Chlamydia Screening Programme Research Articles

P23 Investigation of the economic impact of implementing national guidelines to retest young people (aged 16–24) who test positive for chlamydia

<h3>Background</h3> The National Chlamydia Screening Programme (NCSP) updated its guidelines in 2013 to recommend retesting for all chlamydia positive individuals around three months after treatment, due to the risk of reinfection. <h3>Objectives</h3> Investigate the impact of implementing new retesting guidance on chlamydia screening activities and the economic cost of updating current testing practice. <h3>Methods</h3> We developed a spreadsheet tool to calculate the additional costs of implementing new retesting guidance. We collected data from pilot evaluations of retesting to estimate the number of tests performed and the cost of administering retesting within existing services. We used these to estimate the national impact of the new guidelines, and to inform future updates to guidelines. <h3>Results</h3> The baseline scenario is based on findings from pilot evaluations: for every 10,000 chlamydia tests, this will generate 750 positives (assuming 7.5% positivity), of whom 40% (300) would be retested within 6 months. This would identify an additional 30 positives (10% positivity at retest). In this scenario, only 3% of all tests performed are retests, which would have minimal impact on the overall cost of the screening programme. The slight increased cost of retesting, associated with active recall of positive individuals is offset by the higher positivity observed at retest. <h3>Conclusions</h3> The new guidelines to retest chlamydia positive individuals within 6 months appear feasible within the context of current programmes and will identify individuals at continued risk of infection with relatively low resource and time input.

P30 Gonorrhoea: a rising tide

Background The prevalence of gonorrhoea in England increased by 15% between 2012 and 2013. In contrast, there was a 62% rise in gonorrhoea in our local area in the same time period. Aim To identify potential areas for management improvement that may help reduce infection rates. Methods A retrospective case note review of positive patients between 1st January and 30 th June 2013 was conducted. Positive agar-based gonococcal culture or BD ProbeTec™ GC Q x Amplified DNA Assay results were included. Results The 201 individuals reviewed had a mean age of 24 (range 16–53). 53% were male, 80% Caucasian and 89% heterosexual. There was no geographical postcode pattern seen. 100% resolution of infection at test of cure (TOC) was achieved in the 39% that attended. 10% TOC attendees became re-infected. 100% received Partner Notification (PN), of whom 45% had contacts attending for treatment and 36% declined to provide contact details. Discussion Unlike the epidemic elsewhere in the UK, our outbreak is predominantly amongst male and female heterosexuals. As the majority were in the age range 16–25, targeted screening and health promotion could be delivered using the same resources as the National Chlamydia Screening Programme locally. TOC attendance was poor and the use of automatic text reminders and TOC postal kits maybe beneficial. The quality of information provided for PN can be improved with novel methods of non-standard PN. The high re-infection rate suggests a large reservoir of undiagnosed disease in our local population which needs addressing on a larger public health basis.

P9 Low false positive rate of gonorrhoea cases referred to gum from a low prevalence chlamydia screening population

<h3>Background/introduction</h3> Recent national guidance for the detection of gonorrhoea (GC) has raised concerns that the majority of initial positive GC test results are likely to be false positives when a low prevalence population is screened using a nucleic acid amplification test (NAAT). Our local chlamydia screening programme uses a dual NAAT for chlamydia and GC and has a low reactive GC rate &lt;1%. All GC reactive cases are referred to GUM for further investigation. <h3>Aim(s)/objectives</h3> To determine whether GC reactive cases referred from our local chlamydia screening programme were true GC infections or likely to be false positive cases. <h3>Methods</h3> A retrospective case notes review of 13 consecutive GC reactive cases seen at our clinic referred from the local chlamydia screening programme. <h3>Results</h3> 10/13 were women. 10/13 cases were confirmed as true GC infections by positive genital GC cultures. In 1 case genital culture was negative but screening and supplementary NAAT with a different target confirmed a true GC infection. In 1 case genital cultures were negative however pharyngeal culture was positive indicating a true GC infection. In 1 case GC cultures were all negative but NAAT tests were reactive from genital and pharyngeal sites and equivocal from the rectum. <h3>Discussion/conclusion</h3> Only 1/13 GC reactive cases seen in our GU referred from a low prevalence screening population might have been a false positive. Contrary to recent publications, in our area, using a dual NAAT is unlikely to lead to high numbers of false positive GC results.

O21 Securing excellence in chlamydia screening outcomes on a shrinking budget

Background/introduction The National Chlamydia Screening Programme (NCSP) recommends opportunistically screening sexually active 15 to 24 year olds annually and on change of partner. Through a number of changes to the delivery of screening, Leeds has maintained a higher than average detection rate indicator (DRI) despite declining spend. We describe these changes and corresponding DRIs. Aim(s)/objectives To review and re-structure chlamydia control activity to provide greater value for money. Methods A multi-professional steering group was established and a strategic approach taken to commission chlamydia within sexual health services. Our approach included: screening, treatment and partner notification embedded within contraception and sexual health services; commissioning of online testing and an enhanced pharmacy scheme; signposting website developed; phasing out financial incentives for General Practitioners (GP); reducing outreach testing, marketing and staff. Results In 2014 £371k was spent on screening activities (£538k 2010/11). 2014 Q1-Q2 DRI was 3,104 (2,168 England; 2,325 Yorkshire and Humber) and 2,511 (1,888 England; 2,128 YH 2,367 YH 2,068 Y&H) for equivalent time periods in 2013. In 2013 most tests were performed in GP (30%) followed by GUM (26.6%), Internet (26.8%) and CASH (13.5%). Positivity across all settings in 2013 was 9.5%. Discussion/conclusion By concentrating activity in venues with higher positivity, in line with guidance from the NCSP, it has been possible to achieve the DRI target whilst working within tighter economic constraints. In particular, outreach screening was costly and produced low volumes of tests with low positivity.

P11 Declining rates of chlamydial related epididymitis in men aged 15–35 years: a review of surveillance data from english genitourinary medicine clinics, 2009–2013

Background Monitoring trends in chlamydia-related sequelae, such as epididymitis and pelvic inflammatory disease (PID), is an important aspect of the evaluation of chlamydia control initiatives such as the National Chlamydia Screening Programme (NCSP). Unlike PID, which can be difficult to diagnose, epididymitis may be a useful measure for evaluation purposes. The objective of this analysis was to examine trends in epididymitis diagnosis rates in the era of increased chlamydia testing. Methods Diagnoses of epididymitis among 15–35 year old males were obtained from the genitourinary medicine (GUM) clinic activity dataset version 2. Diagnosis rates were calculated, per year, using the number of new-episode male clinic attendances. This accounted for changes in clinic attendance over the years. Negative binomial regression was used to derive the incidence rate ratios (IRR) and test significance of the trends. Results Between 2009 and 2013, a total of 24,689 diagnoses of epididymitis were made among 15–35 year old males, of which 10% (2,506) were of chlamydial and 2% (473) of gonoccocal aetiology. Diagnosis rates of chlamydial epididymitis declined by an average of 12% per year (IRR = 0.88, 95% CI; 0.81–0.96, p < 0.001), while no statistically significant changes were observed in rates of gonoccocal epididymitis (IRR = 0.93, 95% CI; 0.86–1.00 p = 0.276). A small but significant decline of 2% per year (IRR 0.98: 95% CI; 0.96–0.99, p = 0.001) was observed for rates of non-specific epididymitis. Conclusion The decreased rate of chlamydial epididymitis diagnoses in men may be associated with increased chlamydia testing, however, the influence of other contributing factors should be explored.

The added value of chlamydia screening between 2008-2010 in reaching young people in addition to chlamydia testing in regular care; an observational study.

BackgroundInternet-based Chlamydia Screening Implementation (chlamydia screening programme) was introduced in the Netherlands in 2008-2010 to detect and treat asymptomatic infections and to limit ongoing transmission through annual testing and treatment of Chlamydia trachomatis in young people (16-29 years). This population-based screening may be less effective when addressing individuals who are already covered by regular care, instead of addressing a hidden key population without chlamydia testing experience in regular care. This study had two aims: (1) to assess the rate and determinants of newly reached (i.e. not previously tested in 2006-2010) participants in the chlamydia screening programme, and (2) to assess the chlamydia positivity in these newly reached participants.MethodsThis observational matching study included all chlamydia tests performed in subjects aged 16-29 years in eastern South Limburg in the Netherlands (population 16-29 years:41,000) between 2006-2010. Testing was conducted during the systematic chlamydia screening programme (2008-2010), at a sexually transmitted infections clinic (STI clinic), by general practitioners (GPs), and by medical specialists as reported by the medical laboratory serving the region. Data were matched between testing services on individual level. The study population included all participants who were tested at least once for chlamydia by the chlamydia screening programme. Participants were included at their first chlamydia screening participation.ResultsIn the chlamydia screening programme, 80.7% (4298/5323) of participants were newly reached, others were previously tested by the STI clinic (5.7%, n=304), GPs (6.2%, n=328), medical specialists (3.5%, n=187) or a combination of providers (3.9%, n=206). Chlamydia prevalence was similar in newly reached participants (4.8%, 204/4298) and participants previously tested (4.5%, 46/1025, P=0.82). Independent determinants for being a newly reached participant were male gender (men OR 2.9; 95% CI 2.5-3.4) and young age <21 years (versus 25-29 years OR 1.8; 95% CI 1.5-2.2).ConclusionsThe majority of the chlamydia screening programme participants have not been tested by regular care, and show similar chlamydia prevalence as those previously tested. Thereby population-based chlamydia screening adds to the existing regular care by testing young individuals hidden to current regular care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0612-2) contains supplementary material, which is available to authorized users.

Five years’ experience with a primary care electronic patient record in a community sexual and reproductive health service

Lewisham Sexual and Reproductive Health (SRH) service is one of the largest in the UK with approximately 60 000 attendances a year. It works from four centres spread across a...

Evaluation of diagnosed incidence rate as a measure of performance: an ecological study of England's national chlamydia screening programme

BackgroundEngland's National Chlamydia Screening Programme (NCSP) aims to control infection and reduce sequelae. Public Health England developed a novel monitoring indicator included in the Public Health Outcomes Framework, the diagnosed incidence rate (DIR), with a target of 2300 cases of chlamydia per 100 000 resident 15–24-year-old young people per year. We assessed the utility of DIR as a measure of performance at local authority level. MethodsWe used the NCSP 2012 dataset to derive coverage, positivity, population size, and DIR and linked the dataset to indices of multiple deprivation (IMD) 2010 scores. We used multivariate logistic regression to analyse the association between the DIR (local authorities categorised as achieved or did not achieve the target) and coverage, positivity, population size, IMD score, and proportion of tests done in a genitourinary medicine setting. FindingsThe dataset included 3 403 922 female residents and 3 516 609 male residents from 326 local authorities, two of which were excluded (one with missing values and one suppressed because of small numbers). The recommended DIR of 2300 per 100 000 was achieved by 72 (22%) of 324 local authorities, with those in the most deprived quintile being more likely to reach the target than those in the least deprived quintile (adjusted odds ratio [AOR] for women 25·83, 95% CI 8·70–76·68; men 6·83, 1·34–34·72). The proportion of tests done in a genitourinary medicine setting was negatively associated with attaining the recommended DIR (AOR 0·93, 95% CI 0·91–0·96). No clear associations with population size were seen. InterpretationGreater socioeconomic deprivation strongly influenced whether local authorities attained the recommended DIR. This finding could reflect increased disease burden rather than more appropriate targeting of testing. Consequently, use of the DIR to compare performance of local authorities is difficult. Local-authority-specific DIR targets that reflect local disease burden might be more effective than a single national target. Additionally, the results indicate that an increased proportion of tests done in a genitourinary medicine setting was associated with a reduced likelihood of reaching the DIR target, which suggests the need for more testing outside of this setting, particularly in the least deprived areas. Critical evaluation of local authority performance should be used to inform subsequent versions of the Public Health Outcomes Framework. FundingBD received a Medical Research Council Population Health Scientist Fellowship. JWE received funding from the Bill & Melinda Gates Foundation through a grant to the HIV Modelling Consortium.

Screening for gonorrhoea using samples collected through the English National Chlamydia Screening Programme and risk of false positives: a national survey of Local Authorities

ObjectivesTo investigate use of dual tests for Chlamydia trachomatis and Neisseria gonorrhoeae on samples collected through the National Chlamydia Screening Programme (NCSP) in England.Design and settingDuring May–July 2013, we delivered...

Nucleic acid amplification tests for the diagnosis of Neisseria gonorrhoeae in low-prevalence settings: a review of the evidence

ObjectivesIn UK Microbiology laboratories there is widespread use of nucleic acid amplification tests (NAATs) which allow the simultaneous ‘dual’ detection of Neisseria gonorrhoeae and Chlamydia trachomatis, although the prevalence of...

Response letter to T Fowler and co-authors – estimating the positive predictive value of opportunistic population testing for gonorrhoea as part of the English Chlamydia Screening Programme

Dear Editor, Fowler et al.1 discuss the inclusion of gonorrhoea screening alongside the National Chlamydia Screening Programme (NCSP) in one part of the UK and the calculation of positive predictive values (PPVs) to guide commissioning decisions. This is a timely and welcome contribution given the increased deployment of ‘dual testing’ – where nucleic acid amplification tests (NAAT) simultaneously test for chlamydia and gonorrhoea using the same sample. However, we have concerns about some of the assumptions used when estimating PPVs, particularly the assertion that sensitivity and specificity may vary by prevalence, which is not substantiated in the context of asymptomatic gonorrhoea testing. Although some studies have shown that sensitivity and specificity may vary by prevalence, this relates to differing disease severity and diagnostic definitions.2 In most disease processes, diagnosis becomes more certain as the disease progresses and it is intuitive that diagnostic test performance should improve with progression, the so-called spectrum bias.3 However, opportunistic testing in non-symptomatic individuals is different; this represents a homogenous group. There is no reason to believe that the sensitivity and specificity will systematically vary with the underlying prevalence of an asymptomatic sexually transmitted infection (STI). Furthermore, the absolute difference in diagnosed gonorrhoea prevalence quoted is small; 35 per 100,000 in Greater Manchester versus 28 per 100,000 in England, and any difference in PPV is unlikely to make testing in one area viable and not in another. We agree with the authors’ emphasis on the importance of confirmatory NAAT testing following a reactive screen for gonorrhoea, which supports current national gonorrhoea testing guidance.4 They also suggest restricting gonorrhoea testing in low prevalence areas to those with a positive chlamydia test. However, where dual testing is used in the NCSP, the chlamydia test result would be unknown at the point of gonorrhoea testing, and it is already the case that the NCSP core requirements recommend a full STI screen (including gonorrhoea, syphilis and HIV testing) for all patients diagnosed with chlamydia as part of routine clinical management.5

Comparison of patients diagnosed with gonorrhoea through community screening with those self-presenting to the genitourinary medicine clinic

ObjectivesTo compare the clinical, socioeconomic and demographic characteristics of individuals diagnosed with Neisseria gonorrhoeae (NG) in the community using a concomitant nucleic acid amplification test (NAAT, AptimaCombo2) as part of...

A cross-sectional study of Mycoplasma genitalium infection and correlates in women undergoing population-based screening or clinic-based testing for Chlamydia infection in London

ObjectiveTo determine Mycoplasma genitalium infection and correlates among young women undergoing population-based screening or clinic-based testing for Chlamydia infection.DesignCross-sectional study.SettingNational Chlamydia Screening Programme (NCSP) and two London sexually transmitted infection...

Effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections: observational study, systematic reviews and mathematical modelling

Partner notification is essential to the comprehensive case management of sexually transmitted infections. Systematic reviews and mathematical modelling can be used to synthesise information about the effects of new interventions to enhance the outcomes of partner notification. To study the effectiveness and cost-effectiveness of traditional and new partner notification technologies for curable sexually transmitted infections (STIs). Secondary data analysis of clinical audit data; systematic reviews of randomised controlled trials (MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials) published from 1 January 1966 to 31 August 2012 and of studies of health-related quality of life (HRQL) [MEDLINE, EMBASE, ISI Web of Knowledge, NHS Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment (HTA)] published from 1 January 1980 to 31 December 2011; static models of clinical effectiveness and cost-effectiveness; and dynamic modelling studies to improve parameter estimation and examine effectiveness. General population and genitourinary medicine clinic attenders. Heterosexual women and men. Traditional partner notification by patient or provider referral, and new partner notification by expedited partner therapy (EPT) or its UK equivalent, accelerated partner therapy (APT). Population prevalence; index case reinfection; and partners treated per index case. Enhanced partner therapy reduced reinfection in index cases with curable STIs more than simple patient referral [risk ratio (RR) 0.71; 95% confidence interval (CI) 0.56 to 0.89]. There are no randomised trials of APT. The median number of partners treated for chlamydia per index case in UK clinics was 0.60. The number of partners needed to treat to interrupt transmission of chlamydia was lower for casual than for regular partners. In dynamic model simulations, >10% of partners are chlamydia positive with look-back periods of up to 18 months. In the presence of a chlamydia screening programme that reduces population prevalence, treatment of current partners achieves most of the additional reduction in prevalence attributable to partner notification. Dynamic model simulations show that cotesting and treatment for chlamydia and gonorrhoea reduce the prevalence of both STIs. APT has a limited additional effect on prevalence but reduces the rate of index case reinfection. Published quality-adjusted life-year (QALY) weights were of insufficient quality to be used in a cost-effectiveness study of partner notification in this project. Using an intermediate outcome of cost per infection diagnosed, doubling the efficacy of partner notification from 0.4 to 0.8 partners treated per index case was more cost-effective than increasing chlamydia screening coverage. There is evidence to support the improved clinical effectiveness of EPT in reducing index case reinfection. In a general heterosexual population, partner notification identifies new infected cases but the impact on chlamydia prevalence is limited. Partner notification to notify casual partners might have a greater impact than for regular partners in genitourinary clinic populations. Recommendations for future research are (1) to conduct randomised controlled trials using biological outcomes of the effectiveness of APT and of methods to increase testing for human immunodeficiency virus (HIV) and STIs after APT; (2) collection of HRQL data should be a priority to determine QALYs associated with the sequelae of curable STIs; and (3) standardised parameter sets for curable STIs should be developed for mathematical models of STI transmission that are used for policy-making. The National Institute for Health Research Health Technology Assessment programme.

The effect of financial incentives on chlamydia testing rates: Evidence from a randomized experiment

Financial incentives have been used in a variety of settings to motivate behaviors that might not otherwise be undertaken. They have been highlighted as particularly useful in settings that require a single behavior, such as appointment attendance or vaccination. They also have differential effects based on socioeconomic status in some applications (e.g. smoking). To further investigate these claims, we tested the effect of providing different types of non-cash financial incentives on the return rates of chlamydia specimen samples amongst 16–24 year-olds in England. In 2011 and 2012, we ran a two-stage randomized experiment involving 2988 young people (1489 in Round 1 and 1499 in Round 2) who requested a chlamydia screening kit from Freetest.me, an online and text screening service run by Preventx Limited. Participants were randomized to control, or one of five types of financial incentives in Round 1 or one of four financial incentives in Round 2. We tested the effect of five types of incentives on specimen sample return; reward vouchers of differing values, charity donation, participation in a lottery, choices between a lottery and a voucher and including vouchers of differing values in the test kit prior to specimen return. Financial incentives of any type, did not make a significant difference in the likelihood of specimen return. The more deprived individuals were, as calculated using Index of Multiple Deprivation (IMD), the less likely they were to return a sample. The extent to which incentive structures influenced sample return was not moderated by IMD score. Non-cash financial incentives for chlamydia testing do not seem to affect the specimen return rate in a chlamydia screening program where test kits are requested online, mailed to requestors and returned by mail. They also do not appear more or less effective in influencing test return depending on deprivation level.

Two urine-based sexually transmitted infection screening interventions targeting young men in football club settings (SPORTSMART): a pilot randomised controlled trial

BackgroundYoung people remain at highest risk for sexually transmitted infections (STIs), and engaging men in the UK in effective STI screening is challenging. England's national chlamydia screening programme has failed to reach the desired coverage in men. Sports venues might appeal to men as sites of STI screening, although the use of such venues has not been widely explored in the UK. Our recent random probability survey of men's attitudes to STI screening in Britain showed that in men who regularly participate in sport, just over half were willing to access self-completed screening kits at sporting venues. Other work suggests that sporting role models (popular opinion leaders [POLs]) offer potential for successful promotion of health behaviours. Because football is the highest participation team sport in England, we designed the SPORTSMART trial to develop and assess two models for promotion of STI screening in men in football clubs in London. We aimed to develop two replicable interventions for delivering STI screening in football clubs, including screening promoted by POLs; and to assess feasibility and acceptability of these interventions. MethodsWe undertook a cluster pilot randomised controlled trial with three groups in men aged 18–35 years within six amateur football clubs (clusters) in London recruited between October and December, 2012. Interventions were POL (team captain) and poster-promoted screening; sexual health adviser and poster-promoted screening; and poster-promoted screening only (control). Men were invited to use urine-based self-sampling kits for chlamydia and gonorrhoea, returning their sample to an on-site collection container or mailing it to the study sexual health clinic for routine testing and clinical management. The target was to recruit 200 men to estimate the overall acceptance rate with adequate precision. Six football clubs with two teams each of men aged at least 18 years were grouped by similar characteristics into three pairs and then randomly allocated to the study groups. Participants were unmasked after allocation. Masking of investigators during implementation or assessment was not feasible. A detailed process investigation assessed the extent and quality of intervention delivery and the mechanism, context, and responses of the participants. Robust standard errors acknowledging clustering of participants by team were used for analyses. Ethics approval was granted by the National Research Ethics Service, study 13/SC/0029. Club managers gave consent during the recruitment period. Signed informed consent was provided by team captains (POLs) before the intervention. Football team members opted in to testing by completing the kit offered but could opt out of the intervention at any time. FindingsAcross the three groups, 153 men received the intervention and 90 accepted the offer of screening (59%, 95% CI 35–79). Although acceptance rates varied substantially by club, they were broadly similar across groups: POL led 28 of 56 (50%); health adviser led 31 of 46 (67%); and control 31 of 51 (61%). Process assessment confirmed that the interventions were delivered in a standardised way across the arms. However, the control group was unintentionally enhanced by some team captains, who actively publicised the screening events. There were no adverse effects reported. InterpretationThese findings suggest that young men in football settings find both POL-led and health adviser-led STI screening interventions acceptable and uptake is high compared with existing community testing models. Although the poster-promoted screening control group was intended to be uninfluenced by football club POLs, this intention was not practically possible; many captains were enthusiastic and encouraged their players to participate in screening. This factor resulted in POL influence regardless of group allocation. A health economics assessment is in process. A full-scale randomised controlled trial is needed to examine the broader implications of this approach to men's STI screening in the UK. FundingThis research is funded by a National Institute for Health Research programme grant for applied research.

Comparing swabs for diagnosing chlamydia and gonorrhea in women: recent findings

Journal of Comparative Effectiveness ResearchVol. 2, No. 5 EditorialComparing swabs for diagnosing chlamydia and gonorrhea in women: recent findingsCatherine MW Stewart, Sarah A Schoeman & Janet D WilsonCatherine MW StewartThe Goodman Centre, Lance Burn Health Centre, Churchill Way, Salford, M6 5QX, UKSearch for more papers by this author, Sarah A SchoemanDepartment of Genitourinary Medicine, Leeds General Infirmary, Leeds, LS1 3EX, UKSearch for more papers by this author & Janet D Wilson* Author for correspondenceDepartment of Genitourinary Medicine, Leeds General Infirmary, Leeds, LS1 3EX, UK. Search for more papers by this authorEmail the corresponding author at janet_d.wilson@leedsth.nhs.ukPublished Online:11 Sep 2013https://doi.org/10.2217/cer.13.52AboutSectionsView ArticleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinkedInRedditEmail View articleReferences1 Stewart CM, Schoeman SA, Booth RA, Smith SD, Wilcox MH, Wilson JD. Assessment of self taken swabs versus clinician taken swab cultures for diagnosing gonorrhoea in women: single centre, diagnostic accuracy study. BMJ345,e8107 (2012).Crossref, Medline, Google Scholar2 Schoeman SA, Stewart CM, Booth RA, Smith SD, Wilcox MH, Wilson JD. Assessment of best single sample for finding chlamydia in women with and without symptoms: a diagnostic test study. BMJ345,e8013 (2012).Crossref, Medline, Google Scholar3 LaMontagne DS, Fenton KA, Randall S, Anderson S, Carter P. Establishing the National Chlamydia Screening Programme in England: results from the first full year of screening. Sex. Transm. Infect.80(5),335–341 (2004).Crossref, Medline, CAS, Google Scholar4 Gaydos CA, Dwyer K, Barnes M et al. Internet-based screening for Chlamydia trachomatis to reach non-clinic populations with mailed self-administered vaginal swabs. Sex. Transm. Dis.33,451–457 (2006).Crossref, Medline, Google Scholar5 Blake DR, Maldeis N, Barnes MR et al. Cost–effectiveness of screening strategies for Chlamydia trachomatis using cervical swabs, urine and self-obtained vaginal swabs in a sexually transmitted disease clinic setting. Sex. Transm. Dis.35,649–655 (2008).Crossref, Medline, Google Scholar6 Marions L, Rotzen-Ostlund M, Grillner L et al. High occurrence of a new variant of Chlamydia trachomatis escaping diagnostic tests among STI clinic patients in Stockholm, Sweden. Sex. Transm. Dis.35,61–64 (2008).Crossref, Medline, Google Scholar7 Ison CA, Golparian D, Saunders P, Chisholm S, Unemo M. Evolution of Neisseria gonorrhoeae is a continuing challenge for molecular detection of gonorrhoea: false negative gonococcal porA mutants are spreading internationally. Sex. Transm. Infect.89(3),197–201 (2013).Crossref, Medline, Google Scholar8 CDC. CDC grand rounds: the growing threat of multidrug-resistant gonorrhoea. MMWR Morb. Mortal Wkly Rep.62,103–106 (2013).Medline, Google Scholar9 Carne CA, McClean H, Sullivan AK et al. National audit of asymptomatic screening in UK genitourinary medicine clinics: clinic policies audit. Int. J. STD AIDS21,512–515 (2010).Crossref, Medline, CAS, Google Scholar10 Van Der Pol B, Taylor SN, Liesenfeld O, Williams JA, Hook EW 3rd. Vaginal swabs are the optimal specimen for detection of genital Chlamydia trachomatis or Neisseria gonorrhoeae using the Cobas 4800 CT/NG test. Sex. Transm. Dis.40(3),247–250 (2013).Crossref, Medline, Google Scholar101 Health Protection Agency. GRASP 2011 report: the Gonococcal Resistance to Antimicrobials Surveillance Programme (2012). www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317136030908Google Scholar102 General Medical Council. Good medical practice (2013). www.gmc-uk.org/Good_medical_practice___English_0313.pdf_51527435.pdfGoogle ScholarFiguresReferencesRelatedDetails Vol. 2, No. 5 Follow us on social media for the latest updates Metrics Downloaded 27 times History Published online 11 September 2013 Published in print September 2013 Information© Future Medicine LtdFinancial & competing interests disclosureThe authors were coapplicants in an unconditional research grant from Gen-Probe. JD Wilson is the lead applicant of a National Institute for Health Research for Patient Benefit grant. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.No writing assistance was utilized in the production of this manuscript.PDF download

C. trachomatis pgp3 Antibody Prevalence in Young Women in England, 1993–2010

Seroepidemiology of chlamydia can offer study opportunities and insights into cumulative risk of exposure that may contribute to monitoring the frequency of, and control of, genital chlamydia–the most commonly diagnosed STI in England. We undertook retrospective anonymous population-based cross-sectional surveys using an indirect IgG ELISA for chlamydia Pgp3 antibody. Sera from 4,732 women aged 17–24 years were tested. Samples were taken at 3-yearly intervals between 1993 and 2002, a period during which other data suggest chlamydia transmission may have been increasing, and from each year between 2007 and 2010. Seroprevalence increased in 17–24 year olds over time between 1993 and 2002. Between 2007 and 2010, age-standardised seroprevalence among 17–24 year olds decreased from 20% (95% CI: 17–23) to 15% (95%CI 12–17) (p = 0.0001). The biggest drop was among 20 to 21 year olds, where seroprevalence decreased from 21% in 2007 to 9% in 2010 (p = 0.002). These seroprevalence data reflect some known features of the epidemiology of chlamydia infection, and show that exposure to antibody-inducing chlamydia infection has declined in recent years. This decline was concurrent with increasing rates of screening for asymptomatic chlamydia. Serology should be explored further as a tool for evaluation of chlamydia control, including chlamydia screening programmes.

P3.021 Seroepidemiology to Evaluate Chlamydia Screening Programmes: Results from Two Surveys of Pgp3 Antibody in Residual Stored Serum Samples in England

BackgroundThere have been substantial increases in chlamydia screening among young adults in England since the introduction of the National Chlamydia Screening Programme in 2003. The impact of the programme on...

Gonorrhea Positivity in New Orleans Public High Schools, 1996 to 2005

To the Editors The US Preventive Services Task Force recommends screening all sexually active women for gonorrhea if they are young or have other individual or population risk factors for infection.1 Individual risk factors depend on the local epidemiology of gonorrhea, and population risk factors include residence in urban communities and communities with high rates of poverty.1,2 Gonorrhea rates are higher among adolescents. In 2011, the US rates of reported cases of gonorrhea per 100,000 populations were 98.7 in men and 108.9 in women; among individuals aged 15 to 19 years, these rates were 248.6 in men and 556.5 in women.3 The state of Louisiana reported 545.4 and 1242.0 gonorrhea cases per 100,000 populations in men and women aged 15 to 19 years.3 In 2010, 97% of adolescents aged 14 to 17 years were enrolled in US schools.4 Although the US Preventive Services Task Force does not recommend screening men for gonorrhea for insufficient evidence,1 available evidence clearly makes Louisiana adolescent boys and girls candidates for gonorrhea screening,2,3 and schools are an ideal place to find adolescents.4 From school years 1996 to 1997 to 2004 to 2005, between 1545 (1996–1997) and 6078 (1999–2000) 9th through 12th grade students in New Orleans public schools (age, 14–24 years; mean, 16.7 years; median, 17.0 years) provided urine specimens that were tested for both chlamydia and gonorrhea (LCx Chlamydia trachomatis Assay and LCx Neisseria gonorrhoeae Assay [Abbott Park, IL] until 1999–2000; BDProbeTec ET C. trachomatis and N. gonorrhoeae Amplified DNA Assays [Sparks, MD] thereafter) in a school-wide chlamydia screening program.5 The average 9-year gonorrhea positivity was 1.2% (184/14,988; 95% confidence interval [CI], 1.1%–1.4%) in men and 3.3% (478/14,343; 95% CI, 3.0%–3.6%) in women (P < 0.001). Positivity ranged between 0.8% (24/3084; 1999–2000) and 2.0% (23/1179; 2002–2003) in men and between 2.2% (42/1944; 1997–1998) and 4.8% (67/1399; 2000–2001) in women. In sex-specific multivariate logistic regression analyses with age, race, laboratory assay, school year, and chlamydia test results as covariates (Table 1), gonorrhea positivity in men was significantly associated with age (P = 0.01) and with chlamydia positivity (P < 0.001). In women, gonorrhea positivity was associated significantly only with chlamydia positivity (P < 0.001). The odds of gonorrhea positivity increased in aging women (adjusted odds ratio [AOR], 1.08; 95% CI, 1.00–1.16; P = 0.05) and in African American men (AOR, 2.55; 95% CI, 0.35–18.45; P = 0.36) and women (AOR, 5.59; 95% CI, 0.78–40.14; P = 0.09), although the increases did not achieve significance levels of P < 0.05, partly because of the relatively lower baseline gonorrhea positivity among students who were tested. Gonorrhea positivity did not vary significantly over time (P > 0.16).TABLE 1: Multivariate Logistic Regressions of Gonorrhea Positivity Between 1996 and 2005The lack of significant differences in gonorrhea positivity between 1996 and 2005 reflected endemic and stable prevalence of gonorrhea among New Orleans school-aged adolescents. The morbidity associated with N. gonorrhoeae,6 its role in facilitating sexual transmission of HIV,7 and emerging resistance to antibiotics used against it8 dictate that its public health impact and population distributions be continuously monitored. Diagnostic tests that simultaneously detect C. trachomatis and N. gonorrhoeae in the same specimen9 would allow chlamydia screening programs to detect N. gonorrhoeae in populations that otherwise would not be tested for gonorrhea for lack of clear gonorrhea screening guidelines. Musheni Nsa, MD Department of Pediatrics Our Lady of the Lake Regional Medical Center Baton Rouge, LA Ngozi C. Mezu-Patel, MD David H. Martin, MD Stephanie N. Taylor, MD M. Jacques Nsuami, MD, MPH Department of Medicine Louisiana State University Health Sciences Center New Orleans, LA [email protected]