Sexually Transmitted Infections in Canada: A Sticky Situation

Fisman, David N.; Laupland, Kevin B.

doi:10.1155/2011/701906

Cited by 7 publications

(9 citation statements)

References 50 publications

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“…Rates of sexually transmitted infections (STIs) continue to increase worldwide despite STI control efforts [ 1 – 3 ]. Since the late 1990’s, Canada has experienced an upward trend in reported cases of Chlamydia trachomatis (114 per 100,000 population in 1997 to 255/100,000 in 2011) [ 4 , 5 ]. Chlamydia rates for young men in British Columbia have doubled since 1999 [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Since the late 1990’s, Canada has experienced an upward trend in reported cases of Chlamydia trachomatis (114 per 100,000 population in 1997 to 255/100,000 in 2011) [ 4 , 5 ]. Chlamydia rates for young men in British Columbia have doubled since 1999 [ 5 ]. Neisseria gonorrhea has also increased in Canada (15/100,000 in 1997 to 34/100,000 in 2011) [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Chlamydia rates for young men in British Columbia have doubled since 1999 [ 5 ]. Neisseria gonorrhea has also increased in Canada (15/100,000 in 1997 to 34/100,000 in 2011) [ 5 , 6 ]. The increases in STI rates have occurred despite widespread primary care and targeted public health programs and in Canada, in the setting of universal health care.…”

Section: Introductionmentioning

confidence: 99%

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Self-Collected versus Clinician-Collected Sampling for Chlamydia and Gonorrhea Screening: A Systemic Review and Meta-Analysis

et al. 2015

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BackgroundThe increases in STI rates since the late 1990s in Canada have occurred despite widespread primary care and targeted public health programs and in the setting of universal health care. More innovative interventions are required that would eliminate barriers to STI testing such as internet-based or mail-in home and community service testing for patients that are hard to reach, who refuse to go for clinician-based testing, or who decline an examination. Jurisdictions such as New Zealand and some American states currently use self-collected sampling, but without the required evidence to determine whether self-collected specimens are as accurate as clinician-collected specimens in terms of chlamydia and gonorrhea diagnostic accuracy. The objective of the review is to compare self-collected vaginal, urine, pharyngeal and rectal samples to our reference standard - clinician-collected cervical, urethral, pharyngeal and rectal sampling techniques to identify a positive specimen using nucleic acid amplification test assays.MethodsThe hierarchical summary receiver operating characteristic and the fixed effect models were used to assess the accuracy of comparable specimens that were collected by patients compared to clinicians. Sensitivity and specificity estimates with 95% confidence intervals (CI) were reported as our main outcome measures.FindingsWe included 21 studies based on over 6100 paired samples. Fourteen included studies examined chlamydia only, 6 compared both gonorrhea and chlamydia separately in the same study, and one examined gonorrhea. The six chlamydia studies comparing self-collection by vaginal swab to a clinician-collected cervical swab had the highest sensitivity (92%, 95% CI 87-95) and specificity (98%, 95% CI 97-99), compared to other specimen-types (urine/urethra or urine/cervix). Six studies compared urine self-samples to urethra clinician-collected samples in males and produced a sensitivity of 88% (95% CI 83-93) and a specificity of 99% (95% CI 0.94-0.99). Taking into account that urine samples may be less sensitive than cervical samples, eight chlamydia studies that compared urine self-collected verses clinician-collected cervical samples had a sensitivity of 87% (95% CI 81-91) and high specificity of 99% (95% CI 0.98-1.00). For gonorrhea testing, self-collected urine samples compared to clinician-collected urethra samples in males produced a sensitivity of 92% (95% CI 83-97) and specificity of 99% (95% CI 0.98-1.00).ConclusionThe sensitivity and specificity of vaginal self-collected swabs compared to swabs collected by clinicians supports the use of vaginal swab as the recommended specimen of choice in home-based screening for chlamydia and gonorrhea. Urine samples for gonorrhea collected by men had comparably high sensitivity and specificity, so could be recommended as they can be left at room temperature for several days, allowing for the possibility of mail-in home-based testing. In populations that may not go for testing at all, do not have the option of clinical testing, or who r...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Self-Collected versus Clinician-Collected Sampling for Chlamydia and Gonorrhea Screening: A Systemic Review and Meta-Analysis

et al. 2015

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“…Initially, chlamydia decreased to a low of 129/100,000 in 1998, after which it more than doubled by 2016 (334/100,000). 2 The rise has been attributed to factors such as more risky sex behaviours, 3,4 improvements in test sensitivity, increased screening of men, 5 increased testing and rescreening of women 4,6 and arrested immunity. 3,4,7 It is well established that the epidemiology of sexually transmitted infections (STIs) changes under the pressure of control programs.…”

Section: Introductionmentioning

confidence: 99%

“…16 The majority of chlamydia infections reported to the Brant County Health Unit (BCHU) were in adults between 20 and 24-years-old, followed by females between 15 and 19-years-old and males between 25 and 29-years-old, 15 similar to the epidemiology in Ontario, Canada and elsewhere. 4,15,[17][18][19] The Public Health Standards in Ontario for bacterial STI control focus mainly on screening, retesting cases, and partner notification/contact tracing. 20 When people are diagnosed, they are reported to the Ministry of Health for registration, treatment, and follow-up after 6 months.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and predictors of repeat positive chlamydia tests: The Brant County cohort, Ontario, Canada

Santos

Babayan

Hao

et al. 2019

Preprint

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Objectives: Repeat positive tests for chlamydia (CR) may help explain current high rates of chlamydia despite years of screening, partner notification and treatment to reduce sequelae. We wanted to determine the numbers of CRs over time as a proportion of all chlamydia cases, and define the differences in demographic, clinical, behavioural, and public health management indicators, between individuals who have experienced a CR and individuals who experienced a single infection in Brant County, Ontario. Methods: A retrospective cohort was developed using notifiable disease data extracted from the integrated public health system. Cases were laboratory confirmed chlamydia and gonorrhea infections in Brant County between January 1st, 2006 and December 31st, 2015. During the study period, 3,499 chlamydia cases and 475 gonorrhea cases were diagnosed. The total number of individuals with chlamydia in that period was 3,060, including 157 coinfections with gonorrhea. Differences between those with reinfection and those with single infection were evaluated using univariate and multivariate (Cox proportional hazards model) methods. Results: Four hundred and ninety-nine (16.30%) individuals experienced CR 28 days from initial infection; of which 328 (65.73%) occurred within 2 years and 211 (42.28%) within 1 year. The median time to CR was 276 days, consistent with existing Canadian literature. Independent risk factors for CR included being male, 25 years old or younger, and not receiving recommended treatment for initial and/or subsequent infection. Conclusions: These findings suggest that inadequate treatment play a significant role in CR, while accounting for young age and male gender, likely due to untreated sex partners.

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How to Get and Get Rid of Gonorrhea

Smith

Mailman

MacDonald

2012

Advances in Experimental Medicine and Biology

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Gonorrhea remains as a significant public health concern with an estimated 88 million new cases per year globally. Gonorrhea is a disease of sexual networks and is most prevalent in youth, men who have sex with men, and the socioeconomically disadvantaged. Highly adaptive through years of co-evolution, gonorrhea has developed multiple ways of evading the human immune system. Although new molecular-based strategies have opened avenues for less invasive testing, education and accessibility issues persist. Novel strategies, including use of the internet and social media, are required to better target high risk groups for education, testing, and treatment. Increasing the availability of youth-friendly health services will also help foster earlier gonorrhea diagnosis and management. The inappropriate and overuse of antibiotics and propensity of gonococcus for mutation has led to growing microbe resistance. Treatment failures now include both oral and intravenous formulations of third generation cephalosporins; key front line recommended gonococcal treatment in many countries. With treatment options dwindling, the need for better preventative strategies has never been more important. This overview highlights some of the major aspects of gonococcal infection, including the epidemiology of the disease with an emphasis on sexual networks, new diagnostic techniques, treatment options in the face of evolving gonococcal resistance, and notes potential new preventative strategies.

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Sexually Transmitted Infections in Canada: A Sticky Situation

Cited by 7 publications

References 50 publications

Self-Collected versus Clinician-Collected Sampling for Chlamydia and Gonorrhea Screening: A Systemic Review and Meta-Analysis

Self-Collected versus Clinician-Collected Sampling for Chlamydia and Gonorrhea Screening: A Systemic Review and Meta-Analysis

Epidemiology and predictors of repeat positive chlamydia tests: The Brant County cohort, Ontario, Canada

How to Get and Get Rid of Gonorrhea

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