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Who's at risk of catching Chlamydia trachomatis? Identifying factors associated with increased risk of infection to enable individualized care and intervention
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chlamydia trachomatis (CT) can cause infertility and is the most common sexually transmitted infection (STI) of bacterial origin in Europe. Surveys in seven countries estimated a population prevalence of 1.4-3.0 % in people 18 to 44 years. Approximately 87% of those diagnosed in Sweden are 15-29 years. Since 1997, with the exception of 2009-2010, despite all efforts, CT has increased steadily in many European countries including Sweden. That made us investigate risk factors associated with catching STIs, especially CT. In Sweden partner notification is mandatory by law when a patient is diagnosed with CT. Centralised partner notification, performed by a few experienced counsellors, and evaluation of the sexual history for at least 12 months back in time, shows superior results compared to other studies. Phone-interviews are a good option in remote areas. “The Västerbotten model” for partner notification fulfils these criteria and our evaluation has functioned as a model for changing recommendations of partner notification in Sweden. Preventing CT by primary prevention such as information and counselling is, however, still of great importance. We investigated whether it was necessary to test for CT in the throat. We found that patients testing positive for pharyngeal CT neither had more symptoms or signs nor a sexual history that differed from others. We therefore believe that we will find most or all of these patients by conventional testing of urine and cervical/vaginal samples. We wanted to further identify risk factors among patients attending a clinic for sexually transmitted infections to enable individualized care depending on risk. None or inconsistent use of condoms with new/temporary partners in combination with having at least one new/temporary partner within the past 6 months could identify persons with risk behaviour and at increased risk of CT (re)infection. Additional information about whether the condom was used during the whole intercourse did not add any risk of infection. A drop-in reception is a good contribution to an opportunistic screening approach. The rate of CT infected is high and the clinic attracts men and individuals ≥25 years old at risk of infection, groups which usually have a reduced test rate. The mean age was 28 years and 58% of the patients were men. The figure of correct condom usage is very low indicating the need for risk reducing counselling also in this grown-population. Among adult STI patients anxiety was common and depression uncommon. Neither was linked to high risk sexual behaviour nor ongoing CT infection. Hazardous alcohol consumption, however, was common and linked to anxiety and high risk sex. We conclude that preventive work can not only focus on STI prevention, but must consider the high frequency of hazardous alcohol consumption, which probably is contributing to sexual risk behaviour. 

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2010. , 56 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1389
Keyword [en]
Chlamydia trachomatis; contact tracing; partner notification, sexual behaviour; screening; condom use, individualized care, risk; anxiety; binge drinking
National Category
Dermatology and Venereal Diseases
Research subject
Dermatology and Venerology
Identifiers
URN: urn:nbn:se:umu:diva-37871ISBN: 978-91-7459-105-7 (print)OAI: oai:DiVA.org:umu-37871DiVA: diva2:370776
Public defence
2010-12-10, Hörsal Betula, byggnad 6M, Norrlands Universitetssjukhus, Umeå, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2010-11-19 Created: 2010-11-17 Last updated: 2015-09-11Bibliographically approved
List of papers
1. Improved contact tracing for Chlamydia trachomatis with experienced tracers, tracing for one year back in time and interviewing by phone in remote areas
Open this publication in new window or tab >>Improved contact tracing for Chlamydia trachomatis with experienced tracers, tracing for one year back in time and interviewing by phone in remote areas
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2008 (English)In: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 84, no 3, 239-242 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To evaluate the Swedish model for contact tracing and especially the "Västerbotten model" with centralised, extended contact interview periods, sometimes by telephone.

METHODS: Using questionnaires, the contact tracing and interview procedure was evaluated during 2002, followed by an evaluation of contact interviewing by phone in 2005-6.

RESULTS: Patients with diagnosed Chlamydia trachomatis infection reported on average 2.5 sexual contacts, 3.0 contacts when contact interviewing was performed at the clinic, and 2.3 contacts when performed by phone. 65% of the sexual contacts with a known test result were infected.

CONCLUSION: Centralised contact tracing, exploring the sexual history for at least 12 months back in time, shows good results. Combined with screening of certain risk groups it is probably one effective way of preventing C trachomatis infections. Preventing C trachomatis by primary prevention such as information and counselling is, however, still of great importance.

National Category
Clinical Medicine Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:umu:diva-23589 (URN)10.1136/sti.2007.028068 (DOI)000256206600024 ()18216154 (PubMedID)
Available from: 2009-06-26 Created: 2009-06-26 Last updated: 2017-12-13Bibliographically approved
2. Chlamydia trachomatis in the throat: is testing necessary?
Open this publication in new window or tab >>Chlamydia trachomatis in the throat: is testing necessary?
2008 (English)In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, ISSN ISSN 0001-5555, EISSN 1651-2057, Vol. 88, no 2, 187-188 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-23588 (URN)10.2340/00015555-0382 (DOI)18311460 (PubMedID)
Available from: 2009-06-26 Created: 2009-06-26 Last updated: 2017-12-13Bibliographically approved
3. Asking about condom use: a key to individualized care when screening for chlamydia
Open this publication in new window or tab >>Asking about condom use: a key to individualized care when screening for chlamydia
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2011 (English)In: International Journal of STD and AIDS (London), ISSN 0956-4624, E-ISSN 1758-1052, Vol. 22, no 8, 436-441 p.Article in journal (Refereed) Published
Abstract [en]

Chlamydia trachomatis (CT) infection has been a target for both selective and national screening programmes, and Sweden has an opportunistic approach. A national plan of action states that risk groups should be identified and offered risk reduction counselling. Patients attending a drop-in sexually transmitted infection (STI) clinic reception at the University Hospital, Umeå, Sweden, were invited to complete a questionnaire regarding sociodemographic characteristics, symptoms and sexual risk behaviour; all had a CT test taken. A total of 1305 patients were included, 58% men, mean age 27.8 years. CT prevalence was 11%; 51% of those with CT were ≥ 25 years old. Only 5% used a condom during the entire sexual intercourse with their last new/temporary partner. Sexually active inconsistent condom users comprised 62% of the study population and contributed to 81% of the chlamydia infections. Asking whether a condom was used could quickly triage patients into groups with a 'higher risk' (none or inconsistent use of condoms and at least one new/temporary partners), and 'lower risk' (with more consistent condom use, although not always accurate) allowing for individualized care and counselling when screening for chlamydia. Evaluating whether a condom was used throughout the sexual intercourse did not add any useful information.

Place, publisher, year, edition, pages
Sage Publications, 2011
Keyword
chlamydia screening, Sweden, condom use, individualized care
National Category
Immunology in the medical area Infectious Medicine
Identifiers
urn:nbn:se:umu:diva-57581 (URN)10.1258/ijsa.2011.010481 (DOI)000293717100003 ()21795417 (PubMedID)
Available from: 2012-08-07 Created: 2012-08-07 Last updated: 2017-12-07Bibliographically approved
4. High prevalence of anxiety and hazardous alcohol consumption among patients attending an STI-clinic in northern Sweden
Open this publication in new window or tab >>High prevalence of anxiety and hazardous alcohol consumption among patients attending an STI-clinic in northern Sweden
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction: Depression and hazardous alcohol consumption is associated to high-risk sexual behaviours among adolescents and young adults. Is the same true among grownups? The impact of anxiety on sexual risk behaviour is not thoroughly investigated. Our aim was to evaluate the correlation between hazardous alcohol consumption, depression and anxiety to sexual risk taking including Chlamydia infections, among patients attending an STI reception.

 Method: Patients attending an urban STI reception in Sweden were consecutively included and received questionnaires; screening- and demographic information, Alcohol Use Disorder Identification Test (AUDIT) and Hospital Anxiety and Depression scale (HAD). All patients also had a test for Chlamydia trachomatis taken.

Results: 539 patients were included in the study, mean age 28 years. 152 (30%) had signs of anxiety and 37 (7%) of depression, of which 30 had also anxiety. Neither anxiety nor depression was correlated to sexual risk behaviour. >50% had hazardous alcohol consumption and it was independently linked to sexual risk behaviours and anxiety.

Conclusion: Depression is not associated to sexual risk behaviours among adult STI-patients. Health care staff and must consider the high frequency of anxiety and hazardous alcohol consumption at their treatment of STI-clinic patients and in the preventive work. The society must work with lowering the stigmatization that still seems to be connected to STIs.

Keyword
Chlamydia trachomatis, sexual behaviour, screening
National Category
Dermatology and Venereal Diseases
Research subject
Dermatology and Venerology
Identifiers
urn:nbn:se:umu:diva-37791 (URN)
Available from: 2010-11-16 Created: 2010-11-14 Last updated: 2015-04-29Bibliographically approved

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