journal article
Download Only Collection
Home
doi: 10.1136/sti.2004.010058pmid: 15681715
We report what we think is the first case of localised angioedema of the glans penis as a result of contact allergy to prilocaine in EMLAP cream. We also propose a new term, contact angioedema for this condition.
van Bergen, J; Götz, H M; Richardus, J H; Hoebe, C J P A; Broer, J; Coenen, A J T
doi: 10.1136/sti.2004.010173pmid: 15681716
Objectives:Chlamydia trachomatis (Chlamydia) is the most prevalent sexually transmitted bacterial infection and can cause considerable reproductive morbidity in women. Chlamydia screening programmes have been considered but policy recommendations are hampered by the lack of population based data. This paper describes the prevalence of Chlamydia in 15–29 year old women and men in rural and urban areas, as determined through systematic population based screening organised by the Municipal Public Health Services (MHS), and discusses the implications of this screening strategy for routine implementation. Methods: Stratified national probability survey according to “area address density” (AAD). 21 000 randomly selected women and men in four regions, aged 15–29 years received a home sampling kit. Urine samples were returned by mail and tested by polymerase chain reaction (PCR). Treatment was via the general practitioner, STI clinic, or MHS clinic. Results: 41% (8383) responded by sending in urine and questionnaire. 11% (2227) returned a refusal card. Non-responders included both higher and lower risk categories. Chlamydia prevalence was significantly lower in rural areas (0.6%, 95% CI 0.1 to 1.1) compared with very highly urbanised areas (3.2%, 95% CI 2.4 to 4.0). Overall prevalence was 2.0% (95% CI 1.7 to 2.3): 2.5% (95% CI 2.0 to 3.0%) in women and 1.5% (95% CI 1.1 to 1.8) in men. Of all cases 91% were treated. Infection was associated with degree of urbanisation, ethnicity, number of sex partners, and symptoms. Conclusion: This large, population based study found very low prevalence in rural populations, suggesting that nationwide systematic screening is not indicated in the Netherlands and that targeted approaches are a better option. Further analysis of risk profiles will contribute to determine how selective screening can be done.
Götz, H M; van Bergen, J E A M; Veldhuijzen, I K; Broer, J; Hoebe, C J P A; Richardus, J H
doi: 10.1136/sti.2004.010181pmid: 15681717
Background: Screening for Chlamydia trachomatis infections is aimed at the reduction of these infections and subsequent complications. Selective screening may increase the cost effectiveness of a screening programme. Few population based systematic screening programmes have been carried out and attempts to validate selective screening criteria have shown poor performance. This study describes the development of a prediction rule for estimating the risk of chlamydial infection as a basis for selective screening. Methods: A population based chlamydia screening study was performed in the Netherlands by inviting 21 000 15–29 year old women and men in urban and rural areas for home based urine testing. Multivariable logistic regression was used to identify risk factors for chlamydial infection among 6303 sexually active participants, and the discriminative ability was measured by the area under the receiver operating characteristic curve (AUC). Internal validity was assessed with bootstrap resampling techniques. Results: The prevalence of C trachomatis (CT) infection was 2.6% (95% CI 2.2 to 3.2) in women and 2.0% (95% CI 1.4 to 2.7) in men. Chlamydial infection was associated with high level of urbanisation, young age, Surinam/Antillian ethnicity, low/intermediate education, multiple lifetime partners, a new contact in the previous two months, no condom use at last sexual contact, and complaints of (post)coital bleeding in women and frequent urination in men. A prediction model with these risk factors showed adequate discriminative ability at internal validation (AUC 0.78). Conclusion: The prediction rule has the potential to guide individuals in their choice of participation when offered chlamydia screening and is a promising tool for selective CT screening at population level.
doi: 10.1136/sti.2004.010777pmid: 15681719
Objectives: To identify current levels of testing men for chlamydia and establish levels of knowledge relating to chlamydia infection among practice nurses in primary care in one north Wales local area health group (LHG) as part of a study to improve delivery of sexual health services in primary care. Methods: Anonymous confidential self completed postal questionnaires were sent to 46 practice nurses employed at 22 GP practices within one north Wales LHG. On return of the questionnaires and analysis of the data using SPSS, semistructured interviews with seven practice nurses were undertaken. Results: Responses were obtained from 33/46 (71.7%) practice nurses. The majority, 30 (90.9%), do not examine male genitalia and 18 (54.5%) have never tested male patients for chlamydia infection. 28 (84.8%) practice nurses do not consider contact tracing as part of their role. Conclusions: Primary care has a pivotal part to play in reducing prevalence of chlamydia. The paucity of male testing for chlamydia and a lack of consistent uniform testing and contact tracing in primary care has implications for the prevalence and long term consequences of infection. There is scope to greatly increase male testing for chlamydia both for those presenting with signs and symptoms of infection and those asymptomatic. This cannot be achieved without both educational and financial support for practice nurses.
van der Bij, A K; Stolte, I G; Coutinho, R A; Dukers, N H T M
doi: 10.1136/sti.2003.007997pmid: 15681720
Objectives: The incidence of HIV and STIs increased among men who have sex with men (MSM) visiting our STI clinic in Amsterdam. Interestingly, HIV increased mainly among older (⩾35 years) MSM, whereas infection rates of rectal gonorrhoea increased mainly in younger men. To explore this discrepancy we compared trends in STIs and HIV in a cohort of young HIV negative homosexual men from 1984 until 2002. Methods: The study population included 863 men enrolled at ⩽30 years of age from 1984 onward in the Amsterdam Cohort Studies (ACS). They had attended at least one of the 6 monthly follow up ACS visits at which they completed a questionnaire (including self reported gonorrhoea and syphilis episodes) and were tested for syphilis and HIV. Yearly trends in HIV and STI incidence and risk factors were analysed using Poisson regression. Results: Mean age at enrolment was 25 years. The median follow up time was 4 years. Until 1995 trends in HIV and STI incidence were concurrent, however since 1995 there was a significant (p<0.05) increase in syphilis (0 to 1.4/100 person years (PY)) and gonorrhoea incidence (1.1 to 6.0/100 PY), but no change in HIV incidence (1.1 and 1.3/100 PY). Conclusions: The incidence of syphilis and gonorrhoea has increased among young homosexual men since 1995, while HIV incidence has remained stable. Increasing STI incidence underscores the potential for HIV spread among young homosexual men. However, several years of increasing STIs without HIV, makes the relation between STI incidence and HIV transmission a subject for debate.
Ebrahim, S H; McKenna, M T; Marks, J S
doi: 10.1136/sti.2003.008300pmid: 15681721
As part of an analysis of the burden of disease and injury in the United States, we identified and quantified the incidence of adverse health events, deaths, and disability adjusted life years (DALY) attributed to sexual behaviour. In 1998, about 20 million such events (7532/100 000 people) and 29 782 such deaths (1.3% of all US deaths) occurred, contributing to 2 161 417 DALYs (6.2% of all US DALYs). The majority of incident health events (62%) and DALYs (57%) related to sexual behaviour were among females, and curable infections and their sequelae contributed to over half of these. Viral infections and their sequelae accounted for nearly all sexual behaviour related deaths—mostly HIV/AIDS. Sexual behaviour attributed DALYs in the United States are threefold higher than that in overall established market economies.
Monteiro, E F; Lacey, C J N; Merrick, D
doi: 10.1136/sti.2004.009431pmid: 15681722
Objectives: To examine the interrelation between demographic and geospatial risk factors for gonorrhoea, chlamydia, genital warts, and genital herpes. Design: We analysed age, sex, ethnicity, socioeconomic status, and area of residence for Leeds residents aged 15–54 with Neisseria gonorrhoeae, genital Chlamydia trachomatis, first episode genital herpes, and first episode genital warts during 1994–5. The 1991 UK census provided denominator population information. Results: Regression analysis showed that young age (15–24 years), ethnicity (with a gradient of risk black >white >Asian), and residence in inner city areas of deprivation were independent risk factors for all STDs. There were highly significant correlations in the geospatial distribution of incidence rates between the four infections. However, there was variation in the degree of central urban clustering, with gonorrhoea having the most restricted, and genital warts and chlamydia the widest distribution. 31% of all disease occurred in the four inner city census wards, representing 15% of the population. Conclusion: These results are in keeping with core group theory applying in a unified manner to the four most common UK sexually transmitted diseases in this urban area. Population based studies are needed to clarify whether ethnicity is associated with differing sexual behavioural or mixing patterns. Our data suggest that chlamydia screening in women <25 years of age could detect 70% of cases in the community, that such programmes should give particular emphasis to implementation in core group areas, and that they could function as unifying strategies for the control of most common STDs within urban areas.
Wang, D B; Zhang, X J; Zhang, H B; Zhang, C Y; Su, B
doi: 10.1136/sti.2003.008912pmid: 15681723
Background/objectives: The key to HIV/STI control is community-wide intervention (CWI) which depends heavily on continuous monitoring and evaluation. Unfortunately, comprehensive CWI assessment methodology and reports are generally lacking. This study developed, applied, and evaluated a rapid tool for assessing CWI in China. Methods: A total of 120 county level respondents in charge of county-wide responses to HIV/STI thoughout China were selected randomly and surveyed using a structured inventory consisting of three tiers of indicators developed via consensus group techniques. The respondents were asked to rate each of the indicators against a five grade (1–5) scale. 30 pairs of the same staff from within Anhui Province were surveyed to gauge inter-rater reliability. Results: Response rate for the nationwide survey was 85% and for inter-rater reliability survey, 90%. Correlation coefficients between the inter-rater ratings ranged from 0.68 to 0.95. The overall average rating of CWI in China was 2.85. Average ratings for the six first tier indicators, organisation and policy development, goals and objectives setting, project and action planning, resource exploitation, project and task implementation, and CWI evaluation were 2.87, 2.83, 2.67, 2.77, 3.26, and 2.71 respectively. Ratings derived for the 24 second tier indicators ranged from 2.1 to 3.86; while for the 96 third tier indicators, 1.90 to 4.40 Conclusions: The instrument developed proved to be reliable, useful, and easily applicable in common communities. Application of it in China revealed that a large gap exists between desired and actual CWI, and areas meriting particular attention include policy and incentives development, intervention planning and evaluation, and fund raising and utilisation.
Showing 1 to 10 of 19 Articles