities where prevalence of sexually transmissible infections is high and treatment delays are common. Some suggested that point-of-care testing could be useful in juvenile justice services where young Aboriginal people are over-represented and detention periods may be brief. Other suggested settings included outreach (where populations may be homeless, mobile or hard to access, such as sex workers in the unregulated sex industry and services that see gay, bisexual and other men who have sex with men). Point-of-care testing could also improve the consumer experience and facilitate increased testing for sexually transmissible infections among people with HIV infection between routine HIV-management visits. Some participants disagreed with the idea of introducing point-of-care testing to urban services with easy access to pathology facilities. Conclusions: Participants felt that point-of-care testing may enhance pathology service delivery in priority populations and in particular service settings. Further research is needed to assess test performance, cost, acceptability and impact.
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