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Yenidünya Konuk E. Molecular Approaches to the Diagnosis of Chlamydia. Infect Dis (Lond) 2023. [DOI: 10.5772/intechopen.109746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
Chlamydia trachomatis is known as the most common bacterial infection agent to pass with sexual transition. This microorganism is an obligatory intracellular parasite. A variety of infections are caused by C. trachomatis, including trachoma, pneumonias in newborns, genital and urinary tract infections, and lymphogranuloma venereum (LGV), which is caused by LGV strains. The diagnosis of Chlamydia trachomatis can be made by cultures and isolations, antigens and antibodies (direct fluorescence, enzyme immunoassays), hybridization, or polymerase chain reaction (PCR). Each year, infection and diagnosis rates increase in the developed world. Since Chlamydia is mostly asymptomatic, screening, and treatment are a key to detecting cases. Polymerase chain reaction (PCR), ligase chain reaction (LCR), and nucleic acid sequence-based amplification (NASBAa) molecular methods can be used for the detection, low concentration, quantification, and identification of organisms. While the traditional PCR method confirms its existence, it can quantify real-time PCR (RT-PCR). This method (RT-PCR) may have low sensitivity among variants of the same species. Also, PCR scans, which receive urine service, offer great advantages. PCR from initial void urine (FVU) samples is highly sensitive in detecting the organism. Urine Chlamydia screenings are more acceptable in large populations and asymptomatic detections.
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EVO100 prevents chlamydia and gonorrhea in women at high risk of infection. Am J Obstet Gynecol 2021; 225:162.e1-162.e14. [PMID: 33705748 DOI: 10.1016/j.ajog.2021.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND According to the Centers for Disease Control and Prevention, rates of infection for Chlamydia trachomatis and Neisseria gonorrhoeae are increasing in the United States. EVO100 is an investigational antimicrobial, pH-modulating, vaginal gel with active ingredients L-lactic acid, citric acid, and potassium bitartrate that is being evaluated for the prevention of sexually transmitted infections. OBJECTIVE The objective of this phase 2B/3 study was to assess the efficacy and safety of EVO100 for the prevention of chlamydia and gonorrhea. STUDY DESIGN AMPREVENCE was a double-blinded, placebo-controlled, multicenter study based in the United States conducted over approximately 16 weeks in women at the age of 18 to 45 years who were at risk of urogenital chlamydia and gonorrhea infection. Enrolled women had been diagnosed as having and treated for chlamydia or gonorrhea ≤16 weeks before enrollment. Women received either EVO100 or placebo vaginal gel and were instructed to apply the study drug immediately before or up to 1 hour before each act of vaginal sexual intercourse. The primary and secondary endpoints were the prevention of urogenital chlamydia and gonorrhea, respectively. Exploratory outcomes include women's overall satisfaction with EVO100. RESULTS In total, 860 women were randomized 1:1 to receive EVO100 (n=426) or placebo (n=434), and 764 women (EVO100, n=376; placebo, n=388) were documented as using the study drug at least once. Baseline characteristics were similar between treatment arms. Overall, women had a mean age of 27.7 years (standard deviation, 6.9) and body mass index of 28.9 kg/m2 (standard deviation, 8.0). Most women were of White (54.3% [467 of 860]) or African American (41.6% [358 of 860]) race and of non-Hispanic/Latina ethnicity (67.1% [577 of 860]). The chlamydia infection rate in EVO100 users was 4.8% (14 of 289) compared with 9.7% (28 of 290) among placebo users (P=.0256), representing a relative risk reduction of 50%. For gonorrhea, the infection rate was 0.7% (2 of 280) in the EVO100 arm compared with 3.2% (9 of 277) in the placebo arm (P=.0316), representing a relative risk reduction of 78%. Increased efficacy was observed with increased adherence, and chlamydia infection rates were significantly reduced with increased adherence in the EVO100 group compared with placebo. Across both arms, there were similar rates of all-cause adverse events (EVO100, 21.3% [80 of 376]; placebo, 20.4% [79 of 388]) and treatment-related adverse events (EVO100, 7.2% [27 of 376]; placebo, 7.5% [29 of 388]). The most common adverse events in the EVO100 arm were vulvovaginal candidiasis (5.1% [19 of 376]), vaginal discharge (3.2% [12 of 376]), and urinary tract infection (3.2% [12 of 376]) and, in the placebo arm, bacterial vaginosis (4.6% [18 of 388]), urinary tract infection (2.6% [10 of 388]), and vaginal discharge (2.6% [10 of 388]). Few women discontinued owing to adverse events in either arm (EVO100, 1.1% [4 of 376]; placebo, 1.5% [6 of 388]). No treatment-related serious adverse events were reported. Most EVO100 users (88%) were satisfied or very satisfied with EVO100 after 16 weeks of use. CONCLUSION EVO100 significantly reduced the risk of chlamydia and gonorrhea infections in women at high risk of Chlamydia trachomatis and Neisseria gonorrhoeae infection and was well tolerated, with observed adverse events consistent with its known safety profile.
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Zhou Y, Jiang TT, Li J, Yin YP, Chen XS. Performance of point-of-care tests for the detection of chlamydia trachomatis infections: A systematic review and meta-analysis. EClinicalMedicine 2021; 37:100961. [PMID: 34195578 PMCID: PMC8225697 DOI: 10.1016/j.eclinm.2021.100961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/13/2021] [Accepted: 05/28/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis (CT) is one of the most prevalent bacterial sexually transmitted infections (STIs) globally but has been inadequately detected for intervention. Introduction of point-of-care tests (POCTs) for CT is critical for filling the intervention gaps. We conducted a systematical review and meta-analysis on diagnostic performance of POCTs for CT to assist in guiding the application of these assays in CT screening and detection. METHODS We searched PubMed/Medline and Embase databases, from January 2004 to May 2021, for studies reporting the performance of POCTs for identifying CT using specimens collected from urethral, vaginal, cervical, anorectal, or pharyngeal site or of urine. Two investigators independently screened and extracted data for controlling the quality of data extraction. Any discrepancies in study selection and data extraction were resolved through consensus. We only included studies with sufficient data to estimate sensitivity and specificity, and used laboratory-based nucleic acid amplification test (NAAT) as the reference standard. The main outcomes were pooled sensitivity, specificity, and diagnostic odds ratio (DOR) and their corresponding 95% confidence intervals (CIs). Summary estimates were calculated using a random-effects model and summary receiver operator curves (SROCs) were generated using the Moses-Littenberg method. STATA 14.0 and Meta-DiSc 1.4 were used for statistical analysis. The study protocol is registered with PROSPERO, number CRD42019140544. FINDINGS Of 3,038 records identified, 39 studies (42,336 specimens) were included in the study, including 14 studies on evaluation of antigen detection (AD)-based and 25 on NAAT-based POCTs. The overall pooled sensitivity, specificity and DOR were 56% (95% CI 45%-67%), 99% (95% CI 98%-99%) and 86 (95% CI 46-163), respectively, for AD-based POCTs and corresponding values for NAAT-based POCTs were 94% (95% CI 91%-96%), 99% (95% CI 99%-99%) and 1,933(95% CI 1,018-3,669), respectively. The pooled sensitivity of AD-based POCTs varied across the types of specimens, indicating 46% for cervical swabs (95% CI 37%-56%; range 22.7%-71.4%), 52% for vaginal swabs (95% CI 34%-70%; range 17.1%-86.8%) and 57% for male urine (95% CI 36%-75%; range 20.0%-82.6%). For NAAT-based POCTs, the pooled sensitivity was 94% (95% CI 90%-96%) for cervical swabs, 94% (95% CI 86%-98%) for vaginal swabs, 95% (95% CI 91%-97%) for urine specimens and 93% (95% CI 87%-96%) for anorectal swabs. INTERPRETATION NAAT-based POCTs for CT have a significantly better performance particularly in sensitivity for diagnosing the infection with CT than the AD-based POCTs. Screening strategy with AD-based POCTs may potentially result in a substantial under-detection of the infections.
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Affiliation(s)
- Ying Zhou
- Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, 12 Jiangwangmiao Street, Nanjing 210042, China
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Ting-Ting Jiang
- Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, 12 Jiangwangmiao Street, Nanjing 210042, China
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
| | - Jing Li
- Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, 12 Jiangwangmiao Street, Nanjing 210042, China
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
| | - Yue-Ping Yin
- Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, 12 Jiangwangmiao Street, Nanjing 210042, China
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
| | - Xiang-Sheng Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, 12 Jiangwangmiao Street, Nanjing 210042, China
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
- Institute for Global Health and Sexually Transmitted Diseases, Southern Medical University, Guangzhou, China
- Corresponding author at: Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, 12 Jiangwangmiao Street, Nanjing 210042, China
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Wang C, Li L, Xie Y, Tan Y, Wen Y, Chen Q, Yu J, Song Y, Wu Y. Isolation and Characterization of Avian Chlamydia psittaci from Symptomatic Pet Birds in Southern Hunan, China. Avian Dis 2020; 63:31-37. [PMID: 31251517 DOI: 10.1637/11932-071718-reg.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/15/2018] [Indexed: 11/05/2022]
Abstract
Chlamydia psittaci is a zoonotic pathogen with multiple hosts, especially avian, and can be transmitted to humans, causing psittacosis or ornithosis. No effective vaccines have been developed. We therefore isolate and genotype avian C. psittaci strains and investigate the pathogenicity of isolates in the southern Hunan area of China. Among 200 suspicious avian specimens, eight were positive for the C. psittaci outer membrane protein A (ompA) gene (4%), and seven were successfully cultured in human epithelial type 2 and Vero cells (87.5%). Genotyping of the ompA gene of the eight PCR-positive samples revealed that all of the cultured strains, except for the E9 strain, belonged to genotype A. Pathologic changes in the mice infected with C. psittaci via intranasal inoculation showed severe pneumonia and intense infiltration of inflammatory cells in the lung in a dose-dependent manner, and immunohistochemical staining displayed different levels of infiltration of C. psittaci inclusions in the heart, liver, spleen, kidney, and, especially, lung. Our findings demonstrate that genotype A dominates all C. psittaci genotypes in the southern Hunan area and that the C. psittaci avian isolates in this region possess dose-dependent pathogenicity.
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Affiliation(s)
- Chuan Wang
- Institute of Pathogenic Biology, Medical College, University of South China, Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control and Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang 421001, China
| | - Li Li
- Institute of Pathogenic Biology, Medical College, University of South China, Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control and Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang 421001, China
| | - Yafeng Xie
- Institute of Pathogenic Biology, Medical College, University of South China, Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control and Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang 421001, China
| | - Yuan Tan
- Institute of Pathogenic Biology, Medical College, University of South China, Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control and Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang 421001, China
| | - Yating Wen
- Institute of Pathogenic Biology, Medical College, University of South China, Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control and Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang 421001, China
| | - Qian Chen
- Institute of Pathogenic Biology, Medical College, University of South China, Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control and Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang 421001, China
| | - Jian Yu
- Institute of Pathogenic Biology, Medical College, University of South China, Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control and Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang 421001, China.,Department of Experimental Zoology, Medical College, University of South China, Hengyang 421001, China
| | - Ying Song
- Institute of Pathogenic Biology, Medical College, University of South China, Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control and Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang 421001, China
| | - Yimou Wu
- Institute of Pathogenic Biology, Medical College, University of South China, Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control and Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Hengyang 421001, China,
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Maternal Prenatal Screening and Serologies. Adv Neonatal Care 2018; 18:431-437. [PMID: 30499824 DOI: 10.1097/anc.0000000000000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Maternal prenatal screening is essential in preventing pregnancy complications as well as preventing and/or predicting neonatal and infant medical issues after delivery that are due to certain communicable diseases. PURPOSE This article is aimed at gathering and presenting the most recent information regarding the most common prenatal screening laboratory studies and the implications with the various diseases. METHODS/SEARCH STRATEGY An extensive medical database search was performed and the most relevant medical texts regarding the subject of prenatal screening were obtained. FINDINGS/RESULTS Maternal screenings should be performed at the first provider visit once pregnancy has been confirmed. Additional screenings vary based on the specific disease and on maternal risk factors. Methods of screenings involve measuring antigen or antibody titers, a combination of antigen/antibody titers, or by specialized genetic tests. IMPLICATIONS FOR PRACTICE Providers responsible for pregnant women should be able to identify which diseases they need to screen for and how to interpret the findings. Neonatal providers should be able to interpret the findings and they should also be able to manage neonates appropriately. IMPLICATIONS FOR RESEARCH Future research should be aimed at developing better, cost-effective tests for both existing diseases and new diseases that either impact large or small populations of pregnant women and their fetuses.
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Smith KS, Guy R, Danielewski J, Tabrizi SN, Fairley CK, McNulty AM, Rawlinson W, Saville M, Garland SM, Donovan B, Kaldor JM, Hocking JS. Biological and Behavioral Factors Associated With Positive Chlamydia Retests. Sex Transm Dis 2018; 44:417-422. [PMID: 28608791 DOI: 10.1097/olq.0000000000000616] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Repeat chlamydia detection after treatment is common, and there is concern that treatment failure may be a cause. METHODS Within a randomized trial, we established a prospective cohort of 600 participants with anogenital chlamydia diagnoses (200 each of women, heterosexual men, and men who have sex with men [MSM]). Participants were invited for repeat testing at 3 months and to complete a behavioral survey at 4 months. Positive samples were analyzed for organism DNA load and genovar. We estimated repeat chlamydia positivity, reinfection and treatment failure rates, and investigated the biological and behavioral factors associated with a repeat positive test. RESULTS A total of 290 participants (100 women, 89 heterosexual men, 101 MSM) were retested at 1 to 4 months, with 43 repeat positives, including 26 classed as reinfection and 9 as treatment failures. Comparing MSM with heterosexual men and women combined, repeat positivity was higher (20.8% vs 11.6%, P = 0.04), and treatment failure was higher (6.9% vs 1.1%, P = 0.01), but there was no difference in reinfection rates (11.9% vs 7.4%, P = 0.21). Among MSM, the odds of repeat positivity increased by 90% with each additional log organism load in the original specimen (baseline) (adjusted odds ratio, 1.9; 95% confidence interval, 1.1-3.2). Among heterosexuals, the odds of repeat positivity decreased by 10% with each additional week delay in being retested for chlamydia (adjusted odds ratio, 0.9; 95% confidence interval, 0.8-0.9). CONCLUSIONS Positive retests were more common among MSM than heterosexuals. Treatment failure was more common in MSM with rectal chlamydia, reinforcing concerns about azithromycin treatment failure.
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Affiliation(s)
- Kirsty S Smith
- From the *Kirby Institute, UNSW Australia, Sydney; †Murdoch Childrens Research Institute; ‡Department of Microbiology and Infectious Diseases, The Royal Women's Hospital; §Department of Obstetrics and Gynaecology, University of Melbourne; ¶Melbourne Sexual Health Centre; ∥Central Clinical School, Monash University, Melbourne; **Sydney Sexual Health Centre; ††School of Public Health and Community Medicine, UNSW Australia; ‡‡Serology and Virology Division, (SAViD) SEALS Microbiology, Prince of Wales Hospital; §§SOMS and BABS, UNSW Australia, Sydney; ¶¶VCS Pathology; and ∥∥Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Hoenderboom BM, van Ess EF, van den Broek IVF, van Loo IHM, Hoebe CJPA, Ouburg S, Morré SA. Chlamydia trachomatis antibody detection in home-collected blood samples for use in epidemiological studies. J Microbiol Methods 2017; 144:164-167. [PMID: 29196272 DOI: 10.1016/j.mimet.2017.11.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/24/2017] [Accepted: 11/26/2017] [Indexed: 11/18/2022]
Abstract
Capillary blood collected in serum tubes was subjected to centrifugation delay while stored at room temperature. Chlamydia trachomatis (CT) IgG concentrations in aliquoted serum of these blood samples remained stable for seven days after collection. CT IgG concentrations can reliably be measured in mailed blood samples in epidemiological studies.
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Affiliation(s)
- B M Hoenderboom
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Laboratory of Immunogenetics, Department Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands.
| | - E F van Ess
- Laboratory of Immunogenetics, Department Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - I V F van den Broek
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - I H M van Loo
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - C J P A Hoebe
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands; Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD South Limburg), Geleen, The Netherlands
| | - S Ouburg
- Laboratory of Immunogenetics, Department Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - S A Morré
- Laboratory of Immunogenetics, Department Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands; Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Developmental Biology), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, The Netherlands
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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: 447] [Impact Index Per Article: 63.9] [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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McDonagh LK, Saunders JM, Cassell J, Bastaki H, Hartney T, Rait G. Facilitators and barriers to chlamydia testing in general practice for young people using a theoretical model (COM-B): a systematic review protocol. BMJ Open 2017; 7:e013588. [PMID: 28279998 PMCID: PMC5353274 DOI: 10.1136/bmjopen-2016-013588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/17/2016] [Accepted: 01/31/2017] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Chlamydia is a key health concern with high economic and social costs. There were over 200 000 chlamydia diagnoses made in England in 2015. The burden of chlamydia is greatest among young people where the highest prevalence rates are found. Annual testing for sexually active young people is recommended; however, many of those at risk do not receive testing. General practice has been identified as an ideal setting for testing, yet efforts to increase testing in this setting have not been effective. One theoretical model which may provide insight into the underpinnings of chlamydia testing is the Capability, Opportunity and Motivation Model of Behaviour (COM-B model). The aim of this systematic review is to: (1) identify barriers and facilitators to chlamydia testing for young people in general practice and (2) use a theoretical model to conduct a behavioural analysis of chlamydia testing behaviour. METHODS AND ANALYSIS Qualitative, quantitative and mixed methods studies published after 2000 will be included. Seven databases (MEDLINE, PubMed, EMBASE, Informit, PsycInfo, Scopus, Web of Science) will be searched to identify peer-reviewed publications which examined barriers and facilitators to chlamydia testing in general practice. Risk of bias will be assessed using the Critical Appraisal Skills Programme. Data regarding study design and key findings will be extracted. The data will be analysed using thematic analysis and the resultant factors will be mapped onto the COM-B model components. All findings will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. ETHICS AND DISSEMINATION Ethical approval is not required. The results will be disseminated via submission for publication to a peer-review journal when complete and for presentation at national and international conferences. The review findings will be used to inform the development of interventions to facilitate effective and efficient chlamydia testing in general practice.
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Affiliation(s)
- Lorraine K McDonagh
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - John M Saunders
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
- National Chlamydia Screening Programme, Public Health England, London, UK
| | - Jackie Cassell
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton, UK
| | - Hamad Bastaki
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Thomas Hartney
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Greta Rait
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
- Research Department of Primary Care and Population Health, University College London, London, UK
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Tunley S. Herd protection from the female HPV vaccination programme. THE LANCET. INFECTIOUS DISEASES 2016; 16:1333-1334. [PMID: 27998598 DOI: 10.1016/s1473-3099(16)30468-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/10/2016] [Accepted: 10/10/2016] [Indexed: 06/06/2023]
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Usefulness of a novel multiplex real-time PCR assay for the diagnosis of sexually-transmitted infections. Enferm Infecc Microbiol Clin 2015; 34:471-6. [PMID: 26706392 DOI: 10.1016/j.eimc.2015.10.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Sexually transmitted infections (STI) are currently on the increase worldwide. New molecular tools have been developed in the past few years in order to improve their diagnosis. An evaluation was carried out using a new commercially available real-time PCR assay, Anyplex™ II STI-7 (Seegene, Seoul, Korea), which detects seven major pathogens in a single reaction - Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum, and Ureaplasma parvum - and compared with conventional methods performed in our laboratory. MATERIALS AND METHODS Two different populations were included, and 267 specimens from different sites of infection (urines, endocervical swabs, rectal swabs, vaginal swabs, urethral swabs and one inguinal adenopathy) were processed for both methods. RESULTS The parameters of clinical performance were calculated for C. trachomatis, N. gonorrhoeae, and T. vaginalis, and the assay achieved sensitivities (SE) from 93.94% to 100%, and specificities (SP) from 96.55% to 100%, with negative predictive values (NPV) from 93.33% to 98.85%, and positive predictive values (PPV) from 96.88% to 100%, with a very good agreement (kappa index from 0.88 to 1). CONCLUSIONS Anyplex™ II STI-7 is a good tool for the reliable diagnosis of STI. Its ease of use and processing allows it to be incorporated into the day to day laboratory work.
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Microbiological Characteristics of Chlamydia trachomatis and Neisseria gonorrhoeae Infections in South African Women. J Clin Microbiol 2015; 54:200-3. [PMID: 26511740 DOI: 10.1128/jcm.02848-15] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 10/25/2015] [Indexed: 11/20/2022] Open
Abstract
We analyzed data of 263 women with at least one genital or anorectal sexually transmitted infection from a cross-sectional study conducted in rural South Africa. We provide new insights concerning the concurrence of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Trichomonas vaginalis infections as well as the characteristics of bacterial loads.
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Lunny C, Taylor D, Hoang L, Wong T, Gilbert M, Lester R, Krajden M, Ogilvie G. Self-Collected versus Clinician-Collected Sampling for Chlamydia and Gonorrhea Screening: A Systemic Review and Meta-Analysis. PLoS One 2015; 10:e0132776. [PMID: 26168051 PMCID: PMC4500554 DOI: 10.1371/journal.pone.0132776] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/19/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The increases in STI rates since the late 1990s in Canada have occurred despite widespread primary care and targeted public health programs and in the setting of universal health care. More innovative interventions are required that would eliminate barriers to STI testing such as internet-based or mail-in home and community service testing for patients that are hard to reach, who refuse to go for clinician-based testing, or who decline an examination. Jurisdictions such as New Zealand and some American states currently use self-collected sampling, but without the required evidence to determine whether self-collected specimens are as accurate as clinician-collected specimens in terms of chlamydia and gonorrhea diagnostic accuracy. The objective of the review is to compare self-collected vaginal, urine, pharyngeal and rectal samples to our reference standard - clinician-collected cervical, urethral, pharyngeal and rectal sampling techniques to identify a positive specimen using nucleic acid amplification test assays. METHODS The hierarchical summary receiver operating characteristic and the fixed effect models were used to assess the accuracy of comparable specimens that were collected by patients compared to clinicians. Sensitivity and specificity estimates with 95% confidence intervals (CI) were reported as our main outcome measures. FINDINGS We included 21 studies based on over 6100 paired samples. Fourteen included studies examined chlamydia only, 6 compared both gonorrhea and chlamydia separately in the same study, and one examined gonorrhea. The six chlamydia studies comparing self-collection by vaginal swab to a clinician-collected cervical swab had the highest sensitivity (92%, 95% CI 87-95) and specificity (98%, 95% CI 97-99), compared to other specimen-types (urine/urethra or urine/cervix). Six studies compared urine self-samples to urethra clinician-collected samples in males and produced a sensitivity of 88% (95% CI 83-93) and a specificity of 99% (95% CI 0.94-0.99). Taking into account that urine samples may be less sensitive than cervical samples, eight chlamydia studies that compared urine self-collected verses clinician-collected cervical samples had a sensitivity of 87% (95% CI 81-91) and high specificity of 99% (95% CI 0.98-1.00). For gonorrhea testing, self-collected urine samples compared to clinician-collected urethra samples in males produced a sensitivity of 92% (95% CI 83-97) and specificity of 99% (95% CI 0.98-1.00). CONCLUSION The sensitivity and specificity of vaginal self-collected swabs compared to swabs collected by clinicians supports the use of vaginal swab as the recommended specimen of choice in home-based screening for chlamydia and gonorrhea. Urine samples for gonorrhea collected by men had comparably high sensitivity and specificity, so could be recommended as they can be left at room temperature for several days, allowing for the possibility of mail-in home-based testing. In populations that may not go for testing at all, do not have the option of clinical testing, or who refuse a clinical examination, self-collected screening would be a good alternative. We recommend that guidelines on how to self-collect gonorrhea and chlamydia urine, vaginal, rectal and pharyngeal specimens be published.
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Affiliation(s)
- Carole Lunny
- Division of STI/HIV Prevention and Control, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
- Australasian Cochrane Centre, Monash University, Melbourne, Australia
| | - Darlene Taylor
- Division of STI/HIV Prevention and Control, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda Hoang
- Division of STI/HIV Prevention and Control, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
- BC Public Health Microbiology and Reference Laboratory, Vancouver, British Columbia, Canada
| | - Tom Wong
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Mark Gilbert
- Division of STI/HIV Prevention and Control, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard Lester
- Division of STI/HIV Prevention and Control, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Mel Krajden
- Division of STI/HIV Prevention and Control, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
- BC Public Health Microbiology and Reference Laboratory, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- Division of STI/HIV Prevention and Control, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
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A web-based personally controlled health management system increases sexually transmitted infection screening rates in young people: a randomized controlled trial. J Am Med Inform Assoc 2015; 22:805-14. [DOI: 10.1093/jamia/ocu052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/29/2014] [Indexed: 01/19/2023] Open
Abstract
Abstract
Objective To determine if a web-based personally controlled health management system (PCHMS) could increase the uptake of sexually transmitted infections (STI) screening among a young university population.
Methods A non-blinded parallel-group randomized controlled trial was conducted. Participants aged 18–29 years were recruited from a university environment between April and August 2013, and randomized 1:1 to either the intervention group (immediate online PCHMS access) or control group (no PCHMS access). The study outcome was self-reported STI testing, measured by an online follow-up survey in October 2013.
Results Of the 369 participants allocated to the PCHMS, 150 completed the follow-up survey, and of the 378 in the control group, 225 completed the follow-up survey. The proportion of the PCHMS group who underwent an STI test during the study period was 15.3% (23/150) compared with 7.6% (17/225) in the control group (P = .017). The difference in STI testing rates within the subgroup of sexually active participants (20.4% (23/113) of the PCHMS group compared with 9.6% (15/157) of the control group) was significantly higher (P = .027) than among non-sexually active participants.
Discussion Access to the PCHMS was associated with a significant increase in participants undergoing STI testing. This is also the first study to demonstrate efficacy of a PCHMS targeting a health concern where susceptibility is generally perceived as low and the majority of infections are asymptomatic.
Conclusion PCHMS interventions may provide an effective means of increasing the demand for STI testing which, combined with increased opportunistic testing by clinicians, could reduce the high and sustained rates of STIs in young people.
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Lorch R, Hocking J, Guy R, Vaisey A, Wood A, Lewis D, Temple-Smith M. Practice nurse chlamydia testing in Australian general practice: a qualitative study of benefits, barriers and facilitators. BMC FAMILY PRACTICE 2015; 16:36. [PMID: 25880077 PMCID: PMC4371842 DOI: 10.1186/s12875-015-0251-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 02/27/2015] [Indexed: 11/17/2022]
Abstract
Background Chlamydia infection is a significant public health issue for young people; however, testing rates in Australian general practice are low. Practice nurses (PNs) could have an important role in contributing to increasing chlamydia testing rates. The Australian Chlamydia Control Effectiveness Pilot (ACCEPt), a large cluster randomised control trial of annual testing for 16 to 29 year olds in general practice, is the first to investigate the role of PNs in maximising testing rates. In order to assess the scope for PN involvement, we aimed to explore PN’s views in relation to involvement in chlamydia testing in general practice. Methods Semi structured interviews were conducted between June 2011 and April 2012 with a purposive sample of 23 PNs participating in ACCEPt. Interview data was thematically analysed using a conventional content analysis approach. Results The participants in our study supported an increased role for PNs in chlamydia testing and identified a number of patient benefits from this involvement, such as an improved service with greater access to testing and patients feeling more comfortable engaging with a nurse rather than a doctor. An alleviation of doctors’ workloads and expansion of the nurse’s role were also identified as benefits at a clinic level. Time and workload constraints were commonly considered barriers to chlamydia testing, along with concerns around privacy in the “small town” rural settings of the general practices. Some felt negative GP attitudes as well as issues with funding for PNs’ work could also be barriers. The provision of training and education, streamlining chlamydia testing pathways in clinics and changes to pathology ordering processes would facilitate nurse involvement in chlamydia testing. Conclusion This study suggests that PNs could take a role in increasing chlamydia testing in general practice and that their involvement may result in possible benefits for patients, doctors, PNs and the community. Strategies to overcome identified barriers and facilitate their involvement must be further explored.
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Affiliation(s)
- Rebecca Lorch
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Jane Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Alaina Vaisey
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Anna Wood
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Dyani Lewis
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
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Lorch R, Hocking J, Guy R, Vaisey A, Wood A, Donovan B, Fairley C, Gunn J, Kaldor J, Temple-Smith M. Do Australian general practitioners believe practice nurses can take a role in chlamydia testing? A qualitative study of attitudes and opinions. BMC Infect Dis 2015; 15:31. [PMID: 25885341 PMCID: PMC4314754 DOI: 10.1186/s12879-015-0757-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 01/15/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Chlamydia notifications continue to rise in young people in many countries and regular chlamydia testing is an important prevention strategy. Although there have been initiatives to increase testing in primary care, none have specifically investigated the role of practice nurses (PNs) in maximising testing rates. PNs have previously expressed a willingness to be involved, but noted lack of support from general practitioners (GPs) as a barrier. We sought GPs' attitudes and opinions on PNs taking an expanded role in chlamydia testing and partner notification. METHODS In the context of a cluster randomised trial in mostly rural towns in 4 Australian states, semi structured interviews were conducted with 44 GPs between March 2011 and July 2012. Data relating to PN involvement in chlamydia testing were thematically analysed using a conventional content analysis approach. RESULTS The majority of GPs interviewed felt that a role for PNs in chlamydia testing was appropriate. GPs felt that PNs had more time for patient education and advice, that patients would find PNs easier to talk to and less intimidating than GPs, and that GPs themselves could benefit through a reduction in their workload. Although GPs felt that PNs could be utilised more effectively for preventative health activities such as chlamydia testing, many raised concerns about how these activities would be renumerated whilst some felt that existing workload pressures for PNs could make it difficult for them to expand their role. Whilst some rural GPs recognised that PNs might be well placed to conduct partner notification, they also recognised that issues of patient privacy and confidentiality related to living in a "small town" was also a concern. CONCLUSION This is the first qualitative study to explore GPs' views around an increased role for PNs in chlamydia testing. Despite the concerns raised by PNs, these findings suggest that GPs support the concept and recognise that PNs are suited to the role. However issues raised, such as funding and remuneration may act as barriers that will need to be addressed before PNs are supported to make a contribution to increasing chlamydia testing rates in general practice.
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Affiliation(s)
- Rebecca Lorch
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia.
| | - Jane Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Rebecca Guy
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia.
| | - Alaina Vaisey
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Anna Wood
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Basil Donovan
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia.
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia.
| | - Christopher Fairley
- Central Clinical School, Monash University and Melbourne Sexual Health Centre, Carlton, Victoria, Australia.
| | - Jane Gunn
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia.
| | - John Kaldor
- The Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW, Australia.
| | - Meredith Temple-Smith
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia.
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Dyke T, Patel AR, Foley E. Summary and highlights from the International Union against Sexually Transmitted Infections Congress 2014, Malta. Int J STD AIDS 2015; 26:215-7. [PMID: 25614520 DOI: 10.1177/0956462414566255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vodstrcil LA, McIver R, Huston WM, Tabrizi SN, Timms P, Hocking JS. The Epidemiology of Chlamydia trachomatis Organism Load During Genital Infection: A Systematic Review. J Infect Dis 2014; 211:1628-45. [PMID: 25492913 DOI: 10.1093/infdis/jiu670] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/26/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The role of organism load in Chlamydia trachomatis infection is not well understood. We conducted a systematic review to investigate the epidemiology of C. trachomatis organism load in human genital chlamydia infection. METHODS Embase, PubMed, and Medline databases were searched for literature published through August 2014. English-language publications that quantified load in humans were eligible. Participant characteristics and laboratory data were extracted. RESULTS A total of 737 records were identified, and 29 publications involving 40 883 participants were included. In women, load was highest for cervical swabs and lowest for urine specimens. In men, load was highest for rectal swabs and similar for urethral swabs and urine specimens. Evidence of any association between load and age, serovar, risk of transmission, hormone levels, and concurrent sexually transmitted infections was inconsistent. Eight of 9 culture-based studies found an association between load and signs and symptoms, in contrast with only 3 of 8 nucleic acid amplification test (NAAT)-based studies (P = .03). CONCLUSION Chlamydia organism load varies by specimen type and site of sampling, and viable chlamydia organism load may be a more important indicator of severity of infection than total load measured by NAAT.
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Affiliation(s)
- Lenka A Vodstrcil
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne Melbourne Sexual Health Centre, Carlton Murdoch Children's Research Institute, Parkville
| | - Ruthy McIver
- Sydney Sexual Health Centre, South Eastern Sydney Local Health District, Sydney
| | - Wilhelmina M Huston
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane
| | - Sepehr N Tabrizi
- Murdoch Children's Research Institute, Parkville Department of Obstetrics and Gynaecology, University of Melbourne, The Royal Women's Hospital
| | - Peter Timms
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane University of the Sunshine Coast, Sippy Downs, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne
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Dukers-Muijrers NHTM, van der Sande MAB, Wolffs PFG, Hoebe CJPA. Limits of chlamydial diagnostic tests in epidemiological studies. J Infect Dis 2014; 209:2017-8. [PMID: 24415785 DOI: 10.1093/infdis/jiu011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Geleen Department of Medical Microbiology, School of Public Health and Primary Care, Maastricht University Medical Center, Maastricht
| | - Marianne A B van der Sande
- Epidemiology and Surveillance, Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Bilthoven Julius Center, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Petra F G Wolffs
- Department of Medical Microbiology, School of Public Health and Primary Care, Maastricht University Medical Center, Maastricht
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Geleen Department of Medical Microbiology, School of Public Health and Primary Care, Maastricht University Medical Center, Maastricht
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Hocking JS, Garland SM. Low chlamydia testing uptake among young pregnant women in Australia highlights the need for national leadership in this area. Aust N Z J Obstet Gynaecol 2013; 53:329-30. [PMID: 23870028 DOI: 10.1111/ajo.12115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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