Sinka and colleagues found that using self-taken vaginal swabs for HPV testing was acceptable to young women who had defaulted from their initial HPV screening appointment at age 211. However, the rate of return of postal samples was low (13%, 725/5500). In October 2011 we conducted a feasibility study to evaluate response rates of 16-24yo female GUM clinic attenders to providing two self-taken vaginal swabs for Chlamydia tra...
Sinka and colleagues found that using self-taken vaginal swabs for HPV testing was acceptable to young women who had defaulted from their initial HPV screening appointment at age 211. However, the rate of return of postal samples was low (13%, 725/5500). In October 2011 we conducted a feasibility study to evaluate response rates of 16-24yo female GUM clinic attenders to providing two self-taken vaginal swabs for Chlamydia trachomatis and Mycoplasma genitalium testing and allowing access to NHS numbers and medical records for follow up. Women sitting in the female-only waiting area in the Courtyard Clinic at St George’s Hospital were approached by female Foundation Year 2 research doctors or medical students and given a flier about the study. This explained that women aged under 25 were being asked to help in research by providing self-taken samples and completing a questionnaire and that they would be given a lollipop. Those expressing interest were taken to a side room where they were given the full patient information leaflet and taken through the written consent process. They were shown how to take the swabs and asked to provide them in the nearest toilet in addition to any samples taken during their clinic consultation.
Of 154 women approached, 104 (68%) consented to take part. Non responders were similar mean age to responders (19.5 SD 2.5 versus 19.9 SD 2.9 years) but more likely to come from ethnic minority groups: 68% (32/47) versus 50% (50/101) p<_0.05. _="_" p="p"/>
Among responders, mean age of sexual debut was 15.9 (range 12-21 n=103); 48% (49/102) reported two or more sexual partners in the preceding 12 months; 33% (34/104) said they used condoms; and 51% (53/104) were smokers. There was a high prevalence of reported history of sexually transmitted infections. Of 101 responders, 26% said they had had chlamydia infection, 5% gonorrhoea and 5% pelvic inflammatory disease. Tests showed that 11.5% (12/104) were positive for Chlamydia trachomatis and 1% (1/104) for Neisseria gonorrhoeae.
All but one of the 104 participants gave consent for their NHS number to be obtained and used to access their hospital, general practice and GUM clinic records. This is important for future UK studies investigating long-term sequelae of sexually transmitted infections. All participants agreed their samples could be stored for future research. However, although all but one (103/104) agreed to provide follow up postal samples after three months, the current rate of return is 33% (17/52). As in the study by Sinka and colleagues1 and a postal survey of female students2, it is likely that the rate of return of follow up samples will be less than predicted.
References
1. Sinka K, Lacey M, Robertson C, Kavanagh K, Cushieri K, Nicholson D, Donaghy M, Acceptability and response to a postal survey using self-taken samples for HPV vaccine impact monitoring. STI Online First, published on October 11, 2011 as 10.1136/sextrans-2011-050211
2. Oakeshott P, Aghaizu A, Hay P, Reid F, et al. Is Mycoplasma genitalium in women the ‘new Chlamydia?’ A community-based prospective cohort study. Clinical Infectious Diseases 2010; 51: 1160-6
Bender and colleagues found that relationships between levels of
chlamydia infection and complication rates of pelvic inflammatory disease
and ectopic pregnancy between and within countries over time were not
straightforward1. Many women diagnosed with a chlamydial infection are
anxious about future fertility. Fertiloscopy is a novel procedure to
assess fallopian tube function and may be a suitable alternative to the
go...
Bender and colleagues found that relationships between levels of
chlamydia infection and complication rates of pelvic inflammatory disease
and ectopic pregnancy between and within countries over time were not
straightforward1. Many women diagnosed with a chlamydial infection are
anxious about future fertility. Fertiloscopy is a novel procedure to
assess fallopian tube function and may be a suitable alternative to the
gold standard diagnostic of laparoscopy2. It is done under local
anaesthetic and may involve transvaginal hydrolaparoscopy, methylene blue
dye test, salpingoscopy, microsalpingoscopy and hysteroscopy. The main
feature of fertiloscopy is the ability of an optical device to be
introduced into the tubal ostium to bilaterally explore the tubal mucosa.
Optical magnification allows the assessment of the functional capability
of the fallopian tubes to be made. This may guide decisions about referral
for other treatments such as in vitro fertilisation2. Little is known
about women's attitudes towards fertiloscopy compared with other methods
of assessing tubal patency: hysterosalpingogram (HSG), hysterosalpingo
contrast-sonography (HyCoSy) or laparoscopy.
In December 2010 for a medical student research project we conducted
a community-based questionnaire survey of female patients' opinions
regarding these four methods of imaging to determine uterine tubal
patency. Following ethical review by the St. George's course organiser, an
information sheet and a questionnaire were given to consecutive female
patients aged between 15- 45 all attending a General Practice in
Cricklewood, North London. Patients who agreed to complete the
questionnaire were also given four information cards which described each
method of assessing tubal patency, including possible advantages and
disadvantages. An accompanying simple diagram of the female reproductive
tract was given as an aid. For the 20% of patients who could not read or
write English the investigator (AJ) explained the questions and the four
methods to them. The completed questionnaires were returned to the
investigator and the data were entered and analysed using SPSS.
The response rate was 94% (64/68) and the average age of responders
was 30 years old (range 16 to 45). Out of 64 respondents, 45% described
themselves as Asian, 37.7% White, 10% Black, 4.7% mixed, and 2.6% other
ethnic groups. Six participants (9%) reported that they had had a
chlamydia infection in the past.
The most preferred method to test tubal patency was fertiloscopy
(32%, n=20). The main reasons given were that the procedure was relatively
quick, no post surgery scars, and this method was the only one which
enabled visualisation of the interior of the fallopian tubes. The least
preferred method was laparoscopy (53%, n=34) as this caused post operative
scars, and required general anaesthetic. Although most women had heard
about chlamydia and knew it could be asymptomatic and prevented by using
condoms, nearly a quarter (23%, n=15) of this group of mainly Asian women
had never heard of chlamydia.
We agree with Bender et al.1 that development and validation of
indicators of chlamydia -related complications should be pursued.
Fertiloscopy appeared to be acceptable to women in this study and might be
more widely used to assess fertility, but more research should be done on
the opinions of women who have undergone the procedure. These findings
could also be useful in the design of a pilot study for a trial of
chlamydia screening using tubal patency as an outcome measure.
Acknowledgements
We thank the Chichele road GP surgery in Cricklewood, North West London
for allowing us to conduct the study.
Anushree Jagadambe, Dr. Pippa Oakeshott, Dr. Phillip Hay and Dr.
Kamal Ojha
Population Health Sciences and Education, St George's University of
London, London, SW17 ORE, UK
Correspondence to: A Jagadambe
Email: m0701746@sgul.ac.uk
References
1. Bender N, Herrmann B, Andersen B.et al. Chlamydia infection,
pelvic inflammatory disease, ectopic pregnancy and infertility: cross-
national study. Sex Transm Infect 2011;87: 601-608
2. Fertiloscopy in the management of female infertility [web page
online]. [cited 2011 Nov 16]; Available from:
URL:http://hcp.obgyn.net/laparoscopy/content/article/1760982/1891840
The recently published article, Chacko L, Ford N, Sbaiti M, Siddiqui
R. Adherence to HIV post-exposure prophylaxis in victims of sexual
assault: a systematic review and meta-analysis, Sex Transm Infect
doi:10.1136/sextrans-2011-050371, contributes greatly to our understanding
of the extent of poor adherence to post-exposure prophylaxis in victims
of sexual assault. It also clarifies the percentage of such patients
defau...
The recently published article, Chacko L, Ford N, Sbaiti M, Siddiqui
R. Adherence to HIV post-exposure prophylaxis in victims of sexual
assault: a systematic review and meta-analysis, Sex Transm Infect
doi:10.1136/sextrans-2011-050371, contributes greatly to our understanding
of the extent of poor adherence to post-exposure prophylaxis in victims
of sexual assault. It also clarifies the percentage of such patients
defaulting from care. The article illustrates how victims of sexual
assault fail to adhere to guidelines for prevention of HIV infection1.
Sadler AG, Mengeling MA, Syrop CH, Torner JC, Booth BM. Lifetime
Sexual Assault and Cervical Cytological Abnormalities Among Military
Women. Journal of Women's Health;20(11):1693-1701, revealed that female
victims of military sexual trauma have increased risk of cervical
cytological abnormalities. This increased gynecological health risk factor
requires vigilance in long-term screening to prevent poor future
outcomes. The adherence of women Veterans for cervical cancer screening is
imperative for their future welfare2,3.
The recent publication, Chacko L, Ford N, Sbaiti M, Siddiqui R.
Adherence to HIV post-exposure prophylaxis in victims of sexual assault: a
systematic review and meta-analysis, Sex Transm Infect
doi:10.1136/sextrans-2011-050371,thus reflects the poor adherence of
victims of sexual assault in the prevention of HIV infection1.
Up to 40% of female Veterans may have experienced military sexual
trauma, putting them at risk for cervical cytological abnormalities. It is
therefore clear that female Veterans, many of whom have experienced sexual
assault while in the military,would benefit from preventive care2-4.
Chacko L, et al. reinforce that victims of sexual assault need
support and encouragement to seek the medical care they require.
VA applauds such authors in clarifying the needs of those who have
experienced sexual assault and make it evident that these victims require
much support and help. VA hopes to provide the required support to victims
of sexual assault.1,3.
1. Chacko L, Ford N, Sbaiti M, Siddiqui R. Adherence to HIV post
-exposure prophylaxis in victims of sexual assault: a systematic review
and meta-analysis, Sex Transm Infect doi:10.1136/sextrans-2011-050371.
2. Sadler AG, Mengeling MA, Syrop CH, Torner JC, Booth BM. Lifetime
Sexual Assault and Cervical Cytological Abnormalities Among Military
Women. Journal of Women's Health;20(11):1693-1701.
3. Lutwak N. The Need for Gynecological Follow-Up Among Women
Veterans: The Association of Sexual Assault and Abnormal Cervical
Cytology. Journal of Women's Health; 2012;21(3).
4. Kelly UA, Skelton K, Patel M, Bradley B. More Than Military Sexual
Trauma: Interpersonal Violence, PTSD, and Mental Health in Women Veterans.
Research in Nursing and Health.2011;34(6):457-467.
The International AIDS Society (IAS) nowadays expresses its deep
concern about continuing inflammatory and homophobic statements by
political leaders from different countries, and urges national and
international leaders to reject homophobia and to take affirmative steps
to reduce its impact on HIV.
One of the many lessons learned in the IAS more than 20 years of
leadership in HIV/AIDS, is that well-designed and appropr...
The International AIDS Society (IAS) nowadays expresses its deep
concern about continuing inflammatory and homophobic statements by
political leaders from different countries, and urges national and
international leaders to reject homophobia and to take affirmative steps
to reduce its impact on HIV.
One of the many lessons learned in the IAS more than 20 years of
leadership in HIV/AIDS, is that well-designed and appropriately targeted
programs, implemented with the support of public health and political
leadership, can effectively reduce HIV transmission in communities most at
risk for HIV, including gay men and other men who have sex with men (MSM).
A report issued at the end of 2011, led by some researchers in Cuba
provides solid evidence that HIV among MSM continues to be widespread, and
in many cases, is exacerbated by stigma, criminalization and the lack of
appropriate services. The study indicates that even in countries with low
HIV prevalence in the general population, the epidemic among MSM is
raging.
According to UNAIDS, fewer than one in 20 MSM around the world has access
to HIV prevention, treatment, and care and even fewer in low-
income settings. Compared to the HIV teuntries, reducing the social
exclusion of gay and MSM communities through the promotion and protection
of their human rights (including sexual rights and the right to health) is
not only consistent with, but a prerequisite to, good public health. Once
discriminatory policies are abolished and stigma and discrimination are
confronted, country-based programs can be put in place to encourage gay
men and MSM to stay free of HIV-infection, thus supporting national goals
of reducing HIV burden.
However, efforts to replicate these successful strategies in more
countries are hampered by recent homophobic statements made by political
leaders from some countries. Comments from these leaders, and other
politicians who call for the arrest, detention, and even killing of
homosexuals, are reprehensible.
Despite its much heralded success in promoting a public health response to
HIV, Uganda continues to cling to a colonial-era sodomy law that punishes
homosexual conduct with life imprisonment. And, Uganda is by no means the
exception. Worldwide, more than 85 countries criminalize consensual
homosexual conduct. Such laws give governments a pretext to invade
people's private lives and deny them essential hosting rates of 63-
85 percent seen among MSM in Australia, Europe, and North America, rates
among MSM in much of Africa, Asia, and Eastern Europe are often under 20
percent.
As it has been demonstrated in many different human rights: to live in
peace and in health.
Homophobia, whether propagated by government leaders, enforced by
outdated laws, or perpetuated through stigma and discrimination,
continues to fuel this epidemic, and should therefore be the number one
enemy of those who are serious about ending this global tragedy.
In our country, Cuba, the leaders are fighting against this, but we have
to do more to help these persons.
Jacques Pepin addresses the important
question of parenteral transmission of HIV-1 in Leopoldville, and criticises
aspects of our article (Sousa_et_al,2010,PLoS_ONE
5(4):e9936, http://www.plosone.org/article/info:doi/10.1371/journal.pone.0009936), in which we modelled the initial heterosexual
spread of HIV-1 in that city.1 Here, we respond directly to his
criticisms.
He writes that we used a genital ulcer
disease(GUD)-related risk ratio of HIV-1 transmission of up to 430. He derives
the latter from the measured and published 43% risk incurred by an
uncircumcised man exposed to a HIV-1-infected index woman with a genital ulcer,
which is 430 times the 0.1% baseline.2,3 However, it is misleading
to represent this parameter as equivalent to a GUD risk ratio of 430, as Pepin
does, because the measured 43% risk derived from two concomitant cofactors,
GUD and lack of circumcision, the latter increasing the risk from 4% to 43%.3
In addition, for most other situations involving GUD, the cofactor effect was
much lower in our simulations, consistent with the studies that estimated them
on a per act basis.3,4
The GUD-related risk ratios of around 3-5 cited by Pepin
are based on studies that asked participants whether they had GUD at any time within a long period (e.g.,
the last 12 months), a procedure that strongly underestimates the per act GUD effect.2
Pepin questions our postulated 10 weeks average ulcer
duration. Chancroid's ulcer lasts 10 weeks on average.5 On average,
syphilis' chancre lasts 12 days, and the secondary stage lasts 3.6 months, often
relapsing.6 A modelling study postulated 4 weeks of high sexual
infectiousness during syphilis secondary stage.7 We feel it is reasonable
to assume 4-6 weeks high HIV-1 infectiousness due to primary syphilis or
mucosal lesions associated with secondary syphilis. Lymphogranulomavenereum (LGV)
causes short initial genital ulcers but, in some women, it causes
genitoanorectal syndrome, involving years-lasting genital ulceration.8,9
Given that syphilis, chancroid, and LGV were the most common GUDs in early 20th
century Leopoldville, we consider our choice of ulcers averaging 10 weeks
appropriate.
As Pepin acknowledges, we previously reported low GUD prevalence
in 1950s Leopoldville/Kinshasa.1 We agree with him that substantial parenteral
transmission of HIV-1 may have occurred in Leopoldville/Kinshasa.
I noticed an error in the editorial "Effective HIV prevention requires gender-transformative work with men" by Kristin L. Dunkle and Rachel Jewkes. The list should indicate that the first article referenced, "How men’s power over women fuels the HIV epidemic" by G.R. Gupta, is from the 324th, not the 321st, volume (issue 7331). At this time, your web site's Crossref link links to a review of a movie, 28...
I noticed an error in the editorial "Effective HIV prevention requires gender-transformative work with men" by Kristin L. Dunkle and Rachel Jewkes. The list should indicate that the first article referenced, "How men’s power over women fuels the HIV epidemic" by G.R. Gupta, is from the 324th, not the 321st, volume (issue 7331). At this time, your web site's Crossref link links to a review of a movie, 28 Days.
In addition to the confusion this may (and has) cause readers, it also detracts from the referenced author's citation record.
Recent Commentary in the journal (1) encourages wider implementation of nucleic acid amplification tests (NAATs) to detect gonorrhoea (GC). We have used GC NAATs (Gen-Probe APTIMA Combo2) since 2003, with high uptake, in a Liverpool chlamydia screening population and with referral of GC
positives to our local Genitourinary Medicine (GUM) clinic for management (2). We have now observed a doubling of femal...
Recent Commentary in the journal (1) encourages wider implementation of nucleic acid amplification tests (NAATs) to detect gonorrhoea (GC). We have used GC NAATs (Gen-Probe APTIMA Combo2) since 2003, with high uptake, in a Liverpool chlamydia screening population and with referral of GC
positives to our local Genitourinary Medicine (GUM) clinic for management (2). We have now observed a doubling of female cases of GC and a reversal of the downward trend for male GC as reported through KC60 - the national
indicator of GC activity which is based on central reporting but essentially only of cases seen at GUM clinics. For females (Fig 1), compared to a four year average baseline (2000-2003) of 101 cases per annum, KC60 reports showed an extra 51 cases in 2004 and an extra 99 cases in 2005. These extra numbers reflect closely the 45 cases in 2004 and the
107 cases in 2005 detected by concomitant screening for GC in the community chlamydia screening programme. For males (Fig 2), the upturn in KC60 reports can be matched to the total of cases detected directly by community screening plus by contact tracing of female community cases (assumed 50% success).
This significant local impact on detection of GC cases suggests that concomitant / dual testing in the community can benefit the wider provision of services for Sexual Health. Empirical evidence gained from screening in Liverpool has been recognised by the Cheshire and Merseyside
Sexual Health Network; the development of a Care Pathway for asymptomatic low-risk individuals recommends concomitant screening for chlamydia and gonorrhoea using APTIMA (3). This facilitates prompt, easy access to more comprehensive screening for sexually transmitted infections at a wide
range of venues, and may also promote opportunities for increased participation in the National Chlamydia Screening Programme.
Also with regard to data collection, KC60 data is an important tool in assessing progress towards the Department of Health target for a twenty-five percent reduction in cases of GC diagnosed at GUM clinics (4). Consideration of changes to KC60 reporting may be needed to prevent increased use of GC NAATs and/or dual testing in the community becoming a confounder to monitoring of this aim.
Figure 1
Figure 2
References
1. Bignell CJ, Sex Transm Infect 2007;83:179-80.
2. Lavelle SJ, Jones KE, Mallinson H et al. Finding, confirming and managing gonorrhoea in a population screened for chlamydia using the Gen-Probe Aptima Combo2 assay. Sex Transm Infect 2006;82:221-4.
3. Abbott, M (on behalf of the Care Pathways Working Group) Cheshire and Merseyside Sexual Health Network: STI Care Pathways explanatory document. 2007. Available at:
http://www.cmshn.nhs.uk/document_uploads/Care%20Pathways/CMSHNCarePath_1.pdf
4. Department of Health, Better prevention better services better sexual health: the national strategy for sexual health and HIV. London: DOH, 2001
Violence against women is a global problem, and rates in Southeast Asia is high enough.Patriarchy culture take a part for this condition. The culture is also contribute to the situation. Gender inequality is especially visible in developing countries. Women and girls often have less information and access to services, especially in rural areas. Girls make their sexual debut early, either through early ma...
Violence against women is a global problem, and rates in Southeast Asia is high enough.Patriarchy culture take a part for this condition. The culture is also contribute to the situation. Gender inequality is especially visible in developing countries. Women and girls often have less information and access to services, especially in rural areas. Girls make their sexual debut early, either through early marriage or sexual abuse. In most cases their partners are typically much older men. Physical and sexual violence within marriage are also common, and women have little
room to negotiate the use of condoms or to refuse sex to an unfaithful partner. Culture is not immutable, but change has to come from within a society,because people feel the need for it.Mobilization of local resources and indigenous knowledge, as well as the promotion of women's
creativity and productivity, can be vital tools in the prevention and control of HIV/AIDS amongst women. There is a strong need of media support, NGO, and government.
While sharing Adams and colleagues’ concerns about the use of major outcomes averted, I should like to point out a factual error in their description[1] of the results from the ClaSS model[2]. The definition of major outcome used in that report, which appears in the text on page 107
and in the caption to Figure 18 on page 108 of the report[2] excludes epididymitis. The “seemingly perverse” result that sc...
While sharing Adams and colleagues’ concerns about the use of major outcomes averted, I should like to point out a factual error in their description[1] of the results from the ClaSS model[2]. The definition of major outcome used in that report, which appears in the text on page 107
and in the caption to Figure 18 on page 108 of the report[2] excludes epididymitis. The “seemingly perverse” result that screening males in addition to females is more cost-effective than screening females alone is therefore based on an outcome measure that does not include epididymitis. While it is true that the cost of epididymitis is included in the calculations, the result cited still holds even if the cost of epididymitis is removed. In the interests of further clarity, I should also like to point out that we only considered screening males in addition to females: we never considered screening males alone.
References
[1] Adams E J, Edmunds W J, Turner K M. Commentary on “The cost-effectiveness of opportunistic chlamydia screening in England”. Sex Transm Infect 2007;83:275.
[2] Low N, McCarthy A, Macleod J, et al. Epidemiological, social, diagnostic and economic evaluation of population screening for genital
chlamydial infection. Health Technology Assessment, 2007. Report No. 11(8).
Sinka and colleagues found that using self-taken vaginal swabs for HPV testing was acceptable to young women who had defaulted from their initial HPV screening appointment at age 211. However, the rate of return of postal samples was low (13%, 725/5500). In October 2011 we conducted a feasibility study to evaluate response rates of 16-24yo female GUM clinic attenders to providing two self-taken vaginal swabs for Chlamydia tra...
Bender and colleagues found that relationships between levels of chlamydia infection and complication rates of pelvic inflammatory disease and ectopic pregnancy between and within countries over time were not straightforward1. Many women diagnosed with a chlamydial infection are anxious about future fertility. Fertiloscopy is a novel procedure to assess fallopian tube function and may be a suitable alternative to the go...
The recently published article, Chacko L, Ford N, Sbaiti M, Siddiqui R. Adherence to HIV post-exposure prophylaxis in victims of sexual assault: a systematic review and meta-analysis, Sex Transm Infect doi:10.1136/sextrans-2011-050371, contributes greatly to our understanding of the extent of poor adherence to post-exposure prophylaxis in victims of sexual assault. It also clarifies the percentage of such patients defau...
The International AIDS Society (IAS) nowadays expresses its deep concern about continuing inflammatory and homophobic statements by political leaders from different countries, and urges national and international leaders to reject homophobia and to take affirmative steps to reduce its impact on HIV. One of the many lessons learned in the IAS more than 20 years of leadership in HIV/AIDS, is that well-designed and appropr...
...
Dear Editor
I noticed an error in the editorial "Effective HIV prevention requires gender-transformative work with men" by Kristin L. Dunkle and Rachel Jewkes. The list should indicate that the first article referenced, "How men’s power over women fuels the HIV epidemic" by G.R. Gupta, is from the 324th, not the 321st, volume (issue 7331). At this time, your web site's Crossref link links to a review of a movie, 28...
Dear Editor,
Recent Commentary in the journal (1) encourages wider implementation of nucleic acid amplification tests (NAATs) to detect gonorrhoea (GC). We have used GC NAATs (Gen-Probe APTIMA Combo2) since 2003, with high uptake, in a Liverpool chlamydia screening population and with referral of GC positives to our local Genitourinary Medicine (GUM) clinic for management (2). We have now observed a doubling of femal...
Dear Editor,
Violence against women is a global problem, and rates in Southeast Asia is high enough.Patriarchy culture take a part for this condition. The culture is also contribute to the situation. Gender inequality is especially visible in developing countries. Women and girls often have less information and access to services, especially in rural areas. Girls make their sexual debut early, either through early ma...
Dear Editor,
While sharing Adams and colleagues’ concerns about the use of major outcomes averted, I should like to point out a factual error in their description[1] of the results from the ClaSS model[2]. The definition of major outcome used in that report, which appears in the text on page 107 and in the caption to Figure 18 on page 108 of the report[2] excludes epididymitis. The “seemingly perverse” result that sc...
This article contains invaluable information to learn more about Syphilis and it's control strategy. Thanks to the author.
Conflict of Interest:
None declared
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