Older and swinging; need to identify hidden and emerging risk groups at STI clinics

International audienceObjective Identification of STI risk groups is essential for optimal prevention and medical care. Until now, swingers, i.e. heterosexual couples who are practicing mate swapping, group sex, visit sex clubs for couples, are not considered as a specific risk group for STI in health care services and prevention. Here, we compare STI prevalence rates in swingers to other risk groups. Methods At the STI clinic, South Limburg, The Netherlands, we systematically register since 2007 whether an attendee is a swinger. STI clinic surveillance data are analyzed to assess swingers' share in consultations and STI diagnoses; here Chlamydia Trachomatis (CT) and/or Neisseria Gonorrhoea (NG). Results Of all 8971 consultations, 12% were comprised by swingers (median age 43 years, interquartile range 38-48). Overall, STI prevalence is highest in youth, MSM and swingers. Older swingers show a CT prevalence of 10% and a NG prevalence of 4%. In the older age group with STI diagnosis, swingers have with 55% and MSM with 31% the largest share in STI. Conclusions Swingers comprise substantial part of STI consultations. They are a mainly older group and have an important share in STI diagnoses. While other risk groups for STI, such as young heterosexuals and MSM, are systematically identified at STI health care facilities in order to provide them with fitting services, for swingers this is generally not the case. Swingers, as other groups with risk behaviours, need to be identified and treated as a risk group in STI prevention and care

Acceptability of self-taken vaginal swabs and first-catch urine samples for the diagnosis of urogenital Chlamydia trachomatis and Neisseria gonorrhoeae with an amplified DNA assay in young women attending a public health sexually transmitted disease clinic

Public health efforts are needed to encourage young women to get tested for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). To assess the acceptability and feasibility of 2 noninvasive diagnostic approaches. Participants of this cross-sectional survey were 413 young women (age 16-35) who underwent STD testing by self-taken vaginal swab (SVS) and a first-catch urine sample (FCU) by nucleic acid amplification test (BDProbTec) and filled out a questionnaire. CT and GC were diagnosed in 10.9% (45/413) and 1.5% (6/413). Eleven percent of the participants who never previously had an STD examination (68%) tested STD positive. SVS and FCU were almost uniformly reported as easy to perform and preferred above gynecologic examination. Using SVS combined with FCU can be an important enhancing tool in public health approaches. Acceptability among potential patients is high, enabling the noninvasive detection of STDs that would otherwise remain undetected and untreate

Alarmingly poor performance in Chlamydia trachomatis point-of-care testing

International audienceObjectives Infection by Chlamydia trachomatis (CT) is the most prevalent sexually transmitted infection (STI) worldwide. The most frequently used diagnostic test for CT is a nucleic acid amplification test (NAAT), which is highly sensitive and specific. To further shorten time delay until diagnosis has been made, in order to prevent CT spread, the use of point of care (POC) tests could be the way forward. Three POC tests, Handilab-C, Biorapid CHLAMYDIA Ag test and QuickVue Chlamydia test, were evaluated regarding diagnostic performance in comparison with NAAT. Methods All women, above the age of 16 years old, consulting at an STI clinic between September 2007 and April 2008, were asked to participate. Women were asked to complete a short questionnaire and to collect 6 self-taken vaginal swabs (SVS). SVS 2 was used for NAAT and SVS 3 to 5 were randomized for the different POC tests. SVS 1 and 6 were used for determining quantitative CT load to validate the use of successive SVS. All POC tests were performed without knowledge of NAAT results. NAAT was used as the ‘gold standard'. Results 772 women were included. CT prevalence was 11% in our population. Sensitivities of the Biorapid CHLAMYDIA Ag test, QuickVue Chlamydia and Handilab-C test were 17%, 27% and 12% respectively. Conclusions In our opinion, the evaluated POC tests, due to the very low sensitivities, are not ready for widespread use. Our results underline the need for good quality assurance of POC tests, especially in view of Internet possibilities

Effectiveness of yearly, register based screening for chlamydia in the Netherlands: controlled trial with randomised stepped wedge implementation

To evaluate the effectiveness of register based, yearly chlamydia screening

Sex Transm Infect Alarmingly poor performance in Chlamydia trachomatis point-of-care testing

These results underline the need for good-quality assurance of POC tests, especially in view of the increased availability of these tests on the internet

High yield of reinfections by home-based automatic rescreening of Chlamydia positives in a large-scale register-based screening programme and determinants of repeat infections

In a systematic internet-based Chlamydia Screening Implementation Programme in The Netherlands, all chlamydia-positive participants automatically received a testkit after 6 months to facilitate early detection of repeat infections. The authors describe participation in repeat testing and prevalence and determinants of repeat infection during three consecutive annual screening rounds. Data collection included information on testkits sent, samples received and results of laboratory tests at time of baseline test and retest; (sexual) behavioural variables and socio-demographic variables were assessed. Chlamydia positives were requested to answer additional questions about treatment and partner notification 10 days after checking their results. Retest rate was 66.3% (2777/4191). Retest chlamydia positivity was 8.8% (242/2756) compared with a chlamydia positivity at first screening test of 4.1%. Chlamydia positivity was significantly higher in younger age groups (14.6% in 16-19 years, 8.5% and 5.5% in 20-24 and 25-29 years; p <0.01); in participants with lower education (15.2% low, 11.1% medium and 5.1% high; p <0.001) and in Surinamese/Antillean (13.1%), Turkish/Moroccan (12.9%) and Sub-Saharan African participants (18.6%; p <0.01). At baseline, 88.7% infected participants had reportedly been treated and treatment of current partner was 80.1%. Automated retesting by sending a testkit after 6 months to all chlamydia positives achieved high retest uptake and yielded a positivity rate twice as at baseline and can therefore be recommended as an additional strategy for chlamydia control. The high rate of repeat infections among known risk groups suggests room for improvement in patient case management and in effective risk reduction counsellin

Systematic selection of screening participants by risk score in a Chlamydia screening programme is feasible and effective

Systematic screening for Chlamydia trachomatis by individual invitation can be optimised by filtering participants on risk profile, excluding people at no or low risk. The authors investigated this technique in a large-scale chlamydia screening programme in The Netherlands in one rural region where relatively low prevalence was expected ( <2%). Invitees were alerted by personal letter to log in to http://www.chlamydiatest.nl and fill in an 8-item questionnaire. Only invitees with sufficient score could proceed to request a test kit. The authors investigated the effect of selection on participation, positivity and acceptability in three screening rounds and on the number needed to invite and the number needed to screen. The selection led to exclusion of 36% of potential participants and a positivity rate of 4.8% among participants, achieving similar number needed to screen values in the rural and urban areas. Higher scores were clearly related to higher positivity rates. Persons who were excluded from participation did not have a lower response in the next round. The acceptability study revealed disappointment about exclusion of 30% of excluded participants but most approved of the screening set-up. Systematic selection of screening participants by risk score is feasible and successful in realising higher positivity rates. A somewhat stricter selection could be applied in the rural and urban areas of the screening programme. Multiple-item selection with a cut-off total score may work better than, more commonly used, selection by single criteria, especially in low-risk populations. Acceptability of selection is high but could still be improved by better communication on expectation