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Cunningham VC, Hurdelbrink J, Smith HL, Sittig KR, Veach LA. Impact of education and clinic site champion on extragenital testing for sexually transmitted infections. Int J STD AIDS 2024:9564624241254875. [PMID: 38756016 DOI: 10.1177/09564624241254875] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 05/18/2024]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are on the rise in the United States. Infections at extragenital (EG) sites (throat or rectum) may serve as an overlooked reservoir for STIs. The aims of this project were to determine the proportion of patients receiving EG testing and to observe the impact of an educational intervention. METHODS Phase I included four urgent care clinics and baseline data for adults receiving STI testing (Chlamydia trachomatis and Neisseria gonorrhoeae). Clinics received access to an educational presentation regarding the importance of EG testing. Two of these clinics served as pilot sites for the implementation of self-collection kits. Phase II involved further expansion and utilization of clinic site champions. RESULTS Phase I baseline data indicated that less than 1% of samples from patients receiving STI testing were from EG sites. There was an increase in EG testing after the educational intervention and implementation of self-collection kits. A larger increase in EG testing was seen after utilization of a site champion in Phase II. CONCLUSION EG infections serve as a potential source for STI transmission which makes multi-site testing necessary. Our interventions to improve EG testing were most effective in Phase II after implementing a clinic site champion.
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Louly Nathan A, O'Broin C, Lally A. Increasing awareness of the risk of drug-induced intracranial hypertension in patients with acne requiring treatment for bacterial STI. Sex Transm Infect 2024; 100:121. [PMID: 38050136 DOI: 10.1136/sextrans-2023-055936] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Affiliation(s)
- Anusha Louly Nathan
- The Charles Centre Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - Cathal O'Broin
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland
| | - Aoife Lally
- The Charles Centre Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
- Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
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Parekh VR, Martin SJ, Tyson A, Brkic A, McMinn J, Beaumont C, Bowden FJ. Sexually transmitted infections diagnosed in individuals presenting for forensic and medical care following sexual assault. Sex Transm Infect 2024; 100:45-47. [PMID: 38050157 DOI: 10.1136/sextrans-2023-055944] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/26/2023] [Accepted: 10/08/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND People who report sexual assault express concerns regarding contracting sexually transmitted infection (STI); however, published literature regarding the risk of STI transmission in this context is sparse. METHOD We audited STI and blood-borne virus (BBV) testing at a forensic and medical sexual assault care service in the Australian Capital Territory between 2004 and 2022. Eligibility for testing among 1928 presentations was defined based on risk (eg, reported penetration). Testing at presentation included chlamydia and gonorrhoea 1850, syphilis and BBV 1472, and after 2-6 weeks, 890 out of 1928 (46.2%) and after 3 months 881 out of 1928 (45.7%), respectively. RESULTS At presentation, 100 out of 1928 (5.2%) individuals were diagnosed with chlamydia, of those, 95 out of 1799 (5.3%) were female, and 5 out of 121 (4.1%) were male. Gonorrhoea was diagnosed in 7 out of 1920 (0.4%), 5 out of 95 female and 2 out of 5 male. Hepatitis B, which was all pre-existing, was diagnosed in 5 out of 1799 (0.3%). Overall, chlamydia prophylaxis was given to 203 out of 1928 (10.5%) and HIV post-exposure prophylaxis to 141 out of 1928 (7.3%).At 2-6 weeks of follow-up, 10 out of 890 (1.1%) individuals were diagnosed with chlamydia, with no gonorrhoea diagnosed. There were no cases of syphilis, hepatitis B or HIV diagnosed at 3-month serology testing in 881 individuals. Chlamydia detection at follow-up was more common in the group aged 15-29 years. Of those provided with chlamydia prophylaxis, 203 out of 1928, only 16 out of 203 (7.9%) were diagnosed with chlamydia. CONCLUSIONS The offer of STI testing is almost universally accepted by individuals presenting for post-sexual assault care. There were no identifiable factors to justify the routine use of chlamydia prophylaxis. STI testing provided an opportunity for screening and should remain part of the clinical care of people who report sexual assault.
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Affiliation(s)
- Vanita R Parekh
- Clinical Forensic Medical Services, Canberra Health Services, Canberra, Australian Capital Territory, Australia
- School of Clinical Medicine, Canberra Hospital Campus, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sarah J Martin
- Clinical Forensic Medical Services, Canberra Health Services, Canberra, Australian Capital Territory, Australia
- School of Clinical Medicine, Canberra Hospital Campus, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Alexandra Tyson
- Clinical Forensic Medical Services, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Anna Brkic
- Clinical Forensic Medical Services, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Janine McMinn
- Clinical Forensic Medical Services, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Cassandra Beaumont
- Canberra Hospital, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Francis J Bowden
- Faculty of Medicine, Monash University School of Rural Health - Bendigo, Bendigo, Victoria, Australia
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Alexiou ZW, van Aar F, Hoenderboom BM, Morre SA, Heijne JCM. Trends in Chlamydia trachomatis IgG seroprevalence in the general population of the Netherlands over 20 years. Sex Transm Infect 2024; 100:31-38. [PMID: 37985129 PMCID: PMC10850662 DOI: 10.1136/sextrans-2023-055888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/08/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVES To report sex and age-specific Chlamydia trachomatis (Ct) seroprevalence estimates in the general population of the Netherlands between 1996 and 2017 and identify risk factors associated with Ct seropositivity. METHODS Participants (n=5158, aged 15-59 years) were included from three independent nationwide population-based serosurveillance studies in 1996, 2007 and 2017. Participants completed a questionnaire on demographics and sexual behaviour. Serum antibodies were analysed using Medac Ct IgG ELISA test. Census weights were assigned to achieve seroprevalence estimates representative of the general Dutch population. Weighted seroprevalence estimates were stratified by gender, age and birth cohort. Trends and risk factors in men and women were identified using multivariable logistic regression. RESULTS Weighted overall Ct seroprevalence was 10.5% (95% CI: 9.2% to 12.0%) in women and 5.8% (95% CI: 4.7% to 7.0%) in men. Among women <25 years, there was a non-significant increase in seroprevalence from 5.9% (95% CI 3.7% to 9.2%) in 1996, to 7.6% (95% CI 5.1% to 11.1%) in 2007 and 8.8% (95% CI 5.5% to 13.9%) in 2017. Among women ≥25 years, the seroprevalence significantly decreased from 15.6% (95% CI: 12.2% to 19.7%) in 1996 to 9.5% (95% CI: 7.2% to 12.4%) in 2007 but did not further drop (11.2% (95% CI 8.1% to 15.3%) in 2017). In men, we did not observe trends between study rounds. In both men and women, having a non-Western migration background was a risk factor for seropositivity. In women, having had a prior sexually transmitted infection and ≥2 recent sex partners were risk factors for seropositivity as well. CONCLUSIONS We have not found evidence for a decrease in population seroprevalence in those under 25 years old despite decades of intensified testing-and-treatment efforts in the Netherlands. This suggests further monitoring of Ct burden in the general population is needed. If serum banks are used for this, specifically individuals <25 years old and with diverse migration backgrounds should be included.
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Affiliation(s)
- Zoïe Willemijn Alexiou
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Genetics and Cell Biology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Fleur van Aar
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Bernice Maria Hoenderboom
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Servaas Antonie Morre
- Department of Genetics and Cell Biology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Dutch Chlamydia trachomatis Reference Laboratory, Department of Medical Microbiology, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, India
| | - Janneke Cornelia Maria Heijne
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Clay PA, Pollock ED, Copen CE, Anyalechi EG, Danavall DC, Hong J, Khosropour CM, Galloway E, Spicknall IH. Using infection prevalence, seroprevalence and case report data to estimate chlamydial infection incidence. Sex Transm Infect 2023; 99:513-519. [PMID: 37648446 DOI: 10.1136/sextrans-2023-055808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/12/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES To measure the effectiveness of chlamydia control strategies, we must estimate infection incidence over time. Available data, including survey-based infection prevalence and case reports, have limitations as proxies for infection incidence. We therefore developed a novel method for estimating chlamydial incidence. METHODS We linked a susceptible infectious mathematical model to serodynamics data from the National Health and Nutritional Examination Survey, as well as to annual case reports. We created four iterations of this model, varying assumptions about how the method of infection clearance (via treatment seeking, routine screening or natural clearance) relates to long-term seropositivity. Using these models, we estimated annual infection incidence for women aged 18-24 and 25-37 years in 2014. To assess model plausibility, we also estimated natural clearance for the same groups. RESULTS Of the four models we analysed, the model that best explained the empirical data was the one in which longer-lasting infections, natural clearance and symptomatic infections all increased the probability of long-term seroconversion. Using this model, we estimated 5910 (quartile (Q)1, 5330; Q3, 6500) incident infections per 100 000 women aged 18-24 years and 2790 (Q1, 2500; Q3, 3090) incident infections per 100 000 women aged 25-37 years in 2014. Furthermore, we estimated that natural clearance rates increased with age. CONCLUSIONS Our method can be used to estimate the number of chlamydia infections each year, and thus whether infection incidence increases or decreases over time and after policy changes. Furthermore, our results suggest that clearance via medical intervention may lead to short-term or no seroconversion, and the duration of untreated chlamydial infection may vary with age, underlining the complexity of chlamydial infection dynamics.
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Affiliation(s)
- Patrick A Clay
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily D Pollock
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Casey E Copen
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - E Gloria Anyalechi
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Damien C Danavall
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jaeyoung Hong
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Eboni Galloway
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ian H Spicknall
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Dalmau M, Ware R, Field E, Sanguineti E, Si D, Lambert S. Effect of COVID-19 pandemic restrictions on chlamydia and gonorrhoea notifications and testing in Queensland, Australia: an interrupted time series analysis. Sex Transm Infect 2023; 99:447-454. [PMID: 36823113 DOI: 10.1136/sextrans-2022-055656] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/10/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE To investigate trends in testing and notifications of chlamydia and gonorrhoea during the COVID-19 pandemic in Queensland, Australia. METHODS Statewide disease notification and testing data between 1 January 2015 and 31 December 2021 were modelled using interrupted time series. A segmented regression model estimated the pre-pandemic trend and observed effect of the COVID-19 pandemic response on weekly chlamydia notifications, monthly gonorrhoea notifications and monthly testing figures. The intervention time point was 29 March 2020, when key COVID-19 public health restrictions were introduced. RESULTS There were 158 064 chlamydia and 33 404 gonorrhoea notifications and 2 107 057 combined chlamydia and gonorrhoea tests across the 72-month study period. All three studied outcomes were increasing prior to the COVID-19 pandemic. Immediate declines were observed for all studied outcomes. Directly after COVID-19 restrictions were introduced, declines were observed for all chlamydia notifications (mean decrease 48.4 notifications/week, 95% CI -77.1 to -19.6), gonorrhoea notifications among males (mean decrease 39.1 notifications/month, 95% CI -73.9 to -4.3) and combined testing (mean decrease 4262 tests/month, 95% CI -6646 to -1877). The immediate decline was more pronounced among males for both conditions. By the end of the study period, only monthly gonorrhoea notifications showed a continuing decline (mean decrease 3.3 notifications/month, p<0.001). CONCLUSION There is a difference between the immediate and sustained impact of the COVID-19 pandemic on reported chlamydia and gonorrhoea notifications and testing in Queensland, Australia. This prompts considerations for disease surveillance and management in future pandemics. Possible explanations for our findings are an interruption or change to healthcare services during the pandemic, reduced or changed sexual practices or changed disease transmission patterns due to international travel restrictions. As pandemic priorities shift, STIs remain an important public health priority to be addressed.
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Affiliation(s)
- Marguerite Dalmau
- Communicable Diseases Branch, Department of Health, Queensland Health, Brisbane, Queensland, Australia
- National Centre for Epidemiology and Population Health, Canberra, Australian Capital Territory, Australia
| | - Robert Ware
- Menzies Health Institute, Griffith University, Nathan, Queensland, Australia
| | - Emma Field
- National Centre for Epidemiology and Population Health, Canberra, Australian Capital Territory, Australia
| | - Emma Sanguineti
- Communicable Diseases Branch, Department of Health, Queensland Health, Brisbane, Queensland, Australia
| | - Damin Si
- Communicable Diseases Branch, Department of Health, Queensland Health, Brisbane, Queensland, Australia
| | - Stephen Lambert
- Communicable Diseases Branch, Department of Health, Queensland Health, Brisbane, Queensland, Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Westmead, New South Wales, Australia
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Rowlinson E, Hughes JP, Khosropour CM, Manhart LE, Golden MR, Barbee LA. Inadequate performance of a risk score to predict asymptomatic Neisseria gonorrhoeae and Chlamydia trachomatis infection among cisgender men who have sex with men. Sex Transm Infect 2023; 99:380-385. [PMID: 36609346 PMCID: PMC10323043 DOI: 10.1136/sextrans-2022-055608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/26/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Epidemiological treatment of persons who are sexual contacts to partners with Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) often results in treatment of uninfected persons, which may increase the risk of antibiotic-resistant infections. We sought to identify the predictors of NG and/or CT infections to develop a risk score that could be used to limit epidemiological treatment to persons most likely to have these infections. METHODS We included visits to the Public Health - Seattle & King County Sexual Health Clinic by asymptomatic cisgender men who have sex with men (MSM) aged ≥18 who presented as a sexual contact to partner(s) with CT or NG infection between 2011 and 2019. We used logistic regression to estimate the odds of CT and/or NG infections associated with demographic and clinical predictors, selecting the final set of predictors using the Akaike information criteria and obtaining score weights from model coefficients. We used a cross-validation approach to obtain average model discrimination from each of 10 models, leaving out 10% of the data, and evaluated sensitivity and specificity at various score cut-offs. RESULTS The final model for predicting NG or CT infection included seven predictors (age <35 years, HIV status, receptive oral sex in the prior 2 months, CT diagnosis, condomless receptive anal intercourse, condomless insertive anal intercourse and methamphetamine use in the prior 12 months). Model discrimination, as measured by the receiver operating curve, was 0.60 (95% CI 0.54 to 0.66). Sensitivity for detection of infection was ≥90% for scores ≥3, ≥5 and ≥7; specificity for these cut-offs was <16%. At scores ≥9, ≥12 and ≥14, specificity increased but sensitivity decreased to ≤76%. CONCLUSIONS Our risk score did not sufficiently discriminate between asymptomatic MSM with and without NG/CT infection. Additional studies evaluating epidemiological treatment as a standard of care in diverse populations are needed to guide best practices in the management of contacts to NG/CT infection.
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Affiliation(s)
- Emily Rowlinson
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - James P Hughes
- Biostatistics, University of Washington, Seattle, Washington, USA
| | | | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Global Health, University of Washington, Seattle, Washington, USA
| | | | - Lindley A Barbee
- Medicine, University of Washington, Seattle, Washington, USA
- HIV/STD, Public Health - Seattle & King County, Seattle, Washington, USA
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Rasul R, McIver R, Patel P, Foster R, McNulty A. Non-empirical management of asymptomatic chlamydia and gonorrhoea reduces unnecessary antibiotic use fivefold: a before and after study. Sex Transm Infect 2023; 99:30-34. [PMID: 35383124 DOI: 10.1136/sextrans-2021-055382] [Citation(s) in RCA: 1] [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: 12/20/2021] [Accepted: 03/13/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES In 2019, informed by favourable patient and provider acceptability surveys and concerns about antimicrobial resistance, Sydney Sexual Health Centre stopped routinely providing empirical antibiotic treatment to asymptomatic contacts of Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoea (gonorrhoea). We aimed to assess if this policy change had any negative impact on patient outcomes. METHODS A retrospective file review of people who presented as asymptomatic contacts of chlamydia and gonorrhoea cases before and after the policy change was conducted. Data on infection type, test results and treatment were extracted. For contacts who tested positive and were treated non-empirically, additional data were reviewed including sexual activity and symptom or complication development between testing and treatment, time from testing to notification and treatment and loss to follow-up. RESULTS Of 1194 asymptomatic sexual contacts of chlamydia or gonorrhoea, most tested negative to both infections (814, 68%). All contacts with a positive result who were not treated empirically were notified of their result and 173 (99%) were treated within a mean time of 5 days. More contacts were overtreated in 2018 (n=355, 58%) under the empirical treatment model compared with 2019 (n=58, 11%, p≤0.001). There was no significant difference in the proportion of contacts who tested positive and were treated (p=0.111) or developed symptoms (p=0.413) before and after the policy change and no contacts who were treated non-empirically developed complications of pelvic inflammatory disease, epididymitis or proctitis between testing and treatment. CONCLUSION In this population, a switch from empirically treating all asymptomatic contacts to treating only those who tested positive significantly reduced antibiotic overuse with minimal adverse outcomes. Our findings support results-directed treatment for asymptomatic sexual contacts of chlamydia and gonorrhoea.
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Affiliation(s)
- Rafeeqah Rasul
- School of Population Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Ruthy McIver
- Sydney Sexual Health Centre, Sydney, New South Wales, Australia
| | - Prital Patel
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rosalind Foster
- Sydney Sexual Health Centre, Sydney, New South Wales, Australia.,The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Anna McNulty
- School of Population Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia.,Sydney Sexual Health Centre, Sydney, New South Wales, Australia
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Vanbaelen T, Reyniers T, Rotsaert A, Vuylsteke B, Florence E, Kenyon C, De Baetselier I. Prophylactic use of antibiotics for sexually transmitted infections: awareness and use among HIV PrEP users in Belgium. Sex Transm Infect 2022; 98:625. [PMID: 35896415 PMCID: PMC9685694 DOI: 10.1136/sextrans-2022-055511] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Thibaut Vanbaelen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Anke Rotsaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Eric Florence
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Chris Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Irith De Baetselier
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Dukers-Muijrers NHTM, Schim van der Loeff M, Wolffs P, Bruisten SM, Götz HM, Heijman T, Zondag H, Lucchesi M, De Vries H, Hoebe CJPA. Incident urogenital and anorectal Chlamydia trachomatis in women: the role of sexual exposure and autoinoculation: a multicentre observational study (FemCure). Sex Transm Infect 2022; 98:427-437. [PMID: 35039435 DOI: 10.1136/sextrans-2021-055032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/21/2021] [Accepted: 11/08/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Anorectal infections with Chlamydia trachomatis (CT) are common in women visiting STI outpatient clinics. We here evaluated the risk posed by sexual exposure and by alternate anatomical site infection for incident anorectal and urogenital CT. METHODS Prospective multicentre cohort study, FemCure. Participants were treated for CT, and after 4, 6, 8, 10 and 12 weeks, they self-collected anorectal and urogenital samples (swabs) for CT-DNA testing. We calculated the proportion with incident CT, that is, CT incidence (at weeks 6-12) by 2-week time-periods. Compared with no exposure (A), we estimated the risk of incident CT for (B) sexual exposure, (C) alternate site anatomic site infection and (D) both, adjusted for confounders and expressed as adjusted ORs with 95% CIs. RESULTS We analysed data of 385 participants contributing 1540 2-week periods. The anorectal CT incidence was 2.9% (39/1343) (95 CI 1.8 to 3.6); 1.3% (A), 1.3% (B), 27.8% (C) and 36.7% (D). The ORs were: 0.91 (95% CI 0.32 to 2.60) (B), 26.0 (95% CI 7.16 to 94.34) (C), 44.26 (95% CI 14.38 to 136.21) (D).The urogenital CT incidence was 3.3% (47/1428) (95% CI 2.4 to 4.4); 0.7% (A), 1.9% (B), 13.9% (C) and 25.4% (D). The ORs were: 2.73 (95% CI 0.87 to 8.61) (B), 21.77 (95% CI 6.70 to 70 71) (C) and 49.66 (95% CI 15.37 to 160.41) (D). CONCLUSIONS After initial treatment, an alternate anatomical site CT infection increased the risk for an incident CT in women, especially when also sex was reported. This may suggest a key role for autoinoculation in the re-establishment or persistence of urogenital and anorectal chlamydia infections.
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Affiliation(s)
- Nicole H T M Dukers-Muijrers
- Department of Health Promotion, CAPHRI, University of Maastricht, Maastricht, The Netherlands .,Department of Sexual Health, Infectious Diseases, and Environment, Public Health Service South Limburg, Heerlen, The Netherlands
| | - Maarten Schim van der Loeff
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam Infection & Immunity Institute (AII), Amsterdam University Medical Center (UMC), Amsterdam, The Netherlands
| | - Petra Wolffs
- Department of Medical Microbiology, CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sylvia M Bruisten
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.,Department of Medical Microbiology, Amsterdam Infection & Immunity Institute (AII), Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
| | - Hannelore M Götz
- Department of Infectious Disease Control, Rotterdam Rijnmond Public Health Service, Rotterdam, The Netherlands.,Center for Infectious Diseases Control, Rijksinstituut voor Volksgezondheid en Milieu, Bilthoven, The Netherlands.,Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Titia Heijman
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Helene Zondag
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Mayk Lucchesi
- Department of Medical Microbiology, CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Henry De Vries
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.,Department of Dermatology, Amsterdam Infection & Immunity Institute (AII), Amsterdam University Medical Center (UMC), Amsterdam, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases, and Environment, Public Health Service South Limburg, Heerlen, The Netherlands.,Department of Medical Microbiology, CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Social Medicine, CAPHRI, Maastricht University Medical Centre, Maastricht, Netherlands
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11
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Huntington S, Weston G, Adams E. Assessing the clinical impact and resource use of a 30-minute chlamydia and gonorrhoea point-of-care test at three sexual health services. Ther Adv Infect Dis 2021; 8:20499361211061645. [PMID: 34881023 PMCID: PMC8647227 DOI: 10.1177/20499361211061645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/29/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives To assess clinical metrics and resource use of a 30-minute point-of-care test (POCT) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) compared to laboratory-based testing. Methods Three English sexual health services (SHSs) were recruited as part of a study. Existing processes for CT/NG testing and treatment were assessed, and adaptions to incorporate the CT/NG POCT were developed during semi-structured interviews. Staff time and consumables data were collected by clinic staff prior to and following introduction of the POCT. Results SHSs selected patient groups for whom the CT/NG POCT would be used. Testing and treatment process data were collected for 225 patients (n = 118 POC; n = 107 standard). The percentage of patients receiving unnecessary CT treatment was 5% (5/95) and 13% (12/93) for POC and standard care respectively. The average CT/NG pathway cost varied and was on average £61.55 for POC and £50.88 for standard care. For the two SHSs where the POCT was used during a patient's visit, for standard and POC respectively, the average time to CT treatment was 10.0 and 0.0 days and to NG treatment, 0.3 and 0.0 days. Conclusion Use of a 30-minute POCT at three SHSs yielded clinical benefits by reducing time to treatment and unnecessary CT treatment.
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12
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Causer L, Liu B, Watts C, McManus H, Donovan B, Ward J, Guy R. Hospitalisations for pelvic inflammatory disease in young Aboriginal women living in remote Australia: the role of chlamydia and gonorrhoea. Sex Transm Infect 2021; 98:445-447. [PMID: 34887352 DOI: 10.1136/sextrans-2021-055242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/21/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Aboriginal women living in remote Australia experience a high burden of both chlamydia and gonorrhoea infections and disproportionately high rates of pelvic inflammatory disease (PID). We estimated for the first time the fraction of PID attributable to these infections in young Aboriginal women living in these settings. METHODS Using published data from two large Australian studies (2002-2013; 2010-2014), we calculated the fraction of emergency department presentations and hospitalisations for PID attributable to chlamydia and/or gonorrhoea infection in Aboriginal women aged 16-29 years living in remote Australia. We used a Monte Carlo simulation to estimate the mean and 95% CIs for the assumed prevalence and population attributable fractions for PID for infection stratifications (chlamydia only, gonorrhoea only and dual infection) as well as for any infection (chlamydia and/or gonorrhoea). Additional outputs were calculated for chlamydia infection with/without gonorrhoea coinfection, and vice versa. RESULTS The prevalence of chlamydia only was 12.9% (95% CI: 11.6% to 14.2%), gonorrhoea only was 7.8% (95% CI: 6.6% to 8.9%) and dual infection was 6.5% (95% CI: 5.8% to 7.2%); rate ratios of PID were 1.9 (95% CI: 1.5 to 2.3), 5.2 (95% CI: 4.3 to 6.4) and 4.6 (95% CI: 3.8 to 5.5), respectively. The overall fraction of PID attributable to chlamydia and/or gonorrhoea was 40.2% (95% CI: 36.0% to 44.4%); any gonorrhoea was 33.4% (95% CI: 29.2% to 37.8%) and any chlamydia was 20.6% (95% CI: 16.9% to 24.6%). CONCLUSION Our study demonstrates the importance of calculating the fraction of PID related to chlamydia and gonorrhoea in the local context, demonstrating the major contribution gonorrhoea makes to PID hospitalisations among Australian Aboriginal women living in remote settings. To significantly and sustainably reduce the unacceptable rate of PID in this population, strategies are urgently needed to improve timely testing and treatment and recognition and management of PID in primary care.
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Affiliation(s)
- Louise Causer
- Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Bette Liu
- School of Population Health, UNSW, Sydney, New South Wales, Australia
| | - Caroline Watts
- Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Hamish McManus
- Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Basil Donovan
- Kirby Institute, UNSW, Sydney, New South Wales, Australia.,Sydney Sexual Health Centre, Sydney, New South Wales, Australia
| | - James Ward
- Poche Centre for Indigenous Health, The University of Queensland-Saint Lucia Campus, Saint Lucia, Queensland, Australia
| | - Rebecca Guy
- Kirby Institute, UNSW, Sydney, New South Wales, Australia
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13
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Kuitunen I, Ponkilainen V. COVID-19-related nationwide lockdown did not reduce the reported diagnoses of Chlamydia trachomatis and Neisseria gonorrhoeae in Finland. Sex Transm Infect 2021; 97:550. [PMID: 33397798 PMCID: PMC7783371 DOI: 10.1136/sextrans-2020-054881] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/13/2020] [Accepted: 12/22/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- Ilari Kuitunen
- Mikkeli Central Hospital, Mikkeli, Finland
- School of Medicine, University of Eastern Finland, Kuopio, Finland
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14
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van Wees DA, Diexer S, Rozhnova G, Matser A, den Daas C, Heijne J, Kretzschmar M. Quantifying heterogeneity in sexual behaviour and distribution of STIs before and after pre-exposure prophylaxis among men who have sex with men. Sex Transm Infect 2021; 98:395-400. [PMID: 34716228 DOI: 10.1136/sextrans-2021-055227] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/21/2021] [Accepted: 10/14/2021] [Indexed: 11/03/2022] Open
Abstract
Objectives: Pre-exposure prophylaxis (PrEP) use may influence sexual behaviour and transmission of STIs among men who have sex with men (MSM). We aimed to quantify the distribution of STI diagnoses among MSM in the Netherlands based on their sexual behaviour before and after the introduction of PrEP.Methods: HIV-negative MSM participating in a prospective cohort study (Amsterdam Cohort Studies) completed questionnaires about sexual behaviour and were tested for STI/HIV during biannual visits (2009-2019). We developed a sexual behaviour risk score predictive of STI diagnosis and used it to calculate Gini coefficients for gonorrhoea, chlamydia and syphilis diagnoses in the period before (2009 to mid-2015) and after PrEP (mid-2015 to 2019). Gini coefficients close to zero indicate that STI diagnoses are homogeneously distributed over the population, and close to one indicate that STI diagnoses are concentrated in individuals with a higher risk score.Results: The sexual behaviour risk score (n=630, n visits=10 677) ranged between 0.00 (low risk) and 3.61 (high risk), and the mean risk score increased from 0.70 (SD=0.66) before to 0.93 (SD=0.80) after PrEP. Positivity rates for chlamydia (4%) and syphilis (1%) remained relatively stable, but the positivity rate for gonorrhoea increased from 4% before to 6% after PrEP. Gini coefficients increased from 0.37 (95% CI 0.30 to 0.43) to 0.43 (95% CI 0.36 to 0.49) for chlamydia, and from 0.37 (95% CI 0.19 to 0.52) to 0.50 (95% CI 0.32 to 0.66) for syphilis comparing before to after PrEP. The Gini coefficient for gonorrhoea remained stable at 0.46 (95% CI 0.40 to 0.52) before and after PrEP.Conclusions: MSM engaged in more high-risk sexual behaviour and gonorrhoea diagnoses increased after PrEP was introduced. Chlamydia and syphilis diagnoses have become more concentrated in a high-risk subgroup. Monitoring the impact of increasing PrEP coverage on sexual behaviour and STI incidence is important. Improved STI prevention is needed, especially for high-risk MSM.
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Affiliation(s)
- Daphne Amanda van Wees
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands .,Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Sophie Diexer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ganna Rozhnova
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,BioISI - Biosystems & Integrative Sciences Institute, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Amy Matser
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Chantal den Daas
- Aberdeen Health Psychology Group, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK
| | - Janneke Heijne
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Mirjam Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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15
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Ong JJ, Fairley CK, Hocking JS, Turner KME, Booton R, Tse D, Wong WWCW. Preferences for chlamydia testing and management in Hong Kong: a discrete choice experiment. Sex Transm Infect 2021; 98:408-413. [PMID: 34535577 DOI: 10.1136/sextrans-2021-055182] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/18/2021] [Accepted: 09/05/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES As most chlamydia cases are asymptomatic, regular testing and timely management may be necessary for control. We aimed to determine the preferences of people living in Hong Kong for chlamydia testing and management services. METHODS An online panel of sexually active individuals living in Hong Kong completed the survey with two discrete choice experiments (DCEs). The first DCE examined the preferred attributes of a chlamydia testing service (cost, location, appointment time, speed of results, delivery of results and availability of other STI testing). The second DCE examined the preferred attributes of a chlamydia management service (cost, access to patient-delivered partner therapy, location, travel time, type of person consulted and attitude of staff). RESULTS In total, 520 individuals participated: average age 36.8 years (SD 9.9), 40% males and 66% had a bachelor's degree or higher. Choosing to test was most influenced by cost, followed by speed of results, delivery of results, extra STI testing, appointment available and the least important was the location of testing. Choosing to attend for management was most influenced by staff's attitude, followed by cost, who they consult, access to patient-delivered partner therapy, travel time and the least important was treatment location. CONCLUSION To design effective chlamydia testing and management services, it is vital to respond to patient needs and preferences. For people living in Hong Kong, cost and staff attitude were the most important factors for deciding whether to test or be managed for chlamydia, respectively.
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Affiliation(s)
- Jason J Ong
- Central Cllinical School, Monash University, Melbourne, Victoria, Australia .,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Central Cllinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Katy M E Turner
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | - Ross Booton
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | - Desiree Tse
- Department of Family Medicine & Primary Care, University of Hong Kong, Hong Kong, Hong Kong
| | - William W C W Wong
- Department of Family Medicine & Primary Care, University of Hong Kong, Hong Kong, Hong Kong.,Department of Family Medicine & Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People's Republic of China
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16
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Cole MJ, Davis GS, Fifer H, Saunders JM, Unemo M, Hadad R, Roberts DJ, Fazal M, Day MJ, Minshull J, Muir P, Horner PJ, Gill NO, Folkard K. No widespread dissemination of Chlamydia trachomatis diagnostic-escape variants and the impact of Neisseria gonorrhoeae positivity on the Aptima Combo 2 assay. Sex Transm Infect 2021; 98:366-370. [PMID: 34510008 DOI: 10.1136/sextrans-2021-054988] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/28/2021] [Accepted: 09/04/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES A Finnish Chlamydia trachomatis (CT) new variant was detected in 2019 that escaped detection in the Hologic Aptima Combo 2 (AC2) assay due to a C1515T mutation in the CT 23S rRNA target region. Reflex testing of CT-negative/CT-equivocal specimens as well as those positive for Neisseria gonorrhoeae (NG) with the Hologic Aptima CT (ACT) assay was recommended to identify any CT variants. METHODS From June to October 2019, specimens with discrepant AC2/ACT CT results were submitted to Public Health England and screened for detectable CT DNA using an inhouse real-time (RT)-PCR. When enough DNA was present, partial CT 23S rRNA gene sequencing was performed. Analysis of available relative light units and interpretative data was performed. RESULTS A total of 317 discordant AC2/ACT specimens were collected from 315 patients. Three hundred were tested on the RT-PCR; 53.3% (n=160) were negative and 46.7% (n=140) were positive. Due to low DNA load in most specimens, sequencing was successful for only 36 specimens. The CT 23S rRNA wild-type sequence was present in 32 specimens, and two variants with C1514T or G1523A mutation were detected in four specimens from three patients. Of the discordant specimens with NG interpretation, 36.6% of NG-negative/CT-negative AC2 specimens had detectable CT DNA on the inhouse RT-PCR vs 53.3% of NG-positive/CT-negative specimens. CONCLUSIONS No widespread dissemination of AC2 diagnostic-escape CT variants has occurred in England. We however identified the impact of NG positivity on the discordant AC2/ACT specimens; a proportion appeared due to NG positivity and the associated NG signal, rather than any diagnostic-escape variants or low DNA load. Several patients with gonorrhoea may therefore receive false-negative AC2 CT results. Single diagnostic targets and multiplex diagnostic assays have their limitations such as providing selection pressure for escape mutants and potentially reduced sensitivity, respectively. These limitations must be considered when establishing diagnostic pathways.
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Affiliation(s)
| | - Grahame S Davis
- National Infection Service, Public Health England, London, UK
| | - Helen Fifer
- National Infection Service, Public Health England, London, UK
| | - John Michael Saunders
- National Infection Service, Public Health England, London, UK.,Research Department of Infection and Population Health, University College London, London, UK
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden
| | - Ronza Hadad
- WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Orebro, Sweden
| | - David J Roberts
- National Infection Service, Public Health England, London, UK
| | - Mohammed Fazal
- National Infection Service, Public Health England, London, UK
| | | | - Jack Minshull
- National Infection Service, Public Health England, London, UK
| | - Peter Muir
- Bristol Public Health Laboratory, Public Health England, Bristol, UK
| | - Paddy J Horner
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,Bristol Sexual Health Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Noel O Gill
- National Infection Service, Public Health England, London, UK
| | - Kate Folkard
- National Infection Service, Public Health England, London, UK
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17
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Pearce E, Jolly K, Harris IM, Adriano A, Moore D, Price M, Ross J. What is the effectiveness of community-based health promotion campaigns on chlamydia screening uptake in young people and what barriers and facilitators have been identified? A mixed-methods systematic review. Sex Transm Infect 2021; 98:62-69. [PMID: 34446545 PMCID: PMC8785066 DOI: 10.1136/sextrans-2021-055142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/10/2021] [Accepted: 08/13/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The UK National Chlamydia Screening Programme uses an opportunistic approach. Many programmes use campaigns to raise awareness of chlamydia screening in young people. This review aimed to assess the effectiveness of campaigns on uptake of chlamydia screening in young people. METHODS We conducted a mixed-methods systematic review of articles assessing the outcomes of community-based health-promotion campaigns to increase chlamydia screening in young people, their experiences of the campaigns and other facilitators and barriers to the conduct of the campaigns. We searched four databases for quantitative and qualitative studies with no language restrictions. MAIN RESULTS From 10 329 records identified, 19 studies (20 articles) were included in the review: 14 quantitative, 2 qualitative and 3 mixed methods. All studies with quantitative outcomes were before-after study designs or interrupted time series. The prediction interval for relative change (RC) in test counts ranged from 0.95 to 1.56, with a summary pooled estimate of RC 1.22 (95% CI 1.14 to 1.30, 13 studies, I2=97%). For test positivity rate, 95% prediction interval was 0.59 to 1.48, with a summary pooled estimate of RC 0.93 (95% CI 0.81 to 1.07, 8 studies, I2=91.8%). Large variation in characteristics between studies precluded exploring outcomes by type of campaign components. Seven major qualitative themes to improve screening were identified: targeting of campaigns; quality of materials and message; language; anonymity; use of technology; relevance; and variety of testing options. CONCLUSIONS Health promotion campaigns aiming to increase chlamydia testing in those aged 15-24 years may show some effectiveness in increasing overall numbers of tests, however numbers of positive tests do not follow the same trend. Qualitative findings indicate that campaigns require clear, relevant messaging that displays the full range of testing options and assures anonymity in order to be effective.
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Affiliation(s)
- Emma Pearce
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Ada Adriano
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Malcolm Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan Ross
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
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18
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Visser M, Dvorakova M, van Aar F, Heijne JCM. Increased risk of subsequent chlamydia infection among women not tested at the anorectal anatomical location. Sex Transm Infect 2021; 98:317-322. [PMID: 34272331 DOI: 10.1136/sextrans-2021-054991] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/26/2021] [Accepted: 06/24/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Universal anorectal testing for Chlamydia trachomatis (chlamydia) among women is not recommended in many countries, while anorectal chlamydia infections are common. Missed anorectal infections might cause sequelae at the genital site if autoinoculation from the anorectum is possible, but evidence is limited. This study investigates the association between potentially missed anorectal infections and subsequent genital chlamydia infections in women, using not being tested at the anorectal site as a proxy for having a potentially missed anorectal infection. METHODS We included all women with a repeat chlamydia test within 1 year (with at least a genital test) from the Dutch sexual health centre surveillance between 2014 and 2019. Multilevel logistic regression analyses were used to identify determinants of genital chlamydia infection at the repeat test, with anorectal testing at the previous chlamydia test as the main determinant. RESULTS A total of 40 217 women were included in the analyses, of whom 15.4% tested chlamydia-positive genitally at their second test. Not being tested anorectally at the first test was an independent risk factor for genital chlamydia infection at the repeat test (adjusted OR 1.24, 95% CI 1.15 to 1.33). This association was in the same range as most other significant risk factors in the model: low education level, no condom use, STI symptoms and previous STI diagnosis. Young age (<20 years) (2.67, 2.39-2.98) and those who received partner notification (3.11, 2.91-3.31) showed stronger associations. The findings were robust; correcting for interactions and a sensitivity analysis stratifying by chlamydia infection at first visit did not show significant differences in the adjusted OR of not being tested anorectally at first test. CONCLUSION The results are suggestive of an autoinoculation process from the anorectal to the genital anatomical site in women. To enhance chlamydia control, future studies on the role of extragenital testing and autoinoculation in chlamydia transmission are needed.
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Affiliation(s)
- Maartje Visser
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Milada Dvorakova
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Fleur van Aar
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Janneke C M Heijne
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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19
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Goller JL, Coombe J, Bittleston H, Bourne C, Bateson D, Vaisey A, Tomnay J, O'Donnell H, Garret C, Estcourt CS, Temple-Smith M, Hocking JS. Patient delivered partner therapy for chlamydia infection is used by some general practitioners, but more support is needed to increase uptake: findings from a mixed-methods study. Sex Transm Infect 2021; 98:298-301. [PMID: 34193530 DOI: 10.1136/sextrans-2020-054933] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/17/2020] [Accepted: 06/09/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Patient-delivered partner therapy (PDPT) describes the giving of a prescription or antibiotics by an index case with chlamydia to their sexual partners. PDPT has been associated with higher numbers of partners receiving treatment. In Australia, general practitioners (GPs) previously expressed negative views about PDPT. Health authority guidance for PDPT has since been provided in some areas. We investigated recent use and perceptions of PDPT for chlamydia among GPs in Australia. METHODS In 2019, we conducted an online survey comprising multiple-choice and open-ended questions to investigate GPs' chlamydia management practices, including PDPT. Logistic regression identified factors associated with ever offering PDPT. A directed content analysis of free-text data explored GPs' perceptions towards PDPT. RESULTS The survey received responses from 323 GPs; 85.8% (n=277) answered PDPT-focused questions, providing 628 free-text comments. Over half (53.4%) reported never offering PDPT, while 36.5% sometimes and 10.1% often offered PDPT. GPs more likely to offer PDPT were aged ≥55 years (adjusted OR (AOR) 2.9, 95% CI 1.4 to 5.8), worked in non-metropolitan areas (AOR 2.5, 95% CI 1.5 to 4.4) and jurisdictions with health authority PDPT guidance (AOR 2.3, 95% CI 1.4 to 3.9). Qualitative data demonstrated that many GPs recognised PDPT's potential to treat harder to engage partners but expressed hesitancy to offer PDPT because they considered partners attending for care as best practice. GPs emphasised a case-by-case approach that considered patient and partner circumstances to determine PDPT suitability. To alleviate medicolegal concerns, many GPs indicated a need for professional and health authority guidance that PDPT is permissible. They also desired practical resources to support its use. CONCLUSION GPs appear to accept the place of PDPT as targeted to those who may otherwise not access testing or treatment. Availability of health authority guidance appears to have supported some GPs to incorporate PDPT into their practice.
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Affiliation(s)
- Jane L Goller
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Jacqueline Coombe
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Helen Bittleston
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Christopher Bourne
- Sydney Sexual Health Centre, Sydney, New South Wales, Australia.,Kirby Institute, Kensington, New South Wales, Australia
| | - Deborah Bateson
- Family Planning New South Wales, Ashfield, New South Wales, Australia.,Discipline of Obstetrics, Gyanecology and Neonatology, Faculty of Medicine and Science, University of Sydney SDN, Sydney, New South Wales, Australia
| | - Alaina Vaisey
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Jane Tomnay
- Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia
| | - Heather O'Donnell
- Centre for Excellence in Rural Sexual Health, Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia
| | | | - Claudia S Estcourt
- Glasgow Caledonian University School of Health and Life Sciences, Glasgow, UK
| | | | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
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20
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Miranda AE, da Silveira MF, Pinto VM, Alves GC, de Carvalho NS. Brazilian Protocol for Sexually Transmitted Infections, 2020: infections that cause cervicitis. Rev Soc Bras Med Trop 2021; 54:e2020587. [PMID: 34008716 PMCID: PMC8210491 DOI: 10.1590/0037-8682-587-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 12/05/2022] Open
Abstract
Infections that cause cervicitis are a topic presented in the "Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections", published by the Brazilian Ministry of Health in 2020. The document was developed based on scientific evidence and validated in discussions with experts. This article presents epidemiological and clinical aspects of infections that cause cervicitis and recommendations on screening, diagnosis, and treatment of affected people and their sexual partnerships. Also, it discusses strategies for surveillance, prevention, and control of these infections for health professionals and health service managers involved in the programmatic and operational management of sexually transmitted infections. Expanding access to diagnostic tests and early treatment are crucial for controlling the spread of pathogens that cause cervicitis. Associated factors to cervicitis: sexually active women younger than 25 years old, new or multiple sexual partners, partners with STI, previous history or presence of other STI, and irregular use of condoms.
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Affiliation(s)
| | | | - Valdir Monteiro Pinto
- Secretaria Estadual de Saúde de São Paulo, Programa Estadual de DST/Aids, São Paulo, SP, Brasil
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21
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Armstrong HL, Tang W, Shields K. Research news in clinical context. Sex Transm Infect 2021; 97:247-248. [PMID: 34001668 DOI: 10.1136/sextrans-2020-054859] [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)
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, People's Republic of China
| | - Kristine Shields
- Shields' Medical Writing and Consulting, Philadelphia, Pennsylvania, USA
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22
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Estcourt CS, Flowers P, Cassell JA, Pothoulaki M, Vojt G, Mapp F, Woode-Owusu M, Low N, Saunders J, Symonds M, Howarth A, Wayal S, Nandwani R, Brice S, Comer A, Johnson AM, Mercer CH. Going beyond 'regular and casual': development of a classification of sexual partner types to enhance partner notification for STIs. Sex Transm Infect 2021; 98:108-114. [PMID: 33927009 PMCID: PMC8862076 DOI: 10.1136/sextrans-2020-054846] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/03/2021] [Accepted: 02/27/2021] [Indexed: 12/05/2022] Open
Abstract
Objectives To develop a classification of sexual partner types for use in partner notification (PN) for STIs. Methods A four-step process: (1) an iterative synthesis of five sources of evidence: scoping review of social and health sciences literature on partner types; analysis of relationship types in dating apps; systematic review of PN intervention content; and review of PN guidelines; qualitative interviews with public, patients and health professionals to generate an initial comprehensive classification; (2) multidisciplinary clinical expert consultation to revise the classification; (3) piloting of the revised classification in sexual health clinics during a randomised controlled trial of PN; (4) application of the Theoretical Domains Framework (TDF) to identify index patients’ willingness to engage in PN for each partner type. Results Five main partner types emerged from the evidence synthesis and consultation: ‘established partner’, ‘new partner’, ‘occasional partner’, ‘one-off partner’ and ‘sex worker’. The types differed across several dimensions, including likely perceptions of sexual exclusivity, likelihood of sex reoccurring between index patient and sex partner. Sexual health professionals found the classification easy to operationalise. During the trial, they assigned all 3288 partners described by 2223 index patients to a category. The TDF analysis suggested that the partner types might be associated with different risks of STI reinfection, onward transmission and index patients’ engagement with PN. Conclusions We developed an evidence-informed, useable classification of five sexual partner types to underpin PN practice and other STI prevention interventions. Analysis of biomedical, psychological and social factors that distinguish different partner types shows how each could warrant a tailored PN approach. This classification could facilitate the use of partner-centred outcomes. Additional studies are needed to determine the utility of the classification to improve measurement of the impact of PN strategies and help focus resources.
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Affiliation(s)
- Claudia S Estcourt
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Sandyford Sexual Health Service, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Paul Flowers
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Jackie A Cassell
- Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, Brighton and Hove, UK
| | - Maria Pothoulaki
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Gabriele Vojt
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Fiona Mapp
- Institute for Global Health, University College London, London, UK
| | | | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - John Saunders
- Institute for Global Health, University College London, London, UK
- Blood Safety, Hepatitis, STI & HIV Division, Public Health England, London, UK
| | - Merle Symonds
- Department of Sexual Health, West Sussex Health and Social Care NHS Trust, Worthing, West Sussex, UK
| | - Alison Howarth
- Institute for Global Health, University College London, London, UK
| | | | - Rak Nandwani
- Sandyford Sexual Health Service, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Alex Comer
- Central and North West London NHS Foundation Trust, London, UK
| | - Anne M Johnson
- Department of Infection & Population Health, University College London, London, UK
| | - Catherine H Mercer
- Centre for Sexual Health and HIV Research, University College London, London, UK
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23
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Hoyos-Mallecot Y, Garcia JN, Sulleiro E, Esperalba J, Salmeron P, Zarzuela F, Blanco A, Arando M, Descalzo V, Lopez L, Vall-Mayans M, Barberá MJ, Serra-Pladevall J, LLinas M, Almirante B, Pumarola T, Espasa M. Drassanes Exprés: a public and confidential testing service for asymptomatic STIs with same-day result notification. Sex Transm Infect 2021; 98:166-172. [PMID: 33846278 DOI: 10.1136/sextrans-2020-054779] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/09/2020] [Revised: 02/16/2021] [Accepted: 03/12/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND STIs are a major public health concern. Screening programmes for asymptomatic users are key components of STI control. Traditional limitations of screening programmes include low population coverage and delays in treatments, thus reducing the expected impact on STI control. In our centre, the normal time from test to results was 4 days, and 7 days until treatment was established.To reduce time to treatment and to increase population coverage, we developed 'Drassanes Exprés', a testing service for asymptomatic STIs. The objectives of this study were to provide a guide for the implementation of a service with these characteristics and to evaluate the results of this intervention. METHODS The Drassanes Exprés programme was launched in Spain on 07 November 2016 as a public, confidential and free-of-charge testing service for asymptomatic STIs, with same-day result notification. For this walk-in service, confidentiality was obtained by registering all information into the Laboratory Internal Software instead of the Electronic Patient Records. Samples were processed in a point-of-care laboratory and result notification was provided via mail or short message service.Information about workflow, screening protocols and result interpretation is detailed. Additionally, demographic characteristics, STI prevalence, and time from patients' sample collection to notification and treatment are analysed. RESULTS Between 07 November 2016 and 07 November 2019, 13 993 users attended the Drassanes Exprés screening programme. Of these, 0.5% were transgender people, 29.3% women, 45.2% men who have sex with men and 25.1% men who have sex with women. The median age was 31 years (range: 26-39 years). Overall, 14.6% of users tested positive for at least one STI. The most prevalent infection was Chlamydia trachomatis (8.3%), followed by Neisseria gonorrhoeae (5.7%), syphilis (1.8%), HIV (0.4%) and hepatitis C virus (0.2%). The median time from test to results was 2.4 hours (range: 2-3.1 hours). Of 2049 users diagnosed with an STI, treatment was achieved in 97.0% of cases; the average time to treatment was 2.0 days. CONCLUSIONS Drassanes Exprés is the first public programme for rapid, asymptomatic, STI screening and treatment in Spain. Assessing high-risk practices and providing confidentiality, easy access and rapid results/treatments are key elements in the development of STI screening programmes.
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Affiliation(s)
- Yannick Hoyos-Mallecot
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain .,Microbiology, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Jorge Nestor Garcia
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Elena Sulleiro
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain.,Microbiology, Vall d'Hebron Research Institute, Barcelona, Spain.,Medicine Department, Autonomous University of Barcelona, Bellaterra, Spain
| | - Juliana Esperalba
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain.,Microbiology, Vall d'Hebron Research Institute, Barcelona, Spain.,Medicine Department, Autonomous University of Barcelona, Bellaterra, Spain
| | - Paula Salmeron
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Francesc Zarzuela
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Albert Blanco
- Department of Clinical Biochemistry, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Maider Arando
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Medicine Department, Autonomous University of Barcelona, Bellaterra, Spain
| | - Vicente Descalzo
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Luis Lopez
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Martí Vall-Mayans
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - María Jesús Barberá
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Judit Serra-Pladevall
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain.,Microbiology, Vall d'Hebron Research Institute, Barcelona, Spain.,Medicine Department, Autonomous University of Barcelona, Bellaterra, Spain.,Department of microbiology, Consorci Hospitalari de Vic, Vic, Spain
| | - Montserrat LLinas
- STI Unit Vall d'Hebron Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Benito Almirante
- Medicine Department, Autonomous University of Barcelona, Bellaterra, Spain.,Infectious Diseases Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Tomas Pumarola
- Department of Microbiology, Vall d'Hebron University Hospital, Barcelona, Spain.,Microbiology, Vall d'Hebron Research Institute, Barcelona, Spain.,Medicine Department, Autonomous University of Barcelona, Bellaterra, Spain
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24
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Layton E, Goller JL, Coombe J, Temple-Smith M, Tomnay J, Vaisey A, Hocking JS. 'It's literally giving them a solution in their hands': the views of young Australians towards patient-delivered partner therapy for treating chlamydia. Sex Transm Infect 2021; 97:256-260. [PMID: 33441448 DOI: 10.1136/sextrans-2020-054820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/29/2020] [Revised: 12/12/2020] [Accepted: 12/22/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Patient-delivered partner therapy (PDPT) is a method for providing antibiotic treatment for the sexual partners of an index patient with an STI by means of a prescription or medication that the index patient gives to their sexual partner(s). Qualitative research regarding barriers and enablers to PDPT has largely focused on the views of healthcare providers. In this study, we sought to investigate the views of young people (as potential health consumers) regarding PDPT for chlamydia. METHODS Semi-structured telephone interviews were conducted with young Australian men and women. Participants were asked to provide their views regarding PDPT from the perspective of both an index patient and partner. Purposive and snowball sampling was used. Data were analysed thematically. RESULTS We interviewed 22 people (13 women, 9 men) aged 18-30 years, 15 of whom had previously been tested for chlamydia. Despite none having previous knowledge of or experience using PDPT, all viewed it positively and thought it should be widely available. Participants reported that they would be willing to give PDPT to their sexual partners in situations where trust and comfort had been established, regardless of the relationship type. Protecting their partners' privacy was essential, with participants expressing reluctance to provide their partners' contact details to a doctor without consent. Beyond logistical benefits, PDPT was viewed as a facilitator to partner notification conversations by offering partners a potential solution. However, most interviewees indicated a preference to consult with a healthcare provider (GP or pharmacist) before taking PDPT medication. Participants indicated that legitimacy of information when navigating a chlamydia diagnosis was crucial and was preferably offered by healthcare providers. CONCLUSIONS Though PDPT is unlikely to fully replace partners' interactions with healthcare providers, it may facilitate partner notification conversations and provide partners greater choice on how, when and where they are treated.
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Affiliation(s)
- Elly Layton
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Jane L Goller
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Jacqueline Coombe
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Meredith Temple-Smith
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | - Jane Tomnay
- Centre for Excellence in Rural Sexual Health, University of Melbourne, Shepparton, Victoria, Australia
| | - Alaina Vaisey
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
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25
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Grillo‐Ardila CF, Torres M, Gaitán HG. Rapid point of care test for detecting urogenital Chlamydia trachomatis infection in nonpregnant women and men at reproductive age. Cochrane Database Syst Rev 2020; 1:CD011708. [PMID: 31995238 PMCID: PMC6988850 DOI: 10.1002/14651858.cd011708.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chlamydia trachomatis (C trachomatis) is one of the most frequent sexually transmitted infections and a source of deleterious effects on the reproductive health of men and women. Because this infection is likely asymptomatic and is associated with subfertility, ectopic pregnancy, and chronic pain, its presence needs to be confirmed. Technologies available for the diagnosis of C trachomatis infection can be classified into tests performed in a laboratory and rapid tests at the point of care (POC tests). Laboratory-based tests include culture, nucleic acid amplification tests, enzyme immunoassays (EIA), direct fluorescent antibody, nucleic acid hybridization, and transformation tests. Rapid tests include solid-phase EIA and solid-phase optical immunoassay. POC tests can be performed within 30 minutes without the need for expensive or sophisticated equipment. The principal advantage of this technology is the immediate presentation of results with the subsequent possibility to start the treatment of infected patients immediately. OBJECTIVES To determine the diagnostic accuracy of rapid point-of-care (POC) testing for detecting urogenital C trachomatis infection in nonpregnant women and men of reproductive age, as verified with nucleic acid amplification tests (NAATs) as the reference standard. SEARCH METHODS In November 2019 we searched CENTRAL, MEDLINE, Embase and LILACS. We also searched Web of Science, two trials registries and an abstract database. We screened reference lists of included studies for additional references. SELECTION CRITERIA We included diagnostic accuracy studies of symptomatic or asymptomatic nonpregnant women and men reproductive age. Included trials should have prospectively enrolled participants without previous diagnostic testing, co-infections or complications and consecutively or through random sampling at primary or secondary care facilities. Only studies reporting that all participants received the index test and the reference standard and presenting 2 x 2 data were eligible for inclusion. We excluded diagnostic case-control studies. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts for relevance. Two review authors independently, and in duplicate, assessed eligibility, extracted data, and carried out quality assessment. We resolved differences through consensus or by involving a third review author. We assessed studies for methodological quality using QUADAS-2 and used meta-analysis to combine the results of studies using the bivariate approach to estimate the expected sensitivity and specificity values. We assessed the quality of the evidence using GRADE criteria and explored sources of heterogeneity. MAIN RESULTS We included a total of 19 studies, with 13,676 participants, that assessed the diagnostic accuracy of POC tests for C trachomatis infection in nonpregnant women and men of reproductive age, as verified with NAATs as the reference standard. Rapid tests were provided by the distributors in nine studies. Seven studies recruited a predominantly high risk or symptomatic population; the studies were conducted in America, Asia, Africa, Europe and Oceania, with a median prevalence of 10% (range 8% to 28%); nine different brands were assessed. The mean sensitivity for rapid tests for detecting urogenital infection was 0.48 (95% confidence interval (CI) 0.39 to 0.58; low-quality evidence) with a mean specificity of 0.98 (95% CI 0.97 to 0.99; moderate-quality evidence). We explored sources of heterogeneity by looking into differences in diagnostic accuracy according to the specimen (endocervical versus urine or vaginal), symptoms among participants (symptomatic versus asymptomatic), and setting (low/middle-income versus high-income countries). Likelihood ratio tests were not significantly different in terms of sensitivity or specificity by specimen (P = 0.27) or setting (P = 0.28); for this reason, these covariates do not appear to explain the observed variability. Included studies did not provide enough information to assess the 'presence of symptoms' covariate. We downgraded the quality of evidence because of some limitations in applicability and heterogeneity. AUTHORS' CONCLUSIONS Based on the results of this systematic review, the POC test based on antigen detection has suboptimal sensitivity but good specificity. Performance of this test translates, on average, to a 52% chance of mistakenly indicating absence of infection and a 2% chance of mistakenly pointing to the presence of this condition. Because of its deleterious consequences for reproductive health, and considering the current availability of safe and effective interventions to treat C trachomatis infection, the POC screening strategy should not be based on a rapid diagnostic test for antigen detection. Research in this topic should focus on different technologies.
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Affiliation(s)
- Carlos F. Grillo‐Ardila
- Faculty of Medicine, Universidad Nacional de ColombiaDepartment of Obstetrics and GynecologyCarrera 30 No 45‐03BogotaColombia
| | - Marcela Torres
- Faculty of Medicine, Universidad Nacional de ColombiaClinical Research InstituteCalle 45 No. 30‐05BogotaColombia
| | - Hernando G Gaitán
- Faculty of Medicine, Universidad Nacional de ColombiaDepartment of Obstetrics and GynecologyCarrera 30 No 45‐03BogotaColombia
- Faculty of Medicine, Universidad Nacional de ColombiaClinical Research InstituteCalle 45 No. 30‐05BogotaColombia
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26
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Abstract
The aim of the study was to evaluate if an intervention including theater in school sex education affects students' knowledge, attitudes, and behavior regarding condom use in Sweden. The study was a cluster randomized controlled trial. The intervention group got a play, value exercises, chlamydia games, condom school, and interactive replay with professional actors and staff from a youth guidance center. The control group got standard sex education from school staff. Students in both groups answered web surveys on knowledge, attitudes, and behavior regarding condom use. Posteducation, knowledge on condom use, chlamydia, and protection had increased in both groups. However, students in the intervention group showed higher levels of knowledge, improved attitudes, and less risky behavior in regard to condom use compared to the control group. The intervention titled SAFETY seemed to be a beneficial supplement to standard sex education and more effective with regard to knowledge of condom use.
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Affiliation(s)
- Charlotta Jerlström
- Gumaeliusskolan, Örebro, Sweden.,Faculty of Medicine, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Annsofie Adolfsson
- Faculty of Medicine, School of Health Sciences, Örebro University, Örebro, Sweden
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27
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Cheng YJ, Lin KY, Chen CC, Huang YL, Liu CE, Li SY. Zoonotic atypical pneumonia due to Chlamydophila psittaci: first reported psittacosis case in Taiwan. J Formos Med Assoc 2012; 112:430-3. [PMID: 23927984 DOI: 10.1016/j.jfma.2012.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 05/03/2012] [Revised: 08/20/2012] [Accepted: 08/26/2012] [Indexed: 10/27/2022] Open
Abstract
Human psittacosis caused by Chlamydophila psittaci is one of the most common zoonotic atypical pneumonias featuring pulmonary as well as extrapulmonary infections. Most of the cases involve avian contact history especially with psittacine birds. Herein we report a 44-year-old male patient displaying atypical pneumonia symptoms of intermittent fever, dry cough, chest pain, dyspnea, headache, hepatitis, and hyponatremia. He had two sick cockatiels, one of which had died a month previously. A microimmunofluorescence test was performed to check the serum antibody levels against Chlamydophila psittaci. The serum IgM titer showed positive titer of 1:256, 1:256, and 1:128 on Days 11, 23, and 43 after disease onset, respectively. His fever subsided soon and clinical symptoms improved after minocycline was administrated on Day 12. The psittacosis case was confirmed by history of psittacine bird contact, clinical symptoms, treatment response, and positive IgM titer. To our knowledge, this is the first report of a psittacosis case in Taiwan.
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Affiliation(s)
- Yu-Jen Cheng
- Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Taiwan
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28
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Swain GR, McDonald RA, Pfister JR, Gradus MS, Sedmak GV, Singh A. Decision analysis: point-of-care Chlamydia testing vs. laboratory-based methods. Clin Med Res 2004; 2:29-35. [PMID: 15931332 PMCID: PMC1069068 DOI: 10.3121/cmr.2.1.29] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2003] [Accepted: 11/29/2003] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate and compare the performance of several different methods available for detection of Chlamydia trachomatis (Ct) infection, and to explore possible testing and treatment strategies incorporating point-of-care testing versus laboratory-based tests. DESIGN Prospective trial and decision analysis. SETTING Large, urban, publicly funded sexually transmitted disease clinic. PARTICIPANTS 1,384 female patients. METHODS Each subject was tested for Ct infection by direct fluorescent antibody (DFA, Sanofi/Kallestad, Chaska, MN), optical immunoassay (OIA, Thermo Electron, Point of Care and Rapid Diagnostics, Louisville CO), McCoy cell culture (in-house method), and polymerase chain reaction (microwell PCR, microwell assay, Roche, Branchburg NJ). RESULTS Performing a rapid in-clinic test on women who did not meet empiric treatment criteria would have increased the overall proportion of infected persons receiving same-day treatment from 48.6% to 79.1% using DFA or 78.4% using OIA. CONCLUSIONS Use of empiric treatment criteria and same-day point-of-care testing for patients not meeting the empiric treatment threshold appears to be an appropriate, useful, and cost-effective strategy for increasing same-day treatment of Ct infections in this population.
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Affiliation(s)
- Geoffrey R Swain
- City of Milwaukee Health Department, Milwaukee, Wisconsin 53202, USA.
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29
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Anderson JL, Muhlestein JB. Antibiotic trials for coronary heart disease. Tex Heart Inst J 2004; 31:33-8. [PMID: 15061624 PMCID: PMC387430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The possibility has been raised in recent years that infection might contribute as an inflammatory stimulus to chronic "noninfectious" degenerative diseases. Within the past decade, serious attention has been given to the possibility of bacterial vectors as causal factors of atherosclerosis. To date, the greatest amount of information has related to the intracellular organism Chlamydia pneumoniae. This interest has been stimulated by the frequent finding of bacterial antigens and, occasionally, recoverable organisms, within human atherosclerotic plaque. Indirect evidence for and against the benefit of anti-Chlamydia antibiotic agents comes from epidemiologic studies. Given the potential for confounding in observational studies, prospective, randomized intervention trials are required. These antibiotic trials have generated enthusiastic expectations for proving (or disproving) the infectious-disease hypothesis of atherosclerosis and establishing new therapies. However, these expectations have been tempered by important limitations and uncertainties. Negative outcomes can be explained not only by an incorrect hypothesis but also by inadequate study size or design or by an ineffective antibiotic regimen. In contrast, if studies are positive, the hypothesis still is not entirely proved, because a nonspecific anti-inflammatory effect or an anti-infective action against other organisms might be operative. The clinical trial data to date have not provided adequate support for the clinical use of antibiotics in primary or secondary prevention of coronary heart disease. New and innovative experimental approaches, in addition to traditionally designed antibiotic trials, should be welcome in our attempts to gain adequate insight into the role of infection in atherosclerosis and its therapy.
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Affiliation(s)
- Jeffrey L Anderson
- University of Utah School of Medicine, Cardiovascular Department, LDS Hospital, Salt Lake City, Utah 84143, USA.
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30
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La Ruche G, Faye-Ketté H, Bankolé HS, Dabis F. Sexually transmitted infections and cervical neoplasia. Int J STD AIDS 2000; 11:67-8. [PMID: 10667905 PMCID: PMC5382228 DOI: 10.1258/0956462001914823] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Guy La Ruche
- National AIDS control program
National AIDS control program
| | - H. Faye-Ketté
- National AIDS control program
National AIDS control program
| | - H. S. Bankolé
- Institut Pasteur de Côte d'Ivoire
Réseau International des Instituts PasteurInstitut Pasteur de Côte d'Ivoire01 B.P. 490 Abidjan
| | - François Dabis
- Epidémiologie, santé publique et développement
INSERMUniversité Bordeaux Segalen - Bordeaux 2146, rue Léo Saignat 33076 Bordeaux Cedex
- * Correspondence should be addressed to François Dabis
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