Sarah R Kerry

Where do sexually active female London students go to access healthcare? Evidence from the POPI (Prevention of Pelvic Infection) chlamydia screening trial

Background Little is known about where sexually active female students access healthcare. Objectives Using data from the Prevention of Pelvic Infection (POPI) cohort, the authors aimed to: Describe where sexually active female students aged ≤27 years reported accessing healthcare. Investigate the association between numbers of sexual partners during 12 months of follow-up and healthcare usage, health-related quality of life (EQ-5D) and demographic and behavioural characteristics. Methods Participants provided vaginal swabs and completed questionnaires on sexual health and quality of life at baseline and at a 12-month follow-up. The follow-up questionnaire also asked about healthcare attendances during the previous 12 months. Mann–Whitney tests were used to relate healthcare seeking behaviour and other characteristics to reported numbers of partners during follow-up. Results Of 1865 women included in the analysis, 79% paid at least one visit to their general practice during follow-up, 23% attended an accident and emergency/walk-in clinic, 21% a family planning clinic and 14% a genitourinary medicine clinic. As the number of sexual partners increased (0–1, 2–3, 4+), women were more likely to have visited a genitourinary medicine clinic (10%, 16%, 30%, p<0.001) or accident and emergency/walk-in clinic (21%, 26%, 29%, p<0.002). Women with more sexual partners were also more likely to smoke, use condoms, be aged <16 years at sexual debut, have bacterial vaginosis, chlamydia or gonorrhoea at baseline and to have lower EQ5-D scores. Conclusion This is the first UK study of healthcare attendance in multiethnic female students recruited outside healthcare settings. The high attendance in general practice may represent a valuable opportunity for screening for sexually transmitted infections.

Chlamydia related bacteria (Chlamydiales) in early pregnancy: community-based cohort study.

Objectives Serological case–control studies suggest that certain chlamydia-related bacteria (Chlamydiales) which cause cows to abort may do the same in humans. Chlamydiales include Waddlia chondrophila, Chlamydia abortus and Chlamydia trachomatis. Data on prevalence of Chlamydiales in pregnancy are sparse. Using stored urine samples from a carefully characterised cohort of 847 newly pregnant women recruited from 37 general practices in London, UK, we aimed to investigate the prevalence and types of Chlamydiales infections. We also explored possible associations with miscarriage or spontaneous preterm birth. Methods Samples were tested using W. chondrophila and pan-Chlamydiales specific real-time PCRs targeting the 16S rRNA gene. Samples positive on either PCR were subjected to DNA sequencing and C. trachomatis PCR. Results The overall prevalence of Chlamydiales was 4.3% (36/847, 95% CI 3.0% to 5.8%). The prevalence of W. chondrophila was 0.6% (n = 5), C. trachomatis 1.7% (n = 14), and other Chlamydiales species 2.0% (n = 17). Infection with C. trachomatis was more common in women aged <25, of black ethnicity or with bacterial vaginosis, but this did not apply to W. chondrophila or other Chlamydiales. Follow up was 99.9% at 16 weeks gestation and 90% at term. No infection was significantly associated with miscarriage at ≤12 weeks (prevalence 10%, 81/827) or preterm birth <37 weeks (prevalence 4%, 23/628). Of 25 samples sequenced, seven (28%) were positive for Chlamydiales bacterium sequences associated with respiratory tract infections in children. Conclusion In the first study to use the pan-Chlamydiales assay on female urine samples, 4% of pregnant women tested positive for Chlamydiales, including species known to be pathogenic in mothers and neonates.

Which sexually active young female students are most at risk of pelvic inflammatory disease? A prospective study.

Objective To identify risk factors for pelvic inflammatory disease (PID) in female students. Methods We performed a prospective study set in 11 universities and 9 further education colleges in London. In 2004–2006, 2529 sexually experienced, multiethnic, female students, mean age 20.8 years, provided self-taken vaginal samples and completed questionnaires at recruitment to the Prevention of Pelvic Infection chlamydia screening trial. After 12 months, they were followed up by questionnaire backed by medical record search and assessed for PID by blinded genitourinary medicine physicians. Results Of 2004 (79%) participants who reported numbers of sexual partners during follow-up, 32 (1.6%, 95% CI 1.1% to 2.2%) were diagnosed with PID. The strongest predictor of PID was baseline Chlamydia trachomatis (relative risk (RR) 5.7, 95% CI 2.6 to 15.6). After adjustment for baseline C. trachomatis, significant predictors of PID were ≥2 sexual partners or a new sexual partner during follow-up (RR 4.0, 95% CI 1.8 to 8.5; RR 2.8, 95% CI 1.3 to 6.3), age <20 years (RR 3.3, 95% CI 1.5 to 7.0), recruitment from a further education college rather than a university (RR 2.6, 95% CI 1.3 to 5.3) and history at baseline of vaginal discharge (RR 2.7, 95% CI 1.2 to 5.8) or pelvic pain (RR 4.1, 95% CI 2.0 to 8.3) in the previous six months. Bacterial vaginosis and Mycoplasma genitalium infection were no longer significantly associated with PID after adjustment for baseline C. trachomatis. Conclusions Multiple or new partners in the last 12 months, age <20 years and attending a further education college rather than a university were risk factors for PID after adjustment for baseline C. trachomatis infection. Sexual health education and screening programmes could be targeted at these high-risk groups. Trial registration number (ClinicalTrials.gov NCT00115388).

Trichomonas vaginalis among multiethnic female UK students.

In their study of HIV outpatient clinic attenders, Gatski and colleagues found a high rate of bacterial vaginosis (67%, 163/244) in HIV positive, mainly African American women infected with Trichomonas vaginalis (TV).1 We recently conducted a pilot study to test for TV in 183 stored self-taken vaginal samples from multiethnic female London students who took part in the prevention of pelvic infection chlamydia screening …

Pilot study for the ‘Test n Treat’ trial of on-site rapid chlamydia/gonorrhoea tests and same day treatment

Outreach sexual health services usually target hard to reach, higher risk populations who are not accessing mainstream services. These include some black minority ethnic groups and young people.1 In May 2016, we carried out a pilot study in a Further Education (FE) college to explore the feasibility of providing rapid, on-site chlamydia/gonorrhoea testing with results within 2 hours, and same day treatment if required (‘Test n Treat’). Consecutive students were approached and asked if they were willing to complete a questionnaire and provide a genitourinary sample for rapid chlamydia/gonorrhoea testing. Students who had never had sexual intercourse or were outside the 16–24 years age range were …

Chlamydia testing: where are we now? Recruiting high-risk women to a pilot STI screening trial

In their topical editorial, Jain and Ison state that ‘testing (for chlamydia) is a crucial part of any effective control strategy’.1 In January 2013 we conducted a pilot study of Chlamydia trachomatis and Neisseria gonorrhoea testing in female students at Lambeth Further Education College, London to assess recruitment to a possible prevention of pelvic infection-2 screening trial.2 Two female general practitioners approached consecutive female students in the common room and asked them to help with a womens health study. We explained that only women aged …

Original article: Which sexually active young female students are most at risk of pelvic inflammatory disease? A prospective study

Objective To identify risk factors for pelvic inflammatory disease (PID) in female students. Methods We performed a prospective study set in 11 universities and 9 further education colleges in London. In 2004–2006, 2529 sexually experienced, multiethnic, female students, mean age 20.8 years, provided self-taken vaginal samples and completed questionnaires at recruitment to the Prevention of Pelvic Infection chlamydia screening trial. After 12 months, they were followed up by questionnaire backed by medical record search and assessed for PID by blinded genitourinary medicine physicians. Results Of 2004 (79%) participants who reported numbers of sexual partners during follow-up, 32 (1.6%, 95% CI 1.1% to 2.2%) were diagnosed with PID. The strongest predictor of PID was baseline Chlamydia trachomatis (relative risk (RR) 5.7, 95% CI 2.6 to 15.6). After adjustment for baseline C. trachomatis, significant predictors of PID were ≥2 sexual partners or a new sexual partner during follow-up (RR 4.0, 95% CI 1.8 to 8.5; RR 2.8, 95% CI 1.3 to 6.3), age <20 years (RR 3.3, 95% CI 1.5 to 7.0), recruitment from a further education college rather than a university (RR 2.6, 95% CI 1.3 to 5.3) and history at baseline of vaginal discharge (RR 2.7, 95% CI 1.2 to 5.8) or pelvic pain (RR 4.1, 95% CI 2.0 to 8.3) in the previous six months. Bacterial vaginosis and Mycoplasma genitalium infection were no longer significantly associated with PID after adjustment for baseline C. trachomatis. Conclusions Multiple or new partners in the last 12 months, age <20 years and attending a further education college rather than a university were risk factors for PID after adjustment for baseline C. trachomatis infection. Sexual health education and screening programmes could be targeted at these high-risk groups. Trial registration number (ClinicalTrials.gov NCT00115388).

Which sexually active female students get themselves tested for Chlamydia trachomatis? A cohort study

Using data from the Prevention of Pelvic Infection (POPI) chlamydia screening trial, we compared the characteristics of female students who did or did not get tested for chlamydia outside the trial during 12 months’ follow-up. Of the 2529 women in the trial, we excluded 68 chlamydia positives in the intervention group who were referred for treatment at baseline. Of the remaining 2461 women, 1980 (80%) answered the question about testing during follow-up on their 12 months’ questionnaire and were included in the cohort. Of 1980 respondents, 529 (27%) reported having an independent chlamydia test, including 30 (48%) of 63 women with undiagnosed chlamydia at baseline. Predictors of testing included having undiagnosed chlamydia at baseline (adjusted odds ratio 2.44; 95% confidence interval 1.39–4.28), ≥2 sexual partners in the year prior to baseline (OR 1.99; 95% CI 1.60–2.48), history of sexually transmitted infection (1.63: 1.20–2.22); symptoms of pelvic discomfort, dyspareunia, abnormal vaginal discharge or inter-menstrual bleeding (1.38; 1.09–1.73); and black ethnicity (1.37, 1.06–1.76). Although more women with risk factors got tested, half of women with undiagnosed chlamydia did not get tested. To optimise detection of chlamydia, testing should be offered routinely.

Which sexually active young female students are most at risk of pelvic inflammatory disease

Objective To identify risk factors for pelvic inflammatory disease (PID) in female students. Methods We performed a prospective study set in 11 universities and 9 further education colleges in London. In 2004–2006, 2529 sexually experienced, multiethnic, female students, mean age 20.8 years, provided self-taken vaginal samples and completed questionnaires at recruitment to the Prevention of Pelvic Infection chlamydia screening trial. After 12 months, they were followed up by questionnaire backed by medical record search and assessed for PID by blinded genitourinary medicine physicians. Results Of 2004 (79%) participants who reported numbers of sexual partners during follow-up, 32 (1.6%, 95% CI 1.1% to 2.2%) were diagnosed with PID. The strongest predictor of PID was baseline Chlamydia trachomatis (relative risk (RR) 5.7, 95% CI 2.6 to 15.6). After adjustment for baseline C. trachomatis, significant predictors of PID were ≥2 sexual partners or a new sexual partner during follow-up (RR 4.0, 95% CI 1.8 to 8.5; RR 2.8, 95% CI 1.3 to 6.3), age <20 years (RR 3.3, 95% CI 1.5 to 7.0), recruitment from a further education college rather than a university (RR 2.6, 95% CI 1.3 to 5.3) and history at baseline of vaginal discharge (RR 2.7, 95% CI 1.2 to 5.8) or pelvic pain (RR 4.1, 95% CI 2.0 to 8.3) in the previous six months. Bacterial vaginosis and Mycoplasma genitalium infection were no longer significantly associated with PID after adjustment for baseline C. trachomatis. Conclusions Multiple or new partners in the last 12 months, age <20 years and attending a further education college rather than a university were risk factors for PID after adjustment for baseline C. trachomatis infection. Sexual health education and screening programmes could be targeted at these high-risk groups. Trial registration number (ClinicalTrials.gov NCT00115388).

Home blood pressure monitoring in hypertensive stroke patients: a prospective cohort study following a randomized controlled trial.

BACKGROUND We found little data on long-term home blood pressure monitoring in stroke patients. OBJECTIVES After completing a 12-month trial of home monitoring in hypertensive stroke patients, we investigated the following: 1. The proportion of 118 control patients offered a monitor at the end of the trial without nurse support who used it at least monthly after 6 months. 2. The proportion of 119 intervention patients continuing to use their monitor monthly after 18 months. 3. Possible predictors of monitoring weekly in the first month after receiving a monitor: age, gender, ethnicity, cognition, anxiety, disability, ability to monitor blood pressure unaided and smoking. METHODS Participants (mean age 71, 34% with disability and 21% from ethnic minorities) were surveyed 1 and/or 6 months after the trial ended by postal and/or telephone questionnaire. RESULTS Of 237 potential participants, 53 (22%) declined, 16 (6%) were lost and 9 (4%) died during follow-up. Overall, reported monthly use of the monitor without nurse support was 47% [54/114, 95% confidence interval (CI) 38.2-56.5] at 6 months and 50% (57/114, 95% CI 40.8-59.2) at 18 months. Participants who monitored weekly after 1 month were more likely than the remainder to have no disability [Rankin score ≤ 1; relative risk (RR) 1.2; 95% CI 1.0-1.5] and low anxiety levels (FEAR score = 0; RR 1.5; 95% CI 1.1-2.0). CONCLUSION Around half of hypertensive stroke patients offered a blood pressure monitor but no support continued to use it after 6 and 18 months. Monitoring in the first month was common in those who were not anxious or disabled.