Search

Background The advent of fully automated nucleic acid amplification test (NAAT) technology brings new public health opportunities to provide Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) point-of-care testing (POCT) in non-traditional settings., Methods: This pilot study evaluated the integration of the CT/NG Xpert diagnostic assay into an urban peer-led community setting providing HIV and syphilis POCT. A comprehensive protocol of testing, result notification, referral and follow up, managed by peer test facilitators, was undertaken., Results: Over 67 weeks, there were 4523 occasions of CT/NG testing using urine, oropharyngeal and anorectal samples with 25.7% (803) of the 3123 unique participants returning for repeat testing. The prevalence of CT and NG was 9.5% and 5.4% respectively. Where CT and or NG infection was detected, 98.4% (604/614) of participants were successfully notified of detected infection and referred for treatment. Evaluation Survey responses (11.4%, 516/4523) indicated a substantial proportion of respondents (27.1%, 140/516) 'would not have tested anywhere else'. Of note, 17.8% (92/516) of participants reported no previous CT/NG test and an additional 17.8% (92/516) reported testing more than 12 months ago. A total of 95.9% (495/516) of participants 'Strongly agreed' or 'Agreed' to being satisfied with the service., Conclusion: The project successfully demonstrated an acceptable and feasible model for a peer-delivered community-led service to provide targeted molecular CT/NG POCT. This model offers capacity to move beyond the traditional pathology and STI testing services and establish community-led models that build trust and increase testing rates for key populations of epidemiological significance.

Background: To assess a mailed self-collection kit for chlamydia testing as an intervention to increase post-treatment retesting rates., Methods: This prospective intervention study took place at a sexual health clinic in Townsville, North Queensland (Australia) between 2006 and 2008. The intervention consisted of offering to mail a self-collection kit for retesting 3 months after treatment. The achieved retesting rates were compared to those from the previous year and to concurrent controls who did not participate in the intervention. Both control groups received standard advice on retesting., Results: Of the 46 participants in the intervention group, 34.8% returned the sample for retesting 3 to 4 months after initial treatment, in comparison to 6.8% of the historic control groups (n=206) and 1.4% of the concurrent control group (n=142) (P<0.001, respectively)., Conclusions: Retesting rates for Chlamydia trachomatis were substantially and significantly improved using the mailed self-collection kit evidencing that the kit could deliver a much needed intervention to improve notoriously low retesting rates.

Background: Untreated Chlamydia trachomatis infections in women can result in disease sequelae such as salpingitis and pelvic inflammatory disease (PID), ultimately culminating in tubal occlusion and infertility. Whilst nucleic acid amplification tests can effectively diagnose uncomplicated lower genital tract (LGT) infections, they are not suitable for diagnosing upper genital tract (UGT) pathological sequelae. As a consequence, this study aimed to identify serological markers that can, with a high degree of sensitivity and specificity, discriminate between LGT infections and UGT pathology., Methods: Plasma was collected from 73 women with a history of LGT infection, UGT pathology due to C. trachomatis, or no serological evidence of C. trachomatis infection. Western blotting was used to analyze antibody reactivity against extracted chlamydial proteins. Sensitivity and specificity of differential markers were also calculated., Results: Four antigens (CT157, CT423, CT727 and CT396) were identified and found to be capable of discriminating between the infection and disease sequelae state. Sensitivity and specificity calculations showed that our assay for diagnosing LGT infection had a sensitivity of 75% and specificity of 76%, whilst the assay for identifying UGT pathology demonstrated 80% sensitivity and 86% specificity., Conclusions: The use of these assays could potentially facilitate earlier diagnoses in women suffering UGT pathology due to C. trachomatis., (Copyright © 2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Chlamydia trachomatis sexually transmitted infection can cause serious reproductive morbidities. This study determined the prevalence of a serum IgG response to C. trachomatis putative stress response proteins in women, to test for an association with genital tract pathology. There was no significant association of serum IgG reactive with C. trachomatis HtrA, Tsp, or RseP with infection or pathology. cHSP60 serum IgG prevalence was significantly associated with infection compared to IgG negative infertile controls, but not with upper genital tract pathology. Serum IgG(1-4) antibody subclasses reactive with these antigens was not significantly different between cohorts, although different responses to each antigen were detected., (Crown Copyright (c) 2010. Published by Elsevier Ireland Ltd. All rights reserved.)

Objectives: To develop, implement and evaluate the processes of a novel approach to chlamydia testing that is accessible, confidential, free of charge, easy to use, and allows for self-collection of specimens, their transportation by regular mail and the central management of results., Methods: A 'self-collection kit' was developed including all items and instructions necessary to obtain a sample. A network of distribution sites at locations frequented by the target population has been established. The 'kits' can be requested via an advertised website and by phone. Specimens are returned via reply paid mail. A centralised system for the management of results and follow up has been established. Test results are conveyed by the participant's method of choice. Treatment is organised via a network of health care providers., Results: Of the first 100 returned kits 99% were safely packed and 86% were sent back with a completely filled out pathology request form. Ninety-two participants provided contact details; 70.7% indicated mobile phone or SMS as the preferred methods to receive results. Seven positive cases were identified and treatment was confirmed for all within 6 days., Discussion: These findings provide evidence that the presented approach to chlamydia testing is easy to implement, achieves excellent follow-up and treatment rates, and therefore opens important new channels to otherwise difficult to access high-risk populations, such as young people and geographically and socially isolated populations.

We genotyped Chlamydia trachomatis strains from 45 women or men living in either a rural indigenous community or in urban heterosexual communities. We found six different C. trachomatis serovars: E (n = 22; 48.9%), F (n = 10; 22.2%), J/Ja (n = 5; 11.1%), D/Da (n = 4; 8.9%), G (n = 3; 6.7%), and K (n = 1; 2.2%). The distribution of C. trachomatis serovars among members of the indigenous rural and the urban Australian communities appears similar to that in other Western countries.

Background: Cases of endometriosis with no tubal damage are associated with infertility, suggesting an immunological rather than mechanical barrier to reproduction. Laparoscopy and falloposcopy results of clinically asymptomatic women undergoing investigation of infertility were correlated with the outcomes of microbiological screening for Chlamydia trachomatis, Mycoplasma pneumoniae, Mycoplasma hominis, ureaplasma species, Neisseria gonorrhoeae, Neisseria meningitidis and Chlamydia pneumoniae., Methods: A total of 44 women presenting to a hospital IVF service for laparoscopic or laparoscopic/falloposcopic investigation of infertility provided endocervical swabs, fallopian tube washings, and peripheral whole blood for analysis., Results: Of these 44 women, 15.9% (7) showed evidence of C. trachomatis infection as detected by either PCR or EIA serology. Of these 7 women, 5 (71%) had no or mild endometriosis and 2 (29%) had moderate or severe endometriosis. Of the remaining 37 women who showed no evidence of chlamydial infection, 15 (40.5%) had no or mild endometriosis., Conclusion: Women with infertility, but without severe endometriosis at laparoscopy, showed a trend towards tubal damage and a higher rate of previous C. trachomatis infection. Although not statistically significant, this trend would suggest that, where moderate to severe tubal damage is found to be the primary cause of infertility, C. trachomatis infection could be a likely cause for such tubal damage.

Objective: To develop a model of pathogenesis by which Chlamydia trachomatis progresses from acute to chronic infection, and finally serious disease (salpingitis, tubal occlusion)., Design: Review of current literature located through web-based Medline searches using key words: Chlamydia trachomatis, immunology, cytokines, heat shock protein, infertility., Result(s): Cell-mediated immune mechanisms appear to be critical in determining whether acute infection is resolved or progresses into chronicity with pathological outcome. What determines the particular immune pathway depends on a range of determinants-HLA subtype and human genetics, cytokine profile, infectious load, route of infection, and endocrinology. A clearer picture of the natural history of chlamydial pathology may assist in providing better predictors of those women who may go on to develop significant sequelae after infection., Conclusion(s): Predicting those who may develop serious disease, including infertility, may contribute to improved management of such persons during earlier stages of infection and assist in prevention.

Background The aim of this study was to compare the performance of pooled self-collected urogenital, pharyngeal and anorectal specimens to that of individual specimen results for the molecular detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) near the point of care (POC) for diagnostic sensitivity.Methods: Clients (mostly men who have sex with men) attending an urban community testing service and three sex-on-premises venues in Brisbane, Australia, were offered CT and NG testing by trained lay providers. Participants provided three self-collected specimens (urine, pharyngeal and rectal) for testing by GeneXpert (Cepheid, Sunnyvale, CA, USA). If any of the individual specimens from a participant were positive, all three specimens were pooled and retested.Results: Of the 388 participants who provided three individual anatomical specimens, 76 (19.6%) were found to be positive for CT and/or NG at one or more sites. The pooling approach failed to detect five CT rectal and four NG pharyngeal infections. The overall performance (sensitivity) of the pooling approach compared with individual specimen testing and Cohen's κ were 90.0% and 0.86 respectively for CT and 89.7% and 0.89 respectively for NG.Conclusions: Reduced sensitivity was observed when using pooled specimens for the detection of CT and NG using GeneXpert near the POC, similar to results reported in laboratory-based CT and NG pooling studies. These data suggest specimen pooling is feasible near to the POC, potentially saving time and costs when screening at-risk populations for CT and NG. Our data also suggest a reduction in pooled urine could improve overall test sensitivity. [ABSTRACT FROM AUTHOR]

Background Chlamydia trachomatis infection is the most commonly notified sexually transmissible bacterial infection in the developed world. An effective approach to improve screening lies with programs that specifically target high risk populations through accessible testing strategies. Objective To pilot the distribution of chlamydia postal testing kits through a network of community pharmacies. Methods Chlamydia postal test kits, adapted from a current online service, were sold at a minimal price across 18 community pharmacies located in Brisbane. Samples, collected by Uri swab, were mailed to a centralised service for processing, and results directly communicated to clients. Results Over a 9-month period, 333 test kits were made available through pharmacies, of which 109 (32.7% of total) were sold. Of these, 43 specimens were returned for processing, comprising 39.4% of sales, or 12.9% of total. Of these returned samples, seven (16.3% of specimens) returned a reactive result, 34 specimens were non-reactive and one was invalid. Conclusions Despite a low specimen return rate (12.9% of total kits available, 39.4% of kits sold), a high reactivity rate (16.3%) for chlamydia was identified among those persons purchasing a kit and returning a sample, suggesting that the pharmacy program had been effectively targeted. Overall, this pilot has demonstrated the feasibility of a system for distributing chlamydia test kits through pharmacy and the use of the existing health infrastructure to follow up results and manage clients. [ABSTRACT FROM AUTHOR]

Background: To assess the prevalence and increase awareness of Neisseria gonorrhoeae and Chlamydia trachomatis infections among men who have sex with men, a screening program was conducted at three inner-city homosexual entertainment venues and one community function.Study Design: Each venue was accessed twice over a 3-month period between March and June 2000. First-catch urine specimens were collected for analysis by polymerase chain reaction (PCR), and throat swabs were collected for culture and PCR.Results: A total of 202 men were tested during the 7 screening nights, including 16 who were tested more than once. From the 186 men tested for the first time, 184 urine specimens were collected, of which 8 (4.3%; 95% CI, 1.9-7.8%) were PCR-positive for C trachomatis and 1 (0.5%; 95% CI, 0-2.1%) was PCR-positive for N gonorrhoeae. Of the 161 throat swabs collected, none were positive for C trachomatis or N gonorrhoeae.Conclusions: C trachomatis is a potentially significant pathogen in this population of urban homosexual men. Screening programs such as these are valuable as health-promotion exercises. [ABSTRACT FROM AUTHOR]