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Jane S Hocking - One of the best experts on this subject based on the ideXlab platform.

  • Sexually transmissible Infections, partner notification and intimate relationships: a qualitative study exploring the perspectives of general practitioners and people with a recent Chlamydia Infection.
    Sexual health, 2020
    Co-Authors: Jacqueline Coombe, Jane L Goller, Helen Bittleston, Alaina Vaisey, Lena Sanci, Anita Groos, Jane Tomnay, Meredith Temple-smith, Jane S Hocking
    Abstract:

    Background Individuals diagnosed with a Chlamydia Infection are advised to notify their sexual partners from the previous 6 months so that they too can get tested and treated as appropriate. Partner notification is an essential component of Chlamydia management, helping to prevent ongoing transmission and repeat Infection in the index case. However, partner notification can be challenging, particularly in circumstances where a relationship has ended or transmission has occurred beyond the primary relationship. Methods: In this study we use data from 43 semistructured interviews with general practitioners (GPs) and people with a recent diagnosis of Chlamydia. The interviews examined experiences of Chlamydia case management in the general practice context. Here, we focus specifically on the effect of a Chlamydia Infection on intimate relationships in the context of the consultation and beyond.? Results: A Chlamydia Infection can have significant consequences for intimate relationships. Although GPs reported speaking to their patients about the importance of partner notification and participants with a recent Chlamydia Infection reported notifying their sexual partners, both would appreciate further support to engage in these conversations. Conclusions: Conversations with patients should go beyond simply informing them of the need to notify their sexual partners from the previous 6 months, and should provide information about why partner notification is important and discuss strategies for informing partners, particularly for those in ongoing relationships. Ensuring GPs have the training and support to engage in these conversations with confidence is vital.

  • azithromycin versus doxycycline for the treatment of genital Chlamydia Infection a meta analysis of randomized controlled trials
    Clinical Infectious Diseases, 2014
    Co-Authors: Fabian Y S Kong, Christopher K. Fairley, Marcus Y Chen, Catriona S. Bradshaw, Rebecca Guy, Sepehr N Tabrizi, Matthew Law, Lenka A Vodstrcil, Jane S Hocking
    Abstract:

    Background. There has been recent debate questioning the efficacy of azithromycin for the treatment of urogenital Chlamydia Infection. We conducted a meta-analysis to compare the efficacy of 1 g azithromycin with 100 mg doxycycline twice daily (7 days) for the treatment of urogenital Chlamydia Infection. Methods. Medline, PubMed, Embase, Cochrane Controlled Trials Register, Cochrane reviews, and Cumulative Index to Nursing and Allied Health Literature were searched until 31 December 2013. Randomized controlled trials comparing azithromycin with doxycycline for the treatment of genital Chlamydia with evaluation of microbiological cure within 3 months of treatment were included. Sex, diagnostic test, follow-up time, attrition, patient symptomatic status, and microbiological curewere extracted. The primaryoutcome wasthe difference in efficacyat final follow-up. Study bias was quantitatively and qualitatively summarized. Results. Twenty-three studies were included evaluating 1147 and 912 patients forazithromycin and doxycycline, respectively. We found a pooled efficacy difference in favor of doxycycline of 1.5% (95% confidence interval [CI], −.1% to 3.1%; I 2 =1 .9%;P= .435; random effects) to 2.6% (95% CI, .5%–4.7%; fixed effects). Subgroup analyses showed that the fixed effects pooled efficacy difference for symptomatic men was 7.4% (95% CI, 2.0%–12.9%), and the random effects was 5.5% (95% CI, −1.4% to 12.4%). Conclusions. There may be a small increased efficacy of up to 3% for doxycycline compared with azithromycin for the treatment of urogenital Chlamydia and about 7% increased efficacy for doxycycline for the treatment of symptomatic urethral Infection in men. However, the quality of the evidence varies considerably, with few double-blind placebo-controlled trials conducted. Given increasing concern about potential azithromycin failure, further welldesigned and statistically powered double-blind, placebo-controlled trials are needed.

  • Chlamydia Infection pelvic inflammatory disease ectopic pregnancy and infertility cross national study
    Sexually Transmitted Infections, 2011
    Co-Authors: Nicole Bender, Jane S Hocking, Bjorn Herrmann, Berit Andersen, Jan E A M Van Bergen, Jane Morgan, Ingrid V F Van Den Broek, Marcel Zwahlen, Nicola Low
    Abstract:

    Objectives To describe, using routine data in selected countries, Chlamydia control activities and rates of Chlamydia Infection, pelvic inflammatory disease (PID), ectopic pregnancy and infertility and to compare trends in Chlamydia positivity with rates of PID and ectopic pregnancy. Methods Cross-national comparison including national data from Australia, Denmark, the Netherlands, New Zealand, Sweden and Switzerland. Routine data sources about Chlamydia diagnosis and testing and International Classification of Disease-10 coded diagnoses of PID, ectopic pregnancy and infertility in women aged 15–39 years from 1999 to 2008 were described. Trends over time and relevant associations were examined using Poisson regression. Results Opportunistic Chlamydia testing was recommended in all countries except Switzerland, but target groups differed. Rates of Chlamydia testing were highest in New Zealand. Chlamydia positivity was similar in all countries with available data (Denmark, New Zealand and Sweden) and increased over time. Increasing Chlamydia positivity rates were associated with decreasing PID rates in Denmark and Sweden and with decreasing ectopic pregnancy rates in Denmark, New Zealand and Sweden. Ectopic pregnancy rates appeared to increase over time in 15–19-year-olds in several countries. Trends in infertility diagnoses were very variable. Conclusions The intensity of recommendations about Chlamydia control varied between countries but was not consistently related to levels of Chlamydia diagnosis or testing. Relationships between levels of Chlamydia Infection and complication rates between or within countries over time were not straightforward. Development and validation of indicators of Chlamydia-related morbidity that can be compared across countries and over time should be pursued.

  • Pelvic examination leads to changed clinical management in very few women diagnosed with asymptomatic Chlamydia Infection.
    Sexual health, 2010
    Co-Authors: Yi Man Lee, Christopher K. Fairley, Anil Samaranayake, Marcus Y Chen, Fiona Macfarlane, Catriona S. Bradshaw, Jane S Hocking
    Abstract:

    The present study aimed to determine whether pelvic examinations change clinical management of women with asymptomatic Chlamydia Infection. Records for women with asymptomatic Chlamydia who underwent a pelvic examination at a sexual health clinic in Melbourne, Australia (January 2006 to June 2007) were analysed retrospectively. Of 91 cases, 31 (34%) warranted examination; one woman (1%; 95% confidence interval: 0.5%, 6.4%) had muco-purulent cervicitis and mild tenderness, and was treated for possible pelvic inflammatory disease. These data suggest that a pelvic examination will lead to changes in treatment for very few women diagnosed with asymptomatic Chlamydia Infection.

  • Associations between condom use and rectal or urethral Chlamydia Infection in men.
    Sexually Transmitted Diseases, 2006
    Co-Authors: Jane S Hocking, Christopher K. Fairley
    Abstract:

    The objective was to investigate the association of condom use with Chlamydia Infection in men attending a large sexually transmitted Infection (STI) clinic in Australia. Computerized records for all attendances between July 2002 and June 2003 were included and separate analyses were performed for men reporting male-to-male sexual contact (MSM) and for men reporting heterosexual contact only (non-MSM). Associations among age condom use and number of partners with Chlamydia Infection were assessed. Chlamydia was diagnosed at a rate of 8.6 cases per 100 consultations (95%CI: 7.1 10.3) among MSM and at a rate of 6.8 cases per 100 consultations (95%CI: 5.9 7.8) among non-MSM. Condom use was associated with a lower odds of rectal Chlamydia but not urethral Infection in MSM. Condom use was associated with lower odds of urethral Chlamydia among non-MSM. The findings suggest that condoms do provide some protection against rectal Chlamydia Infection in MSM and Chlamydial urethritis in non-MSM but other factors may play an important role in the transmission of Chlamydial urethritis in MSM. (authors)

Helen Ward - One of the best experts on this subject based on the ideXlab platform.

  • screening for genital Chlamydia Infection
    Cochrane Database of Systematic Reviews, 2016
    Co-Authors: Nicola Low, Berit Andersen, Jan E A M Van Bergen, Helen Ward, Shelagh Redmond, Anneli Uuskula, Hannelore M Gotz
    Abstract:

    BACKGROUND Genital Infections caused by Chlamydia trachomatis are the most prevalent bacterial sexually transmitted Infection worldwide. Screening of sexually active young adults to detect and treat asymptomatic Infections might reduce Chlamydia transmission and prevent reproductive tract morbidity, particularly pelvic inflammatory disease (PID) in women, which can cause tubal infertility and ectopic pregnancy. OBJECTIVES To assess the effects and safety of Chlamydia screening versus standard care on Chlamydia transmission and Infection complications in pregnant and non-pregnant women and in men. SEARCH METHODS We searched the Cochrane Sexually Transmitted Infections Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, CINAHL, DARE, PsycINFO and Web of Science electronic databases up to 14 February 2016, together with World Health Organization International Clinical Trials Registry (ICTRP) and ClinicalTrials.gov. We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) in adult women (non-pregnant and pregnant) and men comparing a Chlamydia screening intervention with usual care and reporting on a primary outcome (C. trachomatis prevalence, PID in women, epididymitis in men or incidence of preterm delivery). We included non-randomised controlled clinical trials if there were no RCTs for a primary outcome. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, extracted data and assessed the risk of bias. We resolved disagreements by consensus or adjudication by a third reviewer. We described results in forest plots and conducted meta-analysis where appropriate using a fixed-effect model to estimate risk ratios (RR with 95% confidence intervals, CI) in intervention vs control groups. We conducted a pre-specified sensitivity analysis of the primary outcome, PID incidence, according to the risks of selection and detection bias. MAIN RESULTS We included six trials involving 359,078 adult women and men. One trial was at low risk of bias in all six specific domains assessed. Two trials examined the effect of multiple rounds of Chlamydia screening on C. trachomatis transmission. A cluster-controlled trial in women and men in the general population in the Netherlands found no change in Chlamydia test positivity after three yearly invitations (intervention 4.1% vs control 4.3%, RR 0.96, 95% CI 0.84 to 1.09, 1 trial, 317,304 participants at first screening invitation, low quality evidence). Uptake of the intervention was low (maximum 16%). A cluster-randomised trial in female sex workers in Peru found a reduction in Chlamydia prevalence after four years (adjusted RR 0.72, 95% CI 0.54 to 0.98, 1 trial, 4465 participants, low quality evidence).Four RCTs examined the effect of Chlamydia screening on PID in women 12 months after a single screening offer. In analysis of four trials according to the intention-to-treat principle, the risk of PID was lower in women in intervention than control groups, with little evidence of between-trial heterogeneity (RR 0.68, 95% CI 0.49 to 0.94, I(2) 7%, 4 trials, 21,686 participants, moderate quality evidence). In a sensitivity analysis, the estimated effect of Chlamydia screening in two RCTs at low risk of detection bias (RR 0.80, 95% CI 0.55 to 1.17) was compatible with no effect and was lower than in two RCTs at high or unclear risk of detection bias (RR 0.42, 95% CI 0.22 to 0.83).The risk of epididymitis in men invited for screening, 12 months after a single screening offer, was 20% lower risk for epididymitis than in those not invited; the confidence interval was wide and compatible with no effect (RR 0.80, 95% CI 0.45 to 1.42, 1 trial, 14,980 participants, very low quality evidence).We found no RCTs of the effects of Chlamydia screening in pregnancy and no trials that measured the harms of Chlamydia screening. AUTHORS' CONCLUSIONS Evidence about the effects of screening on C. trachomatis transmission is of low quality because of directness and risk of bias. There is moderate quality evidence that detection and treatment of Chlamydia Infection can reduce the risk of PID in women at individual level. There is an absence of RCT evidence about the effects of Chlamydia screening in pregnancy.Future RCTs of Chlamydia screening interventions should determine the effects of Chlamydia screening in pregnancy, of repeated rounds of screening on the incidence of Chlamydia-associated PID and Chlamydia reInfection in general and high risk populations.

  • heterogeneity in risk of pelvic inflammatory diseases after Chlamydia Infection a population based study in manitoba canada
    The Journal of Infectious Diseases, 2014
    Co-Authors: Bethan Davies, Stella Leung, Helen Ward, Katherine Mary Elizabeth Turner, Geoff P Garnett, James F. Blanchard
    Abstract:

    Background. The association between Chlamydia Infection and pelvic inflammatory disease (PID) is a key parameter for models evaluating the impact of Chlamydia control programs. We quantified this association using a retrospective population-based cohort. Methods. We used administrative health data sets to construct a retrospective population-based cohort of women and girls aged 12–24 years who were resident in Manitoba, Canada, between 1992 and 1996. We performed survival analysis on a subcohort of individuals whowere tested forChlamydia to estimate the riskof PID diagnosed in a primary care, outpatient, or inpatient setting after ≥1 positive Chlamydia test. Results. A total of 73 883 individuals contributed 625 621 person years of follow-up. Those with a diagnosis of Chlamydia had an increased risk of PID over their reproductive lifetime compared with those who tested negative (adjusted hazard ratio [AHR], 1.55; 95% confidence interval [CI], 1.43–1.70). This risk increased with each subsequent Infection: the AHR was 1.17 for first reInfection (95% CI, 1.06–1.30) and 1.35 for the second (95% CI, 1.04–1.75). The increased risk of PID from reInfection was highest in younger individuals (AHR, 4.55 (95% CI, 3.59–5.78) in individuals aged 12–15 years at the time of their second reInfection, compared with individuals older than 30 years). Conclusions. There is heterogeneity in the risk of PID after a Chlamydia Infection. Describing the progression to PID in mathematical models as an average rate may be an oversimplification; more accurate estimates of the costeffectiveness of screening may be obtained by using an individual-based measure of risk. Health inequalities may be reduced by targeting health promotion interventions at sexually active girls younger than 16 years and those with a history of Chlamydia.

  • rectal Chlamydia a reservoir of undiagnosed Infection in men who have sex with men
    Sexually Transmitted Infections, 2009
    Co-Authors: Naa Torshie Annan, A K Sullivan, Achyuta V Nori, Polia Naydenova, Sarah Alexander, Alex Mckenna, B Azadian, Sundhiya Mandalia, Marco Rossi, Helen Ward
    Abstract:

    Objective: To determine the prevalence of rectal Chlamydia Infection in a cohort of men who have sex with men (MSM) and the proportion of Infection that would be missed without routine screening. Methods: MSM presenting to four HIV/GUM outpatient clinics at the Chelsea & Westminster Hospital NHS Foundation Trust between 1 November 2005 and 29 September 2006 were offered testing for rectal Chlamydia Infection in addition to their routine screen for sexually transmitted Infections (STIs). Chlamydia trachomatis (CT) tests were performed using the Beckton-Dickinson Probe-Tec Strand Displacement Assay. Positive samples were re-tested at the Sexually Transmitted Bacteria Reference Laboratory, to confirm the result and identify lymphogranuloma venereum (LGV)-associated serovars. Results: A total of 3076 men were screened. We found an 8.2% prevalence of Infection with CT (LGV and non-LGV serovars) in the rectum and 5.4% in the urethra. The HIV and rectal Chlamydia co-Infection rate was 38.1%. The majority of rectal Infections (69.2%, (171/247)) were asymptomatic and would have been missed if routine screening had not been undertaken. Of the samples re-tested, 94.2% (227/242) rectal and 91.8% (79/86) urethral specimens were confirmed CT positive and 36 cases of LGV were identified. Conclusion: Our data show a high rate of rectal Chlamydia Infection, in the majority of cases it was asymptomatic. We recommend routine screening for rectal Chlamydia in men at risk, as this may represent an important reservoir for the onward transmission of Infection.

Christopher K. Fairley - One of the best experts on this subject based on the ideXlab platform.

  • azithromycin versus doxycycline for the treatment of genital Chlamydia Infection a meta analysis of randomized controlled trials
    Clinical Infectious Diseases, 2014
    Co-Authors: Fabian Y S Kong, Christopher K. Fairley, Marcus Y Chen, Catriona S. Bradshaw, Rebecca Guy, Sepehr N Tabrizi, Matthew Law, Lenka A Vodstrcil, Jane S Hocking
    Abstract:

    Background. There has been recent debate questioning the efficacy of azithromycin for the treatment of urogenital Chlamydia Infection. We conducted a meta-analysis to compare the efficacy of 1 g azithromycin with 100 mg doxycycline twice daily (7 days) for the treatment of urogenital Chlamydia Infection. Methods. Medline, PubMed, Embase, Cochrane Controlled Trials Register, Cochrane reviews, and Cumulative Index to Nursing and Allied Health Literature were searched until 31 December 2013. Randomized controlled trials comparing azithromycin with doxycycline for the treatment of genital Chlamydia with evaluation of microbiological cure within 3 months of treatment were included. Sex, diagnostic test, follow-up time, attrition, patient symptomatic status, and microbiological curewere extracted. The primaryoutcome wasthe difference in efficacyat final follow-up. Study bias was quantitatively and qualitatively summarized. Results. Twenty-three studies were included evaluating 1147 and 912 patients forazithromycin and doxycycline, respectively. We found a pooled efficacy difference in favor of doxycycline of 1.5% (95% confidence interval [CI], −.1% to 3.1%; I 2 =1 .9%;P= .435; random effects) to 2.6% (95% CI, .5%–4.7%; fixed effects). Subgroup analyses showed that the fixed effects pooled efficacy difference for symptomatic men was 7.4% (95% CI, 2.0%–12.9%), and the random effects was 5.5% (95% CI, −1.4% to 12.4%). Conclusions. There may be a small increased efficacy of up to 3% for doxycycline compared with azithromycin for the treatment of urogenital Chlamydia and about 7% increased efficacy for doxycycline for the treatment of symptomatic urethral Infection in men. However, the quality of the evidence varies considerably, with few double-blind placebo-controlled trials conducted. Given increasing concern about potential azithromycin failure, further welldesigned and statistically powered double-blind, placebo-controlled trials are needed.

  • Pelvic examination leads to changed clinical management in very few women diagnosed with asymptomatic Chlamydia Infection.
    Sexual health, 2010
    Co-Authors: Yi Man Lee, Christopher K. Fairley, Anil Samaranayake, Marcus Y Chen, Fiona Macfarlane, Catriona S. Bradshaw, Jane S Hocking
    Abstract:

    The present study aimed to determine whether pelvic examinations change clinical management of women with asymptomatic Chlamydia Infection. Records for women with asymptomatic Chlamydia who underwent a pelvic examination at a sexual health clinic in Melbourne, Australia (January 2006 to June 2007) were analysed retrospectively. Of 91 cases, 31 (34%) warranted examination; one woman (1%; 95% confidence interval: 0.5%, 6.4%) had muco-purulent cervicitis and mild tenderness, and was treated for possible pelvic inflammatory disease. These data suggest that a pelvic examination will lead to changes in treatment for very few women diagnosed with asymptomatic Chlamydia Infection.

  • Associations between condom use and rectal or urethral Chlamydia Infection in men.
    Sexually Transmitted Diseases, 2006
    Co-Authors: Jane S Hocking, Christopher K. Fairley
    Abstract:

    The objective was to investigate the association of condom use with Chlamydia Infection in men attending a large sexually transmitted Infection (STI) clinic in Australia. Computerized records for all attendances between July 2002 and June 2003 were included and separate analyses were performed for men reporting male-to-male sexual contact (MSM) and for men reporting heterosexual contact only (non-MSM). Associations among age condom use and number of partners with Chlamydia Infection were assessed. Chlamydia was diagnosed at a rate of 8.6 cases per 100 consultations (95%CI: 7.1 10.3) among MSM and at a rate of 6.8 cases per 100 consultations (95%CI: 5.9 7.8) among non-MSM. Condom use was associated with a lower odds of rectal Chlamydia but not urethral Infection in MSM. Condom use was associated with lower odds of urethral Chlamydia among non-MSM. The findings suggest that condoms do provide some protection against rectal Chlamydia Infection in MSM and Chlamydial urethritis in non-MSM but other factors may play an important role in the transmission of Chlamydial urethritis in MSM. (authors)

Nicola Low - One of the best experts on this subject based on the ideXlab platform.

  • screening for genital Chlamydia Infection
    Cochrane Database of Systematic Reviews, 2016
    Co-Authors: Nicola Low, Berit Andersen, Jan E A M Van Bergen, Helen Ward, Shelagh Redmond, Anneli Uuskula, Hannelore M Gotz
    Abstract:

    BACKGROUND Genital Infections caused by Chlamydia trachomatis are the most prevalent bacterial sexually transmitted Infection worldwide. Screening of sexually active young adults to detect and treat asymptomatic Infections might reduce Chlamydia transmission and prevent reproductive tract morbidity, particularly pelvic inflammatory disease (PID) in women, which can cause tubal infertility and ectopic pregnancy. OBJECTIVES To assess the effects and safety of Chlamydia screening versus standard care on Chlamydia transmission and Infection complications in pregnant and non-pregnant women and in men. SEARCH METHODS We searched the Cochrane Sexually Transmitted Infections Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, CINAHL, DARE, PsycINFO and Web of Science electronic databases up to 14 February 2016, together with World Health Organization International Clinical Trials Registry (ICTRP) and ClinicalTrials.gov. We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) in adult women (non-pregnant and pregnant) and men comparing a Chlamydia screening intervention with usual care and reporting on a primary outcome (C. trachomatis prevalence, PID in women, epididymitis in men or incidence of preterm delivery). We included non-randomised controlled clinical trials if there were no RCTs for a primary outcome. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, extracted data and assessed the risk of bias. We resolved disagreements by consensus or adjudication by a third reviewer. We described results in forest plots and conducted meta-analysis where appropriate using a fixed-effect model to estimate risk ratios (RR with 95% confidence intervals, CI) in intervention vs control groups. We conducted a pre-specified sensitivity analysis of the primary outcome, PID incidence, according to the risks of selection and detection bias. MAIN RESULTS We included six trials involving 359,078 adult women and men. One trial was at low risk of bias in all six specific domains assessed. Two trials examined the effect of multiple rounds of Chlamydia screening on C. trachomatis transmission. A cluster-controlled trial in women and men in the general population in the Netherlands found no change in Chlamydia test positivity after three yearly invitations (intervention 4.1% vs control 4.3%, RR 0.96, 95% CI 0.84 to 1.09, 1 trial, 317,304 participants at first screening invitation, low quality evidence). Uptake of the intervention was low (maximum 16%). A cluster-randomised trial in female sex workers in Peru found a reduction in Chlamydia prevalence after four years (adjusted RR 0.72, 95% CI 0.54 to 0.98, 1 trial, 4465 participants, low quality evidence).Four RCTs examined the effect of Chlamydia screening on PID in women 12 months after a single screening offer. In analysis of four trials according to the intention-to-treat principle, the risk of PID was lower in women in intervention than control groups, with little evidence of between-trial heterogeneity (RR 0.68, 95% CI 0.49 to 0.94, I(2) 7%, 4 trials, 21,686 participants, moderate quality evidence). In a sensitivity analysis, the estimated effect of Chlamydia screening in two RCTs at low risk of detection bias (RR 0.80, 95% CI 0.55 to 1.17) was compatible with no effect and was lower than in two RCTs at high or unclear risk of detection bias (RR 0.42, 95% CI 0.22 to 0.83).The risk of epididymitis in men invited for screening, 12 months after a single screening offer, was 20% lower risk for epididymitis than in those not invited; the confidence interval was wide and compatible with no effect (RR 0.80, 95% CI 0.45 to 1.42, 1 trial, 14,980 participants, very low quality evidence).We found no RCTs of the effects of Chlamydia screening in pregnancy and no trials that measured the harms of Chlamydia screening. AUTHORS' CONCLUSIONS Evidence about the effects of screening on C. trachomatis transmission is of low quality because of directness and risk of bias. There is moderate quality evidence that detection and treatment of Chlamydia Infection can reduce the risk of PID in women at individual level. There is an absence of RCT evidence about the effects of Chlamydia screening in pregnancy.Future RCTs of Chlamydia screening interventions should determine the effects of Chlamydia screening in pregnancy, of repeated rounds of screening on the incidence of Chlamydia-associated PID and Chlamydia reInfection in general and high risk populations.

  • P3.029 Secular Trends of Chlamydia Infection and Testing: A Close Look at the Risk Factors and Regional Variations of a Canadian Population, 1992–2008
    Sexually Transmitted Infections, 2013
    Co-Authors: Dessalegn Y. Melesse, Nicola Low, P Caetano, Stella Leung, Bethan Davies, James F. Blanchard
    Abstract:

    Background Screening and case-finding for Chlamydia Infection among all sexually active men and women under the age of 25, annually or during presentation to a health care provider were introduced in Canada and US in 2001. This strategy was aimed to reduce new Chlamydia Infections and its long term adverse reproductive complications. The objective of this study is to explore the temporal trends of Chlamydia Infections and test uptake in the targeted population of Manitoba. Method We used Manitoba Cadham Provincial Laboratory (CPL) Chlamydia test data (1992 to 2008). CPL captured almost all sexually transmitted disease testing data of Manitoba. Descriptive statistics and logistic regression were used to describe the trend of Chlamydia Infections and tests uptake over time. Results Overall Chlamydia Infection showed an initial flat trend in 1992–2001 and followed by a steady increasing in 2002–2008 trend in all women and men. Using Rural South as reference, the increasing Infection rates are most prominent in Rural North rural, OR = 6.12 [CI = 6.06–6.17], Urban Core, OR = 3.52 [CI = 3.49–3.55], Urban non-Core, OR = 3.06 [3.04–3.08], Middle Rural, OR = 1.78 [1.76–1.79], p Conclusions The increasing trends of Chlamydia Infection rates cannot be fully explained by the Chlamydia test uptakes in Manitoba young women. The geographic variations flag alarming signals for more effective core group targeted public health intervention.

  • Chlamydia Infection pelvic inflammatory disease ectopic pregnancy and infertility cross national study
    Sexually Transmitted Infections, 2011
    Co-Authors: Nicole Bender, Jane S Hocking, Bjorn Herrmann, Berit Andersen, Jan E A M Van Bergen, Jane Morgan, Ingrid V F Van Den Broek, Marcel Zwahlen, Nicola Low
    Abstract:

    Objectives To describe, using routine data in selected countries, Chlamydia control activities and rates of Chlamydia Infection, pelvic inflammatory disease (PID), ectopic pregnancy and infertility and to compare trends in Chlamydia positivity with rates of PID and ectopic pregnancy. Methods Cross-national comparison including national data from Australia, Denmark, the Netherlands, New Zealand, Sweden and Switzerland. Routine data sources about Chlamydia diagnosis and testing and International Classification of Disease-10 coded diagnoses of PID, ectopic pregnancy and infertility in women aged 15–39 years from 1999 to 2008 were described. Trends over time and relevant associations were examined using Poisson regression. Results Opportunistic Chlamydia testing was recommended in all countries except Switzerland, but target groups differed. Rates of Chlamydia testing were highest in New Zealand. Chlamydia positivity was similar in all countries with available data (Denmark, New Zealand and Sweden) and increased over time. Increasing Chlamydia positivity rates were associated with decreasing PID rates in Denmark and Sweden and with decreasing ectopic pregnancy rates in Denmark, New Zealand and Sweden. Ectopic pregnancy rates appeared to increase over time in 15–19-year-olds in several countries. Trends in infertility diagnoses were very variable. Conclusions The intensity of recommendations about Chlamydia control varied between countries but was not consistently related to levels of Chlamydia diagnosis or testing. Relationships between levels of Chlamydia Infection and complication rates between or within countries over time were not straightforward. Development and validation of indicators of Chlamydia-related morbidity that can be compared across countries and over time should be pursued.

  • partner notification of Chlamydia Infection in primary care randomised controlled trial and analysis of resource use
    BMJ, 2006
    Co-Authors: Nicola Low, Anne Marie Mccarthy, T E Roberts, Mia Huengsberg, Emma Sanford, Jonathan A C Sterne, John Macleod, Chris Salisbury, Karl Pye, Aisha Holloway
    Abstract:

    Abstract Objective To evaluate the effectiveness of a practice nurse led strategy to improve the notification and treatment of partners of people with Chlamydia Infection. Design Randomised controlled trial. Setting 27 general practices in the Bristol and Birmingham areas. Participants 140 men and women with Chlamydia (index cases) diagnosed by screening of a home collected urine sample or vulval swab specimen. Interventions Partner notification at the general practice immediately after diagnosis by trained practice nurses, with telephone follow up by a health adviser; or referral to a specialist health adviser at a genitourinary medicine clinic. Main outcome measures Primary outcome was the proportion of index cases with at least one treated sexual partner. Specified secondary outcomes included the number of sexual contacts elicited during a sexual history, positive test result for Chlamydia six weeks after treatment, and the cost of each strategy in 2003 sterling prices. Results 65.3% (47/72) of participants receiving practice nurse led partner notification had at least one partner treated compared with 52.9% (39/68) of those referred to a genitourinary medicine clinic (risk difference 12.4%, 95% confidence interval −1.8% to 26.5%). Of 68 participants referred to the clinic, 21 (31%) did not attend. The costs per index case were £32.55 for the practice nurse led strategy and £32.62 for the specialist referral strategy. Conclusion Practice based partner notification by trained nurses with telephone follow up by health advisers is at least as effective as referral to a specialist health adviser at a genitourinary medicine clinic, and costs the same. Trial registration Clinical trials: NCT00112255.

Rebecca Guy - One of the best experts on this subject based on the ideXlab platform.

  • azithromycin versus doxycycline for the treatment of genital Chlamydia Infection a meta analysis of randomized controlled trials
    Clinical Infectious Diseases, 2014
    Co-Authors: Fabian Y S Kong, Christopher K. Fairley, Marcus Y Chen, Catriona S. Bradshaw, Rebecca Guy, Sepehr N Tabrizi, Matthew Law, Lenka A Vodstrcil, Jane S Hocking
    Abstract:

    Background. There has been recent debate questioning the efficacy of azithromycin for the treatment of urogenital Chlamydia Infection. We conducted a meta-analysis to compare the efficacy of 1 g azithromycin with 100 mg doxycycline twice daily (7 days) for the treatment of urogenital Chlamydia Infection. Methods. Medline, PubMed, Embase, Cochrane Controlled Trials Register, Cochrane reviews, and Cumulative Index to Nursing and Allied Health Literature were searched until 31 December 2013. Randomized controlled trials comparing azithromycin with doxycycline for the treatment of genital Chlamydia with evaluation of microbiological cure within 3 months of treatment were included. Sex, diagnostic test, follow-up time, attrition, patient symptomatic status, and microbiological curewere extracted. The primaryoutcome wasthe difference in efficacyat final follow-up. Study bias was quantitatively and qualitatively summarized. Results. Twenty-three studies were included evaluating 1147 and 912 patients forazithromycin and doxycycline, respectively. We found a pooled efficacy difference in favor of doxycycline of 1.5% (95% confidence interval [CI], −.1% to 3.1%; I 2 =1 .9%;P= .435; random effects) to 2.6% (95% CI, .5%–4.7%; fixed effects). Subgroup analyses showed that the fixed effects pooled efficacy difference for symptomatic men was 7.4% (95% CI, 2.0%–12.9%), and the random effects was 5.5% (95% CI, −1.4% to 12.4%). Conclusions. There may be a small increased efficacy of up to 3% for doxycycline compared with azithromycin for the treatment of urogenital Chlamydia and about 7% increased efficacy for doxycycline for the treatment of symptomatic urethral Infection in men. However, the quality of the evidence varies considerably, with few double-blind placebo-controlled trials conducted. Given increasing concern about potential azithromycin failure, further welldesigned and statistically powered double-blind, placebo-controlled trials are needed.

  • sms reminders improve re screening in women and heterosexual men with Chlamydia Infection at sydney sexual health centre a before and after study
    Sexually Transmitted Infections, 2013
    Co-Authors: Rebecca Guy, Handan Wand, Vickie Knight, Aurelie Kenigsberg, Phillip Read, Anna Mcnulty
    Abstract:

    Background In 2009, Sydney Sexual Health Centre implemented a short message service (SMS) reminder system to improve re-screening after Chlamydia Infection. SMS reminders were sent at 3 months recommending the patient make an appointment for a re-screen. Methods Using a before-and-after study, the authors compared the proportion re-screened within 1–4 months of Chlamydia Infection in women and heterosexual men who were sent an SMS in January to December 2009 (intervention period) with a 18-month period before the SMS was introduced (before period). The authors used a χ 2 test and multivariate regression. Visitors and sex workers were excluded. Results In the intervention period, 141 of 343 (41%) patients were diagnosed with Chlamydia and sent the SMS reminder. In the before period, 338 patients were diagnosed as having Chlamydia and none received a reminder. The following baseline characteristics were significantly different between those sent the SMS in the intervention period and the before period: new patients (82% vs 72%, p=0.02), aged Conclusions SMS reminders increased re-screening in patients diagnosed as having Chlamydia at a sexual health clinic. The clinic now plans to introduce electronic prompts to maximise the uptake of the initiative and consider strategies to further increase re-screening.

  • Developing and validating a risk scoring tool for Chlamydia Infection among sexual health clinic attendees in Australia: a simple algorithm to identify those at high risk of Chlamydia Infection
    BMJ open, 2011
    Co-Authors: Handan Wand, Rebecca Guy, Basil Donovan, Anna Mcnulty
    Abstract:

    Objective To develop and validate a risk scoring tool to identify those who are at increased risk of Chlamydia Infection. Methods We used demographic data, sexual behaviour information and Chlamydia positivity results from more than 45 000 individuals who attended Sydney Sexual Health Centre between 1998 and 2009. Participants were randomly allocated to either the development or internal validation data set. Using logistic regression, we created a prediction model and weighted scoring system using the development data set and calculated the odds ratio of Chlamydia positivity for participants in successively higher quintiles of score. The internal validation data set was used to evaluate the performance characteristics of the model for five quintiles of risk scores including population attributable risk, sensitivity and specificity. Results In the prediction model, inconsistent condom use, increased number of sexual partners in last 3 months, genital or anal symptoms and presenting to the clinic for sexually transmitted Infections screening or being a contact of a sexually transmitted Infection case were consistently associated with increased risk of Chlamydia positivity in all groups. High scores (upper quintiles) were significantly associated with increased risk of Chlamydia Infection. A cut-point score of 20 or higher distinguished a increased risk group with a sensitivity of 95%, 67% and 79% among heterosexual men, women and men who have sex with men (MSM), respectively. Conclusion The scoring tool may be included as part of a health promotion and/or clinic website to prompt those who are at increased risk of Chlamydia Infection, which may potentially lead to increased uptake and frequency of testing.