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Hocking JS, Geisler WM, Kong FYS. Update on the Epidemiology, Screening, and Management of Chlamydia trachomatis Infection. Infect Dis Clin North Am 2023; 37:267-288. [PMID: 37005162 DOI: 10.1016/j.idc.2023.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Chlamydia trachomatis infection ("chlamydia") is the most commonly diagnosed bacterial sexually transmitted infection globally, occurring in the genitals (urethra or vagina/cervix), rectum, or pharynx. If left untreated in women, genital chlamydia can ascend into the upper genital tract causing pelvic inflammatory disease, increasing their risk for ectopic pregnancy, infertility, and chronic pelvic pain. In men, chlamydia can cause epididymitis and proctitis. However, chlamydia is asymptomatic in over 80% of cases. This article provides an update on the epidemiology, natural history, and clinical manifestations of chlamydia in adults and discusses the current approaches to its management and control policy.
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Affiliation(s)
- Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, 3/207 Bouverie Street, Carlton South, Melbourne, Victoria, Australia 3053.
| | - William M Geisler
- Department of Medicine, University of Alabama at Birmingham, 703 19th Street South, ZRB 242, Birmingham, AL 35294, USA
| | - Fabian Y S Kong
- Melbourne School of Population and Global Health, University of Melbourne, 3/207 Bouverie Street, Carlton South, Melbourne, Victoria, Australia 3053
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Hocking JS, Guy R, Walker J, Tabrizi SN. Advances in sampling and screening for chlamydia. Future Microbiol 2013; 8:367-86. [PMID: 23464373 DOI: 10.2217/fmb.13.3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chlamydia is the most commonly diagnosed bacterial sexually transmitted infection in the developed world, with diagnosis rates continuing to increase each year. As chlamydia is largely asymptomatic, screening and treatment is the main way to detect cases and reduce transmission. Recent advances in self-collected specimens and laboratory tests has made chlamydia screening easier to implement as well as possible in nonclinical settings. This review will discuss new approaches to specimen collection and how these have expanded opportunities for reaching target populations for chlamydia screening. Furthermore, it will discuss how advanced molecular microbiological methods can be used with self-collected specimens to further our knowledge of the epidemiology of chlamydia and the dynamics of transmission.
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Affiliation(s)
- Jane S Hocking
- Centre for Women's Health, Gender & Society, University of Melbourne, Victoria, Australia
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Hocking JS, Vodstrcil LA, Huston WM, Timms P, Chen MY, Worthington K, McIver R, Tabrizi SN. A cohort study of Chlamydia trachomatis treatment failure in women: a study protocol. BMC Infect Dis 2013; 13:379. [PMID: 23957327 PMCID: PMC3751832 DOI: 10.1186/1471-2334-13-379] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 08/14/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis is the most commonly diagnosed bacterial sexually transmitted infection in the developed world and diagnosis rates have increased dramatically over the last decade. Repeat infections of chlamydia are very common and may represent re-infection from an untreated partner or treatment failure. The aim of this cohort study is to estimate the proportion of women infected with chlamydia who experience treatment failure after treatment with 1 gram azithromycin. METHODS/DESIGN This cohort study will follow women diagnosed with chlamydia for up to 56 days post treatment. Women will provide weekly genital specimens for further assay. The primary outcome is the proportion of women who are classified as having treatment failure 28, 42 or 56 days after recruitment. Comprehensive sexual behavior data collection and the detection of Y chromosome DNA and high discriminatory chlamydial genotyping will be used to differentiate between chlamydia re-infection and treatment failure. Azithromycin levels in high-vaginal specimens will be measured using a validated liquid chromatography-tandem mass spectrometry method to assess whether poor azithromycin absorption could be a cause of treatment failure. Chlamydia culture and minimal inhibitory concentrations will be performed to further characterize the chlamydia infections. DISCUSSION Distinguishing between treatment failure and re-infection is important in order to refine treatment recommendations and focus infection control mechanisms. If a large proportion of repeat chlamydia infections are due to antibiotic treatment failure, then international recommendations on chlamydia treatment may need to be re-evaluated. If most are re-infections, then strategies to expedite partner treatment are necessary.
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Affiliation(s)
- Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie St, Carlton 3053, Victoria, Australia
| | - Lenka A Vodstrcil
- Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie St, Carlton 3053, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville 3052, Victoria, Austrlaia
| | - Wilhelmina M Huston
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane 4057, Queensland, Australia
| | - Peter Timms
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane 4057, Queensland, Australia
| | - Marcus Y Chen
- Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie St, Carlton 3053, Victoria, Australia
- Melbourne Sexual Health Centre, 580 Swanston Street, Carlton 3053, Victoria, Australia
| | - Karen Worthington
- Melbourne Sexual Health Centre, 580 Swanston Street, Carlton 3053, Victoria, Australia
| | - Ruthy McIver
- Sydney Sexual Health Centre, Sydney Hospital, Macquarie Street, Sydney 2001, New South Wales, Australia
| | - Sepehr N Tabrizi
- Murdoch Children’s Research Institute, Parkville 3052, Victoria, Austrlaia
- Department of Microbiology and Infectious Diseases, the Royal Women’s Hospital, Parkville 3052, Victorian, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Carlton 3053, Victoria, Australia
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Abu Raya B, Bamberger E, Kerem NC, Kessel A, Srugo I. Beyond "safe sex"--can we fight adolescent pelvic inflammatory disease? Eur J Pediatr 2013; 172:581-90. [PMID: 22777641 DOI: 10.1007/s00431-012-1786-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 06/19/2012] [Indexed: 12/31/2022]
Abstract
Pelvic inflammatory disease (PID) is a common disorder affecting sexually active adolescents. The Centers for Disease Control and Prevention (CDC) and European CDC report Chlamydia trachomatis as the most common sexually transmitted infection and one of the main etiological agents causing PID. C. trachomatis' and PID's high prevalence may be attributed to multiple factors including high-risk sexual behaviors, sensitive laboratory diagnostics (polymerase chain reaction), and the introduction of chlamydia screening programs. The pathogenesis of C. trachomatis infection is complex with recent data highlighting the role of toll-like receptor 2 and four in the mediation of the inflammatory cascade. The authors review the etiology of the disease, explore its pathogenesis, and discuss a variety of strategies that may be implemented to reduce the prevalence of C. trachomatis including: (a) behavioral risk reduction, (b) effective screening of asymptomatic females, (c) targeted male screening, (d) implementation of a sensitive, rapid, self-administered point-of-care testing, and (e) development of an effective vaccine.
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Affiliation(s)
- Bahaa Abu Raya
- Department of Pediatrics, Bnai Zion Medical Center, Golomb St. 47, Haifa 31048, Israel.
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Exploring attitudes and practices of General Practice staff towards offers of opportunistic screening for chlamydia: a UK survey. Prim Health Care Res Dev 2012; 13:255-68. [PMID: 22781053 DOI: 10.1017/s1463423611000612] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIM This study applied a theory-based questionnaire to examine the behaviours and beliefs of all practice staff who may be involved in offering chlamydia screens to young people aged 15-25 years old. We aimed to identify potential influencing factors and examine the organisational constraints, which may be amenable to change. BACKGROUND The National Chlamydia Screening Programme offers opportunistic screening to men and women between 15 and 25 years old who have ever had sexual intercourse and primary care is the second largest source of screens. In England 15.9% of the target group were screened against a target of 17% in 2008. Interventions to improve the frequency of offers have shown effects with volunteer practices. METHODS A survey of 85 General Practices was completed by 55 doctors, nurses and receptionists. Interviews were conducted with 12 staff from three practices. FINDINGS Respondents were unable to identify the national screening target. Only half record if a patient is sexually active. Half the sample had some recollection of the frequency of offers they made, with a mean of 4 per month. These were predominantly in consultations concerning sexual health. Perceived social norms are favourable to screening and respondents have strong perceived control over offering screens, including to those under 16 who are sexually active. Attitudes towards screening were positive but disadvantages and barriers related to increased pressure on practice resources for longer consultations and contact tracing. There were no differences in beliefs and practice behaviours between medical and nursing staff. CONCLUSIONS Future interventions should be targeted at increasing the range of consultations in which offers are made, demonstrating how to make offers without increasing consultation time, providing more complete records of sexual activity, screens and results, and encouraging audit and review within the practice to promote practice wide approaches to increasing opportunistic screening.
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The utility and cost of Chlamydia trachomatis and Neisseria gonorrhoeae screening of a male infertility population. Fertil Steril 2012; 97:299-305. [DOI: 10.1016/j.fertnstert.2011.11.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 11/13/2011] [Accepted: 11/17/2011] [Indexed: 11/19/2022]
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Brugha R, Balfe M, Jeffares I, Conroy RM, Clarke E, Fitzgerald M, O'Connell E, Vaughan D, Coleman C, McGee H, Gillespie P, O'Donovan D. Where do young adults want opportunistic chlamydia screening services to be located? J Public Health (Oxf) 2011; 33:571-8. [PMID: 21486871 DOI: 10.1093/pubmed/fdr028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study measured the acceptability of urine-based chlamydia screening to young adults, where young adults wanted opportunistic chlamydia screening services to be located, and by whom they wanted to be offered screening. METHODS A cross-sectional survey of 5685 university students and 400 young adult healthcares setting attendees (age: 18-29 years). RESULTS Ninety-six percent of males and 93% of females said that they would find it acceptable to be offered chlamydia screening. Seventy-six percent of males and 77% of females wanted to be offered screening by a doctor or nurse. Young women would prefer female staff. Most respondents preferred that screening be located in traditional healthcare settings such as General Practices, and offered by either doctors or nurses. More than 90% of respondents did not want screening services to be located in pharmacies and almost all rejected public non-health care screening settings. CONCLUSIONS Opportunistic chlamydia screening services should be located in traditional healthcare/medical settings, and screening should be offered by doctors and nurses.
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Affiliation(s)
- Ruairi Brugha
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin 2, Republic of Ireland
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Lorimer K, Reid ME, Hart GJ. Willingness of young men and women to be tested for Chlamydia trachomatis in three non-medical settings in Glasgow, UK. ACTA ACUST UNITED AC 2010; 35:21-6. [PMID: 19126312 DOI: 10.1783/147118909787072252] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess the willingness of young men and women to be tested for Chlamydia trachomatis in three non-medical settings. METHODS Men and women aged between 16 and 24 years were invited to complete a self-administered questionnaire and provide a urine sample in non-medical settings: 'education' (one further education college), 'health and fitness' (three local authority leisure centres) and 'workplace' (two call centres). RESULTS Eighty-four percent of age-eligible users approached in the settings agreed to complete a questionnaire (n = 363). Among the sexually active people (n = 346), the uptake of screening varied by setting [education 19.1% (22/115), health and fitness 48.8% (62/127), workplace 27.8% (29/104); p<0.001]. Health and fitness settings (OR 4.08; 95% CI 2.04-8.14) and perception of being at risk of having chlamydia (OR 2.47; 95% CI 1.33-4.58) were strong predictors of providing a urine sample. Adjusting for setting and age group (<20 years vs 20+ years), women were less likely than men to provide a urine sample (OR 0.42; 95% CI 0.26-0.70). All five positive cases (4.4%; 4.9% in men, 3.8% in women) were contacted with their results by a health adviser and invited to be treated at a local genitourinary medicine clinic. CONCLUSIONS Men were more willing than women to be tested for C. trachomatis in these non-medical settings, but uptake varied by setting. Thus, increasing opportunities for the take-up of testing in particular non-medical settings might be a more effective approach to including young men who are not reached by clinic control efforts.
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Affiliation(s)
- Karen Lorimer
- MRC Social and Public Health Sciences Unit, University of Glasgow, 4 Lilybank Gardens, Glasgow G12 8RZ, UK.
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McNulty CAM, Freeman E, Howell-Jones R, Hogan A, Randall S, Ford-Young W, Beckwith P, Oliver I. Overcoming the barriers to chlamydia screening in general practice--a qualitative study. Fam Pract 2010; 27:291-302. [PMID: 20308246 DOI: 10.1093/fampra/cmq004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is low uptake of chlamydia screening in general practices registered with the English National Chlamydia Screening Programme (NCSP). Aims. To explore staff's attitudes and behaviour around chlamydia screening and how screening could be optimized in general practice. METHODS A qualitative study with focus groups and interviews, in general practices in seven NCSP areas. Twenty-five focus groups and 12 interviews undertaken with a purposively selected diverse group of high and low chlamydia-screening practices in 2006-08. Data were collected and analysed using a framework analytical approach. RESULTS Higher screening practices had more staff with greater belief in patient and population benefits of screening and, as screening was a subjective norm, it was part of every day practice. Many staff in the majority of other practices were uncomfortable raising chlamydia opportunistically and time pressures meant that any extra public health issues covered within a consultation were determined by Quality Outcomes Framework (QOF) targets. All practices would value more training and feedback about their screening rates and results. Practices suggested that use of computer prompts, simplified request forms and more accessible kits could increase screening. CONCLUSION Practice staff need more evidence of the value of opportunistic chlamydia screening in men and women; staff development to reduce the barriers to broaching sexual health; simpler request forms and easily accessible kits to increase their ability to offer it within the time pressures of general practice. Increased awareness of chlamydia could be attained through practice meetings, computer templates and reminders, targets and incentives or QOF points with feedback.
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Affiliation(s)
- Cliodna A M McNulty
- Health Protection Agency Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK.
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Cunningham KA, Beagley KW. Male Genital Tract Chlamydial Infection: Implications for Pathology and Infertility1. Biol Reprod 2008; 79:180-9. [DOI: 10.1095/biolreprod.108.067835] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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