Chlamydia in Canada, 2010–2015

Choudhri, Y; Miller, J; Sandhu, Jeet; Leon, Antônio Ponce de; Aho, Joséphine

doi:10.14745/ccdr.v44i02a03

Cited by 22 publications

(15 citation statements)

References 20 publications

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“…Chlamydia trachomatis (CT) and Neisseria g onorrhoeae (NG) are the most commonly reported bacterial sexually transmitted infections (STIs) in Canada [ 1 , 2 ]. In 2017, CT was reported for 0.6–1.3% of males and 1.1–2.5% of females 15–29 years old, and for <0.4% for those above 30 years old [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…In 2017, CT was reported for 0.6–1.3% of males and 1.1–2.5% of females 15–29 years old, and for <0.4% for those above 30 years old [ 3 ]. NG rates are about one-tenth of CT [ 1 , 2 ]. These annual reported cases are thought to underestimate actual rates by at least 70% [ 4 ], likely because the infections are largely asymptomatic, often treated using syndromic management, and are incompletely reported [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Rates of CT and NG increased three-fold and five-fold, respectively, between 1997 and 2017 in Canada, with steady increases in CT and more accelerated increases in NG over the last 5 years [ 3 ]. These rises to some degree reflect increases in case finding, from the use of highly sensitive (86–98% [ 19 ]) nucleic acid amplification tests [ 1 , 2 ], the availability of urine and self-swab sample collection, and increased screening of extragenital sites. There is also a hypothesis that the increased rates of CT are paradoxically due to increased reinfection rates following aggressive control efforts “seek and treat”, due to an “arrested immune state” associated with early initiation of treatment resulting in interruption of naturally acquired immunity [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Screening for chlamydia and/or gonorrhea in primary health care: systematic reviews on effectiveness and patient preferences

et al. 2021

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Background We conducted systematic reviews on the benefits and harms of screening compared with no screening or alternative screening approaches for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in non-pregnant sexually active individuals, and on the relative importance patients’ place on the relevant outcomes. Findings will inform recommendations by the Canadian Task Force on Preventive Health Care. Methods We searched five databases (to January 24, 2020), trial registries, conference proceedings, and reference lists for English and French literature published since 1996. Screening, study selection, and risk of bias assessments were independently undertaken by two reviewers, with consensus for final decisions. Data extraction was conducted by one reviewer and checked by another for accuracy and completeness. Meta-analysis was conducted where appropriate. We used the GRADE approach to rate the certainty of the evidence. The Task Force and content experts provided input on determining thresholds for important effect sizes and on interpretation of findings. Results Of 41 included studies, 17 and 11 reported on benefits and harms of screening, respectively, and 14 reported on patient preferences. Universal screening for CT in general populations 16 to 29 years of age, using population-based or opportunistic approaches achieving low screening rates, may make little-to-no difference for a female’s risk of pelvic inflammatory disease (PID) (2 RCTs, n=141,362; 0.3 more in 1000 [7.6 fewer to 11 more]) or ectopic pregnancy (1 RCT, n=15,459; 0.20 more per 1000 [2.2 fewer to 3.9 more]). It may also not make a difference for CT transmission (3 RCTs, n=41,709; 3 fewer per 1000 [11.5 fewer to 6.9 more]). However, benefits may be achieved for reducing PID if screening rates are increased (2 trials, n=30,652; 5.7 fewer per 1000 [10.8 fewer to 1.1 more]), and for reducing CT and NG transmission when intensely screening high-prevalence female populations (2 trials, n=6127; 34.3 fewer per 1000 [4 to 58 fewer]; NNS 29 [17 to 250]). Evidence on infertility in females from CT screening and on transmission of NG in males and both sexes from screening for CT and NG is very uncertain. No evidence was found for cervicitis, chronic pelvic pain, or infertility in males from CT screening, or on any clinical outcomes from NG screening. Undergoing screening, or having a diagnosis of CT, may cause a small-to-moderate number of people to experience some degree of harm, mainly due to feelings of stigmatization and anxiety about future infertility risk. The number of individuals affected in the entire screening-eligible population is likely smaller. Screening may make little-to-no difference for general anxiety, self-esteem, or relationship break-up. Evidence on transmission from studies comparing home versus clinic screening is very uncertain. Four studies on patient preferences found that although utility values for the different consequences of CT and NG infections are probably quite similar, when considering the duration of the health state experiences, infertility and chronic pelvic pain are probably valued much more than PID, ectopic pregnancy, and cervicitis. How patients weigh the potential benefits versus harms of screening is very uncertain (1 survey, 10 qualitative studies); risks to reproductive health and transmission appear to be more important than the (often transient) psychosocial harms. Discussion Most of the evidence on screening for CT and/or NG offers low or very low certainty about the benefits and harms. Indirectness from use of comparison groups receiving some screening, incomplete outcome ascertainment, and use of outreach settings was a major contributor to uncertainty. Patient preferences indicate that the potential benefits from screening appear to outweigh the possible harms. Direct evidence about which screening strategies and intervals to use, which age to start and stop screening, and whether screening males in addition to females is necessary to prevent clinical outcomes is scarce, and further research in these areas would be informative. Apart from the evidence in this review, information on factors related to equity, acceptability, implementation, cost/resources, and feasibility will support recommendations made by the Task Force. Systematic review registration International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42018100733.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Screening for chlamydia and/or gonorrhea in primary health care: systematic reviews on effectiveness and patient preferences

et al. 2021

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Recommendation on screening for chlamydia and gonorrhea in primary care for individuals not known to be at high risk

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Reynolds

et al. 2021

CMAJ

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In Canada, Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhea) are the most commonly reported sex ually transmitted bacterial infections (STIs), 1,2 with reported cases in the population increasing annually since 2000. 3 In 2018, reported cases were highest in people aged 15-29 years, with rates of 1.0%-1.9% for chlamydia and 0.2%-0.3% for gonorrhea in this population, 4 while rates among individuals older than 30 years were less than 0.5% for chlamydia and less than 0.2% for gonor rhea. 4 Many infected individuals, however, are asymptomatic or do not seek care, and are not included in reported cases. 3 Taking into account underreporting, the true prevalence of chlamydia in people aged 15 to 29 years may be as high as 5%-7%. [3][4][5][6] Consequences of untreated chlamydia in females can include cervicitis in 10%-20%, 7 pelvic inflammatory disease in 10%-16%, 8,9 infertility in up to 5%, 10 chronic pelvic pain in 3%-8%, 10,11 and ectopic pregnancy in up to 2%. 10 Consequences of untreated gonorrhea may include rates of pelvic inflammatory disease that exceed those for chlamydia. 12 In males, chlamydia may be associ ated with epididymitis in up to 7%, with or without orchitis, 6,13 and, very rarely, infertility. 14 Consequences of chlamydia affect ing both sexes include urethritis in 4% of females and up to 3% of males; 15 pharyngitis; proctitis; reactive arthritis lasting longer than 6 months in 1%-4% (when considering both chlamydia and gonorrhea); 16,17 and disseminated gonococcal infection in less than 1%, which can rarely lead to sepsis, meningitis, endocarditis or osteomyelitis. 18 Screening sexually active individuals for chlamydia and gon orrhea could reduce clinical complications and transmission, but should be done only if benefits from screening exceed harms 19,20 and resource use is justifiable.In Canada, STI screening is most commonly offered oppor tun istically by clinicians in a variety of primary care settings (e.g., family practice, sexual health clinics, school health centres) during visits that may or may not be for sexual health-related

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“…While younger people continue to account for the majority of STI diagnoses, increases in rates of STIs among people over 40 have been observed in high-income countries in recent years 1–4. In England, approximately 7% of new STI diagnoses in 2018 were among individuals aged 45–64 years old 1.…”

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confidence: 99%

Navigating new sexual partnerships in midlife: a socioecological perspective on factors shaping STI risk perceptions and practices

et al. 2020

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ObjectiveDespite increases in STIs among those over 40, little is known about the social context of STI transmission among people experiencing relationship transition in midlife, and few sexual health promotion initiatives are targeted at this group. This study sought to identify factors shaping STI risk perceptions and practices among midlife individuals either contemplating or having sex with new partners following the end of a long-term relationship.MethodsParticipants were purposively selected from respondents to Britain’s third National Survey of Sexual Attitudes and Lifestyles, using three eligibility criteria: aged 40–59, reported experience of the end of a marital or cohabiting relationship with an opposite-sex partner in the past 5 years, and willingness to participate in a qualitative interview. Qualitative data were generated via face-to-face interviews with 10 women and 9 men and analysed inductively using thematic analysis, with themes then organised using a socioecological framework.ResultsParticipants’ accounts of new sexual partnerships in midlife indicate that STI risk perceptions and practices are shaped by factors operating at multiple levels across the socioecological arena (individual, partnership, peers and communities, societal). Constraints on, and resources for, the navigation of sexual safety include self-perceived STI risk rooted in past rather than present circumstances; legacies of mistrust within former relationships; intersecting gender-age dynamics in negotiation of risk prevention strategies with new partners; peers and younger relatives’ influences on understandings of sexual risk and safety; postrelationship change in social networks that increase or mitigate vulnerability to sexual risk; age-related barriers to accessing condoms; and disconnection from safer sex messaging and services culturally coded as for the young.ConclusionsImproving sexual health among midlife adults requires age-sensitive interventions designed to address multilevel constraints, and harness positive influences, on the navigation of sexual safety at this stage of life.

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Chlamydia in Canada, 2010–2015

Abstract: Background: Chlamydia is the most commonly reported notifiable sexually transmitted infection in Canada. Rates have been steadily increasing since 1997.

Cited by 22 publications

References 20 publications

Screening for chlamydia and/or gonorrhea in primary health care: systematic reviews on effectiveness and patient preferences

Screening for chlamydia and/or gonorrhea in primary health care: systematic reviews on effectiveness and patient preferences

Recommendation on screening for chlamydia and gonorrhea in primary care for individuals not known to be at high risk

Navigating new sexual partnerships in midlife: a socioecological perspective on factors shaping STI risk perceptions and practices

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