Chlamydia Infection After Sexual Contact With Chlamydia
Chlamydia Infection After Sexual Contact With Chlamydia
Objectives We aimed to ascertain the proportion of positive, and predictive factors of chlamydia infection among females, heterosexual males and men who have sex with men (MSM) presenting to a sexual health service reporting contact with a chlamydia infected sexual partner.
Methods A cross-sectional analysis of patients attending the Melbourne Sexual Health Centre from October 2010 to September 2013. Behavioural data obtained using computer assisted self-interview were analysed to determine factors predictive of chlamydia.
Results Of the 491 female, 808 heterosexual male, and 268 MSM chlamydia contacts, the proportion diagnosed with chlamydia were 39.9% (95% CI 35.7% to 44.3%), 36.1% (95% CI 32.9% to 39.9%) and 23.5% (95% CI 18.8% to 29.0%), respectively. Female chlamydia contacts were more likely to have chlamydia if age <25 (adjusted OR (AOR) 1.86, 95% CI 1.12 to 3.10) or if they reported inconsistent condom use during vaginal sex with a regular male partner (AOR 2.5, 95% CI 1.12 to 6.14). Heterosexual male contacts were more likely to have chlamydia if age <25 (AOR 1.69, 95% CI 1.25 to 2.28) or if they had a regular female sexual partner (AOR 1.38, 95% CI 1.03 to 1.85). In MSM urethral chlamydia was diagnosed in 8.8%, rectal chlamydia in 20.2%, and 3.9% at both sites. MSM were more likely to have chlamydia if they had a regular male sexual partner (OR 2.12, 95% CI 1.18 to 3.81).
Conclusions This study of female, heterosexual male, and MSM presentations with self-reported chlamydia contact provides insight into the likelihood and predictive factors of infection. The data may inform policy and individual clinical decision making regarding presumptive treatment of chlamydia contacts.
Chlamydia continues to be a very common bacterial sexually transmitted disease in young men and women despite considerable investment in screening and treatment programmes. Estimated population prevalence in young sexually active females in the USA (2007–2012) was 4.7%, and 5% in young Australian females in community or general practice settings. While most infections with chlamydia are asymptomatic, infection has potentially serious consequences particularly for women including pelvic inflammatory disease, chronic pain, ectopic pregnancy and infertility.
A significant proportion of people diagnosed with chlamydia will contact at least one of their sexual partners to let them know they have been exposed. Empiric presumptive treatment at the time of testing but prior to confirmation of infection has generally been adopted for patients who present to a clinic reporting sexual contact with a person diagnosed with chlamydia, as timely treatment is important to preventing complications and further transmission. Presumptive treatment of sexual partners also underpins the practice of partner delivered patient therapy, which is practiced widely in some countries for individuals diagnosed with chlamydia. However, as transmission is not inevitable, a proportion of the sexual partners will not have an infection and yet risk being prescribed antimicrobial therapy unnecessarily.
Justification for presumptive treatment for a treatable sexually transmitted infection such as chlamydia depends in part on the underlying prevalence of infection among those reporting contact with that infection. To provide these data for chlamydia, we performed a cross-sectional study to ascertain the rate of infection and factors predictive of chlamydia infection among patients presenting to a sexual health service reporting contact with a sexual partner diagnosed with chlamydia. These were compared between three groups: women, heterosexual men, and men who reported sex with men (MSM).
Abstract and Introduction
Abstract
Objectives We aimed to ascertain the proportion of positive, and predictive factors of chlamydia infection among females, heterosexual males and men who have sex with men (MSM) presenting to a sexual health service reporting contact with a chlamydia infected sexual partner.
Methods A cross-sectional analysis of patients attending the Melbourne Sexual Health Centre from October 2010 to September 2013. Behavioural data obtained using computer assisted self-interview were analysed to determine factors predictive of chlamydia.
Results Of the 491 female, 808 heterosexual male, and 268 MSM chlamydia contacts, the proportion diagnosed with chlamydia were 39.9% (95% CI 35.7% to 44.3%), 36.1% (95% CI 32.9% to 39.9%) and 23.5% (95% CI 18.8% to 29.0%), respectively. Female chlamydia contacts were more likely to have chlamydia if age <25 (adjusted OR (AOR) 1.86, 95% CI 1.12 to 3.10) or if they reported inconsistent condom use during vaginal sex with a regular male partner (AOR 2.5, 95% CI 1.12 to 6.14). Heterosexual male contacts were more likely to have chlamydia if age <25 (AOR 1.69, 95% CI 1.25 to 2.28) or if they had a regular female sexual partner (AOR 1.38, 95% CI 1.03 to 1.85). In MSM urethral chlamydia was diagnosed in 8.8%, rectal chlamydia in 20.2%, and 3.9% at both sites. MSM were more likely to have chlamydia if they had a regular male sexual partner (OR 2.12, 95% CI 1.18 to 3.81).
Conclusions This study of female, heterosexual male, and MSM presentations with self-reported chlamydia contact provides insight into the likelihood and predictive factors of infection. The data may inform policy and individual clinical decision making regarding presumptive treatment of chlamydia contacts.
Introduction
Chlamydia continues to be a very common bacterial sexually transmitted disease in young men and women despite considerable investment in screening and treatment programmes. Estimated population prevalence in young sexually active females in the USA (2007–2012) was 4.7%, and 5% in young Australian females in community or general practice settings. While most infections with chlamydia are asymptomatic, infection has potentially serious consequences particularly for women including pelvic inflammatory disease, chronic pain, ectopic pregnancy and infertility.
A significant proportion of people diagnosed with chlamydia will contact at least one of their sexual partners to let them know they have been exposed. Empiric presumptive treatment at the time of testing but prior to confirmation of infection has generally been adopted for patients who present to a clinic reporting sexual contact with a person diagnosed with chlamydia, as timely treatment is important to preventing complications and further transmission. Presumptive treatment of sexual partners also underpins the practice of partner delivered patient therapy, which is practiced widely in some countries for individuals diagnosed with chlamydia. However, as transmission is not inevitable, a proportion of the sexual partners will not have an infection and yet risk being prescribed antimicrobial therapy unnecessarily.
Justification for presumptive treatment for a treatable sexually transmitted infection such as chlamydia depends in part on the underlying prevalence of infection among those reporting contact with that infection. To provide these data for chlamydia, we performed a cross-sectional study to ascertain the rate of infection and factors predictive of chlamydia infection among patients presenting to a sexual health service reporting contact with a sexual partner diagnosed with chlamydia. These were compared between three groups: women, heterosexual men, and men who reported sex with men (MSM).
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