Improving STD testing behavior among high-risk young adults by offering STD testing at a vocational school

<p>Abstract</p> <p>Background</p> <p>Chlamydia trachomatis infection (CT) is the most prevalent bacterial STD. Sexually active adolescents and young adults are the main risk group for CT. However, STD testing rates in this group are low since exposed individuals may not feel at risk, owing-at least in part-to the infection's largely asymptomatic nature. Designing new testing environments that are more appealing to young people who are most at risk of acquiring chlamydia can be an important strategy to improve overall testing rates. Here we evaluate the effect of a school-based sexual health program conducted among vocational school students, aiming to obtain better access for counseling and enhance students' STD testing behavior.</p> <p>Methods</p> <p>Adolescents (median age 19 years) attending a large vocational school were provided with sexual health education. Students filled in a questionnaire measuring CT risk and were offered STD testing. Using univariate and multivariate analysis, we assessed differences between men and women in STD-related risk behavior, sexual problems, CT testing behavior and determinants of CT testing behavior.</p> <p>Results</p> <p>Of 345 participants, 70% were female. Of the 287 sexually active students, 75% were at high risk for CT; one third of women reported sexual problems. Of sexually active participants, 61% provided a self-administered specimen for STD testing. Independent determinants for testing included STD related symptoms and no condom use. All CT diagnoses were in the high-CT-risk group. In the high-risk group, STD testing showed an increased uptake, from 27% (previous self-reported test) to 65% (current test). CT prevalence was 5.7%.</p> <p>Conclusions</p> <p>Vocational school students are a target population for versatile sexual health prevention. When provided with CT testing facilities and education, self selection mechanisms seemed to increase CT testing rate dramatically in this high-CT-risk population expressing sexual problems. Considering the relative ease of testing and treating large numbers of young adults, offering tests at a vocational school is feasible in reaching adolescents for STD screening. Although cost-effectiveness remains an issue counseling is effective in increasing test rates.</p

Chlamydia trachomatis transmission between the oropharynx, urethra and anorectum in men who have sex with men: a mathematical model

BACKGROUND: It has been presumed that Chlamydia trachomatis is transmitted between men only through anal or oral sex, but no mathematical models have tested this presumption. METHODS: To test this presumption, we created 20 compartmental mathematical models of different sexual practices that included both oral and anal sex and calibrated these models to the observed rates of Chlamydia trachomatis infection at three anatomical sites from 4888 men who have sex with men (MSM) in Melbourne Sexual Health Centre during 2018-2019. RESULTS: A model that included only oral and anal sex could replicate the observed rates of single-site infection at the oropharynx, urethra and rectum alone, but could not replicate infection at more than one of these sites (multisite). However, if we included transmission from sexual practices that followed one another in the same sexual episode (e.g. saliva contamination of the penis from oral sex transmitting chlamydia to the rectum by anal sex), we significantly improved the calibration of multisite infection rates substantially. CONCLUSIONS: Our modelling study suggests that transmission routes other than just oral and anal sex are necessary to explain the high rate of Chlamydia trachomatis infection at more than one site

What is needed to guide testing for anorectal and pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae in women and men? Evidence and opinion

© 2015 Dukers-Muijrers et al.Background: Anorectal and pharyngeal infections with Chlamydia trachomatis (CT) and Neisseria gonorrheae (NG) are commonly observed in men who have sex with men (MSM). There is increasing evidence that such infections at extra

Trends in Antibiotic Prescribing in Adults in Dutch General Practice

Background: Antibiotic consumption is associated with adverse drug events (ADE) and increasing antibiotic resistance. Detailed information of antibiotic prescribing in different age categories is scarce, but necessary to develop strategies for prudent antibiotic use. The aim of this study was to determine the antibiotic prescriptions of different antibiotic classes in general practice in relation to age. Methodology: Retrospective study of 22 rural and urban general practices from the Dutch Registration Network Family Practices (RNH). Antibiotic prescribing data were extracted from the RNH database from 2000-2009. Trends over time in antibiotic prescriptions were assessed with multivariate logistic regression including interaction terms with age. Registered ADEs as a result of antibiotic prescriptions were also analyzed. Principal Findings: In total 658,940 patients years were analyzed. In 11.5% (n = 75,796) of the patient years at least one antibiotic was prescribed. Antibiotic prescriptions increased for all age categories during 2000-2009, but the increase in elderly patients (>80 years) was most prominent. In 2000 9% of the patients >80 years was prescribed at least one antibiotic to 22% in 2009 (P<0.001). Elderly patients had more ADEs with antibiotics and co-medication was identified as the only independen Conclusion/Discussion: The rate of antibiotic prescribing for patients who made a visit to the GP is increasing in the Netherlands with the most evident increase in the elderly patients. This may lead to more ADEs, which might lead to higher consumption of health care and more antibiotic resistance

Surveillance of HIV infection among injecting drug users in the Netherlands: results Heerlen/Maastricht 1998/1999

Between October 30 1998 and May 27 1999, a serum sample and a questionnaire on risk behaviour were obtained from 222 IDU in Heerlen and Maastricht. Participation was on a voluntary basis and anonymous. Participants were recruited at methadone treatment sites (63%), low-threshold daytime care projects (19%), 'on the street' (10%), and in detainment sites (7%). Of 214 IDU, 30 persons were found to be infected with HIV (prevalence 14.0%, 95% confidence interval [CI] 9.7 - 19.4). Seroprevalence was higher in Heerlen (21.6%) than in Maastricht (5.1%) and has increased in Heerlen since 1994 (11%). Eighteen (14%) out of 134 currently injecting IDU borrowed syringes or needles in the last 6 months (1996: 17%, 1994: 19%, not significant). These percentages seem to be similar in the other cities in our surveillance studies. Condom use was very low during sexual contact between steady partners; this was found consistently for the total group (89% not always using a condom). 26% of the IDU have a non-drug user as a steady sexual partner. In spite of several prevention programmes, residual injecting and sexual risk behaviour continues. The presence of high risk behaviour in combination with a high HIV-prevalence indicates the risk of further spread of HIV infectionTussen 30 oktober 1998 en 27 mei 1999 werd bij 222 IDs uit Heerlen en Maastricht een bloedmonster en een vragenlijst naar risicogedrag afgenomen. De IDs werden geworven via methadon-posten (63%), laagdrempelige instellingen voor druggebruikers (19%), straatwerving (10%) en arrestantenverblijven (7%). Van de 214 IDs waren 30 deelnemers HIV-positief (prevalentie 14,0%; 95% betrouwbaarheidsinterval [BI] 9,7 - 19,4%). De HIV-prevalentie was hoger in Heerlen (21,6%) dan in Maastricht (5,1%). In Heerlen was een stijgende trend te zien ten opzichte van eerdere metingen (1994: 10%). Van de 134 actueel spuitende IDs had 14% in de laatste zes maanden een gebruikte spuit of naald van een ander geleend. Van hen was 11% HIV-positief. Dertien procent had een spuit of naald uitgeleend. Vijfenveertig procent van de IDs had langer dan zes maanden voor het onderzoek spuiten/naalden van een ander geleend, waarvan 24% HIV-positief was. Veertig procent van de IDs had in de laatste zes maanden een vaste seksuele partner gehad. Bij 36% hiervan was deze partner geen druggebruiker, bij 21% een niet-injecterende druggebruiker. Met de vaste seksuele partner werd in 89% van de contacten niet altijd een condoom gebruikt. Met losse partners en klanten worden condooms vaker gebruikt (niet altijd condoom gebruikt: losse partners 49%, klanten 25%). Door de aanwezigheid van spuitgerelateerd en seksueel risicogedrag in combinatie met een hoge HIV-prevalentie is het risico op HIV-transmissie aanwezig

Surveillance of HIV infection among injecting drug users in the Netherlands: results Heerlen/Maastricht 1998/1999

Tussen 30 oktober 1998 en 27 mei 1999 werd bij 222 IDs uit Heerlen en Maastricht een bloedmonster en een vragenlijst naar risicogedrag afgenomen. De IDs werden geworven via methadon-posten (63%), laagdrempelige instellingen voor druggebruikers (19%), straatwerving (10%) en arrestantenverblijven (7%). Van de 214 IDs waren 30 deelnemers HIV-positief (prevalentie 14,0%; 95% betrouwbaarheidsinterval [BI] 9,7 - 19,4%). De HIV-prevalentie was hoger in Heerlen (21,6%) dan in Maastricht (5,1%). In Heerlen was een stijgende trend te zien ten opzichte van eerdere metingen (1994: 10%). Van de 134 actueel spuitende IDs had 14% in de laatste zes maanden een gebruikte spuit of naald van een ander geleend. Van hen was 11% HIV-positief. Dertien procent had een spuit of naald uitgeleend. Vijfenveertig procent van de IDs had langer dan zes maanden voor het onderzoek spuiten/naalden van een ander geleend, waarvan 24% HIV-positief was. Veertig procent van de IDs had in de laatste zes maanden een vaste seksuele partner gehad. Bij 36% hiervan was deze partner geen druggebruiker, bij 21% een niet-injecterende druggebruiker. Met de vaste seksuele partner werd in 89% van de contacten niet altijd een condoom gebruikt. Met losse partners en klanten worden condooms vaker gebruikt (niet altijd condoom gebruikt: losse partners 49%, klanten 25%). Door de aanwezigheid van spuitgerelateerd en seksueel risicogedrag in combinatie met een hoge HIV-prevalentie is het risico op HIV-transmissie aanwezig.Between October 30 1998 and May 27 1999, a serum sample and a questionnaire on risk behaviour were obtained from 222 IDU in Heerlen and Maastricht. Participation was on a voluntary basis and anonymous. Participants were recruited at methadone treatment sites (63%), low-threshold daytime care projects (19%), 'on the street' (10%), and in detainment sites (7%). Of 214 IDU, 30 persons were found to be infected with HIV (prevalence 14.0%, 95% confidence interval [CI] 9.7 - 19.4). Seroprevalence was higher in Heerlen (21.6%) than in Maastricht (5.1%) and has increased in Heerlen since 1994 (11%). Eighteen (14%) out of 134 currently injecting IDU borrowed syringes or needles in the last 6 months (1996: 17%, 1994: 19%, not significant). These percentages seem to be similar in the other cities in our surveillance studies. Condom use was very low during sexual contact between steady partners; this was found consistently for the total group (89% not always using a condom). 26% of the IDU have a non-drug user as a steady sexual partner. In spite of several prevention programmes, residual injecting and sexual risk behaviour continues. The presence of high risk behaviour in combination with a high HIV-prevalence indicates the risk of further spread of HIV infectionInspectie voor de Gezondheidszorg (IGZ

Infections with HIV, HBV and HCV among injecting drug users in Heerlen/Maastricht (in the Netherlands)

In this study the prevalence of HIV among intravenous drug users (IDU) in Heerlen and Maastricht (Southern Netherlands) is assessed. The results are compared with a previous survey in Heerlen/Maastricht in 1994. The risk of further spread among IDU, to non-IDU and to the general population is evaluated. The prevalence of HBV and HCV is assessed. Between 7 October and 5 december 1996 a saliva specimen, a blood sample and a short questionnaire on risk behaviour were obtained from 203 IDU in Heerlen and 101 IDU in Maastricht. Of the 304 IDU, 36 persons were infected. Independent risk factors for a positive test result were no fixed abode, imprisonment , current injecting, polydrug use and age under 16 at first injecting (OR=2.8 [1.0-7.8]). 17% of the current injectors borrowed used syringes or needles in the last 6 months, the same level as in 1994. 18% of the IDU have a non-drug user as steady sexual partner. Condom use was low during sexual contact between steady partners. The prevalence of anti-HBV was 63%, HBsAg 6% and anti-HCV 74%. In conclusion the prevalence of HIV among IDU in Southern Limburg is about 12%, simular to the level of 1994 but there is a difference between Heerlen (16%) and Maastricht (3%). Injecting and sexual risk behaviour occurs regularly and at the same level of 1994. The risk of further spread among IDU is high. Spread to non-IDU or the general population, especially steady partners of IDUs, is likely.In dit project wordt de prevalentie vastgesteld van HIV, hepatitis B (HBV), hepatitis C (HCV) en het risicogedrag onder injecterende druggebruikers (IDs) in Heerlen/Maastricht. Er werd nagegaan of er belangrijke verschillen zijn ten opzichte van de meting twee jaar geleden. Het risico werd ingeschat op verdere verspreiding van HIV naar andere IDs, niet-injecterende druggebruikers en de rest van de algemene bevolking. Tussen 7 oktober en 5 december 1996 werd bij 203 IDs uit Heerlen en omstreken en 101 IDs uit Maastricht een speekselmonster, een bloedmonster en een vragenlijst naar risicogedrag afgenomen. Van de 304 IDs waren 36 HIV-positief. Risicofactoren voor HIV-infectie waren geen vast adres hebben, gevangenisstraf, actueel spuiten, polydruggebruik en jonger dan 16 jaar bij eerste spuit. Van de 209 actuele spuiters had 17% in de laatste zes maanden een gebruikte spuit of naald van een ander geleend, 11% had een spuit of naald uitgeleend en 30% had een gebruikt watje, lepel, filter of spoelwater (spuitattributen) geleend. Vijfenveertig procent van de IDs had in de laatste zes maanden een vaste seksuele partner gehad. Bij 40% hiervan was dat geen druggebruiker, bij 13% een niet-injecterende druggebruiker. In vier van de vijf vaste relaties werd nooit een condoom gebruikt. De prevalenties van anti-HBV, HBsAg en anti-HCV waren respectievelijk 63%, 6% en 74%. Concluderend is de prevalentie van HIV onder IDs in Heerlen/Maastricht ongeveer 12%, vergelijkbaar met het niveau in de meting van 1994. De prevalentie van HIV onder IDs uit Heerlen e.o. was vijf keer zo hoog als die onder IDs uit Maastricht ; een dergelijk verschil is in 1994 niet vastgesteld. Het risicogedrag is in vergelijking met 1994 niet in belangrijke mate veranderd. Nieuwe HIV-infecties komen nog steeds voor als gevolg van het lenen van gebruikte spuiten en naalden en mogelijk ook via seksuele transmissie. Vooral vaste partners kunnen een risico lopen. Via deze weg is verspreiding naar niet-IDs aannemelijk. Transmissie van HBV en HCV via gebruikte spuitattributen en seksuele contacten (alleen HBV) lijkt waarschijnlijk