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1.
Lancet Infect Dis ; 22(4): 552-561, 2022 04.
Article in English | MEDLINE | ID: covidwho-1839427

ABSTRACT

BACKGROUND: Pharyngeal Chlamydia trachomatis in women might contribute to autoinoculation and transmission to sexual partners. Data for effectiveness of different testing practices for pharyngeal C trachomatis are scarce. We therefore aimed to assess the prevalence of pharyngeal C trachomatis, determinants, and effectiveness of different testing practices in women. METHODS: We did a retrospective cohort study, in which surveillance data for all women visiting sexually transmitted infection clinics in all regions in the Netherlands between Jan 1, 2008, and Dec 31, 2017, were used. We collected consultation-level data and individual-level data from 2016 onwards for sociodemographic characteristics, sexual behaviour in the past 6 months, self-reported symptoms, and STI diagnoses. The primary outcome was the positivity rate of pharyngeal C trachomatis infection compared between routine universal testing (>85% tested pharyngeally per clinic year), selective testing (5-85% tested pharyngeally per clinic year), and incidental testing (<5% pharyngeally tested per clinic year). We calculated the number of missed infections by extrapolating the positivity rate assessed by routine universal testing to all selectively tested women. We used multivariable generalised estimating equations logistic regression analyses to assess independent risk factors for pharyngeal C trachomatis and used the assessed risk factors as testing indicators for comparing alternative testing scenarios. FINDINGS: Between Jan 1, 2008, and Dec 31, 2017, a total of 550 615 consultations with at least one C trachomatis test was recorded, of which 541 945 (98·4%) consultations (including repeat visits) were included in this analysis. Pharyngeal C trachomatis positivity was lower in the routine universal testing group than in the selective testing group (1081 [2·4%; 95% CI 2·2-2·5] of 45 774 vs 3473 [2·9%; 2·8-3·0] of 121 262; p<0·0001). The positivity rate was also higher among consultations done in the incidental testing group (44 [4·1%; 95% CI 3·1-5·5] of 1073; p<0·0001) than in the routine universal testing group. Based on extrapolation, selective testing would have hypothetically missed 64·4% (95% CI 63·5-65·3; 6363 of 9879) of the estimated total of C trachomatis infections. The proportion of pharyngeal-only C trachomatis was comparable between routinely universally tested women (22·9%) and selectively tested women (20·4%), resulting in a difference of 2·5% (95% CI -0·3 to 5·3; p=0·07). When using risk factors for pharyngeal C trachomatis as testing indicators, 15 484 (79·6%) of 19 459 women would be tested to detect 398 (80·6%) of 494 infections. INTERPRETATION: No optimal testing scenario was available for pharyngeal C trachomatis, in which only a selection of high-risk women needs to be tested to find most pharyngeal C trachomatis infections. The relative low prevalence of pharyngeal-only C trachomatis (0·5%) and probably limited clinical and public health effect do not provide support for routine universal testing. FUNDING: Public Health Service South Limburg.


Subject(s)
Chlamydia Infections , Chlamydia trachomatis , Chlamydia Infections/diagnosis , Chlamydia Infections/epidemiology , Female , Humans , Male , Netherlands/epidemiology , Oropharynx , Prevalence , Retrospective Studies
2.
Int J Infect Dis ; 118: 183-193, 2022 May.
Article in English | MEDLINE | ID: covidwho-1838865

ABSTRACT

OBJECTIVES: Molecular testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) is costly. Therefore, we appraised the evidence regarding pooling samples from multiple individuals to test for CT/NG. METHODS: In this systematic review, we searched 5 databases (2000-2021). Studies were included if they contained primary data describing pooled testing. We calculated the pooled sensitivities and specificities for CT and NG using a bivariate mixed-effects logistic regression model. RESULTS: We included 22 studies: most were conducted in high-income countries (81.8%, 18 of 22), among women (73.3%, 17 of 22), and pooled urine samples (63.6%, 14 of 22). Eighteen studies provided 25 estimates for the meta-analysis of diagnostic accuracy, with data from 6,913 pooled specimens. The pooled sensitivity for CT was 98.4% (95% confidence intervals [CI]: 96.8-99.2%, I2=77.5, p<0.001), and pooled specificity was 99.9% (95% CI: 99.6-100.0%, I2=62.6, p<0.001). Only 2 studies reported pooled testing for NG, and both reported similarly high sensitivity and specificity as for CT. Sixteen studies provided data on the cost of pooling, reporting cost-savings ranging from 39%-90%. CONCLUSIONS: Pooled testing from multiple individuals for CT is highly sensitive and specific compared with individual testing. This approach has the potential to reduce the cost of screening in populations for which single anatomic site screening is recommended.


Subject(s)
Chlamydia Infections , Gonorrhea , Chlamydia Infections/diagnosis , Chlamydia trachomatis , Female , Gonorrhea/diagnosis , Humans , Male , Mass Screening , Neisseria gonorrhoeae/genetics , Sensitivity and Specificity
3.
Int J STD AIDS ; 33(6): 604-607, 2022 May.
Article in English | MEDLINE | ID: covidwho-1833020

ABSTRACT

BACKGROUND: BASHH/MEDFASH (Medical Foundation for HIV and Sexual Health) Standards for the Management of Sexual Health Services 20141 set out a number of recommendations regarding time between contacting a service to being seen, time to receiving results, and time to treatment. This audit investigated if UK practice is compliant with BASHH standards of care in terms of: Time to patient being seen after contacting sexual health services, time to chlamydia (CT) NAAT (nucleic acid amplification test) results and time from positive CT result to treatment. METHODS: All UK level 2 (non-specialist) and level 3 (specialist) sexual health clinics were invited to take part. Data were collected via a survey of sexual health clinics and a retrospective case-note review of the last 40 people aged 16 or over per service seen with chlamydia but not syphilis or gonorrhoea. Cases were identified using the SHHAPT (Sexual Health and HIV Activity Types) National STI Surveillance code for chlamydia (C4). RESULTS: There were responses from 221 sites. 67% of sites reported offering both appointment and walk-in access, 26.2% appointment-only, 6.8% walk-in only. The mean turn-away rate of individuals seeking walk-in access on the last open day was 6.1%. There were variations in local service specification turnaround times for chlamydia nucleic acid amplification test results; 32% of sites reported no specified turnaround time. Case note audit of individuals seen with chlamydia showed 74.1% of individuals were tested for chlamydia at a level 3 clinic, 11.8% at a level 2 sexual health clinic, 7.3% used a self-sampling kit requested online and 3.9% tested at a different setting. 92.1% of individuals who initially tested at a sexual health service had an attempted notification within 10 working days of a positive chlamydia test. 95% of individuals were treated within a sexual health service. Overall, 94.0% of individuals were treated within 15 working days of the test result. CONCLUSION: When missing data were excluded, patient initiated GUM/level 3 attenders seen within 2 working days met the audit standard as did patient access to results within 10-working days for those whose initial CT NAAT sample was taken at a GUM/level 3 clinic and treatment within 3 weeks for GUM/level 3 attenders. Patients offered to be seen/assessed within 2 working days and lab report within 5 working days did not meet the audit standard. Recommendations include ensuring that laboratory turn-around times are included in contracts or service level agreements for clinical services, and local monitoring of these. Dates when individuals first seek to access sexual health services should also be recorded and used to monitor performance in comparison with access standards.


Subject(s)
Chlamydia Infections , HIV Infections , Sexual Health , Chlamydia Infections/diagnosis , Chlamydia Infections/drug therapy , Chlamydia Infections/epidemiology , Chlamydia trachomatis , Clinical Audit , HIV Infections/diagnosis , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Patient Compliance , Retrospective Studies
4.
Sex Transm Dis ; 49(7): 490-496, 2022 Jul 01.
Article in English | MEDLINE | ID: covidwho-1806731

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, disruptions were anticipated in the US health care system for routine preventive and other nonemergency care, including sexually transmitted infection care. METHODS: Using a large national laboratory data set, we assessed the impact of the COVID-19 pandemic on the weekly numbers and percent positivity of chlamydia and gonorrhea tests ordered from the 5th week of 2019 to the 52nd week of 2020 in the United States. We compared weekly 2020 values for test volume, percent positive, and number of positives with the same week in 2019. We also examined the potential impact of stay-at-home orders for the month of April 2020. RESULTS: Immediately after the declaration of a national emergency for COVID-19 (week 11, 2020), the weekly number of gonorrhea and chlamydia tests steeply decreased. Tests then rebounded toward the 2019 pre-COVID-19 level beginning the 15th week of 2020. The weekly percent positive of chlamydia and gonorrhea remained consistently higher in 2020. In April 2020, the overall number of chlamydia tests was reduced by 53.0% (54.1% in states with stay-at-home orders vs. 45.5% in states without stay-at-home orders), whereas the percent positive of chlamydia and gonorrhea tests increased by 23.5% and 79.1%, respectively. CONCLUSIONS: To limit the impact of the pandemic on control of chlamydia and gonorrhea, public health officials and health care providers can assess measures put in place during the pandemic and develop new interventions to enable care for sexually transmitted infections to be delivered under pandemic and other emergency conditions. The assessment like this study is continuously needed.


Subject(s)
COVID-19 , Chlamydia Infections , Gonorrhea , Sexually Transmitted Diseases , COVID-19/diagnosis , COVID-19/epidemiology , Chlamydia Infections/diagnosis , Chlamydia Infections/epidemiology , Chlamydia Infections/prevention & control , Chlamydia trachomatis , Gonorrhea/diagnosis , Gonorrhea/epidemiology , Gonorrhea/prevention & control , Humans , Pandemics/prevention & control , Sexually Transmitted Diseases/epidemiology , United States/epidemiology
5.
Acta Derm Venereol ; 102: adv00704, 2022 May 04.
Article in English | MEDLINE | ID: covidwho-1785286

ABSTRACT

The aim of this study was to determine whether COVID-19 restrictions had an impact on Chlamydia trachomatis infections compared with 2018 and 2019. A retrospective nationwide observational study was performed using monthly incidences of laboratory-confirmed chlamydia cases and number of tests, obtained from Danish national surveillance data. Testing rates and positivity rates were compared using Poisson and logistic regression. The first Danish COVID-19 lockdown (12 March to 14 April 2020) resulted in a reduction in the number of chlamydia tests performed (rate ratio 0.72, 95% confidence interval  0.71-0.73) and a consequent reduction in the number of laboratory-identified cases (66.5 vs 88.3 per 100,000 population during the same period in 2018 to 2019). This period was followed by a return of testing and test positivity close to the level seen in 2018 to 2019. The second Danish COVID-19 lockdown (17 December to 31 March 2021) resulted in crude incidence rates of laboratory-confirmed chlamydia infection that were similar to the crude incidence rates seen during same period in 2018 to 2019. In conclusion, the Danish COVID-19 restrictions have had negligible effects on laboratory-confirmed C. trachomatis transmission.


Subject(s)
COVID-19 , Chlamydia Infections , COVID-19/epidemiology , Chlamydia Infections/diagnosis , Chlamydia Infections/epidemiology , Chlamydia trachomatis , Communicable Disease Control , Denmark/epidemiology , Humans , Pandemics/prevention & control , Retrospective Studies , SARS-CoV-2
6.
Sex Transm Dis ; 48(12): 939-944, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1605252

ABSTRACT

BACKGROUND: Reported cases of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are increasing among Canadian men. Estimates of community-based CT/NG prevalence are lacking among gay, bisexual, and other men who have sex with men (GBM). METHODS: Respondent driven sampling was used to recruit GBM in Montréal, Canada between February 2017 and June 2018. Specimens provided from urogenital, rectal, and pharyngeal sites were analyzed using nucleic acid amplification test to detect CT/NG. Prevalence estimates of CT/NG, overall and by anatomical site were calculated. All estimates are respondent-driven sampling-adjusted. RESULTS: Among 1177 GBM, the prevalence of rectal, urogenital, pharyngeal and overall were respectively 2.4%, 0.4%, 0.4%, and 2.8% for CT infections, and 3.1%, 0.4%, 3.5%, and 5.6% for NG infections. If testing had been limited to the urogenital site, 80% and 94% of CT and NG infections, respectively, would have been missed. CONCLUSIONS: This community-based study among GBM shows that the CT prevalence was about half of that observed for NG. A large part of CT/NG infections involves only the extragenital sites, highlighting the need for systematic multisite screening regardless of symptoms. In the mist of the COVID-19 pandemic and the limited CT/NG screening capacity due to test kits shortage, it might be considered to prioritize rectal and pharyngeal CT/NG testing over urogenital testing in asymptomatic GBM.


Subject(s)
COVID-19 , Chlamydia Infections , Gonorrhea , Sexual and Gender Minorities , Canada/epidemiology , Chlamydia Infections/epidemiology , Chlamydia trachomatis/genetics , Gonorrhea/epidemiology , Homosexuality, Male , Humans , Male , Neisseria gonorrhoeae/genetics , Pandemics , Prevalence , SARS-CoV-2
7.
Sex Transm Dis ; 48(8): 521-522, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1532620
8.
APMIS ; 130(1): 34-42, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1511283

ABSTRACT

The COVID-19 pandemic has challenged the societies and health care systems globally, and resulted in many social and physical distancing restrictions to limit the spread of SARS-CoV-2. These restrictions have also likely affected the frequency of intimate contacts and the spread of sexually transmitted infections (STIs). Compared to most other countries, Sweden especially in Spring-Autumn 2020 pursued mainly milder voluntary, that is, not mandatory enforced by laws, recommended restrictions and the impacts of these on society and spread of STIs remain largely unknown. We describe the potential impact of the COVID-19 pandemic on the national and regional incidence, epidemiology and diagnostic testing of chlamydia and gonorrhoea in Sweden in 2020. Compared to 2019, we found a significant decrease in incidence of chlamydia (-4.5%) and gonorrhoea (-17.5%), and in diagnostic testing (-10.5% for chlamydia, -9.4% for gonorrhoea) in 2020. However, the decrease in chlamydia incidence, which has mainly been decreasing in the last 10 years, was not significant when compared with the average incidence in 2017-2019. The largest decrease in national incidence of both infections was observed among young and heterosexual patients, however, some Swedish regions showed an increased incidence, particularly of chlamydia. Increased "internet-based self-sampling" testing approach partly compensated for a decreased attendance at STI clinics. Studies, including sexual behaviour, prevention, reasons for attending STI health care, STIs in different anatomical sites and management of STIs, are required to elucidate the impact of COVID-19-associated social and physical distancing restrictions on sexual activity and the incidence and epidemiology of chlamydia and gonorrhoea in Sweden.


Subject(s)
Chlamydia Infections/diagnosis , Chlamydia Infections/epidemiology , Gonorrhea/diagnosis , Gonorrhea/epidemiology , COVID-19 , Chlamydia , Chlamydia trachomatis , Diagnostic Tests, Routine , Humans , Incidence , Neisseria gonorrhoeae , Pandemics , Physical Distancing , SARS-CoV-2 , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology , Sweden/epidemiology
9.
J Clin Microbiol ; 59(11): e0264620, 2021 10 19.
Article in English | MEDLINE | ID: covidwho-1480240

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic reduced the sexually transmitted infection (STI) testing volume due to social-distancing and stay-at-home orders, among other reasons. These events highlighted previously known benefits of at-home STI self-testing or specimen self-collection and accelerated testing demand via telemedicine. We review testing outside traditional clinical settings. We focus on three curable bacterial STIs among the top 10 U.S. nationally notifiable conditions with screening recommendations: syphilis, gonorrhea (Neisseria gonorrhoeae, also known as the gonococcus [GC]), and chlamydia (Chlamydia trachomatis). At least 19 million GC/C. trachomatis (GC/CT) screening or diagnostic tests are performed annually, presenting a considerable challenge during the pandemic. Unlike for HIV, STI at-home tests are currently not commercially available. However, innovative telemedicine providers currently offer services where specimen self-collection kits are mailed to patients at home who then ship them to laboratories for processing. We discuss technical and regulatory aspects of modifications for home-based specimen self-collection. The telemedicine provider typically manages and communicates results, provides linkage to care, and is responsible for billing and case reporting. We also describe rapid testing devices in development that may present an opportunity for future self-testing. In summary, COVID-19 has accelerated the evaluation and development of STI self-tests and specimen self-collection. The remaining obstacles are high price, regulatory approval, support for laboratories offering the service, and uncertainty regarding whether target populations with the greatest need are reached effectively. However, increased testing, convenience, and privacy are potential benefits that may enhance uptake and outlast the pandemic.


Subject(s)
COVID-19 , Chlamydia Infections , Gonorrhea , Sexually Transmitted Diseases , Chlamydia Infections/epidemiology , Chlamydia trachomatis , Gonorrhea/epidemiology , Humans , Laboratories , Mass Screening , Neisseria gonorrhoeae , Pandemics , SARS-CoV-2 , Self-Testing , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology
10.
PLoS One ; 16(9): e0255878, 2021.
Article in English | MEDLINE | ID: covidwho-1440985

ABSTRACT

BACKGROUND: The COVID-19 pandemic illuminated the benefits of telemedicine. Self-collected specimens are a promising alternative to clinician-collected specimens when in-person testing is not feasible. In this study, we assessed the adequacy of self-collected pharyngeal and rectal specimens for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae among individuals undergoing chlamydia and gonorrhea screening. METHODS: We used data from a large cohort study that included male and female adolescents between the ages of 12-24 years. We considered self-collected specimens adequate for clinical use if the human synthase gene (a control target of the assay) was detected in the specimen. RESULTS: In total, 2,458 specimens were included in the analysis. The human synthase gene was detected in 99.2% (2,439/2,458) of all self-collected specimens, 99.5% (1,108/1,114) of the pharyngeal specimens, and 99.0% (1,331/1,344) of the rectal specimens. CONCLUSION: Self-collected pharyngeal and rectal specimens demonstrated a very high proportion of human gene presence, suggesting that self-collection was accurate. A limitation of this study is that the sample adequacy control detects the presence or absence of the human hydroxymethylbilane synthase gene, but it does not indicate the specific anatomic origin of the human hydroxymethylbilane synthase gene. Self-collected specimens may be an appropriate alternative to clinician-collected specimens.


Subject(s)
Chlamydia Infections/diagnosis , Chlamydia trachomatis/isolation & purification , Gonorrhea/diagnosis , Neisseria gonorrhoeae/isolation & purification , Specimen Handling , Adolescent , Child , Chlamydia Infections/microbiology , Female , Gonorrhea/microbiology , HIV Infections , Humans , Male , Pharynx/microbiology , Polymerase Chain Reaction , Rectum/microbiology , Self Care , Young Adult
11.
J Int AIDS Soc ; 24(9): e25801, 2021 09.
Article in English | MEDLINE | ID: covidwho-1396894

ABSTRACT

INTRODUCTION: Provider-collected swabs are an unappealing procedure for many transgender women and may have led to suboptimal rates of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing. Self-collection for CT/NG testing is recommended for men who have sex with men. However, the information on acceptability and clinical performance to support a recommendation for transgender women is lacking. We aimed to determine the acceptability and satisfaction towards self-collection for CT/NG testing among Thai transgender women. METHODS: Thai transgender women who attended Tangerine Clinic (a transgender-led, integrated, gender-affirming care and sexual health services clinic in Bangkok, Thailand) between May and July 2020 and had condomless sexual intercourse within the past six months were offered to collect urine and perform self-swabs of pharyngeal, rectal, and if applicable, neovaginal compartments for pooled nucleic acid amplification testing for CT/NG infections. Participants received a diagram, video and oral instructions about how to perform self-collection procedure. Those who accepted self-collection were also offered to receive provider collection to evaluate the performance between the two methods. Self-administered questionnaires were used to assess satisfaction. RESULTS: Among 216 transgender women enrolled, 142 (65.7%) accepted self-collection. All who accepted had pharyngeal, rectal and urine samples collected. Of 31 transgender women who had undergone genital surgery, 28 (90.3%) accepted neovaginal self-swab. The acceptance rate increased from 46.2% in May to 84.5% in July 2020. One participant had an invalid result. All transgender women who accepted self-collection could perform it without assistance, and 82.8% were highly satisfied with the method. None reported dissatisfaction. Due to the COVID-19 pandemic, provider collection services were discontinued early, and only eight transgender women were able to perform both methods for performance evaluation. The performance agreement was 100%. CONCLUSIONS: Thai transgender women had high acceptability and satisfaction towards self-collection for CT/NG testing. The performance was promising compared to provider collection. Our results support the implementation of self-collection to the sexually transmitted infection services, particularly during the COVID-19 pandemic where physical distancing is the new normal. A larger study is warranted to determine the performance of self-collection for CT/NG testing in each anatomical compartment and confirm the performance between self-collection and provider collection.


Subject(s)
Chlamydia Infections/diagnosis , Chlamydia trachomatis/isolation & purification , Gonorrhea/diagnosis , Neisseria gonorrhoeae/isolation & purification , Patient Acceptance of Health Care , Personal Satisfaction , Specimen Handling/methods , Transgender Persons , Adult , COVID-19 , Chlamydia Infections/epidemiology , Female , Gonorrhea/epidemiology , Humans , Male , Pandemics , SARS-CoV-2 , Self Care , Thailand/epidemiology
12.
J Am Assoc Nurse Pract ; 34(2): 373-380, 2021 Aug 18.
Article in English | MEDLINE | ID: covidwho-1367074

ABSTRACT

BACKGROUND: The COVID-19 pandemic created new challenges in controlling the transmission of sexually transmitted diseases (STDs), forcing the Centers for Disease Control and Prevention (CDC) to temporarily modify recommendations. As rapid COVID-19 testing emerged, supplies for similar testing platforms, specifically Chlamydia trachomatis and Neisseria gonorrhoeae, became compromised. LOCAL PROBLEM: The local community was identified as having the highest rate of chlamydia infections in North Carolina. Concerns regarding disease transmission within the community were amplified as the project site began experiencing a critical shortage of chlamydia and gonorrhea testing kits. METHODS: This quality improvement (QI) project, conducted in an emergency department, located in an underserved area with high STD infection rates, offered a prioritized approach to STD testing and treatment during a critical time with limited testing capabilities. INTERVENTIONS: Program analysis evaluated the management of 227 patients preintervention and 218 patients postintervention with confirmed or suspected infection, using a testing and treatment algorithm to identify and treat those most likely to be infected while preserving testing supplies for those at higher risk for complications from infections. RESULTS: Test utilization decreased by 25% (p-value = .003 via t-test), whereas a significant improvement in empiric treatment, increasing from 59% (133/227) to 73% (158/218), was also observed (p-value = .002 via chi-square analysis). CONCLUSIONS: Results suggest that a testing and treatment algorithm for providers can successfully guide testing and treatment decisions, reducing onward transmission and preserving supplies for those more likely to experience complications from chlamydia and gonorrhea infections.


Subject(s)
COVID-19 , Gonorrhea , Sexually Transmitted Diseases , COVID-19 Testing , Centers for Disease Control and Prevention, U.S. , Chlamydia trachomatis , Gonorrhea/diagnosis , Gonorrhea/drug therapy , Gonorrhea/epidemiology , Humans , Pandemics , Prevalence , SARS-CoV-2 , Sexually Transmitted Diseases/epidemiology , United States
13.
PLoS Negl Trop Dis ; 15(7): e0009491, 2021 07.
Article in English | MEDLINE | ID: covidwho-1331979

ABSTRACT

The World Health Organization (WHO) recommends continuing azithromycin mass drug administration (MDA) for trachoma until endemic regions drop below 5% prevalence of active trachoma in children aged 1-9 years. Azithromycin targets the ocular strains of Chlamydia trachomatis that cause trachoma. Regions with low prevalence of active trachoma may have little if any ocular chlamydia, and, thus, may not benefit from azithromycin treatment. Understanding what happens to active trachoma and ocular chlamydia prevalence after stopping azithromycin MDA may improve future treatment decisions. We systematically reviewed published evidence for community prevalence of both active trachoma and ocular chlamydia after cessation of azithromycin distribution. We searched electronic databases for all peer-reviewed studies published before May 2020 that included at least 2 post-MDA surveillance surveys of ocular chlamydia and/or the active trachoma marker, trachomatous inflammation-follicular (TF) prevalence. We assessed trends in the prevalence of both indicators over time after stopping azithromycin MDA. Of 140 identified studies, 21 met inclusion criteria and were used for qualitative synthesis. Post-MDA, we found a gradual increase in ocular chlamydia infection prevalence over time, while TF prevalence generally gradually declined. Ocular chlamydia infection may be a better measurement tool compared to TF for detecting trachoma recrudescence in communities after stopping azithromycin MDA. These findings may guide future trachoma treatment and surveillance efforts.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Azithromycin/therapeutic use , Trachoma/drug therapy , Child , Child, Preschool , Chlamydia trachomatis/drug effects , Chlamydia trachomatis/physiology , Female , Humans , Infant , Male , Mass Drug Administration , Randomized Controlled Trials as Topic , Trachoma/epidemiology , Trachoma/microbiology
14.
Biosens Bioelectron ; 192: 113503, 2021 Nov 15.
Article in English | MEDLINE | ID: covidwho-1309167

ABSTRACT

The COVID-19 pandemic has unfortunately demonstrated how easily infectious diseases can spread and harm human life and society. As of writing, pandemic has now been on-going for more than one year. There is an urgent need for new nucleic acid-based methods that can be used to diagnose pathogens early, quickly, and accurately to effectively impede the spread of infections and gain control of epidemics. We developed a flap probe-based isothermal nucleic acid amplification method that is triggered by recombinant FEN1-Bst DNA polymerase, which-through enzymatic engineering-has both DNA synthesis, strand displacement and cleavage functions. This novel method offers a simpler and more specific probe-primer pair than those of other isothermal amplifications. We tested the method's ability to detect SARS-CoV-2 (both ORF1ab and N genes), rotavirus, and Chlamydia trachomatis. The limits of detection were 10 copies/µL for rotavirus, C. trachomatis, and SARS-CoV-2 N gene, and 100 copies/µL for SARS-CoV-2 ORF1ab gene. There were no cross-reactions among 11 other common pathogens with characteristics similar to those of the test target, and the method showed 100% sensitivity and 100% specificity in clinical comparisons with RT-PCR testing. In addition to real-time detection, the endpoint could be displayed under a transilluminator, which is a convenient reporting method for point-of-care test settings. Therefore, this novel nucleic acid senor has great potential for use in clinical diagnostics, epidemic prevention, and epidemic control.


Subject(s)
Biosensing Techniques , Chlamydia trachomatis/isolation & purification , Rotavirus/isolation & purification , SARS-CoV-2/isolation & purification , COVID-19 , DNA, Recombinant , DNA-Directed DNA Polymerase , Flap Endonucleases , Humans , Nucleic Acid Amplification Techniques , Pandemics , Sensitivity and Specificity
15.
BMJ Sex Reprod Health ; 47(3): 185-192, 2021 07.
Article in English | MEDLINE | ID: covidwho-1307922

ABSTRACT

OBJECTIVES: The digitalisation of sexual and reproductive health (SRH) services offers valuable opportunities to deliver contraceptive pills and chlamydia treatment by post. We aimed to examine the acceptability of remote prescribing and 'medication-by-post' in SRH. STUDY DESIGN: An online survey assessing attitudes towards remote management was distributed in three UK SRH clinics and via an integrated sexually transmitted infection (STI) postal self-sampling service. Logistic regressions were performed to identify potential correlates. RESULTS: There were 1281 participants (74% female and 49% <25 years old). Some 8% of participants reported having received medication via post and 83% were willing to receive chlamydia treatment and contraceptive pills by post. Lower acceptability was observed among participants who were: >45 years old (OR 0.43 (95% CI 0.23-0.81)), screened for STIs less than once annually (OR 0.63 (0.42-0.93)), concerned about confidentiality (OR 0.21 (0.90-0.50)), concerned about absence during delivery (OR 0.09 (0.02-0.32)) or unwilling to provide blood pressure readings (OR 0.22 (0.04-0.97)). Higher acceptability was observed among participants who reported: previously receiving medication by post (OR 4.63 (1.44-14.8)), preference for home delivery over clinic collection (OR 24.1 (11.1-51.9)), preference for home STI testing (OR 10.3 (6.16-17.4)), ability to communicate with health advisors (OR 4.01 (1.03-15.6)) and willingness to: register their real name (OR 3.09 (1.43-10.6)), complete online health questionnaires (OR 3.09 (1.43-10.6)) and use generic contraceptive pills (OR 2.88 (1.21-6.83)). CONCLUSIONS: Postal treatment and entering information online to allow remote prescribing were acceptable methods for SRH services and should be considered alongside medication collection in pharmacies. These methods could be particularly useful for patients facing barriers in accessing SRH. The cost-effectiveness and implementation of these novel methods of service delivery should be further investigated.


Subject(s)
Chlamydia trachomatis , Sexually Transmitted Diseases , Adult , Contraceptive Agents , Contraceptive Devices , Female , Humans , Male , Middle Aged , Sexual Behavior , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/drug therapy , Sexually Transmitted Diseases/epidemiology
16.
Int J STD AIDS ; 32(11): 998-1003, 2021 10.
Article in English | MEDLINE | ID: covidwho-1259120

ABSTRACT

Background: During the first two waves of COVID-19, several physical restriction measurements were imposed in Belgium. Our aim was to explore the impact of these restriction measures on the number of tests and positivity rate of Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (NG) before, during, and after the two lockdowns in Belgium. Methods: Chlamydia trachomatis/Neisseria gonorrhoeae molecular data of a Belgian STI clinic were extracted for 2019 and 2020, and both years were divided into four periods (pre-lockdown 1, lockdown 1, after lockdown 1, and lockdown 2). Weekly testing rates and positivity rate for both STIs were estimated, and mixed-effects logistic regression was used to explore statistical significant changes between both years, and the different periods were compared with the corresponding time period in 2019. The same analysis was done for pre-exposure prophylaxis(PrEP) users only. Results: No overall significant changes in positivity rate were found for either CT (8.0% in 2019 and 7.8% in 2020) or NG (4.5% in 2019 and 5.5% in 2020). Besides a significant drop in the number of CT/NG tests during lockdown 1 (decrease of 87%) and a subsequent increase in NG positivity rate (p > 0.05), no changes in CT/NG positivity rate were found in the other periods. The highest positivity rate for either CT or NG was found in lockdown 2 (15.1% vs 12.4% in 2019). The number of CT/NG tests in lockdown 2 was still 25% lower than 2019 levels. Subanalysis of only PrEP users revealed the same trend; however, the number of CT/NG tests in lockdown 2 was exactly the same as in 2019. Conclusion: Despite a significant decline in absolute CT or NG cases in lockdown 1, which was most likely a consequence of both physical distancing and reduced testing, CT/NG testing and positivity rates returned to pre-corona levels in lockdown 2, which may depict physical distancing fatigue.


Subject(s)
COVID-19 , Chlamydia Infections , Gonorrhea , Sexually Transmitted Diseases , Belgium/epidemiology , Chlamydia Infections/diagnosis , Chlamydia Infections/epidemiology , Chlamydia Infections/prevention & control , Chlamydia trachomatis , Communicable Disease Control , Gonorrhea/diagnosis , Gonorrhea/epidemiology , Gonorrhea/prevention & control , Humans , Neisseria gonorrhoeae , Prevalence , SARS-CoV-2 , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/prevention & control
17.
Euro Surveill ; 26(18)2021 05.
Article in English | MEDLINE | ID: covidwho-1219630

ABSTRACT

Despite social distancing measures implemented in Madrid to prevent the propagation of SARS-CoV-2, a significant increase (57.1%; 28.5 to 38.5 cases/month) in cases of lymphogranuloma venereum was detected during the COVID-19 pandemic. This unusual scenario might have accelerated a shift in Chlamydia trachomatis (CT) epidemiology towards a higher proportion of L genotypes compared with non-L genotypes in CT-positive samples. Our data underscore the importance of surveillance of sexually transmitted infections during the pandemic, in particular among vulnerable populations.


Subject(s)
COVID-19 , Lymphogranuloma Venereum , Chlamydia trachomatis/genetics , Homosexuality, Male , Humans , Lymphogranuloma Venereum/diagnosis , Lymphogranuloma Venereum/epidemiology , Male , Pandemics , SARS-CoV-2 , Spain/epidemiology
18.
BMJ Case Rep ; 14(4)2021 Apr 14.
Article in English | MEDLINE | ID: covidwho-1186260

ABSTRACT

A 49-year-old man presented with a 1-week history of abdominal pain, distension, diarrhoea and fatigue. CT of the abdomen and pelvis revealed peritonitis with no identifiable cause. Diagnostic laparoscopy was performed, which excluded gastrointestinal perforation. Peritoneal fluid tested positive for Chlamydia trachomatis and rectal swabs were positive for C. trachomatis serovars consistent with lymphogranuloma venereum (LGV). Additional blood tests also revealed a diagnosis of syphilis. This is a rare documented case of LGV peritonitis in a male without associated immunodeficiency. The patient recovered well following laparoscopic washout and a course of appropriate antibiotics.


Subject(s)
Lymphogranuloma Venereum , Peritonitis , Anti-Bacterial Agents/therapeutic use , Chlamydia trachomatis , Homosexuality, Male , Humans , Lymphogranuloma Venereum/complications , Lymphogranuloma Venereum/diagnosis , Lymphogranuloma Venereum/drug therapy , Male , Middle Aged , Peritonitis/diagnosis , Peritonitis/drug therapy
20.
Viruses ; 12(9)2020 09 05.
Article in English | MEDLINE | ID: covidwho-750632

ABSTRACT

An effective vaccine is essential for controlling the spread of the SARS-CoV-2 virus. Here, we describe an influenza virus-based vaccine for SARS-CoV-2. We incorporated a membrane-anchored form of the SARS-CoV-2 spike receptor binding domain (RBD) in place of the neuraminidase (NA) coding sequence in an influenza virus also possessing a mutation that reduces the affinity of hemagglutinin for its sialic acid receptor. The resulting ΔNA(RBD)-Flu virus can be generated by reverse genetics and grown to high titers in cell culture. A single-dose intranasal inoculation of mice with ΔNA(RBD)-Flu elicits serum neutralizing antibody titers against SAR-CoV-2 comparable to those observed in humans following natural infection (~1:200). Furthermore, ΔNA(RBD)-Flu itself causes no apparent disease in mice. It might be possible to produce a vaccine similar to ΔNA(RBD)-Flu at scale by leveraging existing platforms for the production of influenza vaccines.


Subject(s)
Coronavirus Infections , Influenza Vaccines , Influenza, Human , Pandemics , Pneumonia, Viral , Pregnancy Complications, Infectious , Animals , Antibodies, Neutralizing , Antibodies, Viral , Betacoronavirus , COVID-19 , Chlamydia trachomatis , Fertility , Humans , Mice , Pregnancy , SARS-CoV-2 , Spike Glycoprotein, Coronavirus , Virion
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