New cases of gonorrhoea (Neisseria gonorrhoeae) and chlamydia (Chlamydia trachomatis) infections have been steadily increasing in Scandinavian countries over the last decade. There is a particular urgency in reducing new infections as isolation of multiple drug resistant strains of gonorrhoea is becoming more frequent. The aim of this study was to determine the prevalence and sites of infection of common sexually transmissible infections (STIs) in men who have sex with men (MSM).
We have performed a retrospective analysis of the three major STIs, gonorrhoea, chlamydia and Mycoplasma genitalium in urogenital, anorectal and oropharyngeal samples from MSM that attended two STI clinics in Oslo.
One hundred and thirty-six men (6.0%) out of 2289 MSM tested were found to be positive for gonorrhoea using a porA gene targeted nucleic acid amplification test (NAAT). Of these, 106 (77.9%) would not have been identified through testing first-void urine alone. Two hundred and twenty eight (10.0%) patients from 2289 tested were found to be positive for chlamydia, 164 (71.9%) of which were identified through anorectal specimens. Ninety-one (5.1%) patients from 1778 tested were found to be positive for M. genitalium, with 65 (71.4%) identified through testing of anorectal specimens.
Our results supports the European findings that the MSM population carries a high burden of STIs and that testing the anorectum and oropharynx will identify a significantly higher percentage of infected patients and reservoirs of STIs.
In recent decades, increasing rates of Chlamydia cases have contrasted with decreasing Chlamydia trachomatis seroprevalence rates and decreasing Chlamydia-associated complication rates. We elucidated the conflicting trends by studying incidence of repeated Chlamydia infections over time.
Chlamydia cases reported during 1995 to 2009 were identified in the Finnish National Infectious Diseases Registry. Trends of single and repeated diagnoses of Chlamydia infection were analyzed.
Our study population comprised 147,148 individuals with a total of 177,138 genital chlamydial infections. The proportion of annual repeated diagnoses of genital infections increased among female and males from 4.9% to 7.3% and from 3.8% to 5.3%, respectively. In 2009, 24.8% of the females and 20.3% of the males had had an earlier Chlamydia infection ever during the follow-up time. Of all the repeated diagnoses, 34.1% occurred within 12 months. The highest rates of repeated infection diagnoses occurred in 25-year-old women (37.0%) and in 29-year-old men (30.9%) in a cohort of individuals born in 1979.
A gradual increase of repeated Chlamydia infections resulted in 43% increase in annual infections between 1996 and 2009. The result is supportive of the existing seroprevalence data suggesting that Chlamydia infection burden is not increasing in the whole population. The increasing infection rates in males, in particular, justify development of effective strategy in preventing reinfections and onward transmission.
The prevalence and complications of Mycoplasma genitalium and Chlamydia trachomatis infections among women undergoing termination of pregnancy were studied in this nested case-control study at Malmo University Hospital, Sweden, during 2003 to 2007. The study comprised 2079 women presenting for termination of pregnancy. Forty-nine women with M. genitalium infection and 51 women with C. trachomatis infection, together with 168 negative control women, were evaluated. The prevalences of M. genitalium and C. trachomatis were 2.5% and 2.8%, respectively. The M. genitalium was strongly associated with post-termination pelvic inflammatory disease (odds ratio 6.29, 95% CI 1.56-25.2). The increased risk for pelvic inflammatory disease associated with M. genitalium infection after termination of pregnancy suggests a causal relationship.
Asymptomatic genital infection by Chlamydia trachomatis is common in women, and one or more consultations to test for cure is the routine practice. We have compared the economic implications of two post-treatment regimens: 1) no control, and 2) one control involving a single test for C trachomatis, with renewed treatment and another test for cure in women who were chlamydia-positive, etc. The costs of the control regimen were double those of the no-control regimen. With no control, 79 more cases of pelvic inflammatory disease, eight more cases of infertility requiring work-up and two more cases of ectopic pregnancy would occur per 10,000 patients. We conclude that routine post-treatment control of asymptomatic genital chlamydial infections is not cost beneficial.
Recent studies show divergent results concerning the risk of ectopic pregnancy following Chlamydia trachomatis (CT) infection.
Our goal was to investigate future reproductive health outcomes (births and ectopic pregnancies) among women tested for CT.
Our cohort consisted of 20,762 women born during 1970-1984 who were tested for CT during 1990-2003. We linked CT data to data on ectopic pregnancies and births during 1990-2004. Cox regression with time-dependent covariates was used to assess the association between CT history and births/ectopic pregnancies adjusted for age at first test. Analyses with ectopic pregnancy as outcome were also adjusted for parity.
We observed 9.6 births per 100 person-years of observation among women with negative tests only and 10.2 per 100 person-years among women with at least 1 positive test (hazard ratio adjusted for age at first test, 1.07; 95% CI, 1.01-1.12). Ectopic pregnancy incidence rates were higher for women with positive test(s) compared with women with negative test only (0.24 vs. 0.13 per 100 person-years; hazard ratio adjusted for age at first test and parity, 1.82; 95% CI, 1.27-2.60). Among women with at least 1 registered pregnancy, the adjusted hazard ratio was 2.03; 95% CI, 1.28-3.22).
Although women diagnosed with CT were at higher risk for ectopic pregnancy than women with negative test results only, our study suggest that their fertility prospects were better than they would have been had CT screening not been implemented in this population. Opportunistic CT screening is an appropriate method for maintaining female reproductive health.
Screening for Chlamydia trachomatis in women is generally done using only one specimen from each patient in order to minimize costs. In this study the aim was to compare the performances of vaginal, cervical and urinary specimens in a population of young women with sparse symptoms. During 1998, specimens from 1,001 women at the Departments of Venereology and Youth Health Care at the University Hospital of Uppsala, Sweden were examined by both ligase chain reaction and cell culture for detection of C. trachomatis. The samples from the cervix, vagina and urine were tested by ligase chain reaction, while specimens for cell culture were collected from the cervix and urethra. The prevalence of genital C. trachomatis infections was 5.1%. A single urine specimen had a sensitivity of 80.0%, while the sensitivity of a single vaginal specimen was 96.0%. The specificity was 100% for the urine specimens and 99.4% for the vaginal specimens. The sensitivity and specificity of a single cervical specimen was 92.0% and 99.6%, respectively. Although the urine ligase chain reaction seemed to have the lowest sensitivity of the compared specimens for testing of C. trachomatis infections in this population, the differences in sensitivity between urine, cervical and vaginal specimens were not statistically significant.
BACKGROUND: We wanted to determine the prevalence of Chlamydia trachomatis in a sample of young women and to assess risk factors related to sexual behaviour that are predictive of such infection. MATERIAL AND METHODS: 898 healthy, non-pregnant women aged 16 to 24 years attending primary care centres over a two-year period (September 1998 to December 2000) were recruited for the study. Uterine cervix samples were tested for Chlamydia trachomatis and participants were interviewed about their sexual behaviour. Chlamydia test results from 881 samples were valid. RESULTS: The prevalence of genital Chlamydia trachomatis infection was 2.4% (21/881). In univariable analyses, a high number of lifetime partners (four or more), smoking, previous pregnancy and a previous positive chlamydia test were factors predictive of a positive Chlamydia test. In multivariable analyses, previous pregnancy and a previous positive Chlamydia test were the only significant factors. The number of lifetime partners was higher among women who had been pregnant or previously had tested positively for Chlamydia. INTERPRETATION: The prevalence of Chlamydia was low in this population. Risk behaviour (frequent change of partners) can be expressed by teenage pregnancy and positive Chlamydia test results and these factors can be used for identification of women who should be tested more frequently than others for Chlamydia infection in a low-prevalence population.