Factors affecting co-infection with genital chlamydia and genital gonorrhoea in an urban genitourinary medicine clinic

Demographic and behavioural characteristics predict bacterial STI reinfection and coinfection among a cross-sectional sample of laboratory-confirmed gonorrhea cases in a local health region from Saskatchewan, Canada

OBJECTIVES

We aimed to identify demographic and behavioural determinants associated with risk of repeat STI infection and coinfection with gonorrhea and chlamydia in the Regina Qu'Appelle Health Region, Saskatchewan.

METHODS

We extracted data from a cross-sectional sample of laboratory confirmed gonorrhea cases between 2003 and 2012 from the notifiable disease files of the Regina Qu'Appelle Health Region. Risk factors for repeater status were examined using logistic regression and for coinfection with gonorrhea and chlamydia using mixed-effects logistic regression to account for multiple diagnoses for individual clients.

RESULTS

Data from 1,143 cases (representing 1,027 unique individuals) and 1,524 reported contacts (representing 1,383 unique individuals) were extracted from the 10-year period. Factors associated with repeat infection entries in the database included younger age at first visit (p = 0.01), coinfection (p = 0.01), and sex trade involvement (p < 0.01). Factors associated with coinfection at the time of diagnosis included younger age at diagnosis (p < 0.001) and reported alcohol or drug abuse (p = 0.04).

CONCLUSION

In one of the first epidemiologic studies on gonorrhea in Saskatchewan, we have identified age, engagement in the sex trade, and drug and alcohol abuse as potential markers to identify clients with a high risk of reinfection and coinfection in the Regina Qu'Appelle Health Region. This information can help health care professionals in Saskatchewan's urban centres personalize their approach to counselling and treatment to optimize patient outcomes and disease control efforts, including potentially using expedited partner therapy and/or dual therapy where indicated.

Demographic and behavioural characteristics predict bacterial STI reinfection and coinfection among a cross-sectional sample of laboratory-confirmed gonorrhea cases in a local health region from Saskatchewan, Canada

OBJECTIVES

We aimed to identify demographic and behavioural determinants associated with risk of repeat STI infection and coinfection with gonorrhea and chlamydia in the Regina Qu'Appelle Health Region, Saskatchewan.

METHODS

We extracted data from a cross-sectional sample of laboratory confirmed gonorrhea cases between 2003 and 2012 from the notifiable disease files of the Regina Qu'Appelle Health Region. Risk factors for repeater status were examined using logistic regression and for coinfection with gonorrhea and chlamydia using mixed-effects logistic regression to account for multiple diagnoses for individual clients.

RESULTS

Data from 1,143 cases (representing 1,027 unique individuals) and 1,524 reported contacts (representing 1,383 unique individuals) were extracted from the 10-year period. Factors associated with repeat infection entries in the database included younger age at first visit (p = 0.01), coinfection (p = 0.01), and sex trade involvement (p < 0.01). Factors associated with coinfection at the time of diagnosis included younger age at diagnosis (p < 0.001) and reported alcohol or drug abuse (p = 0.04).

CONCLUSION

In one of the first epidemiologic studies on gonorrhea in Saskatchewan, we have identified age, engagement in the sex trade, and drug and alcohol abuse as potential markers to identify clients with a high risk of reinfection and coinfection in the Regina Qu'Appelle Health Region. This information can help health care professionals in Saskatchewan's urban centres personalize their approach to counselling and treatment to optimize patient outcomes and disease control efforts, including potentially using expedited partner therapy and/or dual therapy where indicated.

Coinfection with Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis: a cross-sectional analysis of positivity and risk factors in remote Australian Aboriginal communities

OBJECTIVES

To determine the co-occurrence and epidemiological relationships of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) in a high-prevalence setting in Australia.

METHODS

In the context of a cluster randomised trial in 68 remote Aboriginal communities, we obtained laboratory reports on simultaneous testing for CT, NG and TV by nucleic acid amplification tests in individuals aged ≥16 years and examined relationships between age and sex and the coinfection positivity. ORs were used to determine which infections were more likely to co-occur by demographic category.

RESULTS

Of 13 480 patients (median age: 30 years; men: 37%) tested for all three infections during the study period, 33.3% of women and 21.3% of men had at least one of them, highest in patients aged 16-19 years (48.9% in women, 33.4% in men). The most frequent combination was CT/NG (2.0% of women, 4.1% of men), and 1.8% of women and 0.5% of men had all three. In all co-combinations, coinfection positivity was highest in patients aged 16-19 years. CT and NG were highly predictive of each other's presence, and TV was associated with each of the other two infections, but much more so with NG than CT, and its associations were much stronger in women than in men.

CONCLUSIONS

In this remote high-prevalence area, nearly half the patients aged 16-19 years had one or more sexually transmitted infections. CT and NG were more common dual infections. TV was more strongly associated with NG coinfections than with CT. These findings confirm the need for increased simultaneous screening for CT, NG and TV, and enhanced control strategies.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry ACTRN12610000358044.

Prevalence and predictors of chlamydia co-infection among patients infected with gonorrhoea at a sexual health clinic in Sydney

Anogenital gonorrhoea (Neisseria gonorrhoeae) is commonly diagnosed at sexual health clinics by on-site microscopy. Whether to add anti-chlamydial therapy in such situations is unclear. The medical records of all patients diagnosed with gonorrhoea between May 2005 and April 2010 at RPA Sexual Health were reviewed. Of 165 patients diagnosed with anogenital gonorrhoea, 27 (16.4%, 95% confidence interval (CI) 11.1-22.9%) were co-infected with chlamydia (Chlamydia trachomatis). Compared with those only infected with anogenital gonorrhoea, there was no correlation of anogenital gonorrhoea-chlamydia co-infection with any demographic, behavioural or clinical variables examined. Anti-chlamydial therapy should be considered for all patients with gram stain diagnosed anogenital gonorrhoea at the initial clinic visit.

Epidemiological correlates of asymptomatic gonorrhea

OBJECTIVES

To assess correlates of asymptomatic gonorrhea among patients attending Genitourinary Medicine Clinics participating in the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in England for 2001-2003.

STUDY DESIGN

GRASP is a sentinel surveillance program that monitors antimicrobial resistance to Neisseria gonorrhoeae. Data collection occurs annually in June to August each year.

RESULTS

Women with previously diagnosed gonorrhea had decreased odds of asymptomatic gonococcal infection, as did women diagnosed with other sexually transmitted infections (all except chlamydia, syphilis, herpes, and warts). Heterosexual men, but not women, coinfected with chlamydia had significantly higher likelihood of being diagnosed with asymptomatic gonorrhea, as did homosexual men coinfected with syphilis and warts.

CONCLUSION

The heterogeneity in correlates of asymptomatic gonorrhea has implications for screening in clinical settings. Such findings also depend on the extent of testing on sexually transmitted infections from different sites of infection, which has particular relevance in homosexual men and would thus need to be investigated in other studies.

Chlamydia and Gonorrhea Co-occurrence in a High School Population

BACKGROUND

Chlamydia and gonorrhea coinfection outside of healthcare facilities is less well known.

GOAL

To determine the co-occurrence of both sexually transmitted diseases (STDs) among high school students participating in a school-based screening and to assess the relevance of dual treatment recommendations in this population.

STUDY DESIGN

During the 1998 to 1999 school year, 5,877 students attending an urban U.S. school district were screened for chlamydia and gonorrhea using urine ligase chain reaction assays.

RESULTS

Overall, 451 students had chlamydia, 117 had gonorrhea, including 50 who had both STDs. The gonorrhea and chlamydia co-infections were 50/451 (11.1%) and 50/117 (42.7%), respectively. STD symptoms were reported by 16.0% of students having both infections, 7.7% of those having gonorrhea only, and 5.0% of students having chlamydia only (P = 0.01).

CONCLUSIONS

The rates of coinfection in this population exceeded those that justify dual treatment in patient-care settings. Chlamydia and gonorrhea co-occurrence may be highly prevalent among certain populations not attending patient-care settings.