[Prevalence of Chlamydia among young men. A screening among men liable for military service and coming before the military board]. / Forekomsten af klamydia blandt unge maend. En screeningsundersøgelse blandt maend fremmødt på session.

INTRODUCTION: Chlamydia is the most common sexually transmitted bacterial infection in Denmark. Each year 13-14,000 cases are diagnosed; of these about 3000 occur in men. In order to describe the prevalence of chlamydia among young men, screening for chlamydia was conducted in those liable for military service and coming before the medical board. MATERIALS AND METHODS: Of 2500 men coming before the medical boards in North Jutland State County, Arhus State County, and Copenhagen County during the winter of 1996-97, 1345 men aged 17-32 (median 18 years) were entered in the study. The participants sent a urine sample and a filled-in questionnaire to Statens Serum Institut. The urine samples were analysed by an in-house PCR and the test results were sent to the participant; if permission had been granted, the positive test results were further sent to the general practitioner, along with a second questionnaire. RESULTS: Chlamydia was found in 4.8% (65/1345) of all participants and in 6.9% of those sexually active. In North Jutland State County 7.1 and 9.8%, respectively, had chlamydia, whereas the corresponding figures for Arhus State County and Copenhagen County were about 4% and 6%. Two-thirds of the patients had no symptoms of urethritis. DISCUSSION: The results of this study indicate that a considerable reservoir of unrecognised chlamydia must exist in young men. The prevalence of chlamydia was higher in North Jutland State County than in the other two districts. One explanation could be that there is more focus on sexually transmitted infections and contact tracing in the largest cities than in the rest of the country.

[Handling of Chlamydia infections in young men aged 15 to 25 years by general practitioners. A questionnaire study]. / Praktiserende laegers håndtering af klamydia hos unge mellem 15 og 25 år. En spørgeskemaundersøgelse.

INTRODUCTION: Urogenital chlamydia is still common in the young. The late risks are well-documented. Most of the infections are diagnosed in general practice. The aim was to assess general practitioners' handling of urogenital chlamydial infections in young people aged 15-25 years. METHODS: Two groups of GPs were selected at random and were asked to complete a questionnaire before and after a "State-of-the-Art" was sent to all GPs from the National Board of Health. The questionnaire covered questions about 1) the test indication; 2) advice on the infection diagnosed; 3) contact tracing; and 4) first choice of treatment for uncomplicated infection in non-pregnant women. RESULTS: There was no difference between the two groups in the answers to questions 1) to 3), but an obvious change towards single-dose treatment in question 4), not because of the "State-of-the-Art", but rather because of the intensive marketing of the simple treatment regime. DISCUSSION: Implementation of new knowledge in general practice does not work only through national guidelines from the authorities to general practice, but is wholly dependent on central and local collaboration and GPs having the chance to discuss it between themselves.

Urogenital Chlamydia trachomatis infections in general practice: diagnosis, treatment, follow-up and contact tracing.

BACKGROUND: Patients with urogenital Chlamydia trachomatis infection are frequently seen in general practice. It is, therefore, important to assess GPs' management of these patients in order to ensure adequate control of the disease. OBJECTIVE: We aimed to evaluate the GPs' routines in diagnosis, medical treatment, follow-up and contact tracing according to knowledge/attitude (criteria) and actual performance. METHODS: The study comprised the 388 GPs in the County of Aarhus. Two questionnaires were used. The first questionnaire was mailed to each of 252 GPs who had attended a patient with urogenital C. trachomatis infection 4 weeks previously. Each GP was asked about his/her actual performance for that particular patient. In order to elucidate the GPs' criteria, the second questionnaire was mailed to each of the 388 GPs in the County of Aarhus, asking about their usual intended routines (criteria) for managing urogenital C. trachomatis infections. The questionnaires covered the same topics. RESULTS: Great variations among the GPs' management of urogenital C. trachomatis infection according to sampling-site, medical treatment, follow-up and contact tracing were found. Furthermore, a discrepancy between criteria and actual performance for obtaining an urethral swab-sample in women and for contact tracing of previous partners were demonstrated. The GPs stated that they had intended to obtain more urethral swab-samples and do more contact tracing than they actually did. CONCLUSIONS: We conclude that increasing the collection of urethral samples from women combined with greater emphasis on contact tracing procedures might limit the prevalence of the infection. In order to achieve this, continuous medical education and auditing procedures on urogenital chlamydial infections may be helpful.

Observer variation in ultrasound assessment of the thyroid gland.

In order to determine observer variation in the assessment of the thyroid gland by ultrasonography, two specialists (one endocrinologist and one radiologist) independently evaluated 76 thyroid glands, and assessed the sonogram as homogeneous, inhomogeneous, containing a solitary solid lesion or a solitary cyst in each of 152 thyroid lobes. The observed agreement between the two observers ranged from 0.80 to 0.91. By the use of the kappa coefficient the observed agreement was adjusted for change agreement. Kappa can vary from -1 (total disagreement) to +1 (total agreement) and kappa values between 0.55 and 0.60 were found. Among 152 lobes a solitary solid lesion, i.e. a nodule, was found in 22 lobes by the two observers; however, they only agreed on a classification in 10 lobes (45%). Clinicians should be aware of the moderate agreement between observers in thyroid ultrasonography.