Prevalence of Chlamydia trachomatis infection in women, heterosexual men and MSM visiting HIV counselling institutions in North Rhine-Westphalia, Germany - should Chlamydia testing be scaled up?

Abstract

BackgroundPatients asking for a free anonymous HIV test may have contracted other sexually transmitted infections (STIs) such as Chlamydia trachomatis, yet Chlamydia prevalence in that population is unknown. This study aimed to assess the prevalence and factors associated with Chlamydia infection in patients seeking HIV testing at local public health authorities (LPHA) in order to evaluate whether Chlamydia testing should be routinely offered to them.MethodsWe conducted a cross-sectional study among patients (≥18 years) attending 18 LPHA in North Rhine-Westphalia from November 2012 to September 2013. LPHA collected information on participants’ socio-demographic characteristics, sexual and HIV testing behaviours, previous STI history and clinical symptoms. Self-collected vaginal swabs and urine (men) were analysed by Transcription-Mediated Amplification. We assessed overall and age-stratified Chlamydia prevalence and 95 % confidence intervals (95 % CI). Using univariate and multivariable binomial regression, we estimated adjusted prevalence ratios (aPR) to identify factors associated with Chlamydia infection.ResultsThe study population comprised 1144 (40.5 %) women, 1134 (40.1 %) heterosexual men and 549 (19.4 %) men who have sex with men (MSM); median age was 30 years. Chlamydia prevalence was 5.3 % (95 % CI: 4.1–6.8 %) among women, 3.2 % (95 % CI: 2.2–4.4) in heterosexual men and 3.5 % (95 % CI: 2.1–5.4) in MSM. Prevalence was highest among 18–24 year-old women (9 %; 95 % CI: 5.8–13) and heterosexual men (5.7 %; 95 % CI: 3.0–9.8 %), respectively. Among MSM, the prevalence was highest among 30–39 year-olds (4.4 %; 95 % CI: 1.9–8.5 %). Among those who tested positive, 76.7 % of women, 75.0 % of heterosexual men and 84.2 % of MSM were asymptomatic. Among women, factors associated with Chlamydia infection were young age (18–24 years versus ≥ 40 years, aPR: 3.0, 95 % CI: 1.2–7.8), having had more than 2 partners over the past 6 months (ref.: one partner, aPR: 2.1, 95 % CI: 1.1–4.0) and being born abroad (aPR: 1.9, 95 % CI: 1.0–3.5). Among heterosexual men, young age was associated with Chlamydia infection (18–24 years versus ≥ 40 years, aPR: 4.1, 95 % CI: 1.3–13). Among MSM, none of the variables were associated with Chlamydia infection.ConclusionsLPHA offering HIV tests should consider offering routine Chlamydia testing to women under 30 years. Women with multiple partners and those born abroad may also be considered for routine testing. Our results also suggest offering routine Chlamydia testing to heterosexual men under 25 years old. For MSM, we cannot draw specific recommendations based on our study as we estimated the prevalence of urethral Chlamydia infection, leaving out rectal and pharyngeal infections.

Vaginal Carriage of Chlamydia Trachomatis and Other Sexually Transmissible Pathogens Among Adolescents in Nigeria

“…Three of the four cases (75%) of C. trachomatis encoun-tered in this study, were asymptomatic, which is similar to 76.7% reported by Lallemand et al (6). Similarly, some of the girls that harbored other potentially pathogenic organisms did not manifest any symptoms, even in situations where multiple organisms were recovered in the vagina.…”

“…Similarly, some of the girls that harbored other potentially pathogenic organisms did not manifest any symptoms, even in situations where multiple organisms were recovered in the vagina. Asymptomatic or mildly symptomatic nature of urogenital pathogens, such as Chlamydia, may allow the infection to go unnoticed until secondary or tertiary symptoms develop and could lead to serious complications and/or sequelae (6,8). The asymptomatic carriage of the organisms coupled with reported high coital activity among teenagers in Nigeria (14), may result in indiscriminate transmission of the carried organisms to sexual partners, who may also pass it along to subsequent sexual partners -extending the transmission chain; this transmission chain could continue to grow until a symptomatic contact is involved or tertiary complications cause a victim to seek treatment, or diagnosis occurs after a universal screening exercise.…”

“…Genital tract infection, if untreated or poorly treated, may lead to some undesirable consequences, such as pelvic inflammatory disease (PID) and infertility (4,5). Especially so are Chlamydial infections of the female genital tract -which are often asymptomatic or mildly symptomatic (6,7); the asymptomatic or mildly symptomatic nature may deceptively go unnoticed until secondary symptoms and sequelae manifest, leading possibly to infertility (8).…”

Prevalence and treatment of sexually transmitted infections in men followed by urologists in Germany – a cross sectional study with 347,090 men

“…In the case of chlamydia and gonorrhea infections, Dudareva-Vizule and colleagues estimated that the prevalence of these two STI in men having sex with men ranged from 1.5% to 8.0% depending on the anatomical site where samples were collected [4]. These findings were later corroborated by a study conducted in North Rhine-Westphalia in which chlamydia infection was found in 3.2% of heterosexual men and 3.5% of homosexual men [5]. Regarding trichomoniasis, no recent works have analyzed the prevalence of this STI in Germany.…”

Barriers and Facilitators of Partner Treatment of Chlamydia: A Qualitative Investigation with Prescribers and Community Pharmacists

“…In Western Australia, the incidence of chlamydia has risen by 193% in the last decade, with 11,807 new cases reported in 2016 alone [ 1 ]. The asymptomatic nature of chlamydial infections in up to 70–90% of women and over 50% of men leaves the control of infections challenging [ 2 ]. If left untreated, chlamydial infections may lead to a number of severe, and possibly permanent, sequelae [ 3 ].…”