1
|
Al Busaidi I, Saeed D, Bogoch II. Cervical lymphadenopathy due to lymphogranuloma venereum infection. Sex Transm Infect 2018; 93:589. [PMID: 29175995 DOI: 10.1136/sextrans-2016-052839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/19/2016] [Accepted: 10/29/2016] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ibrahim Al Busaidi
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Danyal Saeed
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Isaac I Bogoch
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Affiliation(s)
- Daniel Richardson
- Brighton & Sussex University NHS Trust, Brighton, UK.,Brighton & Sussex Medical School, Brighton, UK
| | | |
Collapse
|
3
|
Foley E, Furegato M, Hughes G, Board C, Hayden V, Prescott T, Shone E, Patel R. Inequalities in access to genitourinary medicine clinics in the UK: results from a mystery shopper survey. Sex Transm Infect 2017; 93:472-475. [PMID: 28377420 DOI: 10.1136/sextrans-2016-052882] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 02/19/2017] [Accepted: 02/25/2017] [Indexed: 11/04/2022] Open
Abstract
STUDY DESIGN This study investigated whether access to genitourinary medicine (GUM) clinics meets UK-recommended standards. METHODS In January 2014 and 2015, postal questionnaires about appointment and service characteristics were sent to lead clinicians of UK GUM clinics. In February 2014 and 2015, researchers posing as symptomatic and asymptomatic 'patients' contacted clinics by telephone, requesting to be seen. Clinic and patient characteristics associated with the offer of an appointment within 48 hours were examined using unadjusted and UK country and patient gender adjusted multivariable logistic regression analyses. In March 2015, a convenience sample (one in four) of clinics was visited by researchers with the same clinical symptoms. Ability to achieve a same-day consultation and waiting time were assessed. RESULTS In 2015, 90.8% of clinics offered symptomatic 'patients' an appointment within 48 hours when contacted by telephone, compared with 95.5% in 2014 (aOR=0.46 (0.26 to 0.83); p<0.01). The decline was greatest in women (96.0% to 90.1%; p<0.05), and clinics in England (96.2% to 90.7%; p<0.01). For asymptomatic patients, the proportion offered an appointment within 48 hours increased from 50.7% in 2014 to 74.5% in 2015 (aOR=3.06 (2.23 to 4.22); p<0.001), and in both men (58.2% to 90.8%; p<0.001) and women (49.0% to 59.6%; p<0.01). In adjusted analysis, asymptomatic women were significantly less likely to be offered an appointment than asymptomatic men (aOR=0.33 (0.23 to 0.45); p value<0.001). 95% of clinics were able to see symptomatic patients attending in person. CONCLUSIONS Access to GUM services has worsened for those with symptoms suggestive of an acute STI and is significantly poorer for asymptomatic women. This evidence may support the reintroduction of process targets.
Collapse
Affiliation(s)
- Elizabeth Foley
- Department of Sexual Health, Solent NHS Trust, Royal South Hants Hospital, Southampton, UK
| | | | - Gwenda Hughes
- Department of HIV and STIs, Public Health England, London, UK
| | | | - Vanessa Hayden
- Southampton University School of Medicine, Southampton, UK
| | | | - Eleanor Shone
- Southampton University School of Medicine, Southampton, UK
| | - Rajul Patel
- Solent NHS Trust, Southampton University School of Medicine, Southampton, UK
| |
Collapse
|
4
|
Bellhouse C, Walker S, Fairley CK, Chow EP, Bilardi JE. Getting the terminology right in sexual health research: the importance of accurately classifying fuck buddies among men who have sex with men. Sex Transm Infect 2017; 94:487-489. [PMID: 28356437 DOI: 10.1136/sextrans-2016-053000] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/28/2017] [Accepted: 03/08/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this report was to raise the issue of the definition and classification of partner terminology in men who have sex with men (MSM) research, particularly in regards to 'fuck buddies'. If definitions in research differ from general consensus in the MSM population, it is possible that public health strategies will be ineffective as the target population may be inaccurate. METHODS Thirty semistructured interviews with MSM attending the Melbourne Sexual Health Centre were conducted, focusing on the willingness to change sexual practices to reduce the risk of pharyngeal gonorrhoea. As part of these interviews, men were also asked their views on the terminology they used to describe their relationships and sexual partners. RESULTS The degree of emotional attachment often defined the type or classification of relationships. There was a consensus among men that partners they engaged with for 'sex only' were classified as casual partners and partners with whom there was an emotional attachment or formalisation of the relationship were classified as 'regular partners'. However, the classification of 'fuck buddy' as a regular or casual partner was less clear. CONCLUSIONS Further research is needed to ascertain the ways in which men conceptualise sexual relationships and define or classify partner types, particularly 'fuck buddy' relationships. A third category for sexual relationships should be considered to encapsulate fuck buddy relationships.
Collapse
Affiliation(s)
- Clare Bellhouse
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sandra Walker
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Eric Pf Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jade E Bilardi
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
5
|
Harding-Esch EM, Nori AV, Hegazi A, Pond MJ, Okolo O, Nardone A, Lowndes CM, Hay P, Sadiq ST. Impact of deploying multiple point-of-care tests with a 'sample first' approach on a sexual health clinical care pathway. A service evaluation. Sex Transm Infect 2017; 93:424-429. [PMID: 28159916 PMCID: PMC5574381 DOI: 10.1136/sextrans-2016-052988] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/06/2017] [Accepted: 01/14/2017] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To assess clinical service value of STI point-of-care test (POCT) use in a 'sample first' clinical pathway (patients providing samples on arrival at clinic, before clinician consultation). Specific outcomes were: patient acceptability; whether a rapid nucleic acid amplification test (NAAT) for Chlamydia trachomatis/Neisseria gonorrhoeae (CT/NG) could be used as a POCT in practice; feasibility of non-NAAT POCT implementation for Trichomonas vaginalis (TV) and bacterial vaginosis (BV); impact on patient diagnosis and treatment. METHODS Service evaluation in a south London sexual health clinic. Symptomatic female and male patients and sexual contacts of CT/NG-positive individuals provided samples for diagnostic testing on clinic arrival, prior to clinical consultation. Tests included routine culture and microscopy; CT/NG (GeneXpert) NAAT; non-NAAT POCTs for TV and BV. RESULTS All 70 (35 males, 35 females) patients approached participated. The 'sample first' pathway was acceptable, with >90% reporting they were happy to give samples on arrival and receive results in the same visit. Non-NAAT POCT results were available for all patients prior to leaving clinic; rapid CT/NG results were available for only 21.4% (15/70; 5 males, 10 females) of patients prior to leaving clinic. Known negative CT/NG results led to two females avoiding presumptive treatment, and one male receiving treatment directed at possible Mycoplasma genitalium infection causing non-gonococcal urethritis. Non-NAAT POCTs detected more positives than routine microscopy (TV 3 vs 2; BV 24 vs 7), resulting in more patients receiving treatment. CONCLUSIONS A 'sample first' clinical pathway to enable multiple POCT use was acceptable to patients and feasible in a busy sexual health clinic, but rapid CT/NG processing time was too long to enable POCT use. There is need for further development to improve test processing times to enable POC use of rapid NAATs.
Collapse
Affiliation(s)
- Emma M Harding-Esch
- Applied Diagnostic Research and Evaluation Unit, St George's University of London, Institute for Infection & Immunity, London, UK.,HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - Achyuta V Nori
- Applied Diagnostic Research and Evaluation Unit, St George's University of London, Institute for Infection & Immunity, London, UK.,Courtyard Clinic, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Aseel Hegazi
- Courtyard Clinic, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Marcus J Pond
- Applied Diagnostic Research and Evaluation Unit, St George's University of London, Institute for Infection & Immunity, London, UK
| | - Olanike Okolo
- Courtyard Clinic, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Anthony Nardone
- HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - Catherine M Lowndes
- HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - Phillip Hay
- Applied Diagnostic Research and Evaluation Unit, St George's University of London, Institute for Infection & Immunity, London, UK.,Courtyard Clinic, St George's University Hospitals NHS Foundation Trust, London, UK
| | - S Tariq Sadiq
- Applied Diagnostic Research and Evaluation Unit, St George's University of London, Institute for Infection & Immunity, London, UK.,Courtyard Clinic, St George's University Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
6
|
Osterberg EC, Gaither TW, Awad MA, Truesdale MD, Allen I, Sutcliffe S, Breyer BN. Correlation between pubic hair grooming and STIs: results from a nationally representative probability sample. Sex Transm Infect 2016; 93:162-166. [PMID: 27920223 DOI: 10.1136/sextrans-2016-052687] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 10/06/2016] [Accepted: 10/08/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE STIs are the most common infections among adults. Concurrently, pubic hair grooming is prevalent. Small-scale studies have demonstrated a relationship between pubic hair grooming and STIs. We aim to examine this relationship in a large sample of men and women. DESIGN We conducted a probability survey of US residents aged 18-65 years. The survey ascertained self-reported pubic hair grooming practices, sexual behaviours and STI history. We defined extreme grooming as removal of all pubic hair more than 11 times per year and high-frequency grooming as daily/weekly trimming. Cutaneous STIs included herpes, human papillomavirus, syphilis and molluscum. Secretory STIs included gonorrhoea, chlamydia and HIV. We analysed lice separately. RESULTS Of 7580 respondents who completed the survey, 74% reported grooming their pubic hair, 66% of men and 84% of women. After adjusting for age and lifetime sexual partners, ever having groomed was positively associated with a history of self-reported STIs (OR 1.8; 95% CI 1.4 to 2.2), including cutaneous STIs (OR 2.6; CI 1.8 to 3.7), secretory STIs (OR 1.7; CI 1.3 to 2.2) and lice (OR 1.9; CI 1.3 to 2.9). These positive associations were stronger for extreme groomers (OR 4.4; CI 2.9 to 6.8) and high-frequency groomers (OR 3.5; CI 2.3 to 5.4) with cutaneous STIs, and for non-extreme groomers (OR 2.0; CI 1.3 to 3.0) and low-frequency groomers (OR 2.0; CI 1.3 to 3.1) with lice. CONCLUSIONS Among a representative sample of US residents, pubic hair grooming was positively related to self-reported STI history. Further research is warranted to gain insight into STI risk-reduction strategies.
Collapse
Affiliation(s)
- E Charles Osterberg
- Department of Urology, University of California-San Francisco, San Francisco, California, USA.,Department of Surgery, University of Texas-Dell Medical School, Austin, Texas, USA
| | - Thomas W Gaither
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
| | - Mohannad A Awad
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
| | - Matthew D Truesdale
- Department of Urology, University of California-San Francisco, San Francisco, California, USA
| | - Isabel Allen
- Department of Biostatistics and Epidemiology, University of California-San Francisco, San Francisco, California, USA
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University-St. Louis, Missouri, USA
| | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, California, USA.,Department of Biostatistics and Epidemiology, University of California-San Francisco, San Francisco, California, USA
| |
Collapse
|
7
|
Balendra A, Oakeshott P, Hayes K, Planche T, Hay PE. Chlamydia screening in an early pregnancy unit. Sex Transm Infect 2016; 92:231. [PMID: 27099303 DOI: 10.1136/sextrans-2015-052484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 11/28/2015] [Indexed: 11/04/2022] Open
Affiliation(s)
- Anjella Balendra
- Population Health Research Institute, St George's University of London, London, UK
| | - Pippa Oakeshott
- Population Health Research Institute, St George's University of London, London, UK
| | - Kevin Hayes
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Timothy Planche
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Phillip E Hay
- St George's University Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
8
|
Garrett NJ, McGrath N, Mindel A. Advancing STI care in low/middle-income countries: has STI syndromic management reached its use-by date? Sex Transm Infect 2016; 93:4-5. [PMID: 27084840 DOI: 10.1136/sextrans-2016-052581] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/01/2016] [Indexed: 11/04/2022] Open
Affiliation(s)
- Nigel J Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Nuala McGrath
- Faculty of Medicine and Faculty of Human, Social and Mathematical Sciences, University of Southampton, Southampton, UK.,Africa Centre for Population Health, Somkhele, University of KwaZulu-Natal, Durban, South Africa
| | - Adrian Mindel
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
9
|
Affiliation(s)
- Nick Theobald
- STI Foundation, BASHH, Macclesfield, UK Imperial College London, London, UK
| |
Collapse
|
10
|
Badman SG, Causer LM, Guy R, Tabrizi SN, Francis F, Donovan B, Whiley D. A preliminary evaluation of a new GeneXpert (Gx) molecular point-of-care test for the detection of Trichomonas vaginalis. Sex Transm Infect 2015; 92:350-2. [PMID: 26702132 DOI: 10.1136/sextrans-2015-052384] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/28/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Global concerns regarding the prevalence, asymptomatic nature and burden of disease associated with Trichomonas vaginalis (TV) continue. The lack of a portable molecular point-of-care assay to detect this infectious disease has meant that many remote or low-resource settings still need to rely on delayed results from central laboratories and/or syndromic management as treatment strategies. We evaluated the new GeneXpert (Gx) TV nucleic acid amplification test (NAAT) compared with an in-house laboratory NAAT to determine whether it would be suitable for use at the point of care. METHODS In a state-based laboratory and using their in-house NAAT, we selected the first 60 urine samples that were positive and the first 60 that were negative (n=120) in the study period for Gx TV testing in order to reduce collection delays and avoid the freezing of samples. RESULTS Positive percentage agreement between the Gx TV and NAAT was 95.0% (95% CI 86.1% to 99.0%), negative percentage agreement was 100.0% (95% CI 93.5% to 100.0%) and overall percentage agreement was 97.4% (95% CI 92.5% to 99.5%). Three discordant results were detected with each being close to the cycle threshold of detection using the in-house NAAT assay. CONCLUSIONS Findings suggest the Gx TV assay is easy to use and has suitable overall agreement for sexually transmissible infection (STI) testing at the point of care. It may be used in combination with the Gx CT/NG assay to test for all three STIs simultaneously using this portable and modular-based NAAT platform.
Collapse
Affiliation(s)
- S G Badman
- Kirby Institute, UNSW Australia, Sydney, Australia
| | - L M Causer
- Kirby Institute, UNSW Australia, Sydney, Australia
| | - R Guy
- Kirby Institute, UNSW Australia, Sydney, Australia
| | - S N Tabrizi
- University of Melbourne and the Royal Women's Hospital, Melbourne, Australia
| | - F Francis
- Queensland Health Pathology, Townsville, Australia
| | - B Donovan
- Kirby Institute, UNSW Australia, Sydney, Australia Sydney Sexual Health Centre, Sydney, Australia
| | - D Whiley
- University of Queensland-Centre for Clinical Research, Brisbane, Australia
| | | |
Collapse
|
11
|
Gallo MF, Margolis AD, Malotte CK, Rietmeijer CA, Klausner JD, O'Donnell L, Warner L. Sexual abstinence and other behaviours immediately following a new STI diagnosis among STI clinic patients: Findings from the Safe in the City trial. Sex Transm Infect 2015; 92:206-10. [PMID: 26670913 DOI: 10.1136/sextrans-2014-051982] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 11/14/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Few studies have assessed patients' sexual behaviours during the period immediately following a new diagnosis of a curable sexually transmitted infection (STI). METHODS Data were analysed from a behavioural study nested within the Safe in the City trial, which evaluated a video-based STI/HIV prevention intervention in three urban STI clinics. We studied 450 patients who reported having received a new STI diagnosis, or STI treatment, 3 months earlier. Participants reported on whether they seriously considered, attempted and succeeded in adopting seven sex-related behaviours in the interval following the diagnostic visit. We used multivariable logistic regression to identify, among men, correlates of two behaviours related to immediately reducing reinfection risk and preventing further STI transmission: sexual abstinence until participants were adequately treated and abstinence until their partners were tested for STIs. RESULTS Most participants reported successfully abstaining from sex until they were adequately treated for their baseline infection (89%-90%) and from sex with potentially exposed partners until their partners were tested for HIV and other STIs (66%-70%). Among men who intended to be abstinent until they were adequately treated, those who did not discuss the risks with a partner who was possibly exposed were more likely not to be abstinent (OR, 3.7; 95% CI 1.5 to 9.0) than those who had this discussion. Similarly, among men who intended to abstain from sex with any potentially exposed partner until the partner was tested for HIV and other STIs, those who reported not discussing the risks of infecting each other with HIV/STIs were more likely to be sexually active during this period (OR, 3.5; 95% CI 1.6 to 8.1) than were those who reported this communication. CONCLUSIONS Improved partner communication could facilitate an important role in the adoption of protective behaviours in the interval immediately after receiving a new STI diagnosis. TRIAL REGISTRATION NUMBER NCT00137670.
Collapse
Affiliation(s)
- Maria F Gallo
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Andrew D Margolis
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - C Kevin Malotte
- Center for Health Equity Research, California State University, Long Beach, California, USA
| | | | - Jeffrey D Klausner
- David Geffen School of Medicine and Fielding School of Public Health, University of California-Los Angeles, Los Angeles, California, USA
| | - Lydia O'Donnell
- Health and Human Development, EDC, Waltham, Massachusetts, USA
| | - Lee Warner
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | |
Collapse
|
12
|
Nasirian M, Baneshi MR, Kamali K, Haghdoost AA. Population-based survey on STI-associated symptoms and health-seeking behaviours among Iranian adults. Sex Transm Infect 2015; 92:232-9. [PMID: 26399264 DOI: 10.1136/sextrans-2015-052060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 08/31/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Qualified decision-making for the improved management of sexually transmitted infections (STIs) requires various sources of information. We aimed to estimate the STI-associated symptom prevalence and care-seeking patterns in the general population of Iran. METHODS In 2014, using a street-based survey with a standard gender-specific questionnaire on STI-associated symptoms and willingness to seek treatment, we interviewed 9166 Iranian participants, who were selected from among the 18-60-year-old population using multistage sampling. Data were analysed via generalised estimating equation and survey analysis, taking into account a 95% confidence coefficient. RESULTS About 67.3% of participants, mean age 33 years, were 'assumed sexually active' and were therefore eligible for inclusion. Approximately 39.9% (95% CI 28.4% to 51.4%) of women and 17.6% (95% CI 13.9% to 21.6%) of men reported at least one STI-associated symptom in the current week. The occurrence of symptoms decreased with an increase in age in both genders (p<0.05). About 21.2% (95% CI 13.3% to 29.1%) of women and 7.1% (95% CI 5.4% to 7.8%) of men treated symptoms themselves after symptoms first appeared. Of the women and men with symptoms, 37.4% (95% CI 24.8% to 50.0%) and 46.8% (95% CI 39.7% to 51.4%), respectively, sought care. Most women visited a gynaecologist and midwife; men tended to visit a general practitioner and urologist after their symptoms appeared. CONCLUSIONS The prevalence of STI-associated symptoms in Iranian adults is considerable. The results emphasise the need for appropriate and timely STI care and more attention to sexual health promotion to mitigate onward and future infections. Attention to the care-seeking pattern is fundamental to policymaking and planning.
Collapse
Affiliation(s)
- Maryam Nasirian
- Regional Knowledge Hub, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Reza Baneshi
- Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kianoush Kamali
- Center for Disease Control (CDC), Ministry of Health and Medical Education, Tehran, Iran
| | - Ali Akbar Haghdoost
- Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
13
|
den Heijer CDJ, van Liere GAFS, Hoebe CJPA, van Bergen JEAM, Cals JWL, Stals FS, Dukers-Muijrers NHTM. Who tests whom? A comprehensive overview of Chlamydia trachomatis test practices in a Dutch region among different STI care providers for urogenital, anorectal and oropharyngeal sites in young people: a cross-sectional study. Sex Transm Infect 2015; 92:211-7. [PMID: 26265066 DOI: 10.1136/sextrans-2015-052065] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 07/20/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate and compare Chlamydia trachomatis (CT) diagnostic test practices of different sexually transmitted infection (STI) care providers in 16-29 year olds from one defined geographic Dutch region (280,000 inhabitants). Both number and proportion of positive CT tests (ie, test positivity) were assessed, and factors associated with these outcomes. METHODS Data on laboratory testing and diagnosis of urogenital, anorectal and oropharyngeal CT between 2006 and 2010 were retrieved from general practitioners (GPs), gynaecologists, an STI clinic and a population-based chlamydia screening programme. Multivariable regression analyses explored associations between age, sex, test year, socio-economic status (SES) and STI care provider and the outcomes being the number of tests and test positivity. RESULTS Overall, 22,831 tests were performed (1868 positive; 8.2%). Extragenital (ie, anorectal and oropharyngeal) tests accounted for 4% of all tests (7.5% positive) and were almost exclusively (99%) performed by the STI clinic. STI clinics tested most men (37.2% of all tested men), whereas GPs tested most women (29.9% of all tested women). GPs and STI clinics accounted for 73.3% (1326/1808) of urogenital CT diagnoses. In women, the number of tests increased with age, whereas test positivity decreased for all STI care providers. Lower SES was associated with higher test positivity in GP and gynaecology patients. CONCLUSIONS STI clinics performed most CT tests in men, whereas GPs performed most CT tests in women. GPs and STI clinics accounted for the majority of positives. Extragenital CT testing is rarely performed outside the STI clinic and needs to be promoted, especially in men who have sex with men.
Collapse
Affiliation(s)
- Casper D J den Heijer
- Department of Medical Microbiology, Maastricht University Medical Centre, School of Public Health and Primary Care, Maastricht, The Netherlands Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands
| | - G A F S van Liere
- Department of Medical Microbiology, Maastricht University Medical Centre, School of Public Health and Primary Care, Maastricht, The Netherlands Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands
| | - C J P A Hoebe
- Department of Medical Microbiology, Maastricht University Medical Centre, School of Public Health and Primary Care, Maastricht, The Netherlands Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands
| | - J E A M van Bergen
- Department of General Practice, University of Amsterdam, Amsterdam, The Netherlands Soa Aids Nederland, Amsterdam, The Netherlands
| | - J W L Cals
- Department of General Practice, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - F S Stals
- Department of Medical Microbiology, Atrium Medical Centre, Heerlen, The Netherlands
| | - N H T M Dukers-Muijrers
- Department of Medical Microbiology, Maastricht University Medical Centre, School of Public Health and Primary Care, Maastricht, The Netherlands Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands
| |
Collapse
|
14
|
Estcourt CS, Sutcliffe LJ, Copas A, Mercer CH, Roberts TE, Jackson LJ, Symonds M, Tickle L, Muniina P, Rait G, Johnson AM, Aderogba K, Creighton S, Cassell JA. Developing and testing accelerated partner therapy for partner notification for people with genital Chlamydia trachomatis diagnosed in primary care: a pilot randomised controlled trial. Sex Transm Infect 2015; 91:548-54. [PMID: 26019232 PMCID: PMC4680194 DOI: 10.1136/sextrans-2014-051994] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 05/05/2015] [Indexed: 11/07/2022] Open
Abstract
Background Accelerated partner therapy (APT) is a promising partner notification (PN) intervention in specialist sexual health clinic attenders. To address its applicability in primary care, we undertook a pilot randomised controlled trial (RCT) of two APT models in community settings. Methods Three-arm pilot RCT of two adjunct APT interventions: APTHotline (telephone assessment of partner(s) plus standard PN) and APTPharmacy (community pharmacist assessment of partner(s) plus routine PN), versus standard PN alone (patient referral). Index patients were women diagnosed with genital chlamydia in 12 general practices and three community contraception and sexual health (CASH) services in London and south coast of England, randomised between 1 September 2011 and 31 July 2013. Results 199 women described 339 male partners, of whom 313 were reported by the index as contactable. The proportions of contactable partners considered treated within 6 weeks of index diagnosis were APTHotline 39/111 (35%), APTPharmacy 46/100 (46%), standard patient referral 46/102 (45%). Among treated partners, 8/39 (21%) in APTHotline arm were treated via hotline and 14/46 (30%) in APTPharmacy arm were treated via pharmacy. Conclusions The two novel primary care APT models were acceptable, feasible, compliant with regulations and capable of achieving acceptable outcomes within a pilot RCT but intervention uptake was low. Although addition of these interventions to standard PN did not result in a difference between arms, overall PN uptake was higher than previously reported in similar settings, probably as a result of introducing a formal evaluation. Recruitment to an individually randomised trial proved challenging and full evaluation will likely require service-level randomisation. Trial registration number Registered UK Clinical Research Network Study Portfolio id number 10123.
Collapse
Affiliation(s)
- Claudia S Estcourt
- Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Lorna J Sutcliffe
- Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Andrew Copas
- Research Department of Infection & Population Health, University College London, London, UK
| | - Catherine H Mercer
- Research Department of Infection & Population Health, University College London, London, UK
| | - Tracy E Roberts
- Health Economics Unit, School of Population and Health Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Louise J Jackson
- Health Economics Unit, School of Population and Health Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Merle Symonds
- Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Laura Tickle
- Barts Sexual Health Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Pamela Muniina
- Research Department of Infection & Population Health, University College London, London, UK
| | - Greta Rait
- Research Department of Infection & Population Health, University College London, London, UK
| | - Anne M Johnson
- Research Department of Infection & Population Health, University College London, London, UK
| | - Kazeem Aderogba
- Department of Sexual Health, Eastbourne District General Hospital, East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - Sarah Creighton
- Homerton Sexual Health Services, Homerton Hospital, London, UK
| | - Jackie A Cassell
- Division of Primary Care & Public Health, Brighton & Sussex Medical School, University of Brighton, Brighton, UK
| |
Collapse
|
15
|
Smelov V, Eklund C, Arroyo Mühr LS, Hultin E, Dillner J. Are human papillomavirus DNA prevalences providing high-flying estimates of infection? An international survey of HPV detection on environmental surfaces. Sex Transm Infect 2013; 89:627. [PMID: 24191269 DOI: 10.1136/sextrans-2013-051280] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Vitaly Smelov
- Department of Laboratory Medicine, Karolinska Institutet, , Stockholm, Sweden
| | | | | | | | | |
Collapse
|
16
|
Mugo PM, Duncan S, Mwaniki SW, Thiong'o AN, Gichuru E, Okuku HS, van der Elst EM, Smith AD, Graham SM, Sanders EJ. Cross-sectional survey of treatment practices for urethritis at pharmacies, private clinics and government health facilities in coastal Kenya: many missed opportunities for HIV prevention. Sex Transm Infect 2013; 89:583-9. [PMID: 23698510 PMCID: PMC3812900 DOI: 10.1136/sextrans-2012-050979] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background While bacterial sexually transmitted infections (STIs) are important cofactors for HIV transmission, STI control has received little attention in recent years. The aim of this study was to assess STI treatment and HIV testing referral practices among health providers in Kenya. Methods In 2011 we assessed quality of case management for male urethritis at pharmacies, private clinics and government health facilities in coastal Kenya using simulated visits at pharmacies and interviews at pharmacies and health facilities. Quality was assessed using Ministry of Health guidelines. Results Twenty (77%) of 26 pharmacies, 20 (91%) of 22 private clinics and all four government facilities in the study area took part. The median (IQR) number of adult urethritis cases per week was 5 (2–10) at pharmacies, 3 (1–3) at private clinics and 5 (2–17) at government facilities. During simulated visits, 10% of pharmacies prescribed recommended antibiotics at recommended dosages and durations and, during interviews, 28% of pharmacies and 27% of health facilities prescribed recommended antibiotics at recommended dosages and durations. Most regimens were quinolone-based. HIV testing was recommended during 10% of simulated visits, 20% of pharmacy interviews and 25% of health facility interviews. Conclusions In an area of high STI burden, most men with urethritis seek care at pharmacies and private clinics. Most providers do not comply with national guidelines and very few recommend HIV testing. In order to reduce the STI burden and mitigate HIV transmission, there is an urgent need for innovative dissemination of up-to-date guidelines and inclusion of all health providers in HIV/STI programmes.
Collapse
Affiliation(s)
- Peter M Mugo
- HIV Key Populations Studies, Kenya Medical Research Institute, , Kilifi, Kenya
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Allais L. Ethics is not just medical ethics. Sex Transm Infect 2013; 89:304. [PMID: 23687134 DOI: 10.1136/sextrans-2013-051114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Lucy Allais
- Philosophy, University of Sussex, Falmer, Sussex, UK.
| |
Collapse
|
18
|
Abstract
OBJECTIVES We aimed to examine the impact of a point-of-care (POC) test on overtreatment and undertreatment of sexually transmitted infections (STIs) by comparing treatment patterns for gonorrhoea (detected with nucleic acid amplification testing (NAAT)) with trichomoniasis (detected by POC test) for young women seen in an emergency department (ED). METHODS We reviewed the database of a quality improvement (QI) project that aims to improve follow-up care for STIs in the ED. Data included the test result and antibiotic given (if any) during visits by women age 14-21 for whom an STI test was ordered. We generated Shewhart control charts and compared overtreatment and undertreatment rates for gonorrhoea and trichomoniasis using χ(2) testing. RESULTS Of 1877 visits over 18 months, 8.8% of women had gonorrhoea and 16.5% had trichomoniasis. Overtreatment was higher for women with gonorrhoea than trichomoniasis (54% vs 23%, p<0.001). Overtreatment for gonorrhoea decreased from 58% to 47% (p<0.01) and overtreatment for trichomoniasis decreased from 24% to 18% (p<0.01), which corresponded to improvements in patient follow-up for the QI project. Undertreatment was higher for women with gonorrhoea than trichomoniasis (29% vs 21%, p=0.03), and did not change over time. CONCLUSIONS A POC test improves the accuracy of STI care in an ED compared with NAAT testing. An unanticipated benefit of QI efforts to improve patient follow-up is the observed decrease in antibiotic use in the ED. Given the ability of gonorrhoea to develop antibiotic resistance, future efforts should focus on development of an accurate POC test for gonorrhoea.
Collapse
Affiliation(s)
- Jill S Huppert
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229–3039, USA.
| | | | | | | | | |
Collapse
|
19
|
Muzny CA, Rivers CA, Austin EL, Schwebke JR. Trichomonas vaginalis infection among women receiving gynaecological care at an Alabama HIV Clinic. Sex Transm Infect 2013; 89:514-8. [PMID: 23449600 DOI: 10.1136/sextrans-2012-050889] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Trichomoniasis vaginalis is a risk factor for the acquisition and transmission of HIV. The objective of this study was to determine the prevalence of T vaginalis (using culture) among HIV-infected women receiving gynaecological care at an university HIV clinic in Alabama in addition to predictors of infection. METHODS Electronic medical record review of women presenting to the clinic for gynaecological care during 2006-2012 was performed. Demographic and sexual history data was abstracted in addition to absolute CD4 cell count, HIV-1 viral load and sexually transmitted infection (STI) (including T vaginalis) testing results. Analysis was conducted using Stata V.12. RESULTS T vaginalis was prevalent in 17.4% (83/478) of HIV-infected women; other STIs were less prevalent. Among these women, 384 presented for routine STI screening, of which 12% (46/384) were T vaginalis-infected. Younger age, African-American race, lifetime history of tobacco and drug abuse, lack of HIV therapy, HIV-1 viral load >400 copies/ml, and report of seeking gynaecological care for reasons other than routine STI screening (ie, having symptoms) were significant predictors of T vaginalis in univariate analysis. Age, African American race, and report of seeking gynaecological care for reasons other than routine STI screening remained associated with T vaginalis in multivariable analysis. CONCLUSIONS T vaginalis remains highly prevalent among HIV-infected women, a proportion of which may be asymptomatic. If left undiagnosed and untreated, these women may be more likely to transmit HIV. Increased emphasis on screening for high risk sexual behaviours, testing for T vaginalis, and risk reduction counselling is necessary for all HIV-infected women.
Collapse
Affiliation(s)
- Christina A Muzny
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
| | | | | | | |
Collapse
|