BackgroundChlamydia is a sexually transmitted infection that can cause serious upper genital tract infections, however, in Australia there are limited population data for chlamydia. Understanding the incidence of chlamydia will be important in the design of a chlamydia screening program in Australia.MethodWomen aged 16–25 years were recruited from sexual health clinics (SHC) and general practice clinics (GP) in South-Eastern Australia and consented to participate in longitudinal study over a 12-month period. Participants were requested to send back questionnaires and self-collected vaginal swabs through the post which were tested for chlamydia.ResultsOverall, 1116 women were recruited from 29 clinics; with a 79% retention rate.C trachomatisprevalence at baseline was 4.9% (95% CI: 2.9% to 7.0%) and incidence rate for the 12-month study period was 4.4 per 100 women-years (95% CI: 3.3% to 5.9%). PrevalentC trachomatiswas associated with having hadC trachomatispreviously [AOR: 2.0 (95% CI: 1.1% to 3.9%)], increased numbers of sexual partners [AOR: 6.4 (95% CI: 3.6% to 11.3%)] and unprotected sex [AOR: 3.1 (95% CI: 1.0% to 9.5%)]. Antibiotic use and older age were protective against having a prevalent infection ([AOR: 0.4 (95% CI: 0.2% to 1.0%)] and [AOR: 0.9 (95% CI: 0.8% to 1.0%)] respectively) and an incident infection ([AHR: 0.1 (95% CI: 0.0% to 0.6%)] and [AHR: 0.4 (95% CI: 0.2% to 0.8%)] respectively). IncidentC trachomatiswas also associated with more partners [AHR: 4.0 (95% CI: 1.9% to 8.6%)]. More than 20% of women withC trachomatishad a re-infection during the study [20.3% (95% CI: 11.6% to 31.7%)] with an infection rate of 20.0 (95% CI: 11.9% to 33.8%) per 100 women years. The median chlamydia organism load was 1.4×105/5цl and the most common serovar identified was serovar E (51.9%).ConclusionChlamydia is a common STI in young Australian women, and an incidence of 4.9 per 100 women years for chlamydia suggests annual testing is appropriate for a chlamydia screening program. The high re-infection rate indicates the importance of partner notification and re-testing 3 months after treatment.
The proportion of clinically important diagnoses in a low-risk, asymptomatic population who use a computer-assisted self-interview (CASI) to assess risk was needed to determine optimal health service delivery. Medical records were retrospectively analysed between July 2008 and June 2009 for risk characteristics and diagnoses. A total of 7733 new patients completed a CASI, of whom 1060 were asymptomatic heterosexuals. From this low-risk group, 26 diagnoses were made on the day of presentation, including 22 cases of genital warts (2.08% [95% confidence interval (CI) 1.22-2.93]), three cases of genital herpes (0.28% [95% CI 0.055-0.82]) and one case of unintended pregnancy (0.094% [95% CI 0.0061-0.52]). Additionally, there were 54 cases of chlamydia detected (5.09% [95% CI 3.77-6.42]). As chlamydia is effectively diagnosed and managed from self-collected samples, patient review is not always required. This study provides evidence for an express testing service for chlamydia to streamline the screening of low-risk, asymptomatic heterosexual patients as identified by CASI without the need to for a traditional face-to-face consultation.
Introduction Recurrent vulvovaginal candidiasis (RVVC) results in significant physical, financial and psychological sequelae for women, and many women report that VVC affects their intimate relationships. The aetiology of RVVC remains uncertain, and some studies suggest sexual intercourse may be responsible for transmission of Candida species. No publications have documented the affect of sexual intercourse on vaginal candida colonisation. Methods Fifty nine participants who were culture positive for Candida spp. at screening took part in a randomised controlled trial investigating the effect of oral garlic and placebo on vaginal candidal colonisation. Participants self-collected daily vaginal swabs during the two weeks before menstruation. They kept a daily diary and recorded incidence of sexual intercourse and abnormal vaginal symptoms. Swabs were analysed for quantitative colony counts of candida before and after sexual intercourse. Results There were 149 episodes of sexual intercourse in participants reporting sexual activity (n = 38) over the two week study period. Colonisation levels rose the day following sexual intercourse in 51 episodes, and fell in 56 episodes. In 42 episodes of sexual intercourse, the levels remained the same or women were culture negative on the day following and two days following sexual intercourse. On fifty occasions women had symptoms (itch, abnormal vaginal discharge) on the day of sexual intercourse, and 41 women reported abnormal symptoms two days after sexual intercourse. In 75 episodes, there were no abnormal symptoms the day of, or the day following sexual intercourse. Conclusion In this study, sexual intercourse, colonisation levels and abnormal vaginal symptoms appeared to be unrelated. Further investigation is recommended into dyspareunia and abnormal vaginal symptoms following sexual intercourse experienced by women with RVVC. Disclosure of interest statement No pharmaceutical grants were received in the development of this study.
and treatment failure among men who have sex with men (MSM), heterosexual men and women, diagnosed with repeat chlamydia infection within 1-4 months after treatment with azithromycin. Methods Participants completed an online survey capturing treatment and sexual behaviour data since initial diagnosis. Specimens from initial and repeat infections were included in the study. Chlamydia serovars were determined using quantitative PCR assays. When the same serovar was detected in both specimens for participants, MLST was used to further discriminate between genotypes. An algorithm based on genotype and sexual behaviour data was used to differentiate treatment failure from reinfection. Results There were 600 participants (200 MSM, 200 heterosexual males, 200 females) diagnosed with chlamydia. Of 301/600 who retested between 1-4 months: 258/301 (85.7%) were cured (treated and negative on retest); 4/301 (1.3%) had a definite reinfection (positive retest and different genotype); 19/301 (6.3%) had probable reinfection (positive retest, same genotype and reported unprotected sex with the same or a different partner); 17/301 (5.6%) had possible treatment failure (positive retest, same genotype and reported not having sex or always using condoms); 1/301 (0.3%) had a persistent infection (positive retest, same genotype and no documented treatment); and 2/301 (0.7%) could not be categorised due to insufficient information. Possible treatment failures were more common in MSM (11.3%, 12/106) vs other groups (2.6%, 5/195; p < 0.01). Among the possible treatment failures in MSM, 10/12 (83.3%) were initial rectal samples. Conclusion Treatment failure was common in MSM with rectal chlamydia, suggesting the need for treatment efficacy trials. Disclosure of interest statement No conflict of interest is declared.
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