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Prevention of Chlamydia trachomatis infections
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Urogenital chlamydia infection, caused by the bacterium Chlamydia trachomatis (CT), is the most common sexually transmitted bacterial infection in Sweden. In 2008 it was estimated by WHO that there were 105.7 million new cases of CT worldwide, an increase by 4.2 million cases (4.1%) compared to 2005. If untreated, CT infections can progress to serious reproductive health problems, especially in women. These complications include subfertility/infertility, ectopic pregnancy and chronic pain. The CT infection is often asymptomatic and reliable diagnostic methods and contact tracing are important tools for identifying infected individuals. CT infection is classified in the Swedish Communicable Diseases Act as a serious disease; consequently, written reporting and contact tracing are compulsory. Previous or ongoing CT infection is not uncommon in infertile couples, especially in women with tubal factor infertility (TFI). We have tested 244 infertile couples for CT antibodies, and CT IgG positive couples were tested for CT DNA in urine. The prevalence of CT antibodies was higher in infertile men and women, and ongoing CT infection was common. Our results support a role of CT in infertility and underscore the importance of prevention of CT infection. Contact tracing was studied during using questionnaires. A total of 544 questionnaires was sent to tracers in a Swedish county and 534 (98%) were completed. Centralized contact tracing performed by experienced tracers is effective; on average 65% of sexual contacts found by contact tracing are CT-infected. Our data show that it is worthwhile to extend the tracing period beyond 6 months as 30% of reported sexual contacts between months 7-12 were CT-infected. Contact tracing may be performed face-to-face at the clinic or by telephone. Because of the severe consequences of CT infection there is a need for useful methods for both primary and secondary prevention of CT and other sexually transmitted infections (STIs). An important sub-population for CT/STI-prevention is the “core group”, i.e. a subpopulation with high incidence of STIs combined with risky sexual behaviours. This subpopulation contributes particularly to the spread of STIs in the population. Therefore, we have developed and evaluated a brief standardised but flexible manual-based single-session intervention based on motivational interviewing (MI) for the reduction of high risk sexual behaviour. Women (n=105) and men (n=119) at high risk of contracting CT infection were randomly eighter offered brief MI counselling or standard care. Our findings support the effectiveness of brief MI-based counselling in reducing high-risk sexual behaviour and incident CT infection in women (p<0.01) but not in men. Our results suggest that gender aspects need to be considered and that men and women should be treated differently for achieving maximal risk-reduction. Whereas it might be sufficient to include information and motivation when performing risk-reducing counselling on women, counsellors may also add other components, such as behavioural skills and booster sessions, when counselling is performed on men.

Abstract [sv]

Klamydiainfektion orsakas av Chlamydia trachomatis och är den vanligaste sexuellt överförda bakterieinfektionen. WHO har uppskattat att det år 2008 var 105,7 miljoner nya fall av klamydia i världen, en ökning med 4,2 miljoner fall (4,1 %) jämfört med år 2005. Klamydiainfektion är ett folkhälsoproblem och klassificeras i den svenska smittskyddslagen som en allmänfarlig sjukdom varför det är obligatoriskt att smittspåra och göra en skriftlig anmälan till smittskyddsläkaren och Smittskyddsinstitutet.

Klamydiainfektionen ger oftast inga symtom och tillförlitliga diagnostiska metoder och smittspårning är viktiga ”redskap” för att hitta smittade personer. Om klamydiainfektionen inte behandlas kan den leda till allvarliga hälsoproblem, speciellt hos kvinnor. Bland komplikationer efter klamydiainfektion ingår ofrivillig barnlöshet, utomkvedshavandeskap och kronisk buksmärta. Tecken på tidigare eller pågående klamydiainfektion är vanliga hos ofrivilligt barnlösa par, speciellt hos kvinnor med skadade äggledare som orsak till barnlösheten. Våra resultat ger stöd för betydelsen av klamydia vid ofrivillig barnlöshet och understryker vikten av förebyggande åtgärder mot klamydia samt klamydiaprovtagning av både män och kvinnor vid utredning av ofrivillig barnlöshet.

Centraliserad klamydiasmittspårning utförd av erfarna smittspårare är effektiv och i genomsnitt är 65 % av spårade sexuella kontakter klamydiasmittade. Våra data visar att det lönar sig att förlänga smittspårningsperioden från 6 till 12 månader eftersom betydligt fler klamydiasmittade kontakter då hittas. Den så kallade ”Västerbottensmodellen” med en smittspårningsperiod på 12 månader rekommenderas nu av Socialstyrelsen. Kontaktspårning kan utföras antingen på mottagningen eller per telefon.

På grund av risk för allvarliga konsekvenser av klamydia finns det behov av metoder för att förebygga klamydiasmitta. En viktig grupp för prevention är den så kallade ”kärngruppen", alltså de personer som har en hög förekomst av klamydia och andra sexuellt överförda infektioner i kombination med sexuellt riskbeteende. Denna grupp bidrar särskilt till spridningen av sexuellt överförda infektioner bland befolkningen. Därför har vi utvecklat och utvärderat en kort samtalsmetod som bygger på metoden motiverande samtal (MI, motivational interviewing) för att minska sexuellt risktagande. Våra fynd visar att kort MI-baserad rådgivning för att minska sexuellt riskbeteende och klamydiainfektion fungerar bra på kvinnor men inte lika bra på män. Resultaten tyder på att genusaspekter måste beaktas och att kvinnor och män ska behandlas på olika sätt för att uppnå maximal riskminskning. Det kan vara tillräckligt att fokusera på information och motivation vid rådgivning av kvinnor men för rådgivning av män kan man behöva komplettera med beteendemässiga färdigheter och/eller upprepad MI-baserad rådgivning för att nå god effekt.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2013. , 73 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1607
Keyword [en]
Chlamydia trachomatis, cell culture, infertility, contact tracing, motivational interviewing, prevention
National Category
Dermatology and Venereal Diseases
Identifiers
URN: urn:nbn:se:umu:diva-84043ISBN: 978-91-7459-747-9 (print)OAI: oai:DiVA.org:umu-84043DiVA: diva2:679125
Public defence
2014-01-10, Hörsal Betula, byggnad 6M, Norrlands universitetssjukhus, Umeå, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2013-12-20 Created: 2013-12-13 Last updated: 2015-04-29Bibliographically approved
List of papers
1. Failure to detect Chlamydia trachomatis in cell culture by using a monoclonal antibody directed against the major outer membrane protein
Open this publication in new window or tab >>Failure to detect Chlamydia trachomatis in cell culture by using a monoclonal antibody directed against the major outer membrane protein
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1997 (English)In: Journal of Clinical Microbiology, ISSN 0095-1137, E-ISSN 1098-660X, Vol. 35, no 10, 2679-2680 p.Article in journal (Refereed) Published
Abstract [en]

Two commercially available monoclonal antibodies for cell culture confirmation of Chlamydia trachomatis were compared in two prospective studies and one large retrospective study. In total, more than 33,000 genital specimens were cultured in parallel and stained with both antibodies, one of which was directed against the major outer membrane protein (MOMP) and one uf which was directed against the lipopolysaccharide (LPS). We found the anti-LPS-based assay to be more sensitive and as specific as the anti-MOMP-based assay for C. trachomatis cell culture confirmation of genital specimens.

National Category
Clinical Laboratory Medicine Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:umu:diva-83409 (URN)A1997XX18200050 ()9316934 (PubMedID)
Available from: 2013-11-24 Created: 2013-11-24 Last updated: 2017-12-06Bibliographically approved
2. Demonstration of Chlamydia trachomatis IgG antibodies in the male partner of the infertile couple is correlated with a reduced likelihood of achieving pregnancy
Open this publication in new window or tab >>Demonstration of Chlamydia trachomatis IgG antibodies in the male partner of the infertile couple is correlated with a reduced likelihood of achieving pregnancy
2004 (English)In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 19, no 5, 1121-1126 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The objective of this study was to determine the prevalence of Chlamydia trachomatis among both men and women seeking help at an infertility clinic, and to prospectively follow the effect of previous infection on pregnancy rates and pregnancy outcome after a long follow-up period (mean 37 months). 

METHODS: A total of 244 infertile couples was tested for C. trachomatis IgG antibodies, and IgG(+) couples were also tested for C. trachomatis DNA by PCR in a first-void urine sample. Study parameters were serology, PCR results, clinical diagnoses, treatments, pregnancy rates and pregnancy outcome. As controls, age-matched and spontaneously pregnant women were also tested with serology. 

RESULTS: The prevalence of IgG antibodies was 24.2, 20.1 and 15.6% among infertile women, infertile men and control women respectively. The prevalence of C. trachomatis DNA was 6.8 and 7.1% among tested women and men respectively. The presence of C. trachomatis IgG antibodies in women was related to tubal factor infertility (TFI) (P = 0.002). Decreased pregnancy rates were seen in couples where the man was IgG(+) (P = 0.005) with no relationship to TFI. Among women who achieved pregnancy, there was no difference in pregnancy outcome between IgG(+) or negative couples. 

CONCLUSIONS: C. trachomatis IgG antibodies in the man of the infertile couple was related to decreased pregnancy rates and to the presence of IgG antibodies in the woman. There was a high prevalence of asymptomatic persistent infections among infertile couples.

Keyword
Chlamydia trachomatis, infertility, PCR, pregnancy outcome, serology
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-10383 (URN)10.1093/humrep/deh155 (DOI)000221143000019 ()15121732 (PubMedID)
Available from: 2008-09-02 Created: 2008-09-02 Last updated: 2017-12-14Bibliographically approved
3. 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
4. Development and evaluation of brief manual-based single-session motivational interviewing for reducing Chlamydia trachomatis infection rates in women with high-risk sexual behavior
Open this publication in new window or tab >>Development and evaluation of brief manual-based single-session motivational interviewing for reducing Chlamydia trachomatis infection rates in women with high-risk sexual behavior
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(English)Manuscript (preprint) (Other academic)
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:umu:diva-84041 (URN)
Available from: 2013-12-13 Created: 2013-12-13 Last updated: 2015-04-29Bibliographically approved
5. Is single-session motivational interviewing effective to reduce high risk sexual behavior in men?
Open this publication in new window or tab >>Is single-session motivational interviewing effective to reduce high risk sexual behavior in men?
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(English)Manuscript (preprint) (Other academic)
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:umu:diva-84042 (URN)
Available from: 2013-12-13 Created: 2013-12-13 Last updated: 2015-04-29Bibliographically approved

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