Berit Andersen

Home Sampling versus Conventional Swab Sampling for Screening of Chlamydia trachomatis in Women: A Cluster-Randomized 1-Year Follow-up Study

We compared the efficacy of a screening program for urogenital Chlamydia trachomatis infections based on home sampling with that of a screening program based on conventional swab sampling performed at a physicians office. Female subjects, comprising students at 17 high schools in the county of Aarhus, Denmark, were divided into a study group (tested by home sampling) and a control group (tested in a physicians office). We assessed the number of new infections and the number of subjects who reported being treated for pelvic inflammatory disease (PID) at 1 year of follow-up; 443 (51.1%) of 867 women in the intervention group and 487 (58.5%) of 833 women in the control group were available for follow-up. Thirteen (2.9%) and 32 (6.6%) new infections were identified in the intervention group and the control group, respectively (Wilcoxon exact value, P=.026). Nine (2.1%) women in the intervention group and 20 (4.2%) in the control group reported being treated for PID (P=.045), indicating that a screening strategy involving home sampling is associated with a lower prevalence of C. trachomatis and a lower proportion of reported cases of PID.

Population-Based Strategies for Outreach Screening of Urogenital Chlamydia trachomatis Infections: A Randomized, Controlled Trial

The effect of 2 population-based outreach screening strategies that used in-home sampling was compared with usual care practices for Chlamydia trachomatis infection. All 30,439 persons 21-23 years old in Aarhus County, Denmark, were divided randomly into 3 groups: group 1 (n=4500) had a home sampling kit mailed directly to their centrally registered home address; group 2 (n=4500) had a reply card mailed to their home address with which a home sampling kit could be ordered; and group 3 (n=21,439) had access to usual care. For women in groups 1 and 2, the relative risks of being tested were 4.1 (95% confidence interval [CI], 3.8-4.4) and 3.5 (95% CI, 3.2-3.9), respectively, compared with usual care. The corresponding figures for men were 19.1 (95% CI, 16.0-22.8) and 11.8 (95% CI, 9.8-14.2), respectively. Both screening strategies were highly effective, but men benefited the most from having the home sampling kit provided directly.

Efficacy of home sampling for screening of Chlamydia trachomatis: randomised study

Urogenital infections caused by Chlamydia trachomatis are common and may cause female infertility and ectopic pregnancy. Such infections are treatable but as C trachomatis often causes no symptoms they may remain undetected. As screening for C trachomatis reduces the number of complications,1 and self reportable screening criteria seem to have a low predictive value for infection,2 testing people not seeking medical care seems relevant. C trachomatis can be detected by amplification of DNA from urine and vaginal secretions—samples that can be obtained at home and mailed directly to the laboratory. 3 4 Usually a swab sample is taken by a doctor but if a patient can collect a sample at home this may result in improved screening rates and thus more infections being detected. We randomised all 17 high schools in Aarhus County into two screening groups. In the home sampling group the females were asked to collect two urine samples and one vaginal flush sample3 and the males were asked to collect one first …

Mycoplasma genitalium: prevalence and behavioural risk factors in the general population

Background:Mycoplasma genitalium has been shown to cause urethritis in men and cervicitis in women and may also be a causative agent in female infertility. Objective: To estimate the prevalence of urogenital M genitalium infection and identify sexual behavioural risk factors in the general population. Methods: Participating individuals were 731 men and 921 women aged 21–23 years and not seeking the healthcare system because of symptoms. They answered questionnaires on sexual behaviour and provided samples for M genitalium testing. Results: In women aged 21–23 years, the prevalence of infection was 2.3% (21/921) and in men of the same age it was 1.1% (8/731). For both sexes, an increasing number of partners was associated with a greater chance of being infected. Among women a shorter duration of a steady relationship and having a partner with symptoms was associated with being infected, and for men younger age at first intercourse was associated with M genitalium infection. Conclusions: We conclude that the prevalence of infection in the general population is too low for population-based screening. However, the development of test algorithms based on behavioural risk factors is a promising alternative.

Diagnosis of urogenital Chlamydia trachomatis infection in women based on mailed samples obtained at home: multipractice comparative study

Abstract Objective: To compare urine and vaginal flush samples collected by women at home with endocervical and urethral swabs obtained by general practitioners for their efficacy in the diagnosis of urogenital Chlamydia trachomatis infection. Design: Multipractice comparative study. Setting: 33 general practices and a central department of clinical microbiology in Aarhus County, Denmark. Subjects: 222 women aged 18–25 years who for any reason had a gynaecological examination. Interventions: Endocervical and urethral swabs were obtained by the womens general practitioners. The same women when at home then collected a first void urine sample, a midstream urine sample, and a vaginal flush sample (using a vaginal pipette) and mailed them to the laboratory. Main outcome measures: C trachomatis detected by the polymerase chain reaction and the ligase chain reaction. Eight tests for C trachomatis were performed for every woman. When two of the eight yielded positive results the patient was considered infected. Results: The overall prevalence of C trachomatis infection was 11.2% (23/205 women). Test sensitivities in samples obtained by general practitioners, samples obtained at home subjected to polymerase chain reaction, and samples obtained at home subjected to ligase chain reaction were 91%, 96%, and 100% respectively. The corresponding specificities were 100%, 92.9%, and 99.5%. Conclusions: The diagnostic efficacy of samples obtained by women at home and mailed to the laboratory was as good as for samples obtained by a general practitioner when using the ligase chain reaction. This may have important implications for the practicability of screening for this common, often asymptomatic, and treatable infection. Key messages A combination of mailed samples obtained at home is necessary in order to obtain optimal diagnostic sensitivity; a single urine sample is not enough Mailed samples obtained at home may also be appropriate for diagnosis in young asymptomatic women with regular partners; these women have a high prevalence of urogenital C trachomatis infection The use of mailed self obtained samples in women might limit costs and increase the practicability of screening programmes for urogenital C trachomatis infection

Home sampling versus conventional contact tracing for detecting Chlamydia trachomatis infection in male partners of infected women : randomised study

Urogenital infections with Chlamydia trachomatis are widespread and usually asymptomatic. Major complications from infection include ectopic pregnancies and female infertility.1 Although contact tracing reduces the prevalence of chlamydia infection,2 the test rate among partners is often low, partly because male contacts have to have a urethral swab taken by a doctor. As the polymerase chain reaction can successfully detect infection in urine samples,3 we investigated whether the test rate could be increased by asking the male contacts of infected women to send a urine sample directly from home to a laboratory instead of having a doctor take a urethral swab. Ninety six women with C trachomati s infection seen in general practices in Aarhus County, Denmark, were randomly divided according to their date of birth into an intervention group (45 patients) and a …

Chlamydia infection, pelvic inflammatory disease, ectopic pregnancy and infertility: cross-national study.

Objectives To describe, using routine data in selected countries, chlamydia control activities and rates of chlamydia infection, pelvic inflammatory disease (PID), ectopic pregnancy and infertility and to compare trends in chlamydia positivity with rates of PID and ectopic pregnancy. Methods Cross-national comparison including national data from Australia, Denmark, the Netherlands, New Zealand, Sweden and Switzerland. Routine data sources about chlamydia diagnosis and testing and International Classification of Disease-10 coded diagnoses of PID, ectopic pregnancy and infertility in women aged 15–39 years from 1999 to 2008 were described. Trends over time and relevant associations were examined using Poisson regression. Results Opportunistic chlamydia testing was recommended in all countries except Switzerland, but target groups differed. Rates of chlamydia testing were highest in New Zealand. Chlamydia positivity was similar in all countries with available data (Denmark, New Zealand and Sweden) and increased over time. Increasing chlamydia positivity rates were associated with decreasing PID rates in Denmark and Sweden and with decreasing ectopic pregnancy rates in Denmark, New Zealand and Sweden. Ectopic pregnancy rates appeared to increase over time in 15–19-year-olds in several countries. Trends in infertility diagnoses were very variable. Conclusions The intensity of recommendations about chlamydia control varied between countries but was not consistently related to levels of chlamydia diagnosis or testing. Relationships between levels of chlamydia infection and complication rates between or within countries over time were not straightforward. Development and validation of indicators of chlamydia-related morbidity that can be compared across countries and over time should be pursued.

Chlamydia control activities in Europe: cross-sectional survey

BACKGROUND Chlamydia is the most commonly reported bacterial sexually transmitted infection in Europe. The objective of the Screening for Chlamydia in Europe (SCREen) project was to describe current and planned chlamydia control activities in Europe. METHODS The authors sent a questionnaire asking about different aspects of chlamydia epidemiology and control to public health and clinical experts in each country in 2007. The principles of sexually transmitted infection control were used to develop a typology comprising five categories of chlamydia control activities. Each country was assigned to a category, based on responses to the questionnaire. RESULTS Experts in 29 of 33 (88%) invited countries responded. Thirteen of 29 countries (45%) had no current chlamydia control activities. Six countries in this group stated that there were plans to introduce chlamydia screening programmes. There were five countries (17%) with case management guidelines only. Three countries (10%) also recommended case finding amongst partners of diagnosed chlamydia cases or people with another sexually transmitted infection. Six countries (21%) further specified groups of asymptomatic people eligible for opportunistic chlamydia testing. Two countries (7%) reported a chlamydia screening programme. There was no consistent association between the per capita gross domestic product of a country and the intensity of chlamydia control activities (P = 0.816). CONCLUSION A newly developed classification system allowed the breadth of ongoing national chlamydia control activities to be described and categorized. Chlamydia control strategies should ensure that clinical guidelines to optimize chlamydia diagnosis and case management have been implemented before considering the appropriateness of screening programmes.

Effectiveness of a mass media campaign to recruit young adults for testing of Chlamydia trachomatis by use of home obtained and mailed samples.

Objective: To evaluate the effectiveness of a structured information campaign aiming to recruit young adults for a Chlamydia trachomatis test by use of a non-invasive, home obtained and mailed sample. Methods: All individuals aged 21–23 living in Aarhus county, Denmark (30 000 young adults) were offered a mailed home sampling test for C trachomatis as part of a structured 14 week information campaign on chlamydia. The kit for home sampling could be requested by leaving a message on an answering machine or through a website on the internet. Results: During the campaign 119 of 15 000 women (0.8%) and 64 of 15 000 men (0.4%) were tested. Prevalence of infection was 8.4% (10/119) and 7.8% (5/64) in females and males, respectively. Four infections in women (4/10=40%) and three infections in men (3/5=60%) were asymptomatic. Conclusions: The mass media campaign had only a limited effect, and there is a need for more effective outreach programmes to recruit young asymptomatic individuals for C trachomatis testing.

Prediction of costs, effectiveness, and disease control of a population-based program using home sampling for diagnosis of urogenital Chlamydia trachomatis Infections.

Objective: To estimate the incremental effects and costs of a home sampling screening approach for Chlamydia trachomatis over the current in-office screening practice in Denmark. Goals: To assess the effect of a new screening strategy. Study Design: A dynamic Monte Carlo model estimated prevalence and incidence over 10 years for a home sampling screening program and the current in-office screening. Subsequently, the incremental number of major outcomes averted (MOA) and the related direct and indirect costs were estimated. Results: Infection prevalence after 10 years was 1.0% with a home sampling program and 4.2% with the current in-office screening practice. The total costs per MOA reached