Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, and HIV infection among drug users attending an STD/HIV prevention and needle-exchange program in Quebec City, Canada.

OBJECTIVES: To determine the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, and human immunodeficiency virus (HIV) infection among injection and noninjection drug users in Quebec City and to identify associated risk factors. STUDY DESIGN: Cross-sectional study of 738 drug users attending a sexually transmitted disease/HIV prevention and needle-exchange program in Quebec City, Canada. RESULTS: The prevalences of N. gonorrhoeae and C. trachomatis were, respectively, 0.4% (95% CI: 0.08%-1.2%) and 3.4% (95% Cl: 2.2%-5.0%). Through multivariate analysis, risk factors associated with sexually transmitted diseases were: among women, being aged between 20 and 24 years and having unprotected sex with commercial partners; in noninjection drug users; cocaine use and first intercourse before 13 years of age; in male noninjection drug users, having regular sexual partners in the previous 6 months. No case of HIV was found in participants who have never injected drugs, but the prevalence was 5.5% (6/110) among the exinjectors and 10.1% (35/347) in current injectors. CONCLUSION: Moderate sexually transmitted disease and HIV prevalences were found, although a high proportion of drug users reported risky behaviors. Needle-exchange program sites may offer a good opportunity to provide sexually transmitted disease/HIV prevention and medical services to drug users.     

Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in Turkey among men With urethritis.

BACKGROUND: Chlamydia trachomatis and Neisseria gonorrhoeae are known to cause urethritis. However, only a small number of studies in Eastern European countries have investigated the causes of urethritis. GOALS: To determine the prevalence of C trachomatis and N gonorrhoeae among men with symptomatic urethritis in Istanbul, Turkey, and to determine whether contact with a commercial sex worker increased the likelihood of chlamydial infections. STUDY DESIGN: Men with a diagnosis of urethritis at the Istanbul Faculty of Medicine were screened for C trachomatis and N gonorrhoeae by Abbott's ligase chain reaction (LCR) using either urethral swabs or first-void urine. N gonorrhoeae cultures were done on a subset of these patients. RESULTS: The study enrolled 813 men. All of the men denied condom use during their previous sexual exposures. The overall prevalence of C trachomatis, as determined by LCR, was 15.7%. Only 192 patients were screened for both organisms. N gonorrhoeae prevalence was 9.4%. There was no difference in the chlamydia prevalence between men who had contact with commercial sex workers (CSWs) and men who had no such contact (15.3% versus 17.2%). However, clients of foreign CSWs were more likely to have chlamydia than clients of registered Turkish CSWs. CONCLUSIONS: C trachomatis and N gonorrhoeae are commonly found in Turkish men with urethritis. The findings did not show more chlamydial infection among men who had contact with CSWs than among men who had no such contact. The failure to use condoms among these men must be addressed.     

Prevalence of antibodies to Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma hominis in infertile women.

A total of 57 infertile women, who had been referred for in vitro fertilisation or for diagnostic laparoscopy, were tested for the presence of antibodies to Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma hominis. Four were excluded from the study. Of the remaining 53, 33 had laparoscopically obvious tubal disorders, such as adhesions, distal occlusions and strictures, and 20 did not. Antibodies to C trachomatis were found in 7/33 (21.2%) v 0/20, antibodies to N gonorrhoeae in 20/38 (60.6%) v 5/20 (25%), and antibodies to M hominis in 18/24 (75%) women with tubal disorders v 13/19 (68.4%) of those with no disorder. Antibodies to C trachomatis and N gonorrhoeae were significantly (p less than 0.05) more common in women with tubal disorders. The high prevalence of antibodies to N gonorrhoeae in infertile women without tubal disorders suggests that ciliated tubal epithelium is damaged after inflammation without this being laparoscopically visible. Our results confirm the important role of N gonorrhoeae and C trachomatis in the aetiology of infertility after tubal inflammation.     

Prevalence of human immunodeficiency virus, Chlamydia trachomatis, and Neisseria gonorrhoeae and risk factors for sexually transmitted infections among immigrant female sex workers in Catalonia, Spain

OBJECTIVES: To determine the prevalence of human immunodeficiency virus (HIV), Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG) among immigrant female sex workers (FSW) according to their geographic area of origin and identify possible risk factors independently associated with current infection with CT and/or NG. STUDY DESIGN: Cross-sectional study of 357 FSW in Catalonia in 2005. Information on sociodemographic and sex work characteristics, use of alcohol and drugs, sexual practices, and the use of social and health care services was collected. Oral fluid and urine samples were collected to determine the prevalence of HIV and CT/NG, respectively. Factors independently associated with CT/NG were assessed using multivariate logistic regression models. RESULTS: A total of 36.4% of women were from Eastern Europe, 34.5% from Latin America, and 29.1% from Africa. Overall CT and NG prevalence were 5.9% [95% confidence interval (CI): 3.7-8.9] and 0.6% (95% CI: 0.1-2.0), respectively. No differences were observed by geographic origin. Three African women were HIV positive (overall HIV prevalence was 0.8%, 95% CI: 0.2-2.4). In multivariate analysis, younger age and unprotected sex with clients were associated with the presence of CT/NG. CONCLUSIONS: The prevalence of sexually transmitted infections among FSW in Catalonia was lower than in other European countries. Even though the prevalence of HIV was only 0.8%, it could increase in the future given the high vulnerability of these women and their wide geographic mobility. It is necessary to continue with the work carried out by nongovernmental organizations (harm reduction programs, outreach programs, and safe sex workshops) as well as to facilitate the access to health centers, especially for the youngest women.     

Genital infections with Chlamydia trachomatis and Neisseria gonorrhoeae in Ghanaian women.

Women who attended the gynaecology clinic or were admitted to the postpartum ward of Korle Bu Hospital, Accra, Ghana were tested for infection with Chlamydia trachomatis and Neisseria gonorrhoeae. Eight (4.9%) of 162 gynaecological patients were infected with C trachomatis and five (3.1%) with N gonorrhoeae, and respective prevalences among 148 postpartum women were 7.7% (3/39) and 3.4% (5/148). Among 40 gynaecological patients who were not pregnant and whose principal complaint was of lower abdominal pain, 4 (10%) were infected with C trachomatis and none with N gonorrhoeae. Antibodies against serovars D, E, F, and G were common, and three typable isolates were serovar G. C trachomatis would appear to be more common than N gonorrhoeae in obstetric and gynaecological patients in Ghana.     

Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections in Greenland. A seroepidemiological study

In a sero-epidemiological study of the prevalence of chlamydial and gonococcal infections in Greenland three groups of subjects were studied--262 patients attending an outpatient department in the town of Nuuk (of whom 12% harboured Chlamydia trachomatis and 54% Neisseria gonorrhoeae), 63 controls from the same town, and the entire population of 150 in the settlement of Uvkusigsat. Using a microimmunofluorescence test evidence of exposure to C trachomatis was found in 79% of the female and 26% of the male patients, in 12% and 50% of the female and male controls respectively, and in 51% and 21% of the female and male populations of Uvkusigsat respectively. Using an indirect haemagglutination test antibodies to gonococcal pili were found in sera of 92% of the female and 70% of the male patients, in 30% of the male and 10% of the female controls, and in 41% of the women and 33% of the men in Uvkusigsat. The study indicates that genital chlamydial and gonococcal infections are serious public health problems in Greenland and that such infections are acquired early in both sexes and often occur concomitantly.     

Screening for Neisseria gonorrhoeae and Chlamydia trachomatis at entertainment venues among men who have sex with men

BACKGROUND: To assess the prevalence and increase awareness of Neisseria gonorrhoeae and Chlamydia trachomatis infections among men who have sex with men, a screening program was conducted at three inner-city homosexual entertainment venues and one community function. STUDY DESIGN: Each venue was accessed twice over a 3-month period between March and June 2000. First-catch urine specimens were collected for analysis by polymerase chain reaction (PCR), and throat swabs were collected for culture and PCR. RESULTS: A total of 202 men were tested during the 7 screening nights, including 16 who were tested more than once. From the 186 men tested for the first time, 184 urine specimens were collected, of which 8 (4.3%; 95% CI, 1.9-7.8%) were PCR-positive for C trachomatis and 1 (0.5%; 95% CI, 0-2.1%) was PCR-positive for N gonorrhoeae. Of the 161 throat swabs collected, none were positive for C trachomatis or N gonorrhoeae. CONCLUSIONS: C trachomatis is a potentially significant pathogen in this population of urban homosexual men. Screening programs such as these are valuable as health-promotion exercises.     

Infections with Neisseria gonorrhoeae and Chlamydia trachomatis in women with acute salpingitis.

The value of cultural and serological procedures in diagnosing gonococcal and chlamydial infections was investigated in 85 women who had provisional diagnoses of pelvic inflammatory disease. The correlation between certain clinical variables and the absence or presence of such infections was also studied. In 46 the diagnosis of acute salpingitis was verified by laparoscopy. The laboratory and clinical findings in the patients with acute salpingitis were compared with those in the remaining 39 women in whom laparoscopy did not show signs of inflammation. Salpingitis was considered to be gonococcal if Neisseria gonorrhoeae was isolated or a fourfold or more change in titre of antibodies to gonococcus pilus antigen was found. The diagnosis of chlamydial salpingitis was based on the isolation of Chlamydia trachomatis, a fourfold or more change in titre of IgG antibodies to or from a titre of greater than or equal to 1/256, or the presence of IgG antibodies at a titre of greater than or equal to 1/512. Patients with chlamydial salpingitis had less severe symptoms but a more protracted course of disease than patients with gonococcal salpingitis or with acute salpingitis not associated with the two pathogens.     

Surveillance of Chlamydia trachomatis and Neisseria gonorrhoeae infections in women in detention in Baltimore,Maryland

BACKGROUND: In conjunction with a program to expand syphilis and HIV infection services, women were also offered screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) during intake at the Baltimore Women's Detention Center. GOAL: The goal was to assess the effectiveness of a routine screening program for CT and GC in women in a detention setting. The association among infection, race, and area of residence was also explored. STUDY DESIGN: CT and GC prevalences were determined and analyzed by demographic data, including zipcode, for 1,858 women enrolled over a 48-week period. Informed consent was obtained, and infections were detected with use of urine samples tested by ligase chain reaction. RESULTS: Overall, the population had prevalence rates of 5.9% (109/1,858) and 3.4% (63/1,858) for CT and GC respectively. Among whites, CT and GC prevalences were 9.0% (29/323) and 8.7% (28/323), respectively. Among African Americans the prevalence rates were 5.1% (77/1,510) and 2.3% (34/1,510) for CT and GC, respectively. White women <25 years of age were associated with the highest CT and GC prevalences, at 20.0% (13/65) and 13.9% (9/65), respectively. African American women <25 years of age also were associated with the highest CT and GC prevalences, at 13.9% (24/173) and 5.8% (10/173), respectively. Multivariate analysis of risk factors and demographic data indicated that ages <25 years and 25 to 34 years, white race, and certain zipcodes of residence were risk factors for infection. CONCLUSION: This study illustrated that urine-based screening for CT and GC is feasible in detention settings and can be productive in high-prevalence areas. Geographic analysis demonstrated no definitive relationship among race, infection, and area of residence, although it did demonstrate clustering of infected individuals and could be useful in future interventions. These findings demonstrated the need for implementing screening programs for sexually transmitted infections in detention centers.     

Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections in Greenland. A seroepidemiological study.

In a sero-epidemiological study of the prevalence of chlamydial and gonococcal infections in Greenland three groups of subjects were studied--262 patients attending an outpatient department in the town of Nuuk (of whom 12% harboured Chlamydia trachomatis and 54% Neisseria gonorrhoeae), 63 controls from the same town, and the entire population of 150 in the settlement of Uvkusigsat. Using a microimmunofluorescence test evidence of exposure to C trachomatis was found in 79% of the female and 26% of the male patients, in 12% and 50% of the female and male controls respectively, and in 51% and 21% of the female and male populations of Uvkusigsat respectively. Using an indirect haemagglutination test antibodies to gonococcal pili were found in sera of 92% of the female and 70% of the male patients, in 30% of the male and 10% of the female controls, and in 41% of the women and 33% of the men in Uvkusigsat. The study indicates that genital chlamydial and gonococcal infections are serious public health problems in Greenland and that such infections are acquired early in both sexes and often occur concomitantly.     

Improvement of clinical algorithms for the diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis by the use of Gram-stained smears among female sex workers in Accra, Ghana

BACKGROUND: Screening for cervical infection is difficult in developing countries. Screening strategies must be improved for high-risk women, such as female sex workers. GOAL: To evaluate the sensitivity and specificity of screening algorithms for cervical infection pathogens among female sex workers in Accra, Ghana. STUDY DESIGN: A cross-sectional study among female sex workers was conducted. Each woman underwent an interview and a clinical examination. Biologic samples were obtained for the diagnosis of HIV, syphilis, bacterial vaginosis, yeast infection, Trichomonas vaginalis, Neisseria gonorrhoeae, and Chlamydia trachomatis infection. Signs and symptoms associated with cervicitis agents were identified. Algorithms for the diagnosis of cervical infection were tested by computer simulations. RESULTS: The following prevalences were observed: HIV, 76.6%; N. gonorrhoeae, 33.7%; C. trachomatis, 10.1%; candidiasis, 24.4%; T. vaginalis, 31.4%; bacterial vaginosis, 2.3%; serologic syphilis, 4.6%; and genital ulcers on clinical examination, 10.6%. The best performance of algorithms were reached when using a combination of clinical signs and a search for gram-negative diplococci on cervical smears (sensitivity, 64.4%; specificity, 80.0%). CONCLUSIONS: In the algorithms, examination of Gram-stained genital smears in female sex workers without clinical signs of cervicitis improved sensitivity without altering specificity for the diagnosis of cervical infection.     

A cost-effectiveness evaluation of testing and treatment of Chlamydia trachomatis infection among asymptomatic women infected with Neisseria gonorrhoeae

BACKGROUND: Because patients infected with Neisseria gonorrhoeae are frequently coinfected with Chlamydia trachomatis, routine dual treatment of patients with N gonorrhoeae infection is frequently practiced and has long been recommended. GOAL: The goal of this study was to examine the cost-effectiveness of routine dual treatment of women with infection, with or without separate testing for C trachomatis, compared with an alternative of testing for both infections and restricting treatment for C trachomatis to women testing positive for C trachomatis. STUDY DESIGN: A decision analysis compared the cost-effectiveness of these options using cases of pelvic inflammatory disease prevented as the outcome. Parameter values were taken from the literature. RESULTS: Routine dual treatment is not an effective or cost-effective replacement for testing for C trachomatis, but it can increase the number of cases of C trachomatis treated when combined with testing. Dual treatment results in more overtreatment of infection C trachomatis than treatment based on test results. CONCLUSIONS: Testing for both infections is more cost-effective than routine presumptive treatment for C trachomatis. Providing both presumptive treatment and testing for C trachomatis can also be cost-effective in some settings.     

Prevalence of Chlamydia trachomatis infection in registered female sex workers in northern Mexico

BACKGROUND: Little is known about the epidemiology of Chlamydia trachomatis infection in female sex workers (FSWs) in Mexico. GOAL: The goal of the study was to determine the prevalence of C trachomatis infection in registered FSWs from northern Mexico and to determine the sociodemographic characteristics associated with the infection. STUDY DESIGN: An enzyme immunoassay was used to test 354 FSWs in three northern Mexican cities for cervical C trachomatis infection. All participants were registered in a government health office. Recruitment was consecutive and voluntary. The association between clinical and sociodemographic characteristics of FSWs and infection was evaluated. RESULTS: The overall prevalence of C trachomatis infection among participants in the three cities was 12.4%. Women of low socioeconomic level and those younger than 25 years were the most frequently infected. Among FSWs in Durango, a higher frequency of C trachomatis infection was found for those who did not use condoms. CONCLUSION: C trachomatis is an important pathogen in the sexually transmitted diseases of registered FSWs in northern Mexico.     

School-based screening for Chlamydia trachomatis and Neisseria gonorrhoeae among Philadelphia public high school students

CONTEXT: The prevalence of sexually transmitted diseases among adolescents is high. Innovative screening and treatment programs need evaluation. OBJECTIVES: The objectives of this study were to identify, treat, and describe the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infections among Philadelphia public high school students. DESIGN: We analyzed cross-sectional data from the first year of an annual program offering education, screening, and treatment for CT and GC. For the school year analyzed, screening took place between January 2003 and June 2003. RESULTS: In the first year, 19,394 students aged 12-20 years were voluntarily tested; 1,052 students were identified with GC, CT, or both; 1,051 received treatment. Prevalence of CT among females (95% confidence interval [CI] = 8.1) was 3.3 times higher than among males (95% CI = 2.5%). Attending disciplinary schools and residing in high reported morbidity areas were also related to higher prevalence of CT and GC. CONCLUSIONS: A high prevalence of CT infections was identified among Philadelphia public high school students. This program demonstrated the effectiveness of a school-based screening program to identify and treat these infections.     

Sensitivity requirements for the point of care diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae in women

BACKGROUND/OBJECTIVES: Most current tests for Neisseria gonorrhoeae and Chlmydia trachomatis require the support of a laboratory, and results are not usually available before the patient has left the clinic. This delay can lead to patients not returning for treatment and may allow further STI transmission to occur. Current rapid point of care (POC) STI tests and the syndromic approach are less sensitive than gold standard tests, but allow treatment at the initial visit. This study estimates the required sensitivity of POC tests that ensures as many STIs are averted as with current gold standard tests. METHODS: A mathematical model is developed to compare the STIs averted using different STI diagnostic methods. Data from Benin, South Africa, Tanzania, and England are used to explore how the required sensitivity differs between settings. RESULTS: The required sensitivity of a POC test is low if there is significant STI transmission during the delay in treatment for the gold standard test and/or few women return for treatment. For example, the required sensitivity of a POC test for C trachomatis is 50% (gold standard test sensitivity is 90%) if either 55% return for treatment and there is no STI transmission, or 80% return for treatment and 50% of infected women infect their partner during the delay in treatment. Furthermore, in these settings a POC test of moderate sensitivity can lead to significantly more STI averted than the gold standard test. CONCLUSIONS: These results support the use of moderate sensitivity POC tests in scenarios where many women will not return for treatment, and in populations where the delay in treatment would result in significant STI transmission.