115 results
Search Results
2. Lessons from a case of overlapping publications.
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Wager, Elizabeth and Green, Richard
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REPORT writing ,CHLAMYDIA ,CHLAMYDIA infection diagnosis - Abstract
The authors revisit the events and problems that arose concerning the publication of a study of chlamydia screening in Great Britain in 2000. The research was funded by the Department of Health (DH) and aimed at screening for chlamydia. However, a problem arose when the bodies involved in the research agreed to publish the results in two separate papers.
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- 2009
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3. Notice of redundant publication.
- Author
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Miller, Rob, Ward, Helen, Catchpole, Mike, Underhill, G., Hewitt, G., Randall, S., Tobin, J., Harindra, V., Miller, R, Ward, H, and Catchpole, M
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SEXUALLY transmitted diseases ,COMMUNICABLE diseases ,CHLAMYDIA ,REPRODUCTIVE health ,MEDICAL care ,PUBLICATIONS ,PUBLISHING - Abstract
Editors of "Sexually Transmitted Infections" wish to bring to the attention of readers of the journal the significant overlap between articles entitled "Who has Chlamydia? The prevalence of genital tract Chlamydia trachomatis within Portsmouth and South East Hampshire, UK" which was previously published in the Journal of Family Planning and Reproductive Health Care. The paper published in Sexually Transmitted infections was written and submitted for publication according to a publication strategy agreed by the Department of Health's Steering Committee for the national chlamydia screening pilot, that the first publications from the pilot should be based on a combined analysis of results from the two sites taking part in the pilot.
- Published
- 2004
4. The National Chlamydia Screening Programme and the NICE guidance on one-to-one interventions: remember the under-25s
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Teresa Battison, Jan Clarke, Mary Macintosh, Ian Simms, and Sarah Randall
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Adult ,Male ,medicine.medical_specialty ,Letter ,Reproductive medicine ,Psychological intervention ,Dermatology ,urologic and male genital diseases ,White paper ,Acquired immunodeficiency syndrome (AIDS) ,NICE Guidelines: Commentaries ,medicine ,One-to-one ,Humans ,Mass Screening ,Reproductive health ,Government ,Chlamydia ,business.industry ,Chlamydia Infections ,medicine.disease ,United Kingdom ,Infectious Diseases ,Family medicine ,Immunology ,Practice Guidelines as Topic ,Female ,business - Abstract
In the government White Paper, Choosing Health the National Chlamydia Screening Programme (NCSP) is described as ‘the cornerstone of the drive for better sexual health’.1 The NCSP is delivered through interventions, which aim to control and prevent chlamydia, the most common bacterial sexually transmitted infection (STI) seen in England, through early detection and treatment of asymptomatic infection. This flexible approach includes one-to-one interviewing and innovative methods of opportunistic recruitment such as email access to postal kits in people
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- 2007
5. A prospective study of the effectiveness of electronic patient records in rapid-cycle assessment of treatment and partner notification outcomes for patients with genital chlamydia and gonorrhoea infection.
- Author
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Brook, M Gary, Rusere, Lovemore, Coppin-Browne, Lizz, McDonagh, Stephanie, and McSorley, John
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Objective To assess the effectiveness of electronic patient records (EPRs) in facilitating multiple, rapid measurements of treatment and partner notification (PN) outcomes for chlamydia and gonorrhoea. Methods In two sexual health clinics, the proportion of patients with chlamydia and gonorrhoea who had been treated within 4 weeks of diagnosis was measured, and also the proportion where at least one of their partners had been treated. These outcomes were measured monthly for 6 months, and changes in recording practice were instituted when necessary. Results It took 8 h to capture and analyse the data for 89 patients in month 1. The health advisers subsequently entered data into searchable fields to facilitate better data capture. As a result, by month 6 it took only 1.5 h to measure these outcomes using an electronic search. It had previously taken 2 days to perform the same analysis using paper records. In month 1, successful treatment was recorded in 26/27 (96%) patients with gonorrhoea and 57/61 (93%) with chlamydia, and there was successful PN for gonorrhoea and chlamydia patients in 19/27 (70%) and 39/61 (64%). By month 6, the recorded outcomes were 30/31 (97%) and 81/86 (94%), respectively, for successful treatment and 28/31 (90%) and 74/86 (86%) for successful PN, respectively. Conclusions Frequent rapid clinical outcome monitoring is easily attained using EPRs as long as the data are entered into searchable fields. Treatment and PN success for chlamydia and gonorrhoea with this method are well above national targets, which may be attributable to both the use of EPRs and better data capture. [ABSTRACT FROM PUBLISHER]
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- 2011
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6. Screening for Chlamydia trachomatis: a systematic review of the economic evaluations and modelling.
- Author
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Roberts, T. E., Robinson, S., Barton, P., Bryan, S., and Low, N.
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CHLAMYDIA ,CHLAMYDIACEAE ,PELVIC inflammatory disease ,COMMUNICABLE diseases ,MEDICAL screening ,PUBLIC health ,SENSES testing - Abstract
Objective: To review systematically and critically, evidence used to derive estimates of costs and cost effectiveness of chlamydia screening. Methods: Systematic review. A search of 11 electronic bibliographic databases from the earliest date available to August 2004 using keywords including chlamydia, pelvic inflammatory disease, economic evaluation, and cost. We included studies of chlamydia screening in males and/or females over 14 years, including studies of diagnostic tests, contact tracing, and treatment as part of a screening programme. Outcomes included cases of chlamydia identified and major outcomes averted. We assessed methodological quality and the modelling approach used. Results: Of 713 identified papers we included 57 formal economic evaluations and two cost studies. Most studies found chlamydia screening to be cost effective, partner notification to be an effective adjunct, and testing with nucleic acid amplification tests, and treatment with azithromycin to be cost effective. Methodological problems limited the validity of these findings: most studies used static models that are inappropriate for infectious diseases; restricted outcomes were used as a basis for policy recommendations; and high estimates of the probability of chlamydia associated complications might have overestimated cost effectiveness. Two high quality dynamic modelling studies found opportunistic screening to be cost effective but poor reporting or uncertainty about complication rates make interpretation difficult. Conclusion: The inappropriate use of static models to study interventions to prevent a communicable disease means that uncertainty remains about whether chlamydia screening programmes are cost effective or not. The results of this review can be used by health service managers in the allocation of resources, and health economists and other researchers who are considering further research in this area. [ABSTRACT FROM AUTHOR]
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- 2006
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7. The effect of electronic patient records (EPR) on the time taken to treat patients with genital Chlamydia infection.
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Brook, M. G., Baveja, T., Smondulak, L., and Shukla, S.
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CHLAMYDIA infection treatment ,MEDICAL records ,MEDICAL care ,SEXUALLY transmitted disease treatment ,DISEASE management - Abstract
Objectives To measure the time taken to recall and treat patients with untreated Chlamydia attending a sexual-health clinic before and after the introduction of electronic patient records (EPR). Methods 52 consecutive qualifying patients were identified for January to March 2007 (paper case records) and 2009 (EPR). For each, the patient time intervals were measured between each of following dates: first attendance, first positive result received, first attempted patient contact and attendance for treatment. Results Between 2007 and 2009, the median time taken to treat a patient after receipt of a positive Chlamydia result fell by 11.5 days (median 15 days in 2007, 3.5 days in 2009). The time between first attendance and treatment was reduced by 9.5 days (median 21 days in 2007, 11.5 days in 2009) despite results taking 2 days longer to arrive in 2009. The proportion of patients treated within 2 weeks of a positive result rose from 38% in 2007 to 94% in 2009. Compared with paper notes, EPR decreased the time to recall, by eliminating three time-delaying patient recall processes. By ensuring more accurate patient recall information, EPR also lead to a higher proportion of patients successfully recalled by telephone (26/44, 59% vs 46/52, 88% in 2007 and 2009 respectively), leading to earlier treatment. Conclusions The 'time to treat' interval was dramatically reduced following the introduction of EPR. Clinics using paper notes should consider switching to EPR as a means of improving STI recall efficiency. [ABSTRACT FROM AUTHOR]
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- 2010
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8. What is the excess risk of infertility in women after genital chlamydia infection? A systematic review of the evidence.
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Wallace, L. A., Scoular, A., Hart, G., Reid, M., Wilson, P., and Goldberg, D. J.
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INFERTILITY ,CHLAMYDIA ,GENITALIA infections ,GENITAL diseases ,PREGNANCY ,OBSTETRICS - Abstract
Objective: To summarise evidence on the attributable risk of infertility after chlamydial infection in women. Methods: Twelve databases were searched, limited to peer-reviewed literature published from January 1970 to September 2007. Conference abstracts and reference lists from reviews published since 2000 and from key articles were hand-searched. Studies were selected for review if they met the following criteria: (1) the study population comprised women of child-bearing age (defined as 15-45 years( and incorporated a comparison group of women documented as "chlamydia negative"; (2) the study outcomes included either infertility or successful pregnancy; and (3) the study design was one of the following: cohort, randomised controlled trial, "before and after" study, screening trial and systematic review. Studies were excluded if they described genital infections that either did not include Chlamydia trachomatis or described genital chlamydial co-infection, in which no data were available for C trachomatis infection alone. Results: 3349 studies were identified by the search. One study satisfied the inclusion criteria, a longitudinal investigation measuring pregnancy rates in adolescent women with and without current chlamydial infection at baseline. That study reported no significant difference in subsequent pregnancy rates; however, it had serious methodological limitations, which restricted its conclusions. Conclusions: This systematic review demonstrates the absence of valid evidence on the attributable risk of post-infective tubal factor infertility after genital chlamydial infection. The findings contribute empirical data to the growing debate surrounding previous assumptions about the natural history of chlamydial infection in women. [ABSTRACT FROM AUTHOR]
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- 2008
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9. The performance of non-NAAT point-of-care (POC) tests and rapid NAAT tests for chlamydia and gonorrhoea infections. An assessment of currently available assays.
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Brook, Gary
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POINT-of-care testing ,NUCLEIC acid amplification techniques ,CHLAMYDIA ,GONORRHEA diagnosis ,SEXUALLY transmitted disease diagnosis ,DIAGNOSIS - Abstract
Objectives: To identify point-of-care (POC) and rapid nucleic acid amplification techniques (NAATs) for the diagnosis of chlamydia and gonorrhoea and assess their utility.Methods: Literature search for available POC and rapid NAATs. The performance from the best-performing assays were applied hypothetically to patients in the clinic in which 100 consecutive patients with chlamydia and 100 with gonorrhoea were diagnosed in 1737 and 4575 patients respectively, with 44/100 and 54/100 treated at first attendance, respectively.Results: 11 POC and 1 rapid NAAT were identified. Published performances for the best POC for chlamydia (CRT) were: sensitivity 41%-87%, specificity 89%-99.6%. Our data suggest that if this assay was used instead of our current NAAT, for every 100 patients diagnosed currently, 23-46 extra patients would be treated at first attendance; 10-35 would go undiagnosed with 7-191 false-positives. Best chlamydia rapid NAAT (GeneXpert): sensitivity 97.5%-98.7%, specificity 99.4%-99.9%. Anticipated performance for every 100 patients diagnosed currently: 0 extra patients treated at first attendance, 1-3 undiagnosed, 0-2 false-positives. Best POC for gonorrhoea (GC Check): sensitivity 54%-70%, specificity 97%-98%. Anticipated performance for every 100 patients diagnosed currently: 14-18 extra patients treated at first attendance, 28-32 undiagnosed, 92-137 false-positives. Best rapid NAAT for gonorrhoea (GeneXpert): sensitivity 96%-100%, specificity 99.9%-100%. Anticipated performance for every 100 patients diagnosed currently: 0 extra patients treated at first attendance, 0-4 undiagnosed, 0-5 false-positives. Rapid NAAT would reduce time to treatment by 4 days for initially untreated patients.Conclusions: POC assays would need to be used in conjunction with a NAAT, increasing early treatment rates expense and false-positive results. The rapid NAAT could be used alone, with a reduction in average time-to-treat and a small reduction in sensitivity and specificity. [ABSTRACT FROM AUTHOR]- Published
- 2015
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10. Prevalence of urogenital Chlamydia trachomatis increases significantly with level of urbanisation and suggests targeted screening approaches: results from the first national population based study in the Netherlands.
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van Bergen, J., Göiz, H. M., Richardus, J. H., Hoebe, C. J. P. A., Broer, J., and Coenen, A. T. T.
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CHLAMYDIA ,BACTERIAL diseases ,POLYMERASE chain reaction ,GENERAL practitioners ,MEDICAL screening ,PUBLIC health - Abstract
Objectives: Chiamydia frachomatis (Chlamydia) is the most prevalent sexually transmitted bacterial infection and can cause considerable reproductive morbidity in women. Chlamydia screening programmes have been considered but policy recommendations are hampered by the lack of population based data. This paper describes the prevalence of Chlamydia in 15-29 year old women and men in rural and urban areas, as determined through systematic population based screening organised by the Municipal Public Health Services (MHS), and discusses the implications of this screening strategy for routine implementation. Methods: Stratified national probability survey according to "area address density" (AAD). 21 000 randomly selected women and men in four regions, aged 1 5-29 years received a home sampling kit. Urine samples were returned by mail and tested by polymerase chain reaction (PCR). Treatment was via the general practitioner, STI clinic, or MHS clinic. Results: 41% (8383) responded by sending in urine and questionnaire. 11% (2227) returned a refusal card. Non-responders included both higher and lower risk categories. Chlamydia prevalence was significantly lower in rural areas (0.6%, 95% CI 0.1 to 1.1) compared with very highly urbanised areas (3.2%, 95% CI 2.4 to 4.0). Overall prevalence was 2.0% (95% CI 1.7 to 2.3): 2.5% (95% CI 2.0 to 3.0%) in women and 1.5% (95% CI 1.1 to 1.8) in men. Of all cases 91 % were treated. Infection was associated with degree of urbanisation, ethnicity, number of sex partners, and symptoms. Conclusion: This large, population based study found very low prevalence in rural populations, suggesting that nationwide systematic screening is not indicated in the Netherlands and that targeted approaches are a better option. Further analysis of risk profiles will contribute to determine how selective screening can be done. [ABSTRACT FROM AUTHOR]
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- 2005
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11. Recent trends in HIV and other STIs in the United Kingdom: data to the end of 2002.
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Brown, A. E., Sadler, K. E., Tomkins, S. E., McGarrigle, C. A., LaMontagne, D. S., Goldberg, D., Tookey, P. A., Smyth, B., Thomas, D., Murphy, G., Parry, J. V., Evans, B. G., Gill, O. N., Ncube, F., and Fenton, K. A.
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HIV infections ,MEDICAL personnel ,PUBLIC health ,HEALTH surveys ,CHLAMYDIA ,GENITOURINARY organs - Abstract
Sexual health in the United Kingdom has deteriorated in recent years with further increases in HIV and other sexually transmitted infections (STIs) reported in 2002. This paper describes results from the available surveillance data in the United Kingdom from the Health Protection Agency and its national collaborators. The data sources range from voluntary reports of HIV/AIDS from clinicians, CD4 cell count monitoring, a national census of individuals living with HIV, and the Unlinked Anonymous Programme, to statutory reports of STIs from genitourinary medicine (GUM) clinics and enhanced STI surveillance systems. In 2002, an estimated 49500 adults aged over 15 years were living with HIV in the United Kingdom, of whom 31% were unaware of their infection. Diagnoses of new HIV infections have doubled from 1997 to 2002, mainly driven by heterosexuals who acquired their infection abroad. HIV transmission also continues within the United Kingdom, particularly among homo/bisexual men who, in 2002, accounted for 80% of all newly diagnosed HIV infections acquired in the United Kingdom. New diagnoses of syphilis have increased eightfold, and diagnoses of chlamydia and gonorrhoea have doubled from 1997 to 2002 overall; STI rates disproportionately affect homo/bisexual men and young people. Effective surveillance is essential in the provision of timely information on the changing epidemiology of HIV and other STIs; this information is necessary for the targeting of prevention efforts and through providing baseline information against which progress towards targets can be monitored. [ABSTRACT FROM AUTHOR]
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- 2004
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12. Chlamydia trachomatis infections in eastern Europe: legal aspects, epidemiology, diagnosis, and treatment.
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M. Domeika
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INFECTION ,CHLAMYDIA ,DIAGNOSTIC services ,IMMUNOCYTOCHEMISTRY - Abstract
Objectives: Knowledge concerning genital Chlamydia trachomatis infections in eastern Europe is scarce. Data on the legal aspects, epidemiology, diagnosis, and treatment of the infection have never been collected, summarised, and presented to the international scientific community. The aim of this study was to present the current situation on the main aspects of chlamydial infections in the countries of eastern Europe. Methods: Written questionnaires concerning legal aspects, epidemiology, diagnosis, and treatment of the infection were distributed among national STI operating administrators as well as researchers who had presented papers at earlier meetings of European chlamydia or STI societies. Results: Most of the countries have not legalised reporting of chlamydial infections and in those who have done so, the quality of the reporting system is poor. Contact tracing is mostly done on a voluntary basis. Reported chlamydia incidence varies from 21 to 276 per 100 000 inhabitants. The most commonly used diagnostic test remains the direct immunofluorescence test; however, some tendencies towards nucleic acid amplification are in evidence. Diagnostic services are paid for by the patient himself, while treatment in many countries is partially or completely covered by public insurance. Conclusions: This is the first report summarising data concerning the situation on C trachomatis infections in eastern Europe. The reporting system and diagnosis of C trachomatis infections remain suboptimal, which allows neither control of the epidemiological situation nor optimal treatment of the patients. The most urgent work currently necessary is the education of professionals and the general population. [ABSTRACT FROM AUTHOR]
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- 2002
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13. Health economic methodology illustrated with recent work on Chlamydia screening: the concept of extended dominance.
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Postma, M. J., De Vries, R., Welte, A., Edmunds, W. J., and Welte, R
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MEDICAL screening ,CHLAMYDIA ,LONG-term care facilities ,DIAGNOSIS - Abstract
The health economic concepts of dominance were reviewed on the basis of two recently published cost-effectiveness analyses on screening for asymptomatic Chlamydia trachomatis, one in this journal. On the basis of dominance, some strategies may be deleted from the set options from which to choose. The two investigated studies were from the United Kingdom and The Netherlands. Both studies nicely illustrate situations of so-called extended dominance in practical decision making. Extended dominance is a theoretical topic in many health-economic text books but is only scarcely encountered in daily practice. Although the concept of extended dominance is theoretical in nature, a formal analysis and explanation may help show which options under consideration are not optimal from a strictly health-economic perspective; however, these options might still be attractive policy options for other reasons. [ABSTRACT FROM AUTHOR]
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- 2008
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14. The Great Chlamydia Control Bake Off: the same ingredients (evidence) but different recipes for success
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Gloria E Anyalechi, Kristen Kreisel, Jane S Hocking, Kyle T. Bernstein, and Kate Soldan
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medicine.medical_specialty ,Chlamydia ,business.industry ,media_common.quotation_subject ,Control (management) ,Context (language use) ,Dermatology ,Chlamydia Infections ,medicine.disease ,Article ,Infectious Diseases ,Specimen collection ,Family medicine ,Healthcare settings ,Communicable Disease Control ,Medicine ,Humans ,Quality (business) ,business ,Parallels ,Overdiagnoses ,media_common - Abstract
Successful baking requires careful measurement, the precise mixing of ingredients and an attentive eye while the mixture is in the oven. However, the environment may have an impact on the final product. Humidity, quality of ingredients, type of oven used and altitude can all mean the difference between a perfect cake and a goopy mess. Although chlamydia control may seem quite different from baking, there are some important parallels, notably the context in which control programmes are developed, implemented and evaluated. The same inputs and approaches applied in different contexts may produce drastically different results. van Bergen et al 1 describe the methods of and conclusions from addressing the question ‘Where to go to in Chlamydia control?’ for the Netherlands in this issue of Sexually Transmitted Infections . The author and colleagues1 convened a panel that met in November 2019 and discussed expert perspectives on chlamydia control. This panel considered the interpretation of available evidence on the impact and/or effectiveness of a variety of testing scenarios: asymptomatic screening including opportunistic testing of asymptomatic patients in routine healthcare settings, syndromic testing, and at-home specimen collection and/or testing. Their paper reports on a problem analysis and the consensus viewpoint that evolved from this expert meeting, which suggested that future strategies should reduce rather than expand the role of widespread testing for asymptomatic chlamydial infections, and therefore the authors conclude that they ‘do not recommend age-based screening and widespread testing for chlamydia in asymptomatic persons in the Netherlands’.1 In this thought-provoking paper, van Bergen et al 1 focus on the assessment of three points: evidence for prevalence reductions, the rate of severe long-term complications caused by chlamydia and the potential harms of overdiagnoses and overtreatment. They find that all three points argue for the need to reassess and question current practices. …
- Published
- 2021
15. 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.
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Goller, Jane L., Coombe, Jacqueline, Bittleston, Helen, Bourne, Christopher, Bateson, Deborah, Vaisey, Alaina, Tomnay, Jane, O'Donnell, Heather, Garret, Cameryn, Estcourt, Claudia S., Temple-Smith, Meredith, and Hocking, Jane S.
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CHLAMYDIA ,RESEARCH ,RESEARCH methodology ,EVALUATION research ,COMPARATIVE studies ,QUESTIONNAIRES ,SEXUAL partners ,CONTACT tracing ,CHLAMYDIA infections - 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. [ABSTRACT FROM AUTHOR]- Published
- 2022
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16. Increasing chlamydia screening tests in general practice: a modified Zelen prospective Cluster Randomised Controlled Trial evaluating a complex intervention based on the Theory of Planned Behaviour.
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McNulty, Cliodna A. M., Hogan, Angela H., Ricketts, Ellie J., Wallace, Louise, Oliver, Isabel, Campbell, Rona, Kalwij, Sebastian, O'Connell, Elaine, and Charlett, Andre
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CHLAMYDIA ,CHLAMYDIACEAE ,RANDOMIZED controlled trials ,PLANNED behavior theory ,ATTITUDE (Psychology) - Abstract
Objective To determine if a structured complex intervention increases opportunistic chlamydia screening testing of patients aged 15-24 years attending English general practitioner (GP) practices. Methods A prospective, Cluster Randomised Controlled Trial with a modified Zelen design involving 160 practices in South West England in 2010. The intervention was based on the Theory of Planned Behaviour (TPB). It comprised of practice-based education with up to two additional contacts to increase the importance of screening to GP staff and their confidence to offer tests through skill development (including videos). Practical resources (targets, posters, invitation cards, computer reminders, newsletters including feedback) aimed to actively influence social cognitions of staff, increasing their testing intention. Results Data from 76 intervention and 81 control practices were analysed. In intervention practices, chlamydia screening test rates were 2.43/100 15-24-year-olds registered preintervention, 4.34 during intervention and 3.46 postintervention; controls testing rates were 2.61/100 registered patients prior intervention, 3.0 during intervention and 2.82 postintervention. During the intervention period, testing in intervention practices was 1.76 times as great (CI 1.24 to 2.48) as controls; this persisted for 9 months postintervention (1.57 times as great, CI 1.27 to 2.30). Chlamydia infections detected increased in intervention practices from 2.1/1000 registered 15-24-year-olds prior intervention to 2.5 during the intervention compared with 2.0 and 2.3/1000 in controls (Estimated Rate Ratio intervention versus controls 1.4 (CI 1.01 to 1.93). Conclusions This complex intervention doubled chlamydia screening tests in fully engaged practices. The modified Zelen design gave realistic measures of practice full engagement (63%) and efficacy of this educational intervention in general practice; it should be used more often. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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17. It matters what you measure: a systematic literature review examining whether young people in poorer socioeconomic circumstances are more at risk of chlamydia.
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Sheringham, Jessica, Mann, Sue, Simms, Ian, Stafford, Mai, Hart, Graham J., and Raine, Rosalind
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CHLAMYDIA ,MEDICAL screening ,POOR people ,SOCIOECONOMIC factors ,DISEASES ,DIAGNOSIS - Abstract
Background England has invested in chlamydia screening interventions for young people. It is not known whether young people in poorer socioeconomic circumstances (SEC) are at greater risk of chlamydia and therefore in greater need of screening. Objective To conduct a systematic review examining socioeconomic variations in chlamydia prevalence or positivity in young people. Data sources Eight bibliographic databases using terms related to chlamydia and SEC, supplemented by website and reference searches. Eligibility Studies published 1999-2011 in North America, Western Europe, Australia or New Zealand, including populations aged 15-24 years, with chlamydia prevalence or positivity diagnosed by nucleic acid amplification testing. Appraisal and synthesis Two reviewers independently screened references, extracted data, appraised studies meeting inclusion criteria and rated studies as high, medium or low according to their quality and relevance. Socioeconomic variations in chlamydia were synthesised for medium/high-rated studies only. Results No high-rated studies were identified. Eight medium-rated studies reported variations in chlamydia prevalence by SEC. In 6/8 studies, prevalence was higher in people of poorer SEC. Associations were more often significant when measured by education than when using other indicators. All studies measuring positivity were rated low. Across all studies, methodological limitations in SEC measurement were identified. Conclusions The current literature is limited in its capacity to describe associations between SEC and chlamydia risk. The choice of SEC measure may explain why some studies find higher chlamydia prevalence in young people in disadvantaged circumstances while others do not. Studies using appropriate SEC indicators (eg, education) are needed to inform decisions about targeting chlamydia screening. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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18. Hospitalisations for pelvic inflammatory disease in young Aboriginal women living in remote Australia: the role of chlamydia and gonorrhoea.
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Causer, Louise, Liu, Bette, Watts, Caroline, McManus, Hamish, Donovan, Basil, Ward, James, Guy, Rebecca, and TTANGO2 Collaboration
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CHLAMYDIA ,RESEARCH ,GONORRHEA ,RESEARCH methodology ,EVALUATION research ,COMPARATIVE studies ,HOSPITAL care ,CHLAMYDIA trachomatis ,CHLAMYDIA infections ,PELVIC inflammatory disease - 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. [ABSTRACT FROM AUTHOR]- Published
- 2022
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19. Prevalence of Neisseria gonorrhoeae infection in young subjects attending community clinics in South London.
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Gopal Rao, G., Bacon, L., Evans, J., Dejahang, Y., Michalczyk, P., and Donaldson, N.
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DISEASE prevalence ,NEISSERIA gonorrhoeae ,EPIDEMIOLOGICAL research ,CHLAMYDIA trachomatis ,CHLAMYDIA ,VULVOVAGINAL candidiasis - Abstract
Objectives: To describe the prevalence and epidemiology of gonococcal infection in young subjects attending community clinics in South-East London. Methods: Subjects <25 years of age participating in the National Chlamydia Screening Programme were tested for gonococcal infection using a nucleic acid amplification test Istrand displacement amplification assay). Results: 10 523 tests were performed in 7369 patients (82% female) over a 2-year period in 2004 and 2005. Specimens used for tests were self-taken vulvovaginal swabs (43%), cervical swabs (40%), urine (16%) and urethral swabs (0.9%). Reasons for tests were: screening (67%), diagnosis (27%) and contacts of patients with chlamydia or gonococcus infection (7%). A significantly higher percentage of male subjects were tested as contacts (19% male vs 4% female; p<0.001). Of the 10 117 cases with definite results, 414 were positive (prevalence 4.1%, 95% Cl 3.7% to 4.5%). There was a significantly higher prevalence in male subjects (5.7% male v 3.8% female; p<0.001). The average number of tests was 1.4 per patient (range 1-10). Contacts had a significantly higher prevalence (15.5%, p
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- 2008
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20. "It feels good to be told that I'm all clear": patients' accounts of retesting following genital chiamydial infection.
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Piercy, H.
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CHLAMYDIA ,SEXUAL intercourse ,CONTRACEPTIVES ,SEXUALLY transmitted diseases ,DIAGNOSIS - Abstract
Objective: To examine the meaning that people with genital chlamydial infection attribute to retesting as part of their treatment management. Methods: Unstructured interviews with 50 heterosexual patients (40 female and 10 male) who had or had had genital chlamydia infection. Recruitment was via a genitourinary medicine clinic and a contraceptive clinic. Results: The return visit was understood in terms of the retest. The retest occupied a pivotal position in the infection experience and was invested with symbolic significance because it provided a means by which to deal with feelings of bodily pollution. It marked the end of dirtiness that was important for the restoration of identity. It also marked the beginning of cleanness that was important in relation to sexual relationships. Conclusion: The sociocultural construction of sexually transmitted infections shapes the individual experience of having chlamydial infection. This perspective sheds light on the meaning that individuals invest in aspects of infection management. It is important for some people to know rather than assume that their infection has been eliminated, a function that is fulfilled by the retest. When retesting is not available, individuals may use increasingly available opportunistic chlamydia testing for this purpose with consequent cost and resource implications. [ABSTRACT FROM AUTHOR]
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- 2006
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21. Diagnosis of genital chlamydia in primary care: an explanation of reasons for variation in chlamydia testing.
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McNulty, C. A. M., Freeman, E., Bowen, J., Shefras, J., and Fenton, K. A.
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CHLAMYDIA ,GENITOURINARY diseases ,DIAGNOSIS ,PRIMARY care ,EPIDEMIOLOGY ,MEDICAL care ,CHLAMYDIA infection diagnosis ,CHLAMYDIA trachomatis ,FAMILY medicine ,FOCUS groups ,MEDICAL specialties & specialists ,PRIMARY health care ,RURAL health ,URBAN health - Abstract
Objectives: To explore the reasons for the 40-fold variation in diagnostic testing for genital Chlamydia trachomatis by general practices.Methods: A qualitative study with focus groups. We randomly selected urban and rural high and low testing practices served by Bristol, Hereford, and Gloucester microbiology laboratories. Open questions were asked about the investigation of C trachomatis in men and women in different clinical contexts.Results: The high and low testing practices did not differ in their age/sex make-up or by deprivation indices. There were major differences between high and low chlamydia testing practices. Low testing practices knew very little about the epidemiology and presentation of genital chlamydia infection and did not consider it in their differential diagnosis of genitourinary symptoms until patients had consulted several times. Low testers were less aware that chlamydia was usually asymptomatic, thought it was an inner city problem, and had poor knowledge of how to take diagnostic specimens. High testing practices either had a general practitioner with an interest in sexual health or a practice nurse who had completed specialist training in family planning. High testing practices were more cognizant of the symptoms and signs of chlamydia and always considered it in their differential diagnosis of genitourinary symptoms, including patients attending family planning clinics.Conclusions: Any programme to increase chlamydia testing in primary care must be accompanied by an education and awareness programme especially targeted at low testing practices. This will need to include information about the benefits of testing and who, when, and how to test. [ABSTRACT FROM AUTHOR]- Published
- 2004
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22. How to increase chlamydia testing in primary care: a qualitative exploration with young people and application of a meta-theoretical model.
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McDonagh, Lorraine K., Harwood, Hannah, Saunders, John M., Cassell, Jackie A., and Rait, Greta
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CHLAMYDIA infection diagnosis ,CHLAMYDIA ,RESEARCH ,MATHEMATICAL models ,RESEARCH methodology ,MEDICAL screening ,SOCIAL stigma ,EVALUATION research ,MEDICAL cooperation ,PRIMARY health care ,QUALITATIVE research ,COMPARATIVE studies ,HEALTH attitudes ,THEORY ,CHLAMYDIA infections - Abstract
Objective: The objective of this study was to explore young people's perspectives barriers to chlamydia testing in general practice and potential intervention functions and implementation strategies to overcome identified barriers, using a meta-theoretical framework (the Behaviour Change Wheel (BCW)).Methods: Twenty-eight semistructured individual interviews were conducted with 16-24 year olds from across the UK. Purposive and convenience sampling methods were used (eg, youth organisations, charities, online platforms and chain-referrals). An inductive thematic analysis was first conducted, followed by thematic categorisation using the BCW.Results: Participants identified several barriers to testing: conducting self-sampling inaccurately (physical capability); lack of information and awareness (psychological capability); testing not seen as a priority and perceived low risk (reflective motivation); embarrassment, fear and guilt (automatic motivation); the UK primary care context and location of toilets (physical opportunity) and stigma (social opportunity). Potential intervention functions raised by participants included education (eg, increase awareness of chlamydia); persuasion (eg, use of imagery/data to alter beliefs); environmental restructuring (eg, alternative sampling methods) and modelling (eg, credible sources such as celebrities). Potential implementation strategies and policy categories discussed were communication and marketing (eg, social media); service provision (eg, introduction of a young person's health-check) and guidelines (eg, standard questions for healthcare providers).Conclusions: The BCW provided a useful framework for conceptually exploring the wide range of barriers to testing identified and possible intervention functions and policy categories to overcome said barriers. While greater education and awareness and expanded opportunities for testing were considered important, this alone will not bring about dramatic increases in testing. A societal and structural shift towards the normalisation of chlamydia testing is needed, alongside approaches which recognise the heterogeneity of this population. To ensure optimal and inclusive healthcare, researchers, clinicians and policy makers alike must consider patient diversity and the wider health issues affecting all young people. [ABSTRACT FROM AUTHOR]- Published
- 2020
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23. National chlamydia screening programme in England: making progress.
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Fenton, K. A. and Ward, H.
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CHLAMYDIA ,MEDICAL screening ,AIDS ,HIV infections ,SEXUALLY transmitted diseases ,COMMUNICABLE diseases - Abstract
This article discusses treatment plans for chlamydia screening. Concrete plans for a national chlamydia screening programme gained momentum with the publication of the English "National Strategy for HIV and Sexual Health," in July 2001, which clearly outlined the government's commitment to a national roll-out of chlamydia screening. This was further strengthened by the publication of an implementation plan in June 2002, which confirmed the immediate implementation of screening in 10 areas in England. By September 2002, a national Chlamydia Screening Steering Group with multidisciplinary representation was appointed to advise the department of health on the programme's design and implementation.
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- 2004
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24. Chlamydia sequelae cost estimates used in current economic evaluations: does one-size-fit-all?
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Kate Soldan, Mark Jit, J Kevin Dunbar, Sarah C Woodhall, and Koh Jun Ong
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Male ,Pediatrics ,medicine.medical_specialty ,Canada ,Cost effectiveness ,Total cost ,Cost-Benefit Analysis ,Denmark ,Context (language use) ,Dermatology ,medicine.disease_cause ,Neonatal conjunctivitis ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Pelvic inflammatory disease ,Medicine ,Humans ,Mass Screening ,030212 general & internal medicine ,Netherlands ,Epididymitis ,Sweden ,030505 public health ,Chlamydia ,business.industry ,Australia ,Tubal factor infertility ,Chlamydia Infections ,medicine.disease ,United Kingdom ,Surgery ,Pregnancy, Ectopic ,Infectious Diseases ,Costs and Cost Analysis ,Female ,0305 other medical science ,business ,Chlamydia trachomatis ,Infertility, Female ,Ireland ,Pelvic Inflammatory Disease - Abstract
Background Current evidence suggests that chlamydia screening programmes can be cost-effective, conditional on assumptions within mathematical models. We explored differences in cost estimates used in published economic evaluations of chlamydia screening from seven countries (four papers each from UK and the Netherlands, two each from Sweden and Australia, and one each from Ireland, Canada and Denmark). Methods From these studies, we extracted management cost estimates for seven major chlamydia sequelae. In order to compare the influence of different sequelae considered in each paper and their corresponding management costs on the total cost per case of untreated chlamydia, we applied reported unit sequelae management costs considered in each paper to a set of untreated infection to sequela progression probabilities. All costs were adjusted to 2013/2014 Great British Pound (GBP) values. Results Sequelae management costs ranged from £171 to £3635 (pelvic inflammatory disease); £953 to £3615 (ectopic pregnancy); £546 to £6752 (tubal factor infertility); £159 to £3341 (chronic pelvic pain); £22 to £1008 (epididymitis); £11 to £1459 (neonatal conjunctivitis) and £433 to £3992 (neonatal pneumonia). Total cost of sequelae per case of untreated chlamydia ranged from £37 to £412. Conclusions There was substantial variation in cost per case of chlamydia sequelae used in published chlamydia screening economic evaluations, which likely arose from different assumptions about disease management pathways and the country perspectives taken. In light of this, when interpreting these studies, the reader should be satisfied that the cost estimates used sufficiently reflect the perspective taken and current disease management for their respective context.
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- 2016
25. The effect of electronic patient records (EPR) on the time taken to treat patients with genital Chlamydia infection
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S Shukla, M G Brook, T Baveja, and L Smondulak
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Adult ,Male ,Sexually transmitted disease ,Pediatrics ,medicine.medical_specialty ,Time Factors ,Adolescent ,Waiting Lists ,Reminder Systems ,Dermatology ,Young Adult ,medicine ,Electronic Health Records ,Humans ,Sex organ ,Chlamydia ,Recall ,business.industry ,Medical record ,Attendance ,Patient contact ,Chlamydia Infections ,medicine.disease ,Patient recall ,Telephone ,Surgery ,Infectious Diseases ,England ,Female ,Genital Diseases, Male ,business ,Genital Diseases, Female - Abstract
Objectives To measure the time taken to recall and treat patients with untreated Chlamydia attending a sexual-health clinic before and after the introduction of electronic patient records (EPR). Methods 52 consecutive qualifying patients were identified for January to March 2007 (paper case records) and 2009 (EPR). For each, the patient time intervals were measured between each of following dates: first attendance, first positive result received, first attempted patient contact and attendance for treatment. Results Between 2007 and 2009, the median time taken to treat a patient after receipt of a positive Chlamydia result fell by 11.5 days (median 15 days in 2007, 3.5 days in 2009). The time between first attendance and treatment was reduced by 9.5 days (median 21 days in 2007, 11.5 days in 2009) despite results taking 2 days longer to arrive in 2009. The proportion of patients treated within 2 weeks of a positive result rose from 38% in 2007 to 94% in 2009. Compared with paper notes, EPR decreased the time to recall, by eliminating three time-delaying patient recall processes. By ensuring more accurate patient recall information, EPR also lead to a higher proportion of patients successfully recalled by telephone (26/44, 59% vs 46/52, 88% in 2007 and 2009 respectively), leading to earlier treatment. Conclusions The ‘time to treat’ interval was dramatically reduced following the introduction of EPR. Clinics using paper notes should consider switching to EPR as a means of improving STI recall efficiency.
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- 2010
26. Gonorrhoea and chlamydia in persons with HIV: number needed to screen.
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Tuddenham, Susan, Ghanem, Khalil G., Gebo, Kelly A., Moore, Richard D., Mathews, William Christopher, Agwu, Allison, Mayer, Kenneth, Schumacher, Christina, Raifman, Julia, and Berry, Stephen A.
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CHLAMYDIA infection diagnosis ,GONORRHEA diagnosis ,HIV infection complications ,CHLAMYDIA infections ,CHLAMYDIA trachomatis ,COMPARATIVE studies ,GONORRHEA ,HIV infections ,HOMOSEXUALITY ,RESEARCH methodology ,MEDICAL cooperation ,MEDICAL screening ,NEISSERIA ,RESEARCH ,EVALUATION research ,SEXUAL partners ,MIXED infections - Abstract
Objectives: Current guidelines recommend screening sexually active persons with HIV (PWH) for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) at least annually. Yet, screening rates in many HIV clinics remain low. In this study, we estimated the number needed to screen (NNS) to detect a NG and/or CT infection at each anatomic site among different subpopulations of PWH. NNS provides a concrete, practical measure to aid in assessing the practical impact of screening. METHODS : We included adults in care at three HIV Research Network sites in 2011-2014. Restricting to first tests within each year, annual NNS was defined as number of persons tested divided by number positive. We computed urogenital and extragenital NNS by age and risk group (women, men who have sex with women (MSW) and men who have sex with men (MSM)). RESULTS : A total of 16 864 NG/CT tests were included. Among patients aged ≤25 years, urogenital NNS was similar among women (15 (95% CI 6 to 71)), MSW (21 (95% CI 6 to 167)) and MSM (20 (95% CI 12 to 36)). Over 25, urogenital NNS increased to a greater extent for women (363 (95% CI 167 to 1000)) and MSW (160 (95% CI 100 to 333)) than MSM (46 (95% CI 38 to 56)). The increase for women versus MSM >25 remained significant (p<0.01) in multivariable analysis. Among MSM, rectal NNS was 5 (95% CI 3 to 7) and 10 (95% CI 9 to 12) for ≤25 and for >25 years and pharyngeal NNS values were 8 (95% CI 5 to 13) and 20 (95% CI 16 to 24).Conclusions: These findings suggest the importance of regular, at least annual NG/CT screening, particularly extragenital, of HIV positive MSM of all ages. They provide some support for age-based cutoffs for women and MSW (eg, universal screening for those aged ≤25 and targeted screening for those aged >25 years). [ABSTRACT FROM AUTHOR]- Published
- 2019
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27. COMMENTARY.
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Adams, E. J. and Turner, K. M. E.
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CHLAMYDIA ,CHLAMYDIACEAE ,COST effectiveness ,COST analysis ,CHLAMYDIA infections ,BACTERIAL diseases - Abstract
The article focuses on the cost effectiveness of chlamydia screening. There are several papers that highlight the lack of appropriate methods used in the majority of previous studies. It is stated that cost effectiveness studies have assumed the results of chlamydial infections. Since this has been implemented nationally, it has been suggested that it is an appropriate time to reassess its effectiveness and cost effectiveness.
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- 2006
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28. Point-of-care tests using enzyme detection to diagnoseChlamydia trachomatisinfection do not work. But when they fail in clinical trials, they reappear under different names
- Author
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Julius Schachter
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Adult ,medicine.medical_specialty ,Pathology ,Point-of-care testing ,Chlamydia trachomatis ,Pharmacy ,Dermatology ,Std clinic ,medicine.disease_cause ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Chlamydia trachomatis infection ,Clinical Trials as Topic ,030505 public health ,Chlamydia ,business.industry ,Reproducibility of Results ,Chlamydia Infections ,Clinical Enzyme Tests ,medicine.disease ,Test (assessment) ,Clinical trial ,Infectious Diseases ,Point-of-Care Testing ,Family medicine ,Female ,0305 other medical science ,business - Abstract
While scanning De Baetselier and colleagues’ article evaluating an enzymatic Chlamydia trachomatis (CT) point-of-care assay (POC), I was struck by a feeling of deja vu.1 They found the BioChekSwab Rapid Test performed poorly, missing all nine infections detected by PCR. This reminded me of a paper by Moi in 2007 reporting the very poor performance of a POC for CT, HandiLab-C.2 Reading further, I realised this was not coincidence. The two assays seemed to use the same technology. BioChekSwab Rapid Test seems to be an updated HandiLab-C test that was widely available about 10 years ago. Sold in at least 17 countries, it had a CE mark with approval for POC professional use and over-the-counter sale (meaning self-test).Web1 In 2006, workers at the National Chlamydia Screening Programme, concerned about use of the test in England (it was for sale in pharmacies and supermarkets), asked me to speak about chlamydia diagnostics at their annual meeting. My talk emphasised nucleic acid amplification tests (NAATs) for CT diagnosis and warned about using HandiLab-C because the technology was not new and there were no reproducible clinical data supporting its use despite the company’s claims. Within a year, the Moi paper appeared stating that the HandiLab-C assay was not what it claimed. Subsequent trials confirmed that, finding sensitivity of only 12.5% and 19.4% in two clinics in the Philippines, and 12% in an STD clinic in the Netherlands.3 ,4 I was familiar with the HandiLab-C technology because in the 1980s Diversified Diagnostics Inc. (DDI) had a similar assay ‘MicroZyme the Easy Test’, claiming sensitivity of 96% and specificity of 97.9% for CT detection.Web2 It was described as the only totally biochemical test system; easy to perform; only 10 min to get a result. The procedure was collect …
- Published
- 2016
29. Supplemental testing is required to maintain control following a transition from Pap smear to HPV DNA testing for cervical screening: a mathematical modelling study.
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Regan, David Gabriel, Hui, Ben B., Guy, Rebecca J., Donovan, Basil, Hocking, Jane S., and Law, Matthew G.
- Abstract
Objectives: Using mathematical modelling, we have previously shown that the prevalence of infection with Trichomonas vaginalis (TV) is likely to increase in the general population in Australia with the transition from Pap smear-based cervical screening to human papillomavirus (HPV) DNA testing. Here we use the existing model to estimate the level of supplemental testing required to maintain TV control.Methods: A compartmental mathematical model describing the transmission of TV in the general heterosexual population in Australia was used to evaluate the impact of a range of screening scenarios on TV prevalence over time following the transition to HPV DNA testing for cervical screening. Scenarios considered were the inclusion of a TV test with the HPV test and the addition of TV testing to routine chlamydia testing conducted in primary care.Results: Our modelling suggests that with sufficient coverage, inclusion of TV testing with routine chlamydia screening in general practice, TV prevalence can be reduced over time, but at the current reported coverage will gradually increase following the transition to HPV testing. Inclusion of TV testing with HPV testing in the cervical screening programme is preferable to no supplemental testing but is considerably less effective in controlling TV.Conclusions: These findings support the inclusion of TV testing with routine chlamydia testing of young people. [ABSTRACT FROM AUTHOR]- Published
- 2020
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30. A new role for Chlamydia trachomatis serology?
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Anne M Johnson and Patrick J Horner
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Selection bias ,education.field_of_study ,Chlamydia ,business.industry ,media_common.quotation_subject ,Incidence (epidemiology) ,Population ,Dermatology ,medicine.disease ,medicine.disease_cause ,Serology ,Infectious Diseases ,Acquired immunodeficiency syndrome (AIDS) ,Immunology ,medicine ,Seroprevalence ,Chlamydia trachomatis ,business ,education ,media_common ,Demography - Abstract
Understanding the burden of Chlamydia trachomatis in populations is based primarily on studies of prevalence of current infection, measured using sensitive and specific nucleic acid amplification tests on genital or urinary specimens. Such studies have produced widely varying results, but most have emphasised the high prevalence in young, sexually active women with many fewer studies in men. 1 Studies have frequently been based on clinic populations, which suffer from problems of selection bias (toward those at highest risk) and limited demographic and behavioural data. The few studies based on random and representative population samples have generally demonstrated lower prevalence and increased risk linked to increasing numbers of sexual partners. 2 Studies of Chlamydia incidence in population samples are few and far between. Data from national surveillance programmes consistently show rising rates of diagnosed infection in most developed countries over the last decade. But this cannot measure true incidence of infection because they are biased by the introduction and wider spread use of new sensitive tests leading to increased diagnosis of asymptomatic infection. All these studies measure current infection. They cannot account for past exposure or measure cumulative risk of infection over time, that screening programmes aim to minimise. In this issue, Paavonen et al report on C. trachomatis antibody seroprevalence in a stratified probability sample of 8000 sera from a large Finnish population serum bank.2,3 Participants were women under 29, having at least two pregnancies. The paper illustrates an approach which could potentially be used more widely. The paper assesses prevalence of past exposure to genital C. trachomatis and explores changes over time by comparing age specific prevalence at different time points.
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- 2008
31. Chlamydia screening in an early pregnancy unit.
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Balendra, Anjella, Oakeshott, Pippa, Hayes, Kevin, Planche, Timothy, and Hay, Phillip E.
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CHLAMYDIA infection diagnosis ,CHLAMYDIA ,DIAGNOSIS - Abstract
A letter to the editor is presented concerning chlamydia testing in pregnant women.
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- 2016
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32. Clinical round-up.
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Herbert, Sophie and Haddow, Lewis
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SEXUALLY transmitted diseases ,DIAGNOSIS of HIV infections ,AZITHROMYCIN ,DOXYCYCLINE ,CHLAMYDIA ,THERAPEUTICS - Abstract
This section offers news briefs related to research about sexually transmitted diseases compiled as of May 2016. Topics covered include the factors associated with HIV testing in high-risk individuals and the comparison of the effective of azithromycin and doxycycline in the treatment of uncomplicated urogenital chlamydia infection.
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- 2016
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33. Who tests whom? A comprehensive overview of Chlamydia trachomatis test practices in a Dutch region among different STI care providers for urogenital, anorectal and oropharyngeal sites in young people: a cross-sectional study.
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den Heijer, Casper D. J., van Liere, G. A. F. S., Hoebe, C. J. P. A., van Bergen, J. E. A. M., Cals, J. W. L., Stals, F. S., and Dukers-Muijrers, N. H. T. M.
- Subjects
CHLAMYDIA ,CHLAMYDIA infections ,SEXUALLY transmitted diseases ,CHLAMYDIA trachomatis ,DIAGNOSIS of genitalia diseases ,DIAGNOSIS of bacterial diseases ,CHLAMYDIA infection diagnosis ,SEXUALLY transmitted disease diagnosis ,ANUS ,BACTERIAL diseases ,CERVIX uteri ,DEMOGRAPHY ,MULTIVARIATE analysis ,POISSON distribution ,RECTUM ,URETHRA ,VAGINA ,LOGISTIC regression analysis ,SOCIOECONOMIC factors ,CROSS-sectional method ,BACTERIURIA ,OROPHARYNX - Abstract
Objectives: To evaluate and compare Chlamydia trachomatis (CT) diagnostic test practices of different sexually transmitted infection (STI) care providers in 16-29 year olds from one defined geographic Dutch region (280,000 inhabitants). Both number and proportion of positive CT tests (ie, test positivity) were assessed, and factors associated with these outcomes.Methods: Data on laboratory testing and diagnosis of urogenital, anorectal and oropharyngeal CT between 2006 and 2010 were retrieved from general practitioners (GPs), gynaecologists, an STI clinic and a population-based chlamydia screening programme. Multivariable regression analyses explored associations between age, sex, test year, socio-economic status (SES) and STI care provider and the outcomes being the number of tests and test positivity.Results: Overall, 22,831 tests were performed (1868 positive; 8.2%). Extragenital (ie, anorectal and oropharyngeal) tests accounted for 4% of all tests (7.5% positive) and were almost exclusively (99%) performed by the STI clinic. STI clinics tested most men (37.2% of all tested men), whereas GPs tested most women (29.9% of all tested women). GPs and STI clinics accounted for 73.3% (1326/1808) of urogenital CT diagnoses. In women, the number of tests increased with age, whereas test positivity decreased for all STI care providers. Lower SES was associated with higher test positivity in GP and gynaecology patients.Conclusions: STI clinics performed most CT tests in men, whereas GPs performed most CT tests in women. GPs and STI clinics accounted for the majority of positives. Extragenital CT testing is rarely performed outside the STI clinic and needs to be promoted, especially in men who have sex with men. [ABSTRACT FROM AUTHOR]- Published
- 2016
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34. Is chlamydia screening and testing in Britain reaching young adults at risk of infection? Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).
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Woodhall, Sarah C., Soldan, Kate, Sonnenberg, Pam, Mercer, Catherine H., Clifton, Soazig, Saunders, Pamela, Silva, Filomeno da, Alexander, Sarah, Wellings, Kaye, Tanton, Clare, Field, Nigel, Copas, Andrew J., Ison, Catherine A., Johnson, Anne M., and da Silva, Filomeno
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CHLAMYDIA ,CHLAMYDIA infection diagnosis ,SEXUALLY transmitted diseases ,HUMAN sexuality ,WOMEN'S sexual behavior ,DIAGNOSIS ,CHLAMYDIA infection prevention ,AGE distribution ,ATTITUDE (Psychology) ,CHLAMYDIA infections ,CLUSTER analysis (Statistics) ,INTERVIEWING ,RESEARCH funding ,SOCIOLOGY ,LOGISTIC regression analysis ,LIFESTYLES ,DISEASE prevalence ,BACTERIURIA - Abstract
Background: In the context of widespread opportunistic chlamydia screening among young adults, we aimed to quantify chlamydia testing and diagnosis among 16-24 year olds in Britain in relation to risk factors for prevalent chlamydia infection.Methods: Using data from sexually experienced (≥1 lifetime sexual partner) 16-year-old to 24-year-old participants in Britain's third National Survey of Sexual Attitudes and Lifestyles (conducted 2010-2012), we explored socio-demographic and behavioural factors associated with prevalent chlamydia infection (detected in urine; n=1832), self-reported testing and self-reported diagnosis in the last year (both n=3115).Results: Chlamydia prevalence was 3.1% (95% CI 2.2% to 4.3%) in women and 2.3% (1.5% to 3.4%) in men. A total of 12.3% of women and 5.3% men had a previous chlamydia diagnosis. Factors associated with prevalent infection were also associated with testing and diagnosis (eg, increasing numbers of sexual partners), with some exceptions. For example, chlamydia prevalence was higher in women living in more deprived areas, whereas testing was not. In men, prevalence was higher in 20-24 than 16-19 year olds but testing was lower. Thirty per cent of women and 53.7% of men with ≥2 new sexual partners in the last year had not recently tested.Conclusions: In 2010-2012 in Britain, the proportion of young adults reporting chlamydia testing was generally higher in those reporting factors associated with chlamydia. However, many of those with risk factors had not been recently tested, leaving potential for undiagnosed infections. Greater screening and prevention efforts among individuals in deprived areas and those reporting risk factors for chlamydia may reduce undiagnosed prevalence and transmission. [ABSTRACT FROM AUTHOR]- Published
- 2016
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35. Developing and testing accelerated partner therapy for partner notification for people with genital Chlamydia trachomatis diagnosed in primary care: a pilot randomised controlled trial.
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Estcourt, Claudia S., Sutcliffe, Lorna J., Copas, Andrew, Mercer, Catherine H., Roberts, Tracy E., Jackson, Louise J., Symonds, Merle, Tickle, Laura, Muniina, Pamela, Rait, Greta, Johnson, Anne M., Aderogba, Kazeem, Creighton, Sarah, and Cassell, Jackie A.
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SEXUAL health ,SEXUAL partners ,CHLAMYDIA ,RANDOMIZED controlled trials ,MEDICAL referrals ,DIAGNOSIS ,CHLAMYDIA infection diagnosis ,CHLAMYDIA infection prevention ,CHLAMYDIA infections ,OUTPATIENT medical care ,CHLAMYDIA trachomatis ,COMPARATIVE studies ,RESEARCH methodology ,MEDICAL cooperation ,PRIMARY health care ,RESEARCH ,RESEARCH funding ,HUMAN sexuality ,PILOT projects ,EVALUATION research ,HUMAN services programs ,CONTACT tracing ,PATIENTS' attitudes ,INFECTIOUS disease transmission - Abstract
Background: Accelerated partner therapy (APT) is a promising partner notification (PN) intervention in specialist sexual health clinic attenders. To address its applicability in primary care, we undertook a pilot randomised controlled trial (RCT) of two APT models in community settings.Methods: Three-arm pilot RCT of two adjunct APT interventions: APTHotline (telephone assessment of partner(s) plus standard PN) and APTPharmacy (community pharmacist assessment of partner(s) plus routine PN), versus standard PN alone (patient referral). Index patients were women diagnosed with genital chlamydia in 12 general practices and three community contraception and sexual health (CASH) services in London and south coast of England, randomised between 1 September 2011 and 31 July 2013.Results: 199 women described 339 male partners, of whom 313 were reported by the index as contactable. The proportions of contactable partners considered treated within 6 weeks of index diagnosis were APTHotline 39/111 (35%), APTPharmacy 46/100 (46%), standard patient referral 46/102 (45%). Among treated partners, 8/39 (21%) in APTHotline arm were treated via hotline and 14/46 (30%) in APTPharmacy arm were treated via pharmacy.Conclusions: The two novel primary care APT models were acceptable, feasible, compliant with regulations and capable of achieving acceptable outcomes within a pilot RCT but intervention uptake was low. Although addition of these interventions to standard PN did not result in a difference between arms, overall PN uptake was higher than previously reported in similar settings, probably as a result of introducing a formal evaluation. Recruitment to an individually randomised trial proved challenging and full evaluation will likely require service-level randomisation.Trial Registration Number: Registered UK Clinical Research Network Study Portfolio id number 10123. [ABSTRACT FROM AUTHOR]- Published
- 2015
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36. Healthcare providers' perspectives on expedited partner therapy for chlamydia: a qualitative study.
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Rosenfeld, Elian A., Marx, John, Terry, Martha A., Stall, Ron, Pallatino, Chelsea, and Miller, Elizabeth
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CHLAMYDIA ,SEXUALLY transmitted diseases ,MEDICAL personnel ,CHLAMYDIACEAE ,COMMUNICABLE diseases - Abstract
Objectives Expedited partner therapy (EPT) effectively reduces rates of reinfection with chlamydia and increases the number of partners treated for the infection. Healthcare provider (HCP) provision of EPT is low. The objective of this qualitative study was to understand HCP views and opinions regarding the use of EPT in a state where EPT is permissible but underused. Methods Using a purposive sampling strategy to include diverse HCPs who treat young women at risk for chlamydia, 23 semistructured, in-depth interviews were conducted between October and December 2013. The interviews included questions about knowledge, attitudes, experiences with, and barriers and facilitators regarding the use of EPT. Results Many respondents report using EPT and believe the practice is beneficial for their patients. Most providers were unaware of their colleagues' practices and had limited knowledge regarding institutional policies around EPT. HCPs noted a variety of barriers, such as fear of liability, confusion around the legal status of EPT and not' being able to counsel patients partners that make routine use of this practice a challenge. Facilitators of EPT include speaking on the phone with patients' partners and establishing legislation enabling EPT. Conclusions This is the first study to qualitatively examine HCPs' perspectives on EPT in the USA. Barriers to EPT, including concerns about counselling patients' partners and the legal status of EPT, can be overcome. EPT recommendations could include the use of phone calls as part of their guidelines. Changing EPT legislation at the state level in the USA is an important factor to facilitate EPT use. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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37. Urogenital Chlamydia trachomatis strain types, defined by high-resolution multilocus sequence typing, in relation to ethnicity and urogenital symptoms among a young screening population in Amsterdam, The Netherlands.
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Versteeg, Bart, Himschoot, Michelle, van den Broek, Ingrid V. F., Bom, Reinier J. M., Speksnijder, Arjen G. C. L., van der Loeff, Maarten F. Schim, and Bruisten, Sylvia M.
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CHLAMYDIA trachomatis ,GENOTYPES ,ETHNICITY ,CHLAMYDIA - Abstract
Introduction Previous studies found conflicting results regarding associations between urogenital Chlamydia trachomatis infections and ethnicity or urogenital symptoms among at-risk populations using either ompA-based genotyping or high-resolution multilocus sequence typing (MLST). This study applied high-resolution MLST on samples of individuals from a selected young urban screening population to assess the relationship of C. trachomatis strain types with ethnicity and self-reported urogenital symptoms. Demographic and sexual risk behaviour characteristics of the identified clusters were also analysed. Methods We selected C. trachomatis-positive samples from the Dutch Chlamydia Screening Implementation study among young individuals in Amsterdam, the Netherlands. All samples were typed using high- resolution MLST. Clusters were assigned using minimum spanning tree analysis and were combined with epidemiological data of the participants. Results We obtained full MLST data for C. trachomatis-positive samples from 439 participants and detected nine ompA genovars. MLST analysis identified 175 sequence types and six large clusters; in one cluster, participants with Surinamese/Antillean ethnicity were over-represented (58.8%) and this cluster predominantly consisted of genovar I. In addition, we found one cluster with an over-representation of participants with Dutch ethnicity (90.0%) and which solely consisted of genovar G. No association was observed between C. trachomatis clusters and urogenital symptoms. Conclusions We found an association between urogenital C. trachomatis clusters and ethnicity among young screening participants in Amsterdam, the Netherlands. However, no association was found between C. trachomatis clusters and self-reported urogenital symptoms. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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38. Second tests forChlamydia trachomatisandNeisseria gonorrhoeae
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S. Corden and S Skidmore
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Chlamydia ,Repeat testing ,business.industry ,Chlamydia trachomatis ,Dermatology ,medicine.disease ,medicine.disease_cause ,Polymerase Chain Reaction ,Virology ,Neisseria gonorrhoeae ,N gonorrhoeae ,Gonorrhea ,Infectious Diseases ,Molecular Diagnostic Techniques ,Acquired immunodeficiency syndrome (AIDS) ,Lymphogranuloma Venereum ,Immunology ,Humans ,Mass Screening ,Medicine ,business - Abstract
The paper by Hopkins et al suggests that repeat testing for C trachomatis (CT) and N gonorrhoeae is unnecessary.1 This issue has long been debated2–4 and currently, with many laboratories having to reduce costs, the view put forward in this paper seems attractive. We would, however, like to make the following points. Repeat testing for CT using the same platform is not recommended for the purpose of confirmation. Confirmation must be by a second …
- Published
- 2012
39. The SPORTSMART study: a pilot randomised controlled trial of sexually transmitted infection screening interventions targeting men in football club settings.
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Fuller, Sebastian S., Mercer, Catherine H., Copas, Andrew J., Saunders, John, Sutcliffe, Lorna J., Cassell, Jackie A., Hart, Graham, Johnson, Anne M., Roberts, Tracy E., Jackson, Louise J., Muniina, Pamela, and Estcourt, Claudia S.
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CHLAMYDIA infection diagnosis ,CHLAMYDIA ,DISEASES in women ,SEXUALLY transmitted disease diagnosis ,SEXUAL health - Abstract
Background Uptake of chlamydia screening by men in England has been substantially lower than by women. Non-traditional settings such as sports clubs offer opportunities to widen access. Involving people who are not medically trained to promote screening could optimise acceptability. Methods We developed two interventions to explore the acceptability and feasibility of urine-based sexually transmitted infection (STI) screening interventions targeting men in football clubs. We tested these interventions in a pilot cluster randomised control trial. Six clubs were randomly allocated, two to each of three trial arms: team captain-led and poster STI screening promotion; sexual health adviser-led and poster STI screening promotion; and poster-only STI screening promotion (control/comparator). Primary outcome was test uptake. Results Across the three arms, 153 men participated in the trial and 90 accepted the offer of screening (59%, 95% CI 35% to 79%). Acceptance rates were broadly comparable across the arms: captain-led: 28/56 (50%); health professional-led: 31/46 (67%); and control: 31/51 (61%). However, rates varied appreciably by club, precluding formal comparison of arms. No infections were identified. Process evaluation confirmed that interventions were delivered in a standardised way but the control arm was unintentionally 'enhanced' by some team captains actively publicising screening events. Conclusions Compared with other UK-based community screening models, uptake was high but gaining access to clubs was not always easy. Use of sexual health advisers and team captains to promote screening did not appear to confer additional benefit over a poster-promoted approach. Although the interventions show potential, the broader implications of this strategy for UK male STI screening policy require further investigation. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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40. An early evaluation of clinical and economic costs and benefits of implementing point of care NAAT tests for Chlamydia trachomatis and Neisseria gonorrhoea in genitourinary medicine clinics in England.
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Turner, Katherine M. E., Round, Jeff, Horner, Patrick, Macleod, John, Goldenberg, Simon, Deol, Arminder, and Adams, Elisabeth J.
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NUCLEIC acid amplification techniques ,CHLAMYDIA ,GONORRHEA diagnosis ,COST effectiveness ,PELVIC inflammatory disease ,DIAGNOSIS - Abstract
Objectives To estimate the costs and benefits of clinical pathways incorporating a point of care (POC) nucleic acid amplification test (NAAT) for chlamydia and gonorrhoea in genitourinary medicine (GUM) clinics compared with standard off-site laboratory testing. Method We simulated 1.2 million GUM clinic attendees in England. A simulation in Microsoft Excel was developed to compare existing standard pathways of management for chlamydia and gonorrhoea with a POC NAAT. We conducted scenario analyses to evaluate the robustness of the model findings. The primary outcome was the incremental cost-effectiveness ratio. Secondary outcomes included the number of inappropriate treatments, complications and transmissions averted. Results The baseline cost of using the point of POC NAAT was £103.9 million compared with £115.6 million for standard care. The POC NAAT was also associated with a small increase of 46 quality adjusted life years, making the new test both more effective and cheaper. Over 95 000 inappropriate treatments might be avoided by using a POC NAAT. Patients receive diagnosis and treatment on the same day as testing, which may also prevent 189 cases of pelvic inflammatory disease and 17 561 onward transmissions annually. Discussion Replacing standard laboratory tests for chlamydia and gonorrhoea with a POC test could be cost saving and patients would benefit from more accurate diagnosis and less unnecessary treatment. Overtreatment currently accounts for about a tenth of the reported treatments for chlamydia and gonorrhoea and POC NAATs would effectively eliminate the need for presumptive treatment. [ABSTRACT FROM AUTHOR]
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- 2014
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41. Chlamydia and gonorrhoea infections and the risk of adverse obstetric outcomes: a retrospective cohort study.
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Liu, Bette, Roberts, Christine L., Clarke, Marilyn, Jorm, Louisa, Hunt, Jennifer, and Ward, James
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CHLAMYDIA ,GONORRHEA ,LABOR complications (Obstetrics) ,PREGNANCY complications ,OBSTETRICAL research - Abstract
Objectives To examine the association between prior chlamydia and gonorrhoea infections and adverse obstetric outcomes. Methods Records of women resident in New South Wales, Australia with a singleton first birth during 1999-2008 were linked to chlamydia and gonorrhoea notifications using probabilistic linkage. Obstetric outcomes and potential confounders were ascertained from the birth record. Logistic regression, adjusted for potential confounders was used to estimate the association between a disease notification prior to the birth and adverse birth outcomes: spontaneous preterm birth (SPTB), small for gestational age (SGA) and stillbirth. Results Among 354 217 women, 1.0% (n=3658) had a prior chlamydia notification; 0.06% (n=196) had a prior gonorrhoea notification. The majority of notifications (>80%) occurred before the estimated conception date. 4.1% of women had a SPTB, 12.1% had a SGA baby and 0.6% of women had a stillbirth. Among women with a prior chlamydia notification, the risk of SPTB and stillbirth was increased, aOR 1.17 (95% CI 1.01 to 1.37) and aOR 1.40 (95% CI 1.00 to 1.96) respectively but there was no association with SGA, aOR 0.99 (95% CI 0.89 to 1.09). For women with gonorrhoea the risks for SPTB, stillbirth and SGA were respectively aOR 2.50 (95% CI 1.39 to 4.50), 2.35 (95% CI 0.58 to 9.56) and 0.98 (95% CI 0.58 to 1.68). Among women with a prior chlamydia diagnosis, the risk of SPTB did not differ between women diagnosed >1 year prior to conception, within the year prior to conception or during the pregnancy, (p=0.9). Conclusions Sexually transmissible infections in pregnancy and the preconception period may be important in predicting pregnancy outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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42. Highlights from this issue.
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Cassell, Jackie A
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- 2011
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43. STI management and control in North America IUSTI region.
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Gaydos, Charlotte A
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PREVENTION of sexually transmitted diseases ,CHLAMYDIA ,GONORRHEA ,SYPHILIS - Abstract
The article reports on sexually transmitted infection (STI) management in North America in 2011. It mentions that about 19 million new cases occur annually in the U.S. Cases of chlamydia, gonorrhea and infectious syphilis have risen between 1997 and 2007 in Canada. It says that U.S. youth, especially the African-American and ethnic minority groups, are reportedly the most affected. It states that clinic-based screening has been supplemented with computerised disease surveillance systems.
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- 2011
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44. Who is being tested by the English National Chlamydia Screening Programme? A comparison with national probability survey data.
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Riha, Johanna, Mercer, Catherine H, Soldan, Kate, French, Clare E, and Macintosh, Mary
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CHLAMYDIA ,CHLAMYDIACEAE ,CHLAMYDIA trachomatis ,INFECTION ,CHLAMYDIA infection prevention ,COMPARATIVE studies ,CONDOMS ,RESEARCH methodology ,MEDICAL cooperation ,MEDICAL screening ,RESEARCH ,RESEARCH funding ,SURVEYS ,EVALUATION research ,UNSAFE sex ,ACQUISITION of data ,PATIENT selection ,SEXUAL partners - Abstract
Objectives: We compare data collected by England's National Chlamydia Screening Programme (NCSP) with national probability survey data to examine demographic and behavioural differences that may be important in understanding who the NCSP is reaching and interpreting chlamydia positivity.Methods: Data for 538,119 men and women aged 16-24 years who were screened in 2008 and data collected from 2180 interviewees in Britain's second National Survey of Sexual Attitudes and Lifestyles 1999-2001 (Natsal-2), of whom 644 were tested for chlamydia, were compared using the χ2 statistic and logistic regression.Results: Compared with Natsal-2, the NCSP tested more women (67% vs. 49%). NCSP participants were more likely to be younger: 29% were 16-17 years versus 16% of men and 15% of women in Natsal-2; from ethnic minority groups: 17% of men and 14% of women versus 8% and 6%, respectively, in Natsal-2; not to have used condoms at last sex: 66% of men and 68% of women versus 48% and 63%, respectively, in Natsal-2: and more likely to report two or more partners in the last year: 62% of men and 47% of women versus 47% and 30%, respectively, in Natsal-2. In multivariate analyses, higher AOR of chlamydia positivity were found for those reporting non-use of condoms and for those reporting multiple partners in both the NCSP and Natsal-2.Conclusions: The NCSP is testing young people at increased risk of chlamydia. The impact of this testing bias on the effectiveness of the programme should be evaluated. [ABSTRACT FROM AUTHOR]- Published
- 2011
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45. Contraceptive practices, sexual and reproductive health needs of HIV-positive and negative female sex workers in Goa, India.
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Wayal, Sonali, Cowan, Frances, Warner, Pamela, Copas, Andrew, Mabey, David, and Shahmanesh, Maryam
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SEX workers ,HIV infections ,CONTRACEPTIVES ,GONORRHEA ,CHLAMYDIA ,TRICHOMONAS - Abstract
Objectives: In India, female sex workers (FSWs), suffer from high HIV prevalence and abortions. Contraceptive use among general population women is well understood. However, FSWs contraceptives practices and reproductive health needs are under-researched. We investigated contraceptive practices among HIV-positive and negative FSWs in Goa, India and explored its association with socio-demographic and sex work related factors.Methods: Cross-sectional study using respondent driven sampling recruited 326 FSWs. They completed an interviewer-administered questionnaire and were screened for STI/HIV. Multivariable logistic regression was used to explore factors associated with sterilisation relative to no contraception.Results: HIV prevalence was high (26%). Of the 59 FSWs planning pregnancy, 33% were HIV-positive and 5-7% had Gonorrhoea, Chlamydia and Trichomonas. 25% and 65% of FSWs screened-positive for Syphilis and Herpes simplex virus type 2 antibodies respectively. Among the 260 FSWs analysed for contraceptive use, 39% did not use contraceptives, and 26% had experienced abortion. Half the FSWs had undergone sterilisation, and only 5% used condoms for contraception. Among HIV-positive FSWs, 45% did not use contraceptives. Sterilisation was independently associated with older age, illiteracy, having an intimate non-paying male partner, having children and financial autonomy. Exposure to National AIDS Control Organisation's HIV-prevention interventions was reported by 34% FSWs and was not significantly associated with contraceptive use (adjusted odds ratio 1.4, 95% CI 0.7 to 2.9).Conclusion: HIV-prevention interventions should promote contraception, especially among young and HIV-positive FSWs. Integrating HIV treatment and care services with HIV-prevention interventions is vital to avert HIV-positive births. [ABSTRACT FROM AUTHOR]- Published
- 2011
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46. Sex workers can be screened too often: a cost-effectiveness analysis in Victoria, Australia.
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Wilson, David P., Heymer, Kelly-Jean, Anderson, Jonathan, O'Connor, Jody, Harcourt, Christine, and Donovan, Basil
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SEXUALLY transmitted diseases ,SEX workers ,COST effectiveness ,CHLAMYDIA ,PARAMETER estimation ,SEXUALLY transmitted disease diagnosis ,PREVENTION of sexually transmitted diseases ,MEDICAL screening ,CONDOMS ,MEDICAL protocols ,TIME ,QUALITY-adjusted life years ,ECONOMICS - Abstract
Objectives: Commercial sex is licensed in Victoria, Australia such that sex workers are required to have regular tests for sexually transmitted infections (STIs). However, the incidence and prevalence of STIs in sex workers are very low, especially since there is almost universal condom use at work. We aimed to conduct a cost-effectiveness analysis of the financial cost of the testing policy versus the health benefits of averting the transmission of HIV, syphilis, chlamydia and gonorrhoea to clients.Methods: We developed a simple mathematical transmission model, informed by conservative parameter estimates from all available data, linked to a cost-effectiveness analysis.Results: We estimated that under current testing rates, it costs over $A90,000 in screening costs for every chlamydia infection averted (and $A600,000 in screening costs for each quality-adjusted life year (QALY) saved) and over $A4,000,000 for every HIV infection averted ($A10,000,000 in screening costs for each QALY saved). At an assumed willingness to pay of $A50,000 per QALY gained, HIV testing should not be conducted less than approximately every 40 weeks and chlamydia testing approximately once per year; in comparison, current requirements are testing every 12 weeks for HIV and every 4 weeks for chlamydia.Conclusions: Mandatory screening of female sex workers at current testing frequencies is not cost-effective for the prevention of disease in their male clients. The current testing rate required of sex workers in Victoria is excessive. Screening intervals for sex workers should be based on local STI epidemiology and not locked by legislation. [ABSTRACT FROM AUTHOR]- Published
- 2010
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47. 'It's all in the message': the utility of personalised short message service (SMS) texts to remind patients at higher risk of STIs and HIV to reattend for testing-a repeat before and after study.
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Nyatsanza, Farai, McSorley, John, Murphy, Siobhan, and Brook, Gary
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TEXT messages ,SEXUALLY transmitted disease risk factors ,SEXUALLY transmitted diseases ,HIV ,SEX workers ,CHLAMYDIA ,PATIENTS ,SEXUALLY transmitted disease diagnosis ,CLINICS ,COMPARATIVE studies ,RESEARCH methodology ,MEDICAL appointments ,MEDICAL care research ,MEDICAL cooperation ,MEDICAL screening ,PATIENT compliance ,RESEARCH ,STATISTICAL sampling ,EVALUATION research ,RANDOMIZED controlled trials ,HEALTH care reminder systems - Abstract
Background: Patients at increased risk of sexually transmitted infections (STIs)/HIV acquisition are advised to reattend for retesting. A previous study showed that 'generic' text reminders did not improve reattendance.Aim: To assess if a personalised text message with increased contact information would increase reattendance rates of at-risk patients.Methods: Patients who are at risk of future STIs, defined by having a current acute STI, attending for emergency contraception, commercial sex workers (CSWs) or men who have sex with men (MSM), were sent a text reminder to reattend for retesting 6 weeks after initial visit. Reattendance rates were measured for September to December 2012 (control group who received a generic text message) and February to May 2014 (intervention 'personalised message' group who received a text message containing their first name and ways to contact the clinic). Reattendance was counted within 4 months of the end of the initial episode of care.Results: The reattendance rate was significantly higher for the intervention group: 149/266 (56%) than the control group: 90/273 (33%) (p=0.0001) and was also significantly higher in the intervention group than the control group in patients with the following risks: recent chlamydia (64/123 (52%) vs 43/121 (36%)) (p=0.03), recent gonorrhoea (41/64 (64%) vs 4/21 (19%)) (p=0.0003) and MSM (26/45 (58%) vs 3/18 (16%)) (p=0.006). New STI rates in the reattending intervention group and controls were 26/ 149 (17%) and 13/90 (14%) (n.s), respectively.Conclusions: Sending a personalised text message with increased contact information as a reminder for retesting increased reattendance rates by 23% in patients who are at higher risk of STIs. [ABSTRACT FROM AUTHOR]- Published
- 2016
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48. Chlamydia trachomatis OmpA genotyping as a tool for studying the natural history of genital chlamydial infection.
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Geisler, W. M., Black, C. M., Bandea, C. I., and Morrison, S. G.
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CHLAMYDIA ,CHLAMYDIA trachomatis ,CHLAMYDIA infections ,MEMBRANE proteins ,INFECTION ,RESEARCH funding ,GENOTYPES - Abstract
Objective: To investigate the relationship of Chlamydia trachomatis (CT) outer membrane protein A (OmpA) type to the clearance of CT infection before treatment.Methods: CT OmpA genotyping, with amplification and sequencing of ompA, was utilised to study the natural history of CT infection (spontaneous resolution vs persistence) in 102 individuals with chlamydia-positive screening tests returning for treatment.Results: CT OmpA distribution was associated with spontaneous resolution of CT, most notably with CT OmpA genotype J/Ja detected more often from the initial screening CT test than other genotypes in those who then had spontaneous resolution of CT noted at the time of treatment. Five individuals with presumed persisting CT infection had discordant CT OmpA genotypes at the screening and treatment visits, suggesting possible new interval CT infection.Conclusions: Clearance of chlamydia by the host before treatment may be influenced by the CT OmpA genotype infecting the host. CT OmpA genotyping may be a valuable tool in understanding the natural history of chlamydial infections. [ABSTRACT FROM AUTHOR]- Published
- 2008
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49. Self-reported syphilis and gonorrhoea testing among men who have sex with men: national HIV behavioural surveillance system, 2003-5.
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Tai, E., Sanchez, T., Lansky, A., Mahle, K., Heffelfinger, J., and Workowski, K.
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MEN'S sexual behavior ,SEXUALLY transmitted diseases ,SYPHILIS ,GONORRHEA ,CHLAMYDIA - Abstract
Objectives: The Centers for Disease Control and Prevention provides guidance on sexually transmitted disease (STD) testing specifically for men who have sex with men (MSM( in STD treatment guidelines to address increasing rates of gonorrhoea and syphilis among MSM in the USA. The guidelines recommend at least annual syphilis, gonorrhoea and chlamydia testing for sexually active MSM. The implementation of these guidelines was evaluated. Methods: Data from the 2003-5 MSM cycle of the National HIV Behavioural Surveillance System were used. The proportion of sexually active HIV-negative MSM reporting syphilis and gonorrhoea testing during the previous year was determined and multivariate logistic regression was used to identify factors associated with testing. Results: Of 10030 MSM, 39% and 36% reported having been tested for syphilis and gonorrhoea in the previous year, respectively. Four factors were associated with syphilis and gonorrhoea testing, respectively: age 18-24 years versus ≥45 years (odds ratio (OR) 2.2, 95% Cl 1.8 to 2.5; OR 2.7, 95% Cl 2.3 to 3.2), black versus white race (OR 1.3, 95% Cl 1.1 to 1.4; OR 1.4, 95% Cl 1.2 to 1.6), private insurance versus no insurance (OR 1.3, 95% Cl 1.1 to 1.4; OR 1.3, 95% Cl 1.1 to 1.4) and disclosing male-male sex to a healthcare provider (OR 2.2, 95% Cl 2.0 to 2.5; OR 2.1, 95% Cl 1.9 to 2.3). Conclusions: Syphilis and gonorrhoea testing among MSM was low, despite specific testing recommendations in the STD treatment guidelines. To increase STD testing among MSM, healthcare providers should assess the risks of STD for male patients through routine enquiries about sexual activity. [ABSTRACT FROM AUTHOR]
- Published
- 2008
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50. Trends in sexually transmitted infections (other than HIV) in older people: analysis of data from an enhanced surveillance system.
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Bodley-Tickell, A. T., Olowokure, B., Bhaduri, S., White, D. J., Ward, D., Ross, J. D. C., Smith, G., Duggal, H. V., and Goold, P.
- Subjects
SEXUALLY transmitted diseases ,CHLAMYDIA ,HERPES genitalis ,SYPHILIS - Abstract
Objective: This study examines the distribution of selected sexually transmitted infections (STIs) in older people (aged ⩾45 years) attending genitourinary medicine (GUM) clinics in the West Midlands, UK. Methods: Analysis of data from the regional enhanced STI surveillance system for the period 1996-2003. Selected STIs were chlamydia, genital herpes, genital warts, gonorrhoea and syphilis. Results: Altogether, 4445 STI episodes were reported among older people during the study period. Between 1996 and 2003 older people accounted for 3.7% and 4.3%, respectively, of all GUM clinic attendances. The rate of STIs in older people more than doubled in 2003 compared with 1996 (p<0.0001). Rates for all five selected diagnoses were significantly higher in 2003 compared to 1996. A significantly increasing trend over time was seen overall (p<0.0001) and for each of the selected diagnoses. Overall, males and those aged 55-59 years of age were significantly more likely to be affected. Conclusions: This study provides evidence of significant increases in attendance at GUM clinics by older people. Although it is recognised that young people should remain the focus of sexual health programmes, the results indicate that sexual risk-taking behaviour is not confined to young people but also occurs among older people. There is therefore a need to develop and implement evidence-based multifaceted sexual health programmes that while aiming to reduce STI transmission among all age groups should include interventions aimed specifically at older people and address societal and healthcare attitudes, myths and assumptions about sexual activity among older people. [ABSTRACT FROM AUTHOR]
- Published
- 2008
- Full Text
- View/download PDF
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