Positive Chlamydia Research Articles

What Is the Optimal Time to Retest Patients With a Urogenital Chlamydia Infection? A Randomized Controlled Trial.

Chlamydia trachomatis is a common, often recurring sexually transmitted infection, with serious adverse outcomes in women. Current guidelines recommend retesting after a chlamydia infection, but the optimum timing is unknown. We assessed the optimal retest interval after urogenital chlamydia treatment. A randomized controlled trial among urogenital chlamydia nucleic acid amplification test positive heterosexual clients of the Amsterdam sexually transmitted infection clinic. After treatment, patients were randomly assigned for retesting 8, 16, or 26 weeks later. Patients could choose to do this at home (and send a self-collected sample by mail) or at the clinic. Retest uptake and chlamydia positivity at follow-up were calculated. Between May 2012 and March 2013, 2253 patients were included (45% men; median age, 23 years; interquartile range, 21-26). The overall uptake proportion within 35 weeks after the initial visit was significantly higher in the 8-week group (77%) compared with the 16- and 26-week groups (67% and 64%, respectively, P < 0.001), and the positivity proportions among those retested were comparable (P = 0.169). The proportion of people with a diagnosed recurrent chlamydia infection among all randomized was similar between the groups (n = 69 [8.6%], n = 52 [7.4%], and n = 69 [9.3%]; P = 0.4). Patients with a recent urogenital chlamydia are at high risk of recurrence of chlamydia and retesting them is an effective way of detecting chlamydia cases. We recommend inviting patients for a re-test 8 weeks after the initial diagnosis and treatment.

Effectiveness of a group B outer membrane vesicle meningococcal vaccine against gonorrhoea in New Zealand: a retrospective case-control study

Gonorrhoea is a major global public health problem that is exacerbated by drug resistance. Effective vaccine development has been unsuccessful, but surveillance data suggest that outer membrane vesicle meningococcal group B vaccines affect the incidence of gonorrhoea. We assessed vaccine effectiveness of the outer membrane vesicle meningococcal B vaccine (MeNZB) against gonorrhoea in young adults aged 15-30 years in New Zealand. We did a retrospective case-control study of patients at sexual health clinics aged 15-30 years who were born between Jan 1, 1984, and Dec 31, 1998, eligible to receive MeNZB, and diagnosed with gonorrhoea or chlamydia, or both. Demographic data, sexual health clinic data, and National Immunisation Register data were linked via patients' unique personal identifier. For primary analysis, cases were confirmed by laboratory isolation or detection of Neisseria gonorrhoeae only from a clinical specimen, and controls were individuals with a positive chlamydia test only. We estimated odds ratios (ORs) comparing disease outcomes in vaccinated versus unvaccinated participants via multivariable logistic regression. Vaccine effectiveness was calculated as 100×(1-OR). 11 of 24 clinics nationally provided records. There were 14 730 cases and controls for analyses: 1241 incidences of gonorrhoea, 12 487 incidences of chlamydia, and 1002 incidences of co-infection. Vaccinated individuals were significantly less likely to be cases than controls (511 [41%] vs 6424 [51%]; adjusted OR 0·69 [95% CI 0·61-0·79]; p<0·0001). Estimate vaccine effectiveness of MeNZB against gonorrhoea after adjustment for ethnicity, deprivation, geographical area, and sex was 31% (95% CI 21-39). Exposure to MeNZB was associated with reduced rates of gonorrhoea diagnosis, the first time a vaccine has shown any protection against gonorrhoea. These results provide a proof of principle that can inform prospective vaccine development not only for gonorrhoea but also for meningococcal vaccines. GSK Vaccines.

Biological and Behavioral Factors Associated With Positive Chlamydia Retests.

Repeat chlamydia detection after treatment is common, and there is concern that treatment failure may be a cause. Within a randomized trial, we established a prospective cohort of 600 participants with anogenital chlamydia diagnoses (200 each of women, heterosexual men, and men who have sex with men [MSM]). Participants were invited for repeat testing at 3 months and to complete a behavioral survey at 4 months. Positive samples were analyzed for organism DNA load and genovar. We estimated repeat chlamydia positivity, reinfection and treatment failure rates, and investigated the biological and behavioral factors associated with a repeat positive test. A total of 290 participants (100 women, 89 heterosexual men, 101 MSM) were retested at 1 to 4 months, with 43 repeat positives, including 26 classed as reinfection and 9 as treatment failures. Comparing MSM with heterosexual men and women combined, repeat positivity was higher (20.8% vs 11.6%, P = 0.04), and treatment failure was higher (6.9% vs 1.1%, P = 0.01), but there was no difference in reinfection rates (11.9% vs 7.4%, P = 0.21). Among MSM, the odds of repeat positivity increased by 90% with each additional log organism load in the original specimen (baseline) (adjusted odds ratio, 1.9; 95% confidence interval, 1.1-3.2). Among heterosexuals, the odds of repeat positivity decreased by 10% with each additional week delay in being retested for chlamydia (adjusted odds ratio, 0.9; 95% confidence interval, 0.8-0.9). Positive retests were more common among MSM than heterosexuals. Treatment failure was more common in MSM with rectal chlamydia, reinforcing concerns about azithromycin treatment failure.

Chlamydia Infection Between Men and Women: A Cross-Sectional Study of Heterosexual Partnerships.

BackgroundStudies of sexual partnerships can further our understanding of the sexual transmission of chlamydia, which is important for informing public health interventions and clinical management. The aim of this study was to ascertain among heterosexual dyads the proportion concordantly infected with chlamydia and factors associated with infection between partners.MethodsThis study was conducted at the Melbourne Sexual Health Centre between January 2006 and March 2015. Heterosexual partners attending the clinic on the same day were identified prospectively. Dyads where 1 or both individuals were diagnosed with chlamydia by a test performed on the day of joint attendance or within the prior 30 days were included. Testing was by strand displacement assay. Men and women with genital symptoms underwent clinical examination.ResultsOf 233 females with chlamydia, 76% (n = 178) of their male partners tested positive. Of the chlamydia-positive females with cervicitis, 91% of males were chlamydia positive. Male infection was less likely if their partner had taken azithromycin or doxycycline within 30 days (7% vs 25%; P = .039). Of 235 males with chlamydia, 77% (n = 178) of their female partners tested positive. No associations were found between male symptoms, signs, or recent antibiotic use and a positive chlamydia result in female partners. Sixty-one percent of the dyads were concordantly infected with chlamydia.ConclusionsThese results underscore the high likelihood of heterosexual partners of men and women with chlamydia being infected and the importance that partners are tested and managed appropriately for chlamydia.

P027 Re-testing of patients with positive chlamydia results in primary care

IntroductionWe aimed to establish how many young people (aged 15–24 years) diagnosed with genital Chlamydia infection in General Practice (GP) in 2015 in an inner city area had Partner Notification...

P199 Are we testing in the right locations? use of public health mapping to investigate young people, chlamydia and socioeconomic status

IntroductionChlamydia testing is universal and routine in all local sexual health clinics. Projected local population increases and expansion of the university sector necessitate the appraisal of current services and future planning to meet population need.ObjectiveTo investigate whether the current locations of Chlamydia testing services match areas of high need.MethodWe obtained data from the Sexual Health in Wales Surveillance Scheme (SWS) on Chlamydia diagnoses in integrated sexual health clinics by middle super output area (MSOA) of residence for patients living in our local area. Mapping software is used to overlay Chlamydia testing behaviour and positivity against locations of FE colleges, STI testing clinics, areas of high deprivation and areas with a high proportion of young residents.ResultsBetween 2012 and 2016, 3,450 chlamydia diagnoses were recorded in Cardiff and Vale residents. The maps suggest that Chlamydia diagnoses were most common in areas usually habited by students. Furthermore, mapping fifths of deprivation suggested lower rates of Chlamydia in the more deprived areas, despite more testing venues.DiscussionThe maps suggest University students are frequent testers and have a high positivity for Chlamydia whereas those from more deprived areas have lower rates for Chlamydia. This descriptive analysis suggests that local chlamydia testing services may not be mapped to populations at greatest need. This association is difficult to measure without a robust statistical test and more analysis is needed to quantify the association. Alternative testing paradigms outside clinic settings could help manage demand on clinical services.

O33 Significantly higher rates of chlamydia found in army personnel compared with non-military clinic attendees

IntroductionOur Sexual Health service covers a county-wide population, including large numbers of Army personnel. Despite military personnel being recognised as high risk for sexually-transmitted infections (STIs), accurate data on STI...

P056 Providing written information in the electronic era – is it time for a re-think?

IntroductionRecent BASHH guidelines state that patients should be directed to clear, accurate written or web-based information and this is often an auditable outcome. We stopped providing paper leaflets in 2016...

Electronic Case Reporting of STIs: Assessing EHR Generated CCDs

ObjectiveWe reviewed CCDs (a type of consolidated clinical dataarchitecture (C-CDA) document) shared by our clinical partner,Planned Parenthood of the Great Northwest and Hawaiian Islands(PPGNHI) since October, 2015. Analyses focuses on:-Completeness-Degree to which the CCD matches program area informationneeds-Differences in EHR generation methods-Presence and location of triggers (based on the ReportableConditions Trigger Codes) that would initiate CCD generation.IntroductionUnder the CDC STD Surveillance Network (SSuN) Part B grant,WA DOH is testing electronic case reporting (eCR) of sexuallytransmitted infections (STI) from a clinical partner.MethodsTwo methods of CCD generation, based on existing EHRcapabilities, were used to create CCDs that were delivered to WADOH using secure file transport protocol (SFTP). PPGNHI uses theNextGen EHR system.The first batch received was extracted using the Medical SummaryUtility. Random selection of cases (25) from lab positive Chlamydia(CT), Gonorrhea (GC) or Syphilis encounters with a follow-up planin the EHR (1/1/2015-3/31/2015). Each CCD contained manuallyselected encounters (related to STI case).Cases are now extracted directly from a patient chart(File--&gt;Generate CCD). Two types of CCDs can be created: singleencounter CCDs and longitudinal encounter CCDs.The CCDs were analyzed for completeness, crossover with theexisting paper case report, and with relevant CDA and C-CDAImplementation Guide (IG) standards.ResultsThis analysis includes four reportable events across 6 CCDs.One event is represented by both a longitudinal CCD and 2 singleencounter CCDs.The CCDs contained most of the basic demographic informationrequested in the paper case report with the exception of “middleinitial”.Information on the important paper case report components“gender of sex partner” and “partner management plan” are not foundin the CCD.The CCD Results section contained lab tests and results that includesite of infection and could confirm diagnosis. The ordered test (panel)is not coded, though the individual tests performed are LOINC coded.The CCD Medications section meets STI program needs forinformation about treatment in a case report. Information isrepresented using RxNorm codes as specified by the C-CDA IG.The CCD Problems section was not present in documents generatedusing the MSU but was present in documents created using File --&gt;Generate CCD from the patient chart. The Problems section andcoded entries (ICD-9-CM and ICD-10) are required for CCDs. TheProblems do not include effective dates, which are not required bythe IG.Pregnancy status, and information about HIV testing (includingprevious positive), are present in the CCD Problems section only ifthe encounter during which testing occurred is included in the CCDsubmitted.Using the CCD in place of the paper case report requiresunderstanding of the clinical workflow and use of EHR. Twoinstances that require specific attention are the “exposure” status ofthe case (known/possibly exposed vs. not shared/not known), andthe “presentation” of the diagnosis (symptomatic vs asymptomatic).For example, the ICD-10 code Z11.3 (encounter for screening forinfections with a predominantly sexual mode of transmission), cannotbe interpreted as a true “screening”, as this diagnosis is recorded forall visits that include STI testing. Similarly, a code for exposureto STIs is sometimes used, but not consistently enough to allowreliable identification of cases in which the patient was tested due toan exposure or possible exposure. Work with our clinical partner tounderstand what inferences can and should be made is an importantpart of evaluating the CCD as a replacement to the paper case report.ConclusionsThe CCDs submitted to DOH show that most information requestedin an STI case report can be found in a CCD with some exceptions,notably “gender of sex partners” and “partner management plan”.Some information is only inconsistently present, for example,exposure status and presentation.Understanding how the CCD could replace the paper case reportrequires working with the reporter to insure that the information isinterpreted on the receiving end in the same way that it is interpretedin the clinical workflow and entered in the EHR.

Measuring Transitions in Sexual Risk Among Men Who Have Sex With Men: The Novel Use of Latent Class and Latent Transition Analysis in HIV Sentinel Surveillance.

New combination human acquired deficiency (HIV) prevention strategies that include biomedical and primary prevention approaches add complexity to the task of measuring sexual risk. Latent transition models are beneficial for understanding complex phenomena; therefore, we trialed the application of latent class and latent transition models to HIV surveillance data. Our aims were to identify sexual risk states and model individuals' transitions between states. A total of 4,685 HIV-negative men who have sex with men (MSM) completed behavioral questionnaires alongside tests for HIV and sexually transmissible infections at one of 2 Melbourne, Victoria, Australia, general practices (2007-2013). We found 4 distinct classes of sexual risk, which we labeled "monogamous" (n=1,224), "risk minimizer" (n=1,443), "risk potential" (n=1,335), and "risk taker" (n=683). A positive syphilis, gonorrhea, or chlamydia test was significantly associated with class membership. Among a subset of 516 MSM who had at least 3 clinic visits, there was general stability across risk classes; MSM had on average a 0.70 (i.e., 70%) probability of remaining in the same class between visits 1 and 2 and between visits 2 and 3. Monogamous MSM were one exception; the probability of remaining in the monogamous class was 0.51 between visits 1 and 2. Latent transition analyses identified unobserved risk patterns in surveillance data, characterized high-risk MSM, and quantified transitions over time.

The Diagnosis of Nongonococcal Urethritis in Men: Can There Be a Universal Standard?

The Diagnosis of Nongonococcal Urethritis in Men: Can There Be a Universal Standard?

Trends in chlamydia and gonorrhoea testing and positivity in Western Australian Aboriginal and non-Aboriginal women 2001-2013: a population-based cohort study.

This study aimed to examine trends in chlamydia and gonorrhoea testing and positivity in Aboriginal and non-Aboriginal women of reproductive age. A cohort of 318002 women, born between 1974 and 1995, residing in Western Australia (WA) was determined from birth registrations and the 2014 electoral roll. This cohort was then probabilistically linked to all records of chlamydia and gonorrhoea nucleic acid amplification tests conducted by two large WA pathology laboratories between 1 January 2001 and 31 December 2013. Trends in chlamydia and gonorrhoea testing and positivity were investigated over time and stratified by Aboriginality and age group. The proportion of women tested annually for chlamydia increased significantly between 2001 and 2013 from 24.5% to 36.6% in Aboriginal and 4.0% to 8.5% in non-Aboriginal women (both P-values <0.001). Concurrent testing was high (>80%) and so patterns of gonorrhoea testing were similar. Chlamydia and gonorrhoea positivity were substantially higher in Aboriginal compared with non-Aboriginal women; age-, region- and year-adjusted incidence rate ratios were 1.52 (95% confidence interval (CI) 1.50-1.69, P<0.001) and 11.80 (95% CI 10.77-12.91, P<0.001) respectively. Chlamydia positivity increased significantly in non-Aboriginal women aged 15-19 peaking in 2011 at 13.3% (95% CI 12.5-14.2%); trends were less consistent among 15-19-year-old Aboriginal women but positivity also peaked in 2011 at 18.5% (95% CI 16.9-20.2%). Gonorrhoea positivity was 9.7% (95% CI 9.3-10.1%), 6.7% (95% CI 6.4-7.0%), 4.7% (4.4-5.0%), and 3.1% (2.8-3.4%) among Aboriginal women aged respectively 15-19, 20-24, 25-29 and ≥30 years, compared with <1% in all age groups in non-Aboriginal women. Over time, gonorrhoea positivity declined in all age groups among Aboriginal and non-Aboriginal women. Between 2001 and 2013 in WA chlamydia and gonorrhoea positivity remained highest in young Aboriginal women despite chlamydia positivity increasing among young non-Aboriginal women. More effective prevention strategies, particularly for young Aboriginal women, are needed to address these disparities.

Housing Insecure HIV Patients Have Higher Positive Gonorrhea and Chlamydia Test Results but Lower Testing Rates in a Primary Care Setting

BackgroundHousing insecure HIV-infected patients experience poor treatment outcomes, but whether these outcomes are due to less engagement in care or differential quality of care is unknown. We evaluated gonorrhea and chlamydia (GC-CT) testing among HIV-infected patients to assess whether differences exist by housing status and whether differences are due to frequency of primary care visits or services delivered when visits are made.MethodsWe used retrospective cohort analysis to assess GC-CT testing in patients establishing care at an urban HIV clinic in San Francisco between February, 2013 – December, 2014 who had at least one subsequent primary care visit. The predictor variable of homelessness was defined as having stayed outdoors, in shelters, in vehicles, or in places not made for habitation during the last year and was evaluated during social work intake. The primary outcome was having GC-CT testing at a primary care visit. The probability of GC-CT testing at a primary care visit was calculated using logistic regression modeling with random effects to handle intra-subject correlations for repeated measurements. We adjusted for age, race/ethnicity, methamphetamine use, alcohol use, sexual orientation, prior positive GC-CT test, recent GC-CT test and visit frequency. Comparison of GC-CT test results by housing status was made using chi2.ResultsOf 323 patients, mean age was 41.4 years, 91% were male, 50% non-Latino White, and 45% were homeless. 204 patients (63%) had GC-CT testing done, and 138 (37%) had testing at primary care visits. A median visit frequency for housed patients was 1.42 visits/180 days v 1.61 for homeless patients (p-value 0.36). Average follow-up time was 472 days (sd 292 days). Homelessness was associated with lower odds of GC-CT testing during follow-up (aOR 0.60; 95% CI 0.40, 0.96 p-value 0.032). 28% of first GC-CT tests were positive in homeless v. 12% in housed patients (p-value 0.025).ConclusionHomeless patients had a higher rate of positive GC-CT on first test but 40% lower odds of having GC-CT testing at primary care visits despite controlling for visit frequency, recent testing and history of positive GC-CT. Further evaluation of disparities in GC-CT testing for homeless patients is warranted.Disclosures All authors: No reported disclosures.

Gonorrhoea testing and positivity in non-remote Aboriginal Community Controlled Health Services.

This was a retrospective analysis of clinical encounter data derived from electronic medical records at participating services. Data were extracted using the GRHANITE program for all patients aged 15-54 years from 2009 to 2013. Demographic characteristics and testing and positivity for gonorrhoea were calculated for each year. A total of 2971 patients (2571 Aboriginal and/or Torres Strait Islander) were tested for gonorrhoea during the study period. Among Aboriginal and/or Torres Strait Islander patients, 40 (1.6%) tested positive. Gonorrhoea positivity was associated with clinic location (higher in the regional clinic) and having had a positive chlamydia test. By year, the proportion of patients aged 15-29 years tested for gonorrhoea increased in both men (7.4% in 2009 to 15.9% in 2013) and women (14.8% in 2009 to 25.3% in 2013). Concurrent testing for chlamydia was performed on 86.3% of testing occasions, increasing from 75% in 2009 to 92% in 2013. Factors related to concurrent testing were sex and year of test. The prevalence of gonorrhoea among young Aboriginal and/or Torres Strait Islander people in non-remote settings suggests that the current approach of duplex testing for chlamydia and gonorrhoea simultaneously is justified, particularly for women.

Utility of risk-based chlamydia testing in primary care: analysis of retrospective surveillance data among women in Melbourne, Australia.

A longitudinal analysis was conducted on retrospective surveillance data collected among women attending general practice, family planning and sexual health clinics participating in sentinel surveillance in Melbourne, Australia. Women were aged ≥16 years and underwent urogenital testing for C. trachomatis (chlamydia) at participating clinics between 2007 and 2014. Chlamydia incidence was calculated as positive chlamydia tests over person-years (PY) among women and reported by 5-year age groups. A Cox regression model examined correlates of a positive chlamydia test among women aged ≥30 years. In all, 36770 women contributed 46432 PY and 52395 chlamydia tests, of which 2895 were positive. The overall chlamydia incidence rate was 6.2 per 100 PY (95% confidence interval (CI) 6.0-6.5). Chlamydia incidence declined with age, plateauing to <5 per 100 PY among women aged ≥30 years. Among women aged ≥30 years, being born in North-East Asia (adjusted hazard ratio (aHR) 2.9; 95% CI 1.9-4.5) and reporting multiple partners (aHR 2.5; 95% CI 1.8-3.5) in the past 12 months were associated with a positive chlamydia test. Chlamydia control remains challenging in Australia and optimising testing in primary care is a key priority. The results of the present study suggest that, at least among women aged ≥30 years, chlamydia testing should be risk-based and informed by appropriate sexual history taking.

VP35 Economic Consequences Of A Restricted Dutch Sexually Transmitted Infection-Testing Policy

INTRODUCTION:Due to the rising costs caused by an increasing demand for Sexually Transmitted Infection (STI) care, the Dutch government changed the funding of STI-clinics (1). A more restrictive testing policy introduced in 2015 no longer required syphilis and human immunodeficiency virus (HIV) tests for younger, heterosexual clients. A less extensive testing policy could be detrimental to the aim of finding and treating STIs (2,3). Infections that remain undetected could possibly lead to an increase in both the total and individual burden of disease, due to transmission and the need for more intensive treatment resulting in higher healthcare costs in the long term. In this study, we evaluated the new Dutch testing policy with respect to intended savings and missed syphilis and/or HIV infections. Moreover, we explored the efficiency of alternative test policies.METHODS:Using national surveillance data from 2011 to 2013 with still comprehensive testing for all, we estimated the effects of restrictive testing on test costs, number of infections missed, costs per missed infection, costs per Quality Adjusted Life Year (QALY) lost, and calculated the net monetary benefit.RESULTS:The 2015-policy led to estimated savings of EUR1.1 million, while missing approximately three of ten HIV infections and seven of twenty syphilis infections among all younger heterosexual clients (in total 143,612 consultations) per year. Savings were EUR435,000 per QALY lost. Standard testing second-generation immigrants for syphilis and HIV saved EUR525,000/QALY lost. Offering an HIV test when diagnosed with chlamydia or gonorrhoea resulted in savings of EUR568,000/ QALY lost.CONCLUSIONS:The 2015-testing policy resulted in substantial savings as few missed HIV and syphilis infections caused QALY losses. Additional standard syphilis and HIV tests for second-generation immigrants and an additional HIV test in case of positive chlamydia or gonorrhoea diagnosis could reduce missed infections in a cost-effective way.

Frequency of Serological Markers of &amp;lt;i&amp;gt;Chlamydia trachomatis&amp;lt;/i&amp;gt; in Cases of Ectopic Pregnancy in Antananarivo Madagascar

Introduction: Chlamydia trachomatis is a bacteria responsible of the most prevalent sexually transmitted disease worldwide, causing severe tubal damage responsible of ectopic pregnancy. This study was conducted to determine the incidence of chlamydia in women with ectopic pregnancy ruptured in a reference hospital of capital town of Madagascar. Patients and methods: This is a transversal and descriptive study of screening for Chlamydia trachomatis IgG cases among ectopic pregnancy seen at the University Hospital of Obstetrics Gynecology Befelatanana (CHUGOB) from 01 February to 30 May 2015. Results: During the study period, we recorded 41 cases with a overall rate of ectopic pregnancy of 2.04% when reported to the total number of deliveries. (n: 2347)The average age of patients was 30.50 years with predominance in primiparous (66%). More than half of the patients had at least one risk factor and 90% had a history of abortion induced and spontaneous miscarriage. The frequency of positive Chlamydia trachomatis IgG is 20.83% (n: 10) among which 7 presented pathological fallopian tube. Conclusion: The best way to avoid complications is precocious screening, but the cost of the screening tests remains an obstacle in developing countries like Madagascar.

Effectiveness of Human Papillomavirus Vaccination on Prevalence of Vaccine Genotypes in Young Sexually Active Women in France.

Effectiveness of human papillomavirus (HPV) vaccines in the context of both guidelines, which recommend vaccination at 14 years and modest vaccine coverage, is poorly documented. Residual specimens from females aged <25 years undergoing chlamydia testing were collected, together with demographic, sexual behavior, and vaccine status data. Human pappilomavirus genotypes were determined using the PapilloCheck test system. We compared vaccine type (VT; types 6, 11, 16, 18) prevalence according to vaccination status and identified factors associated with VT prevalence. Of 3736 eligible samples, 822 were from vaccinated women according to immunization record, 1021 from women self-reporting vaccination, and 1893 from unvaccinated women. Adjusted vaccine effectiveness for confirmed vaccinated compared with unvaccinated women was 95.93% (95% confidence interval [CI] = 90.22-98.32) against VT HPV and 38.37% (95% CI = 12.68-56.51) against cross-reactive genotypes (HPV 31, 33, 45), respectively. Vaccine type HPV prevalence was significantly lower (0.61%) among confirmed-vaccinated women than among those who self-reported vaccination or unvaccinated women (1.76% and 15.0%, respectively). Factors associated with prevalent VT in multivariable analysis were vaccine status, positive Chlamydia trachomatis and ≥4 partners in the preceding year. Our study demonstrates evidence of high effectiveness of HPV prophylactic vaccines at an individual level, supporting that wider implementation will help to reduce cervical cancer and precursors incidence.

Safetxt: a pilot randomised controlled trial of an intervention delivered by mobile phone to increase safer sex behaviours in young people

ObjectiveTo test the procedures proposed for a main trial of a safer sex intervention for young people delivered by mobile phone text message (‘safetxt’).Design and settingPilot randomised controlled trial. Participants...

Clinical, diagnostic and pathologic features of presumptive cases of Chlamydia pecorum-associated arthritis in Australian sheep flocks.

BackgroundArthritis is an economically significant disease in lambs and is usually the result of a bacterial infection. One of the known agents of this disease is Chlamydia pecorum, a globally recognised livestock pathogen associated with several diseases in sheep, cattle and other hosts. Relatively little published information is available on the clinical, diagnostic and pathologic features of C. pecorum arthritis in sheep, hindering efforts to enhance our understanding of this economically significant disease. In this case series, a combination of standard diagnostic testing used routinely by veterinarians, such as the Chlamydia complement fixation text (CFT), veterinary clinical examinations, and additional screening via C. pecorum specific qPCR was used to describe putative chlamydial infections in five sheep flocks with suspected ovine arthritis.Case presentationFive separate cases involving multiple lambs (aged six to ten months) of different breeds with suspected C. pecorum arthritis are presented. In two of the five cases, arthritic lambs exhibited marked depression and lethargy. Arthritis with concurrent conjunctivitis was present in four out of five lamb flocks examined. Chlamydia CFT demonstrated medium to high positive antibody titres in all flocks examined. C. pecorum shedding was evident at multiple sites including the conjunctiva, rectum and vagina, as determined via qPCR. Two of the five flocks received antimicrobials and all flocks recovered uneventfully regardless of treatment.ConclusionThis case series highlights the features a field veterinarian may encounter in cases of suspected ovine chlamydial arthritis. Our analysis suggests a presumptive diagnosis of chlamydial arthritis in lambs can be made when there is evidence of joint stiffness with or without synovial effusion and elevated chlamydia antibody titres. C. pecorum-specific qPCR was found to be a useful ancillary diagnostic tool, detecting Chlamydia positivity in low or negative CFT titre animals. Variables such as symptom duration relative to sampling, sheep breed and farm management practices were all factors recorded that paint a complex epidemiological and diagnostic picture for this disease. These case studies serve to provide a platform for further research to improve diagnostic testing and new treatment and control strategies for C. pecorum infections in sheep.