1
|
Darville T. Recognition and Treatment of Chlamydial Infections from Birth to Adolescence. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 764:109-22. [DOI: 10.1007/978-1-4614-4726-9_8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
2
|
Chlamydia trachomatis positivity rates among men tested in selected venues in the United States: a review of the recent literature. Sex Transm Dis 2008; 35:S8-S18. [PMID: 18449072 DOI: 10.1097/olq.0b013e31816938ba] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The cost-effectiveness of screening men for Chlamydia trachomatis depends in part on the prevalence of chlamydia in the screened population and the ease with which screening programs can be implemented. Screening in venues with high rates of chlamydia positivity among men may therefore be an important adjunct to chlamydia control. To evaluate the recent US literature on chlamydia positivity in chlamydia screening programs among asymptomatic men in nonsexually transmitted disease clinic settings, we reviewed published articles between 1995 and June 2007, using PubMed as the primary search tool. Articles were abstracted and positivity rates summarized by type of venue, race/ethnicity, age group, and US region. The overall median positivity rate was 5.1%. The highest rates were observed among men tested in juvenile (7.9%) and adult (6.8%) detention facilities, among blacks (6.7%), the 15 to 19 years old (6.1%) and 20 to 24 years old (6.5%) age groups, and among men screened in the southern United States (6.4%). Chlamydia rates among men are high in certain venues, particularly correctional settings, but also depend on the demographic composition of the target population and location. Programs considering male chlamydia screening programs should conduct pilot programs to assess chlamydia positivity as well as feasibility and cost in target venues.
Collapse
|
3
|
Sheeder J, Stevens-Simon C, Lezotte D, Glazner J, Scott S. Cervicitis: to treat or not to treat? The role of patient preferences and decision analysis. J Adolesc Health 2006; 39:887-92. [PMID: 17116520 DOI: 10.1016/j.jadohealth.2006.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Revised: 06/06/2006] [Accepted: 06/09/2006] [Indexed: 11/30/2022]
Abstract
PURPOSE Mucopurulent cervicitis is neither a sensitive nor a specific indicator of antibiotic sensitive infection. This analysis examines the positive and negative ramifications of treating cervicitis empirically as a Chlamydial (CT) infection. It begins where prior analyses leave off, with the number of cases of pelvic inflammatory disease (PID) prevented. METHODS Three treatments were compared: 1) treat empirically/refer partner; 2) test, treat, and base partner treatment on results; 3) test, base treatment on results. The outcomes were the physical sequelae of PID and the psychological sequelae of being diagnosed with CT in a hypothetical cohort of 500 teenagers with cervicitis, among whom the prevalence of CT averaged 33%, but ranged between 10% and 70%. RESULTS At a CT prevalence of 33%, Treatments 1 and 2 prevented three times as many cases of PID-related physical sequelae (n = 14) as Treatment 3 (n = 5). However, to prevent these 14 cases of physical sequelae, with Treatment 1, 163 teens needlessly suffer the psychological sequelae of a false CT diagnosis and with Treatment 2, 101 do so. The ratio of physical sequelae prevented to psychological sequelae caused, changed in relationship to the prevalence of CT, but was always numerically most favorable with Treatment 3. Moreover, it was the only therapeutic approach for which overall morbidity never exceeded the PID-related physical morbidity incurred in the absence of treatment. CONCLUSIONS By including the effects of over diagnosing and treating CT, we have demonstrated how the risks and benefits of empiric and nonempiric cervicitis therapy vary in relationship to CT prevalence. Failure to consider both the physical and the psychological aspects of patient well-being may mean that well-intentioned policies to reduce physical morbidity do not result in an overall improvement in health of teenagers.
Collapse
Affiliation(s)
- Jeanelle Sheeder
- Department of Pediatrics, Division of Adolescent Medicine, University of Colorado Health Sciences Center, The Children's Hospital, 1056 East 19th Street, Box B025, Denver, CO 80218, USA.
| | | | | | | | | |
Collapse
|
4
|
Tao G, Irwin KL. Gonorrhea prevention and clinical care in the private sector: lessons learned and priorities for quality improvement. Sex Transm Dis 2006; 33:652-62. [PMID: 16645553 DOI: 10.1097/01.olq.0000216030.65618.0e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We reviewed literature on gonorrhea prevention and clinical care in the private sector, the setting where most gonorrhea cases in the United States are now diagnosed. Although most private-sector health settings had a low prevalence of gonorrhea (0.1-2.5%), some private emergency departments and specialty clinics that serve a large number of high-risk or infected patients had prevalences ranged from 1.7% to 11.0%. Studies of diverse settings and populations suggest that, in general, diagnostic testing of symptomatic patients (69-83%), appropriate treatment (61-100%), and case reporting (64-94%) are delivered more commonly than risk assessment for asymptomatic patients (15-28%), routine screening of pregnant women (31-77%), risk-reduction counseling (35-78%), and sex partner management (0-82%). To sustain the recent declines in gonorrhea incidence in the United States, private-sector providers and health systems must continue to offer gonorrhea prevention and clinical services and consider implementing interventions to improve delivery of risk assessment, risk-reduction counseling, and partner management services.
Collapse
Affiliation(s)
- Guoyu Tao
- Health Services Research & Evaluation Branch, Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
| | | |
Collapse
|
5
|
Darville T. Chlamydia trachomatis genital infection in adolescents and young adults. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2006; 582:85-100. [PMID: 16802621 DOI: 10.1007/0-387-33026-7_8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Toni Darville
- Department of Pediatrics and Microbiology/Immunology, University of Arkansas for Medical Sciences, Little Rock, USA
| |
Collapse
|
6
|
Tun W, Stiffman M, Magid D, Lyons E, Irwin K. Evaluation of Clinician-Reported Adherence to Centers for Disease Control and Prevention Guidelines for the Treatment of Chlamydia trachomatis in Two U.S. Health Plans. Sex Transm Dis 2006; 33:235-43. [PMID: 16565644 DOI: 10.1097/01.olq.0000204915.23842.9a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to assess clinician adherence to Centers for Disease Control and Prevention-recommended treatments for Chlamydia trachomatis (CT) in two health plans. STUDY DESIGN Using hypothetical scenarios, a 1999-2000 mail survey questioned clinicians about how they would treat a cervicitis patient (CT and gonorrhea treatment recommended) and two patients with laboratory-confirmed CT: an injection drug user (single-dose azithromycin promotes adherence) and a pregnant patient (nonteratogenic drugs recommended). RESULTS Seven hundred forty-three (82%) of the 907 nonretired clinicians receiving the survey completed it. Eighty-one percent (N=599) reported providing recent CT care. Of these, 70.1% reported they would presumptively treat patients with cervicitis for CT and gonorrhea, 17.1% for CT only, and 11.7% for neither pathogen. Of the 580 clinicians addressing drug injectors, 61.7% reported they would prescribe azithromycin. Most (88.8%) of the 343 clinicians seeing pregnant patients reported they would prescribe Centers for Disease Control and Prevention (CDC)-recommended antibiotics. Reported adherence varied by clinician specialty and sources of treatment guidance. CONCLUSIONS Most clinicians reported treatment consistent with CDC guidelines.
Collapse
Affiliation(s)
- Waimar Tun
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia, USA.
| | | | | | | | | |
Collapse
|
7
|
Risser WL, Bortot AT, Benjamins LJ, Feldmann JM, Barratt MS, Eissa MA, Risser JMH. The epidemiology of sexually transmitted infections in adolescents. ACTA ACUST UNITED AC 2005; 16:160-7. [PMID: 16044389 DOI: 10.1053/j.spid.2005.04.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article addresses the epidemiology of several common sexually transmitted infections (STIs) in adolescents. Chlamydia is a common occurrence in adolescents, more so than is gonorrhea, but both are of particular concern because they may cause pelvic inflammatory disease. Many experts recommend screening for chlamydia in sexually active adolescents, particularly females. Trichomonas vaginalis is significant as a marker for risk of contracting other STIs and because of its association with pregnancy complications and with increased risk of transmission of HIV. Genital herpes simplex virus (HSV) infection, which usually has been caused by HSV-2, is a common finding in adolescents, and it now is caused also by HSV-1 in some populations. Human papillomavirus (HPV), though widespread in adolescents, usually is a self-limited infection, and malignancy resulting from HPV is a rare occurrence in this age group. The least common of the diseases discussed below is syphilis, but a recent sharp increase in incidence has occurred in men who have sex with men.
Collapse
Affiliation(s)
- William L Risser
- Department of Pediatrics, Division of Adolescent Medicine, University of Texas Medical School at Houston, 77030, USA
| | | | | | | | | | | | | |
Collapse
|
8
|
Burstein GR, Snyder MH, Conley D, Newman DR, Walsh CM, Tao G, Irwin KL. Chlamydia screening in a Health Plan before and after a national performance measure introduction. Obstet Gynecol 2005; 106:327-34. [PMID: 16055583 DOI: 10.1097/01.aog.0000171119.81704.51] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate chlamydia-screening policies, testing practices, and the proportion testing positive in response to the new Health Plan Employer Data and Information Set (HEDIS) chlamydia-screening performance measure in a large commercial health plan. METHODS We interviewed health plan specialty departmental chiefs to describe interventions used to increase chlamydia screening and examined electronic medical records of 15- to 26-year-old female patients--37,438 from 1998 to 1999 and 37,237 from 2000 to 2001--who were classified as sexually active by HEDIS specifications to estimate chlamydia testing and positive tests 2 years before and after the HEDIS measure introduction. RESULTS In January 2000, the obstetrics and gynecology department instituted a policy to collect chlamydia tests at the time of routine Pap tests on all females 26 years old or younger by placing chlamydia swabs next to Pap test collection materials. Other primary care departments provided screening recommendations and provider training. During 1998-1999, 57% of eligible female patients seen by obstetrics and gynecology exclusively and 63% who were also seen by primary care were tested for chlamydia; in 2000-2001 the proportions tested increased to 81% (P < .001) and 84% (P < .001). Proportions tested by other primary care specialists did not increase substantially: 30% in 1998-1999 to 32% in 2000-2001. The proportion of females testing positive remained high after testing rates increased: 8% during 1998-1999 and 7% during 2000-2001, and the number of newly diagnosed females increased 10%. CONCLUSION After the obstetrics and gynecology department introduced a simple systems-level change in response to the HEDIS measure, the proportion of females chlamydia-tested and number of newly diagnosed females increased.
Collapse
Affiliation(s)
- Gale R Burstein
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
| | | | | | | | | | | | | |
Collapse
|
9
|
Affiliation(s)
- Catherine Stevens-Simon
- Department of Pediatrics, Division of Adolescent Medicine, University of Colorado Health Sciences Center, Denver, 80218, USA.
| | | |
Collapse
|
10
|
Golijow CD, Abba MC, Mourón SA, Laguens RM, Dulout FN, Smith JS. Chlamydia trachomatis and Human papillomavirus infections in cervical disease in Argentine women. Gynecol Oncol 2005; 96:181-6. [PMID: 15589598 DOI: 10.1016/j.ygyno.2004.09.037] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2004] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To examine the prevalence of Human papillomavirus and Chlamydia trachomatis DNA in cervical samples among women with normal and abnormal cervical cytology from La Plata, Argentina. METHODS Two hundred and seventy-nine women (200 with cervical neoplasia or ICC and 79 women with normal cytology) provided cervical samples for the detection of HPV and C. trachomatis DNA by PCR-based assays. RESULTS HPV DNA increased with the cervical lesion severity, ranging from 30% among women with normal cytology to 99-100% among women with HSIL or ICC. C. trachomatis DNA prevalence increased from low levels in women with normal cytology (11%) to 47% in those with HSIL, but was uncommon among ICC patients (20%). Among women with normal cytology, C. trachomatis prevalence was higher in HPV DNA positive (12.5%) than HPV DNA negative women (10.9%), but this difference was not significant. CONCLUSIONS HPV prevalence in the general population is slightly higher than those reported for other developing countries. C. trachomatis DNA positivity was associated with a higher risk of both LSIL and HSIL lesions, but not with ICC.
Collapse
Affiliation(s)
- Carlos D Golijow
- Centro de Investigaciones en Genética Básica y Aplicada (CIGEBA), Facultad de Ciencias Veterinarias, UNLP.Calle 60 y 118 s/n, B1900AVW, La Plata, Argentina.
| | | | | | | | | | | |
Collapse
|
11
|
Abstract
BACKGROUND Adolescent and young adult minority women are at high risk for chlamydia (CT) and gonorrhea (NGC) cervical infections, which are significant causes of pelvic inflammatory disease, impaired fertility, ectopic pregnancy and chronic pain. The purpose of this article is to review among young women in the United States: (1) the epidemiology of CT and NGC cervical infection and their medical complications; (2) current public health recommendations to promote asymptomatic CT and NGC screening; (3) current screening practices and challenges of implementing public health recommendations; (4) testing and cost issues; and (5) future directions in promoting asymptomatic CT and NGC screening. METHODS We conducted a MEDLINE search for articles published over the last two decades relating to CT and NGC screening in young women and then systematically reviewed all relevant articles. RESULTS The data indicate that CT and NGC infection are geographically widespread in the U.S. and asymptomatic infection is highly prevalent among economically disadvantaged young females. Public health recommendations promoting CT and NGC screening in asymptomatic young women are directed to both health care providers and clients. However, strategies to promote screening efforts have been primarily directed toward health care providers; there are no published studies on client-initiated screening strategies. Challenges of implementing public health recommendations and future directions for CT and NGC screening are discussed. CONCLUSIONS Young sexually active women continue to be at high risk for CT and NGC infection. The data indicate that implementation of health provider-based and client-initiated screening in private and public health care settings is a challenge. However, there is a great need to develop strategies to understand and promote client-initiated screening.
Collapse
Affiliation(s)
- Mariam R Chacko
- Departments of Pediatrics, Obstetrics, and Gynecology, Baylor College of Medicine, Houston, Texas, USA.
| | | | | |
Collapse
|
12
|
Katz AR, Effler PV, Ohye RG, Lee MVC. Assessing age-related risk for gonococcal and chlamydial infections among females in Hawaii, 2001: a comparison of morbidity rates with screening test positivity. ACTA ACUST UNITED AC 2004; 4:188-91. [PMID: 15018599 DOI: 10.1367/a03-100r.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE National and state public health officials generally present sexually transmitted disease (STD) surveillance information in terms of overall cases and population-based rates. Because many adolescents (especially in the younger ages) are not sexually active, the use of population-based denominators leads to the calculation of low age-specific STD rates. This study compared morbidity rates with screening test positivity for gonorrhea and chlamydia to better define age-related STD risk among females in Hawaii. METHODS All female gonorrhea and chlamydia cases reported to the Hawaii State Department of Health (HDOH) during 2001 were grouped by age. Population estimates were used to calculate age-specific morbidity rates. Age-specific screening test positivity was calculated by dividing the number of positive tests identified through the HDOH STD screening programs by the number of screening tests performed in each age category (x100). RESULTS Although morbidity rates for both chlamydia and gonorrhea were low among 10-14 year olds, this group had the highest screening test positivity. Screening test positivity decreased incrementally with increasing age. CONCLUSIONS Screening test positivity may provide a more accurate estimate of STD risk for sexually active adolescents than population-based rates. Physicians should obtain sexual histories from their adolescent patients and provide STD prevention counseling and screening to those found to be sexually active. In addition, expanded STD screening and treatment services should be made available and accessible to young, sexually active adolescents because they appear to be at greatest risk.
Collapse
Affiliation(s)
- Alan R Katz
- Department of Public Health Sciences and Epidemiology, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96822, USA.
| | | | | | | |
Collapse
|
13
|
Cook RL, ØStergaard L. Current Issues in Screening for Chlamydia trachomatis. Curr Infect Dis Rep 2003; 5:153-158. [PMID: 12642002 DOI: 10.1007/s11908-003-0052-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
During the past several years, research related to screening for Chlamydia trachomatis has flourished, with new diagnostic tests, new methods for specimen collection, and new prevalence data in different populations. Public health endorsements for screening are now more specific than ever, yet several important clinical and laboratory questions remain, including questions concerning who to screen and how often to screen. Additional important research is addressing issues related to assay validity, efficacy of screening in different populations, and feasibility of screening on the level of the individual patient and the level of the community and health care system. This article discusses major research findings related to chlamydial screening from the past several years and suggests areas in which additional research is needed.
Collapse
Affiliation(s)
- Robert L. Cook
- *University of Pittsburgh, Division of General Internal Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA.
| | | |
Collapse
|
14
|
Williams H, Tabrizi SN, Lee W, Kovacs GT, Garland S. Adolescence and other risk factors for Chlamydia trachomatis genitourinary infection in women in Melbourne, Australia. Sex Transm Infect 2003; 79:31-4. [PMID: 12576611 PMCID: PMC1744610 DOI: 10.1136/sti.79.1.31] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To establish the prevalence of and risk factors for Chlamydia trachomatis infection to determine the role of universal versus targeted testing. METHODS A prospective study of 1107 women attending two sexual and reproductive health clinics in Melbourne, Australia, was carried out. A questionnaire was used to establish risk factors. Urine samples were tested for C. trachomatis by PCR. The main outcome measures were prevalence of and risk factors for C. trachomatis infection. RESULTS Of 1107 recruitable women, 851 (76.9%) consented and were successfully tested. C. trachomatis was detected in 18 (4.8% (95% CI 2.9 to 7.5)) of 373 women in the inner city and eight (1.7% (95% CI (0.7 to 3.3)) of 478 women in the suburban clinic. Of women under 25 years, 17 (6.2% (95% CI 3.7 to 9.8)) of 273 in the inner city in contrast with three (1.7% (95% CI 0.4 to 5.0)) of 174 in the suburban clinic were infected. In the inner city clinic, age under 25 years (OR 5.4 (95% CI 0.7 to 41.5)), vaginal discharge (OR 4.1 (95% CI 1.5 to 11.1)), and recent change of sexual partner (OR 4.6 (95% CI 1.6 to 12.9)) were associated with C. trachomatis. In contrast, in the suburban clinic, only vaginal discharge (OR 3.5 (95% CI 0.9 to 14.3)) and recent change of sexual partner (OR 3.4 (95% CI 0.8 to 15.7)) were identified as risk factors. Multivariate analysis showed that recent change of partner (OR 4.5 (95% CI 1.5 to 13.8)) was the most strongly associated independent risk factor for infection in the inner city clinic. CONCLUSION The high prevalence of C. trachomatis indicates that universal testing should be undertaken in the inner city clinic. Young age may not be a risk factor for C. trachomatis in more affluent populations with lower prevalence rates. No risk factors were identified with sufficient sensitivity and specificity to be useful for targeted testing. Prevalence and identifiable risk factors for C. trachomatis are not transferable between populations, even in the same city.
Collapse
Affiliation(s)
- H Williams
- Family Planning Victoria, Melbourne, Australia.
| | | | | | | | | |
Collapse
|
15
|
Newland JA. Commentary on 'Screening for chlamydia infection: recommendations and rationale'. Am J Nurs 2002; 102:93. [PMID: 12394312 DOI: 10.1097/00000446-200210000-00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Screening for Chlamydial Infection: Recommendations and Rationale
Collapse
|