Selective screening for Chlamydia trachomatis infection in nonurban family planning clinics in Wisconsin

To determine the prevalence of, and identify risk factors for, Chlamydia trachomatis infection, we studied 380 women attending four Wisconsin family planning clinics in October 1985. The patients completed self-administered sexual history questionnaires, were examined by nurse clinicians and had specimens taken for direct fluorescent antibody (DFA) testing for C. trachomatis. Of 335 women with adequate specimens, 10.7 percent had positive DFA tests. Selective screening criteria were developed based on the following risk factors for C. trachomatis: Age less than 20 years and recent exposure to either a new sexual partner or a partner with more than one partner; a partner with symptoms of urethritis; a diagnosis of cervicitis; and inflammatory changes on Pap smear. Thirty-six percent of patients met one or more of these screening criteria, and the criteria had a sensitivity of 72 percent.     

Knowledge of genital Chlamydia trachomatis infection in family planning clinic attenders

The purpose of this study was to determine the level of awareness of genital Chlamydia infection and level of knowledge related to this infection in family planning (FP) clinic attenders. Clients attending FP clinics during a 3 month study period were invited to complete an anonymous self-administered questionnaire. Five hundred and sixteen questionnaires from female attenders were analysed. Results showed that 54% of respondents had heard of Chlamydia. Subjective knowledge assessment for Chlamydia was low compared to that for other infections. Mean knowledge scores relating to genital chlamydial infection were low. There was no significant age-related trend in knowledge scores. The implications of these findings are discussed in relation to increased Chlamydia screening activity in FP clinics.     

Need for screening for genital Chlamydia trachomatis infection in Australia

Genital Chlamydia trachomatis is the most common notifiable sexually transmissible infection in Australia and is associated with significant complications, particularly for women. There is no screening program for chlamydia in Australia despite this infection fulfilling the criteria for screening--it is easily diagnosed with acceptable self-administered tests and early treatment prevents complications. Screening for chlamydia reduces the prevalence of infection and the rate of complications and is recommended by several Western countries including the United States, England and Canada. If a screening program was introduced in Australia, several issues would first need to be addressed including who would be screened, how often would they be screened and where would screening be offered. We discuss these issues in this paper in an effort to advance the debate and the introduction of chlamydia screening in Australia.     

Provision of Chlamydia trachomatis screening in family planning clinics and emergency contraception in genitourinary medicine clinics: a collaborative cross-speciality survey

Two surveys were undertaken to review (1) provision of Chlamydia trachomatis screening by family planning (FP) clinics in the London region and (2) access to emergency contraception (EC) from genitourinary#10; medicine (GUM) clinics within the former North Thames region. The findings from the first survey suggest that there is insufficient screening (and treatment) in vulnerable groups attending FP clinics. Results#10; from the second survey show that hormonal EC is widely available from within GUM clinics, and those clinics also provide a range of other contraception services. However, these details may not be widely#10; recognised either by policymakers or the general public. #10;     

Non-invasive screening of teenagers for Chlamydia trachomatis in a family planning setting

One hundred women aged 20 or younger attending two family planning clinics specifically targeting teenagers were screened for Chlamydia trachomatis using first void urine specimens. An overall prevalence of 6.2 per cent was found, but there was a marked difference between women attending a city centre site (three per cent) and those attending a clinic in a small rural town.     

Test of cure for genital Chlamydia trachomatis infection in women

Convenient, reliable tests of cure for genital chlamydial infections have not been evaluated. Cervical appearance, endocervical Gram stain, enzyme immunoassay, and culture for Chlamydia trachomatis were evaluated during a pretreatment visit and at two subsequent randomized test-of-cure visits for 64 nongravid women with endocervical C trachomatis of 3544 patients screened. There were no useful correlations between C trachomatis resolution and cervical appearance. Endocervical Gram stain was determined to be unreliable for test-of-cure use. Both C trachomatis culture and enzyme-linked immunosorbent assay (ELISA) were shown to be effective for test-of-cure evaluation. The ELISA test became reliably negative 10 days after initiation of treatment and 1 to 5 days after the clearance of viable organisms detected by culture (P = .03). Convenience and cost considerations favor antigen detection methods. This study suggests that antigen detection methods can be used for situations in which test of cure is indicated, such as therapy noncompliance, circumstances supporting reinfection, pregnancy, complicated infections, requests for psychological reassurance, and evidence of persistent cervicitis.     

Opportunistic screening for genital infections with Chlamydia trachomatis among the sexually active population in Amsterdam. III. Cost-effectiveness analysis of screening women and the role of reinfection and partner treatment

The role of reinfection and the importance of partner treatment were added to a pharmacoeconomic model for the analysis of a GP-based opportunistic screening programme for Chlamydia trachomatis (CT) in sexually active women in Amsterdam. A favourable cost-effectiveness was found for partner treatment. Partner treatment was cost saving and overall net costs per major outcome averted by the screening programme were reduced by 40% or more due to partner treatment. From a pharmacoeconomic point of view partner treatment should be routinely provided in the framework of a CT screening programme for Amsterdam women.     

Opportunistic screening for genital infections with Chlamydia trachomatis in sexually active population of Amsterdam. II. Cost-effectiveness analysis of screening women]

OBJECTIVE: To estimate the cost effectiveness of Chlamydia trachomatis (CT) screening of young women visiting general practitioners. DESIGN: Economic model analysis. METHODS: Data on the health care needs for CT complications were derived from various sources; costing was done using estimated cost prices, charges and the friction cost method; epidemiological data were derived from a pilot study among 22 general practices in Amsterdam, the Netherlands. The analyses were carried out assuming screening with ligase chain reaction test of a urine sample and treatment of identified cases of infection with single-dose azitromycin. The model intervention consisted of screening all heterosexually active women aged 15-19, 15-24, 15-29, or 15-34 years (strategies 1, 2, 3 and 4, respectively). Cost effectiveness was presented in net direct and indirect costs per woman cured and per major outcome averted (pelvic inflammatory disease (PID), chronic pelvic pain, ectopic pregnancy, infertility and pneumonia of newborns). RESULTS: The first two strategies were cost saving. For the third strategy net costs per woman cured and per major outcome averted were almost 110.- Dutch guilders (DFL) and over DFL 300, respectively. The last strategy costs over DFL 320 per woman cured and over DFL 910 per major outcome averted. The cost effectiveness was sensitive to the assumed probability of progression of CT infection to PID. CONCLUSION: Universal implementation of the screening programme investigated in Amsterdam for women aged 15-24 years would result in approximately equal savings and costs. Screening of all 15-29-year-old women would require a net investment of DFL 350,000.     

Chlamydia trachomatis genital infections in a community-based family practice clinic

Primary care physicians must become aware of the epidemiology and current diagnostic and management approaches to genital infections caused by Chlamydia trachomatis, since they are the most common sexually transmitted diseases in the United States. Clinical information was obtained on 282 sexually active female and 54 male patients aged between 14 and 44 years presenting for either asymptomatic physical examination or urogenital symptoms at a community-based family practice clinic that primarily serves middle socioeconomic class patients. A direct fluorescein-conjugated monoclonal antibody staining test for C trachomatis was found to be positive in 34 (12 percent) of 282 women and 15 (28 percent) of 54 men. Two (11 percent) of 19 pregnant women were found to be infected. Significantly more women presenting with urogenital symptoms or as a sexual contact of a symptomatic partner or those with abnormal findings on physical examination were found to have a positive test than were those who had no symptoms and no abnormal findings on physical examination. Similar trends were found in men, but were not statistically significant. It is recommended that primary care physicians presumptively treat those patients who have urogenital symptoms or have been exposed to sexual partners with urogenital symptoms and test asymptomatic patients who have signs of a possible C trachomatis infection.     

Barriers to screening for intimate partner violence: a mixed-methods study of providers in family planning clinics

CONTEXT: Universal screening for intimate partner violence has been recommended for health care settings. However, provider adherence to this recommendation is low, and little research has explored perspectives on relevant policies and procedures among providers in family planning centers. METHODS: In 2009, a sample of 75 health care staff from a large, urban family planning organization that has a protocol for screening for partner violence participated in focus group discussions about their attitudes toward, perceptions of barriers to and preparedness for such screening; 64 of them also completed a brief survey. Multiple analysis of variance was used to assess differences between licensed practitioners (advanced practice clinicians and social workers) and unlicensed health care assistants; findings were analyzed for congruence with and divergence from the focus group data. RESULTS: Barriers included lack of time, training and referral resources, but were reported less by licensed than by unlicensed providers. Overall, participants rated screening as helpful to clients, but licensed providers had more positive attitudes toward and felt more prepared for it than unlicensed ones. In the focus groups, some providers expressed frustration with clients’ responses to referrals, concern about taking too much time away from other health care matters and opinions that it was more appropriate for licensed professionals than for unlicensed practitioners to conduct screening. Both licensed and unlicensed staff wanted more training on responding to disclosures of violence. CONCLUSIONS: Family planning providers who are working under an institutional protocol continue to perceive barriers to screening and may benefit from ongoing professional development.     

生殖道沙眼衣原体感染的不良结局及预防措施

生殖道沙眼衣原体感染是常见的性传播疾病。它的发病率和患病率在我国逐年上升,性活跃人群、男男性行为人群和性工作者是高危人群。生殖道沙眼衣原体感染会导致不孕不育、盆腔炎、尿道炎、早产和死产等不良结局,早发现和早治疗是预防不良结局发生的关键。本文就生殖道沙眼衣原体感染的不良结局和预防措施进行了综述。     

Mass media family planning promotion in three Nigerian cities

Television promotion of family planning and clinic sites in three cities of Nigeria--Ilorin, Ibadan, and Enugu--played a significant role in 1985-88 in increasing the number of new acceptors at family planning clinics in each city. Family planning skits, prepared with advice and support from the local service providers, were included in existing popular entertainment shows. Questions asked in a recall survey among the exposed population in Enugu and Ibadan revealed that about half of those surveyed in both cities had seen the television episodes. Of those who had watched, 79 and 99 percent, respectively, recalled the family planning messages, and 69 and 88 percent, respectively, recalled specific clinic sites mentioned. Following the media promotion, the number of new clinic clients per quarter in Ilorin increased almost fivefold (in the original clinics evaluated); in Enugu, the number of new clients per month more than doubled; and in Ibadan, the number of new clients increased threefold. Use of entertainment through this "enter-educate approach" is a promising technique that can be replicated in different settings to encourage new clients to seek family planning services.     

General practitioners' knowledge and attitudes to contact tracing for genital Chlamydia trachomatis infection in North Queensland

INTRODUCTION: Most diagnoses of genital chlamydia infection in Queensland are made by general practitioners (GPs). This study aimed to assess GP attitudes to and knowledge of contact tracing in rural North Queensland. METHOD: A single page questionnaire mailed to a database of 65 GPs in May 2007. RESULTS: Nearly all respondents (42/43, 97.7%) 'always' or 'mostly' told patients to advise their contacts to seek medical treatment. More than half (24/44, 54.5%) felt that contact tracing was 'sometimes' or 'never' the responsibility of GPs. Around half of respondents (19/39, 48.7%) thought that the local public health unit staff were conducting contact tracing, which is not actually the case. CONCLUSION: There is lack of clarity surrounding the respective roles and responsibilities of sexual health units, public health units and GPs regarding contact tracing for chlamydia infection. IMPLICATIONS: GPs would benefit from education clarifying current contact tracing procedures, methods and resources.     

生殖道沙眼衣原体和解脲支原体感染与自然流产的关系

目的:探讨沙眼衣原体(Chlamydia trachomatis,CT)和解脲支原体(Ureaplasma Urealyticum,UU)与自然流产的关系。方法:应用胶体金法和分离培养法对56例自然流产(流产组)和50例门诊自愿人工流产患者(对照组)进行沙眼衣原体(CT)和解脲支原体(UU)的检测。结果:自然流产组CT和UU的检测率分别为37.5%和46.4%,与对照组比较差异有极显著性(P<0.01),CT和UU复合感染率为19.6%,与对照组比差异有极显著性(P<0.01)。结论:生殖道沙眼衣原体(CT)和解脲支原体(UU)感染与自然流产关系密切,可作为确定自然流产病因的指标。     

Risk behaviors for HIV infection in clients of Pennsylvania family planning clinics

Responses from a statewide survey of risk behaviors among clients of Planned Parenthood clinics in Pennsylvania indicate that a sizable proportion of these women are at intermediate or high risk for exposure to the human immunodeficiency virus (HIV). Overall, nearly five percent of the 15,499 women in the sample reported personal behavior, or a partner's behavior, that placed them at high risk, while an additional 20 percent were at intermediate risk. Among all women surveyed, 13 percent had had three or more partners in the past year, 12 percent had had a sexually transmitted disease, four percent had partners who were intravenous (IV) drug users, two percent were either current or past IV drug users, one percent had bisexual partners and less than one percent had partners who had hemophilia or who were infected with the AIDS virus.     

生殖道沙眼衣原体感染、淋球菌感染与复发性自然流产的关系

目的探讨生殖道沙眼衣原体(CT)感染、淋球菌(NG)感染与复发性自然流产的关系,为临床治疗提供参考。方法采用PCR荧光定量法和细菌培养法对入选者(健康人工流产组、首次自然流产组、复发性自然流产组)宫颈分泌物中CT、NG感染情况进行检测,并考察不同组间病菌感染差异。结果首次自然流产组CT阳性率(25.00%)、NG阳性率(10.00%)及CT+NG阳性率(5.00%)与健康人工流产组相比,差异无统计学意义(χ~2=3.48、0.83、0.40,均P>0.05)。复发性自然流产组CT阳性率(45.83%)、NG阳性率(37.50%)及CT+NG阳性率(29.17%)均明显高于健康人工流产组,也明显高于首次自然流产组,且差异有统计学意义(χ~2=14.38、13.89、11.57;4.09、8.80、8.57,均P<0.05)。结论生殖道CT感染、NG感染与复发性自然流产关系密切,临床上应对CT感染、NG感染检测加以重视。     

输卵管妊娠患者生殖道解脲脲原体和衣原体的感染情况分析

目的分析输卵管妊娠患者血清、宫颈分泌物、输卵管组织中解脲脲原体和沙眼衣原体的感染情况,探讨输卵管妊娠与生殖道解脲脲原体和沙眼衣原体的相关性。方法选取2014年1月-2015年12月医院妇产科输卵管妊娠行腹腔镜下输卵管切除术患者70例为输卵管妊娠组,另选妇科良性病变行腹腔镜下附件切除术或者输卵管切除术患者70例为对照组,检测血清解脲脲原体和沙眼衣原体抗体、宫颈分泌物和输卵管组织中解脲脲原体和沙眼衣原体DNA;比较两组患者血清、宫颈分泌物和标本中沙眼衣原体、解脲脲原体、解脲脲原体+沙眼衣原体的阳性率。结果输卵管妊娠组血清、宫颈分泌物和标本中沙眼衣原体阳性率(31.4%、37.1%、24.3%)均高于对照组(4.3%、5.7%、2.9%),两组比较差异有统计学意义(P<0.05);输卵管妊娠组血清、宫颈分泌物和标本中解脲脲原体阳性率(41.4%、40.4%、31.4%)均高于对照组(11.4%、8.6%、2.9%),两组比较差异有统计学意义(P<0.05);输卵管妊娠组血清、宫颈分泌物和标本中解脲脲原体+沙眼衣原体阳性率(20.0%、12.9%、18.6%)均高于对照组(4.3%、1.4%、1.4%),两组比较差异有统计学意义(P<0.05)。结论输卵管妊娠患者血清、宫颈分泌物、输卵管组织中解脲脲原体和沙眼衣原体阳性率升高,输卵管妊娠和生殖道解脲脲原体和沙眼衣原体感染关系密切。