Assessment of changes in the burden of Chlamydia trachomatis infection in the context of widespread opportunistic chlamydia screening: Pgp3 seroprevalence measured in a series of nationally representative cross-sectional household surveys

BackgroundOpportunistic screening of people aged under 25 years for genital Chlamydia trachomatis infection (chlamydia) was nationally implemented in England in 2008, but its impact is poorly understood. Antibodies to C trachomatis persist after infection, thus providing a marker of past infection. We aimed to explore the effect of screening on cumulative incidence of chlamydia (incidence of infection by a given age), as measured by C trachomatis antibodies.MethodsAnonymised serum samples from participants in the nationally representative Health Surveys for England (HSE) were tested for C trachomatis antibodies using two novel in-house Pgp3 ELISAs, which have demonstrated superior sensitivity to commercial assays. Determinants of being seropositive were explored with logistic regression among women (n=1402) and men (1119) aged 16–44 years in 2010–12 (years when questions about sexual behaviour were included in the survey). Seroprevalence trends among 16–24-year-old women (n=3361) were investigated over ten timepoints from 1994 to 2012.FindingsDuring 2010–12, Pgp3 seroprevalence among participants aged 16–44 years was 24·4% (95% CI 22·0–27·1) in women and 13·9% (11·8–16·2) in men. Seroprevalence increased with age (up to 33·5% [27·5–40·2] in 30–34-year-old women; 18·7% [13·4–25·6] in 35–39-year-old men) and with years since first sexual intercourse (38·2% [32·0–44·7] in women and 22·3% [16·2–29·8] in men aged 15–19 years). Total number of lifetime sexual partners and younger age at first sex were significantly associated with being seropositive (>10 lifetime sexual partners vs 1–4: odds ratio 3·84 women [95% CI 2·68–5·51], 5·95 men [3·41–10·35]; <16 years old at first sex vs >16: 2·26 women [1·61–3·16], 2·14 men [1·41–3·24]). 76·7% of seropositive 16–24-year-olds had never been diagnosed with chlamydia: among women, seroprevalence did not differ between the first (1994–96) and second (2001–02) periods sampled (prevalence ratio 1·04, 0·87–1·25); a non-significant decline was observed from 2008 to 2012 (prevalence ratio per year 0·94, 0·84–1·05).InterpretationOur application of Pgp3 ELISAs demonstrates a high lifetime risk of chlamydia among women and that a large proportion of infections go undiagnosed. A decrease in age-specific cumulative incidence after national implementation of opportunistic chlamydia screening has not yet been demonstrated. We propose that these assays be used more widely to assess the effect of chlamydia control programmes.FundingThe Health Survey for England was funded by the Health and Social Care Information Centre. Testing of stored serum samples was funded by the Health Protection Agency (now Public Health England). The funders played no part in the design, conduct, analysis, or reporting of this study, or in the decision to submit the abstract for publication.     

Domestic violence and abuse in gay and bisexual men attending a sexual health clinic: pilot testing of an educational support intervention for sexual health practitioners

BackgroundDomestic violence and abuse is recognised globally as a pervasive public health issue, but there is less research in relation to gay and bisexual men. This study aimed to measure the occurrence of negative and potentially abusive behaviour and associations with health problems in gay and bisexual men; and pilot test an educational intervention for practitioners to increase awareness of domestic violence and abuse and provide skills in inquiry and support.MethodsBetween Sept 21, 2010, and May 25, 2011, an anonymous Health and Relationships survey was administered to English-literate men (aged 18 years) attending a sexual health clinic in London, UK. Negative behaviour included: feeling frightened of the behaviour of a partner; having to ask permission (beyond being considerate to and checking with a partner); being slapped, hit, kicked, or physically hurt; and forced sex or sexual activity. Health problems included mental health, sexual health, and alcohol and illicit drug use. Sexual health practitioners received training on the educational intervention HERMES (HEalthcare Responding to MEn for Safety). 6 weeks after training, 21 semi-structured interviews were conducted with the practitioners to assess acceptability of HERMES, changes in awareness, and confidence in identifying and responding to gay and bisexual men who were experiencing domestic violence and abuse.FindingsOf 2657 men who attended the clinic, 1132 (42·4%) completed the survey. 532 (47·2%) self-identified as gay or bisexual. 33·9% (95% CI 24·9–37·9) of gay and bisexual men reported ever experiencing a negative and potentially abusive behaviour from a partner. Ever being frightened by a partner and having to ask a partner's permission were associated with increased odds of being anxious (odds ratio [OR] 2·5, 95% CI 2·0–3·1 and 2·7, 1·6–4·7, respectively). Being frightened of a partner, being physically hurt, and physically hurting a partner were associated with increased odds of using a class A drug in the previous 12 months (OR 2·2, 1·5–3·2; 2·3, 1·4–3·8; and 3·1, 2·3–4·2, respectively). Practitioners welcomed HERMES and felt that it raised their awareness and confidence in dealing with domestic violence and abuse among gay and bisexual men.InterpretationIn this clinical setting the occurrence of potentially abusive behaviours in gay and bisexual men was high. HERMES increased sexual health practitioners’ awareness of domestic violence and abuse and confidence in asking about abuse. The results can only be interpreted within the context of the sexual health clinic. Because of the cross-sectional design, it is not possible to determine the temporal direction of the associations between negative behaviour and health problems.FundingThis report presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0108-10084).     

Childhood maltreatment and biomarkers for cardiometabolic disease in mid-adulthood: associations and potential explanations

BackgroundEvidence of the association between childhood maltreatment and risk of adult cardiometabolic disease is sparse. We investigated associations of different forms of child maltreatment with adult cardiometabolic markers and potential explanations.MethodsIn the 1958 British birth cohort, we tested associations of childhood neglect (ascertained at age 7 years and 11 years) and abuse (physical, sexual, psychological, self-reported at 45 years) with adult (45 years) cardiometabolic markers (blood pressure, lipids, glycated haemoglobin [HbA_1c]) using linear and logistic regressions. Models were adjusted, first for factors affecting measurements (eg, room temperature, postal delay of blood sample, and for women oral contraception and hormone replacement therapy) and early life factors (eg, birthweight, socioeconomic status) and second for explanatory factors (change in body-mass index from childhood to adulthood, adult socioeconomic status, lifestyles, mental health). We applied multiple imputation to missing data on neglect and covariates, and restricted analyses to individuals with observed cardiometabolic data.FindingsAmong 9349 participants (4650 men, 4699 women), 12% (1143) reported any form of abuse. Prevalence for sexual abuse was 1·6% (149), physical abuse 6·0% (565), and psychological abuse 10·0% (926), and 1627 (17·4%) had two or more indicators of childhood neglect. Childhood neglect was associated in adulthood with raised triglycerides by 3·9% (95% CI 0·4–7·4) and HbA_1c by 1·2% (0·4–2·0), and for women lower HDL by 0·05 mmol/L (0·01–0·08), after adjusting for early life covariates. Physical abuse was associated with increased risk of high LDL (odds ratio [OR] 1·24, 95% CI 1·00–1·55) and raised HbA_1c in men by 2·4% (0·6–4·2), and lower HDL in women by 0·06 mmol/L (0·01–0·12). Associations for sexual abuse were similar to those for physical abuse but 95% CIs were wide. Psychological abuse was associated with increased risk of high triglycerides (OR 1·23, 1·03–1·46) and low HDL by 0·04 mmol/L (0·01–0·07). Maltreatment was not associated with raised blood pressure. All associations disappeared after further adjustment: adult lifestyle was a key explanatory factor for most associations, adult socioeconomic status was important for associations with neglect but not abuse, body-mass index was important for neglect and physical abuse, and mental health was important for psychological abuse.InterpretationChildhood maltreatments were associated with poor lipid and HbA_1c profiles decades later in adulthood in this population cohort. Explanations for associations varied by form of maltreatment. Further work is needed on the role of life-course explanatory factors and on effective strategies to reduce or prevent long-term health consequences of maltreatment.FundingThis work was funded by the Department of Health Policy Research Programme through the Public Health Research Consortium and supported by the National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London. The views expressed in this abstract are those of the authors and not necessarily those of the Department of Health. Data collection for participants at age 45 years was funded by the Medical Research Council (grant G0000934).     

Association of HIV status with sexual function in women aged 45–60 in England: results from two national surveys

ABSTRACT

Increasing numbers of women living with HIV are reaching their midlife. We explore the association of HIV status with sexual function (SF) in women aged 45–60 using two national cross-sectional surveys: the third British National Survey of Sexual Attitudes and Lifestyles (“Natsal-3”) and “PRIME”, a survey of women living with HIV attending HIV clinics across England. Both studies asked the same questions about SF that take account not only sexual difficulties but also the relationship context and overall level of satisfaction, which collectively allowed an overall SF score to be derived. We undertook analyses of sexually-active women aged 45–60 from Natsal-3 (N?=?1228, presumed HIV-negative given the low estimated prevalence of HIV in Britain) and PRIME (N?=?386 women living with HIV). Women living with HIV were compared to Natsal-3 participants using multivariable logistic regression (adjusting for key confounders identified a priori: ethnicity, ongoing relationship status, depression and number of chronic conditions) and propensity scoring. Relative to Natsal-3 participants, women living with HIV were more likely to: have low overall SF (adjusted odds ratio (AOR) 3.75 [2.15–6.56]), report ≥1 sexual problem(s) lasting ≥3 months (AOR 2.44 [1.49–4.00]), and report almost all 8 sexual problems asked about (AORs all ≥2.30). The association between HIV status and low SF remained statistically significant when using propensity scoring (AOR 2.43 [1.68–3.51]). Among women living with HIV (only), low SF was more common in those who were postmenopausal vs. Premenopausal (55.6% vs. 40.4%). This study suggests a negative association between HIV status and sexual function in women aged 45–60. We recommend routine assessment of SF in women living with HIV.     

Interactive digital interventions for sexual health promotion: a systematic review and meta-analysis of randomised controlled trials

BackgroundSexual ill-health is a global concern. Digital technology offers enormous potential for health promotion. This systematic review assessed the effectiveness of interactive digital interventions (IDIs) for sexual health promotion compared with minimal interventions (eg, waiting list), face-to-face interventions, and compared effectiveness of different designs of digital intervention.MethodsIDIs are interactive programmes that require users' contributions (eg, entering personal data, making choices) to produce personally relevant information, decision support, and behaviour change, emotional support, or both. We searched 40 electronic databases for randomised controlled trials of IDIs for sexual health promotion from start dates to April 30, 2013, with no language restrictions (appendix). Separate meta-analyses were conducted using Cochrane Collaboration methods for all comparisons by type of outcome (knowledge, self-efficacy, intention, sexual behaviour, and biological outcomes). Results were pooled using random effects models to calculate standardised mean differences (SMDs) and odds ratios (ORs). Subgroup analyses tested the following prespecified factors: age, risk grouping, and setting (online, health care, educational).FindingsWe identified 36 randomised controlled trials (11 818 participants) conducted in developed countries. Compared with minimal interventions, IDIs had beneficial effects on knowledge (SMD 0·48, 95% CI 0·19–0·76), safer sex self-efficacy (SMD 0·11, 0·04–0·19), intention (SMD 0·13, 0·05–0·22), and sexual behaviour (OR 1·20, 1·02–1·41), but had no effect on biological outcomes (OR 0·81, 0·56–1·16). IDIs delivered in educational settings significantly improved sexual behaviour (OR 2·09, 95% CI 1·43–3·04), but not when delivered in health-care settings (OR 1·17, 0·94–1·45) or online (OR 0·96, 0·79–1·17) (p_interaction=0·005). Compared with face-to-face interventions, IDIs improved knowledge (SMD 0·36, 95% CI 0·13–0·58) and intention (SMD 0·46, 0·06–0·85), but not self-efficacy (SMD 0·38, ?0·01 to 0·77). No difference in effectiveness of tailored IDIs compared with non-tailored IDIs for knowledge, intention, or sexual behaviour was observed. No data were available for cost-effectiveness.InterpretationIDIs can effectively enhance knowledge, self-efficacy, intention, and sexual behaviour. Further evidence is needed to understand how IDIs work, their cost-effectiveness, and how these positive effects can be translated into improved sexual health.FundingThis project was funded by the National Institute for Health Research Public Health Research Programme (reference PHR - 11/3009/04)     

Trends in absolute and relative risk of acute myocardial infarction in people with type 2 diabetes in Scotland: a national retrospective cohort study

BackgroundWhether more rigorous monitoring and evidence-based treatment of type 2 diabetes has led to improvements in cardiovascular outcomes is unclear. We aimed to explore trends in incidence rates of acute myocardial infarction in the Scottish adult population with type 2 diabetes compared with the non-diabetic population.MethodsIncidence rates of acute myocardial infarction (first admissions and deaths in and out of hospital) between Jan 1, 2001, and Dec 31, 2010, for adults aged 35–84 years were derived from Scottish Morbidity Records and linked death records. Diabetes diagnoses were ascertained by linkage to the Scottish diabetes register. Trends were analysed with negative binomial regression adjusted for age and an area-based measure of socioeconomic deprivation, and then expressed as annual percentage change in rates.FindingsOf 118 340 incident acute myocardial infarctions, 15 798 (13%) were in people with type 2 diabetes 1·88 million (4%) of 50·7 million person-years at risk were in people with type 2 diabetes. In men and women with and without type 2 diabetes, incidence of acute myocardial infarction decreased over time. Incidence was higher among people with than without type 2 diabetes, with higher relative risks in women than in men. The mean annual fall in rate of acute myocardial infarction was 3·7% (95% CI 3·2–4·2) and 2·3% (2·0–2·7) in women and men without diabetes, respectively; and 5·6% (4·6–6·7) and 4·4% (3·6–5·2) in women and men with type 2 diabetes. Relative risks for acute myocardial infarction declined for people with type 2 diabetes compared with people without type 2 diabetes from 1·5 (1·4–1·7) to 1·2 (1·1–1·3) for men and 1·8 (1·6–2·1) to 1·5 (1·3–1·6) for women between 2001 and 2010.InterpretationRates of acute myocardial infarction decreased over time in all population groups with more pronounced declines among people with than without type 2 diabetes. Secular trends in risk factors and improved primary and secondary prevention of cardiovascular disease are potential explanations for the observed time trends.FundingData linkage of the Scottish population-based register of people with diagnosed diabetes to national hospital admission and mortality records and data management was funded by the Scottish Government through the Scottish Diabetes Group, which had no role in the writing of the abstract or the decision to submit for publication.     

Man-to-woman sexual transmission of the human immunodeficiency virus. Risk factors related to sexual behavior, man's infectiousness, and woman's susceptibility. Italian Study Group on HIV Heterosexual Transmission.

To investigate the risk factors for man-to-woman sexual transmission of the human immunodeficiency virus (HIV), we carried out a cross-sectional study of 368 women who were steady partners of HIV-infected men attending 16 Italian clinical centers. Information was collected from the medical records of the infected men and by direct interviews with the women. In a logistic regression analysis, the woman's awareness of her partner's seropositivity (odds ratio [OR], 0.2; 95% confidence interval [CI], 0.0 to 1.1), use of condoms (OR, 0.3; 95% CI, 0.1 to 1), and oral contraceptive use (OR, 0.5; 95% CI, 0.3 to 1.0) were negatively associated with transmission of the HIV infection. An increased risk was found in women having sexual intercourse more than twice a week (OR, 2.4; 95% CI, 1.2 to 4.9) and in women who had been sexually exposed to HIV for between 2 and 5 years (OR, 3.5; 95% CI, 1.8 to 6.7). The transmission rate was higher in couples who engaged in anal sex (OR, 2.8; 95% CI, 1.3 to 6.3); in women reporting vaginitis (OR, 4.9; 95% CI, 2.4 to 10.2) or genital warts (OR, 33.3; 95% CI, 4.5 to 244.1); and in those using intrauterine devices (OR, 3.1; 95% CI, 1.4 to 7.1). The risk for women was also associated with a CD4+ cell count lower than 400/mm3 in their partners. Knowledge of the HIV status of the partner led to increased condom use but did not induce a lower frequency of sexual intercourse or an avoidance of anal sex.     

Childhood sexual abuse among men who have sex with men in urban north China: a cross-sectional survey

Background

Childhood sexual abuse is associated with HIV vulnerabilities and psychological distress. Research indicates that childhood sexual abuse is also more common among sexual minorities. However, there is limited research into childhood sexual abuse among sexual minorities in China. We describe the prevalence and correlates of penetrative childhood sexual abuse among men who have sex with men (MSM) in urban north China.

HIV-testing patterns and psycho-social factors associated with frequency of testing by men who have sex with men: implication for scaling up HIV testing in China

Background

The HIV epidemic is growing among men who have sex with men (MSM) in China. Frequent HIV testing is associated with reduced HIV risk among MSM. However, little is known about factors associated with frequency of HIV testing in this population. We aimed to characterise sociodemographic characteristics and psychosocial factors associated with frequent HIV testing in HIV-negative MSM in Guangzhou, China.

HIV serostatus disclosure from partners before sex: results from an online survey of Chinese men who have sex with men

Background

HIV serostatus disclosure before sex can facilitate serosorting, condom use, and potentially decreased risk of HIV acquisition. However, few studies have evaluated HIV serostatus disclosure from partners before sex. We examined the rate and correlates of receiving HIV serostatus disclosure from regular and casual male partners before sex among an online sample of men who have sex with men (MSM) in China.

Associations of inflammatory factors with glycaemic status among middle-aged and older Chinese people

Objective Low‐grade chronic inflammation is associated with risk for type 2 diabetes. We investigated the associations between inflammatory factors and glycaemic status in a middle‐aged and older Chinese population. Design A population‐based cross‐sectional study of 3289 residents aged 50–70 years from Beijing and Shanghai. Measurements C‐reactive protein (CRP), interleukin‐6 (IL‐6) and soluble tumour necrosis factor α‐receptor two (sTNFR2) were assayed. Results Comparing the highest with the lowest quartile of CRP, the odds ratio (OR) of diabetes was significantly higher in women [3·66 (95% CI 2·23–6·03)] than in men [1·51 (0·95–2·41)] (P for interaction = 0·004), while the increased OR for impaired fasting glucose (IFG) was only observed in women [OR 2·03 (1·44–2·84)] (P for interaction = 0·022), after adjustment for age, geographic location, education, lifestyle factors, family history of diabetes, and use of antibiotics, aspirin and lipid‐lowering drugs. The multiple‐adjusted OR of IL‐6 for diabetes was also higher in women [2·95 (1·78–4·90)] than in men [2·23 (1·39–3·59)] (P for interaction = 0·045). sTNFR2 was not associated with diabetes but inversely associated with IFG in men [OR 0·59 (0·41–0·85)] and women [OR 0·78 (0·56–1·09)] (P for interaction = 0·13). In addition, CRP was significantly associated with increased HbA_1c in both genders within euglycaemia after multiple adjustments. Conclusions Inflammatory markers are closely associated with diabetes and IFG in Chinese people. These associations appear to be stronger in women than in men. Furthermore, plasma CRP is positively associated with HbA_1c even in euglycaemic individuals.     

Identification of Chlamydia trachomatis genotypes in Mexican men with infertile women as sexual partners

BackgroundChlamydia trachomatis is considered a public health problem due to the high prevalence in sexually active women and men. The distribution of genital Chlamydia genotypes among Mexican men is unknown.ObjectiveTo assess the prevalence of Chlamydia genotypes in men with infertile women as sexual partners.MethodsA total of 659 urine samples were collected from men whose sexual partners were infertile women; the identifying Chlamydia infection was by means of a real-time nucleic acid amplification test (qPCR). OmpA gene PCR-RFLP and sequencing were used to confirm the genotypes of C. trachomatis. The association of genotypes with age, spermatic parameters and gynecological data of sexual partners was further analyzed.ResultsForty-nine urine samples were positive infection (7.4%). The Chlamydia infection was significantly associated with teratozoospermia, azoospermia, hypospermia, and oligozoospermia. Five genotypes (F 51%; 12.2% to D; 12.2% to E; 6.1% to L2 and 4.1% Ia) were correctly identified. None genotypes identified in this comparative study were positively associated with changes in some of the spermatic values because all of them typically produce some considerable damage to these cells.ConclusionsThe F genotype was the most frequent genotype identified in infertile men from Mexico City and all genotypes play an important role in the seminal alteration of Mexican men whose female partners are infertile.     

Maternal and paternal obesity and adverse pregnancy outcomes in China: a cohort study

Background

There is growing concern about the potential effect of parental obesity on the newborn child's birth outcomes and health. However, few studies have examined whether parental obesity before pregnancy affects the risk of adverse pregnancy outcomes. We aimed to systematically evaluate the associations of adverse pregnancy outcomes with prepregnancy body-mass index (BMI) of the mother and the father.

Seeking and engaging in internet sex: a survey of patients attending genitourinary medicine clinics in Plymouth and in London

We conducted a survey of patients attending two GUM clinics to evaluate the use of the internet for seeking sexual partners and for seeking on-line sexual health information. Prevalence of internet sex-seeking (ISS) was 11% (57/500) in Plymouth and 21% (50/237) in London. ISS was more common among men who have sex with men (MSM) (43/92 = 47%) than men who have sex with women (MSW) (38/280 = 14%, P < 0.0001) and more common amongst MSW than women who have sex with men (WSM) (25/350 = 7%, P = 0.007). In both samples, accessing sexual health information online was associated with ISS (Plymouth, P = 0.05 and London, P = 0.001), as was reporting more than 10 sexual partners per year (Plymouth and London, P < 0.001). It remains to be seen whether the potential sexual health promotion benefits of the internet could balance potential risks of STI acquisition.     

Social and lifestyle characteristics and burden of ill-health associated with self-reported hearing and vision impairments in older men in the British community: a cross-sectional study

BackgroundSensory impairment is common in older adults and we need to understand more about its association with other health conditions. We explored sensory impairment in relation to demographic, lifestyle factors, and health conditions in older men.MethodsIn a cross-sectional study, 3981 men aged 63–85 years (82% of participants recruited to the British Regional Heart Study cohort in 1978–80 and still alive in 2003) were selected from general practices in 24 British towns. Data on hearing aid use and ability to follow television at a volume others find acceptable allowed for four categories of hearing: can hear (n=2851), can hear with an aid (n=482), cannot hear and no aid (n=424), and cannot hear despite an aid (n=168). Vision impairment was defined as not being able to recognise a friend across a road (n=124). Logistic regression was used to investigate associations of hearing impairment and vision impairment with self-reported doctor-diagnosed coronary heart disease, disability (difficulty taking the stairs, difficulty keeping balance), social interaction (attending few social activities), and quality of life (experiencing pain, feeling anxious or depressed).Findings1074 men (27%) reported hearing impairment and 124 (3%) reported vision impairment. Compared with those reporting no hearing problem, hearing impairment was associated with disability, poor social interaction, and poor quality of life. Poor quality of life remained significant after having adjusted for social class, smoking, obesity, and physical activity. Only men who could not hear despite having a hearing aid were more likely to report coronary heart disease (age-adjusted odds ratio 1·89, 95% CI 1·36–2·63) and falls (1·62, 1·05–2·48). Vision impairment was associated with symptoms of coronary heart disease including chest pain (1·58, 1·07–2·40) and breathlessness (2·06, 1·38–3·06), but not with diagnosed coronary heart disease (1·39, 0·93–2·07). Vision impairment was also significantly associated with falls, poor quality of life, poor social interaction, and disability, which remained significant after adjusting for social class, smoking, obesity, and physical activity. Men with a sensory impairment were more likely to be physically inactive, obese (hearing impairment only), and in a manual social class.InterpretationOlder men with hearing impairment and vision impairment have a high risk of disability, poor health, and poor social interaction. Policy efforts for early detection and treatment of sensory impairment could be crucial for independent living in old age.FundingThe British Regional Heart Study is funded by the British Heart Foundation. AEML is funded by the National Institute for Health Research School for Public Health Research. SER is funded by a UK Medical Research Council Fellowship.     

Anticipated HIV stigma among men who have sex with men and transgender individuals in China: a cross-sectional study

Background

HIV-related stigma has been positively associated with low health-care utilisation and risky sexual behaviours in people living with HIV. However, the relationship between HIV-related stigma and the use of new technologies such as gay mobile applications and HIV self-testing is still not clear. We aimed to examine factors associated with HIV-anticipated stigma among men who have sex with men (MSM) and transgender individuals in China.

Service evaluation of a pilot to improve primary care sexual health services in England implemented using a stepped wedge design

BackgroundSexual health service provision in primary care is an essential component to universal provision of sexual and reproductive health services. However the offer of these services is not consistent. The 3Cs & HIV was a national pilot that combined educational workshops with posters, testing performance feedback, and continuous support from a specialist trainer. The aim was to improve awareness and skills of staff to increase rates of chlamydia screening in the population at highest risk (men and women aged 15–24 years) and to provide condoms with contraceptive information plus HIV testing according to national guidelines.MethodsThe pilot used a stepped wedge design over three phases from Aug 1, 2013, to Sept 30, 2014. Chlamydia testing and diagnosis rates in the control (pretraining) and intervention (post-training) periods were compared by use of a multivariable negative binomial regression model with general practice fitted as a random effect. Owing to the stepped wedge design, the number of months contributing to the control and intervention periods differed depending on which phase the general practice was allocated to and when the practice received training. Characteristics of general practices participating were included in the model. Practices were not paid for the intervention. The Research Governance Coordinator for Public Health England confirmed that no ethics approvals were needed for this study.FindingsThe 460 participating practices conducted 26 021 tests in the control period and 18 797 tests during the intervention period. Intention-to-treat analysis showed decreased median number of tests and diagnoses per month per practice after receiving training (2·68 tests before training [IQR 1·00–4·77] vs 2·67 after training [1·10–4·90]; 0·14 diagnoses before training [0–0·30] vs 0·13 after training [0–0·27]). Adjusted multivariable regression analysis showed no significant change in overall testing or diagnoses (incidence rate ratio [IRR] 1·01, 95% CI 0·96–1·07 and 0·98, 0·84–1·15, respectively). Testing increased significantly in 148 practices where payment was already in place before the intervention (IRR 2·12, 95% CI 1·41–3·18).InterpretationThis large national pilot found that educational support sessions to increase chlamydia screening in primary care were only effective in practices that already receive payment for chlamydia screening. 3Cs & HIV training might be a useful way to make better use of the resources already available. However this intervention will not increase national testing rates substantially. Although increases found in subgroups were statistically significant, they were still relatively small in magnitude.FundingThe 3Cs & HIV pilot was funded by Public Health England and was part of the Chlamydia Testing Training in Europe (CATTE) project. CATTE is part funded by a Leonardo Transfer of Innovation grant as part of European Union Lifelong Learning Programme.     

Multiple sexual partnerships and their correlates among Facebook users in Swaziland: an online cross-sectional study

Social networking sites (SNSs) have been suggested to facilitate risky sexual activities. However, it is unknown and of concern how SNSs such as Facebook shape risky sexual activities in developing settings such as Swaziland, the country hardest hit by HIV and AIDS. We conducted an online cross-sectional study in 2012 to explore the prevalence of multiple sexual partnerships (MSPs) and their correlates among Facebook users in Swaziland. The response rate was 44.1% (N = 882); relatively, an equal proportion of men 82.7% (341/414) and 82.9% (388/468) women had ever had sex. Of those sexually active, 44.9% of men and 30.7% of women reported having sex with someone they met on Facebook. Approximately half of the participants (61.6% men, 41.0% women and 50.6% total) reported MSPs over the past 12 months. Multiple logistic regression analysis revealed that time spent on Facebook, “finding it easier to initiate a romantic conversation on Facebook” and having had sex with someone met on Facebook were significantly associated with having MSPs (adjusted odds ratio = 1.6–3.8). The potential impact of risky sexual behaviour among Facebook users should be appropriately addressed particularly in high HIV-prevalent settings like Swaziland.     

HIV Risk Behaviors Among Black/African American and Hispanic/Latina Female Partners of Men Who Have Sex With Men and Women

We examined the frequencies of HIV-related risk factors among women reporting and not reporting sex with a man who has sex with men and women (MSMW). We used data from 15,625 visits of Black and Hispanic/Latina females, ages 15–64 years, to Los Angeles County HIV testing sites (2007–2008). The following risk factors were associated with reporting an MSMW partner: number of sex partners, use of party drugs, anal sex, and sexual partners with other risk factors. Overall, females who reported an MSMW partner differed little in their likelihood of testing HIV positive (0.93%) compared to those who did not (0.58%, p value = 0.19). Among females reporting one male sex partner, having an MSMW partner was strongly associated with HIV (2.8 vs. 0.63%, p = 0.03). Interventions targeting women who report other risky behaviors may reach many who have been with MSMW. Women with one partner are an important focus of such efforts.     

Is asymptomatic non-chlamydial non-gonococcal urethritis associated with significant clinical consequences in men and their sexual partners: a systematic review

Opinions are divided on whether to screen asymptomatic men for non-chlamydial non-gonococcal urethritis (NCNGU). We systematically reviewed the literature to determine whether male asymptomatic NCNGU is associated with significant clinical outcomes for men and/or their sexual partners. We searched electronic databases and reference lists from retrieved articles and reviews. No studies reporting clinical outcomes in men with asymptomatic NCNGU were identified. Two eligible studies report rates of sexually transmitted infections (STIs) in female partners of men with asymptomatic NCNGU; Chlamydia trachomatis was detected in 2.4% and 8.3% of these women. The evidence available is insufficient in quality and breadth to enable us to conclude whether asymptomatic NCNGU is associated with significant health consequences for men or their sexual partners; however, clinical consequences of asymptomatic NCNGU are poorly investigated. Clinicians should be aware of the limitations of the evidence on which current screening guidelines for asymptomatic men are based.