Displaying 1-10 letters out of 165 published
Trichomonas Vaginalis (TV) is frequently described as being associated with pre-term delivery and low birth weight - and was again by Professor Hillier in her editorial in her (unreferenced) introductory paragraph. As far as I can ascertain, this association appears to be based on published evidence from the 80s and 90s.
Is it possible, given the more recent understanding of a link between TV and poverty, that these 20 year old studies were confounded?
There is conflicting evidence as to whether the use of metronidazole is itself associated with worse birth outcomes1,2 and so it is important to have a full understanding of the role of TV.
In global terms I work and teach in a setting with a low prevalence of HIV. Can anyone help me find reasonably strong evidence that TV is other than a harmless commensal for those of my patients who are asymptomatic?
1.What have we learned about vaginal infections and preterm birth? Carey JC et al Semin Perinatol 2003 27(3):212-6 2. Investigation of metronidazole use during pregnancy and adverse outcomes Catherine A Coss et al Antimicrobial Agents and Chemotherapy 2012 56(9) 4800-5
Conflict of Interest:
Response to a letter Recent Advances of the HIV Surveillance System in Iran: Current Situation and Ways Forward
We very much appreciate the letter that Dr Haghdoost and colleagues wrote in relation to some of the issues outlined in our paper HIV surveillance in MENA: recent developments and results and, in addition, described some more recent developments in HIV surveillance in Iran.
We would like to reflect on several issues that they raised.
Our paper states that Djibouti, Iran, Morocco and Pakistan can be classified as having fully functioning HIV surveillance systems as trends in HIV prevalence in these countries can be assessed over time for certain population sub-groups. Surveillance systems in these countries have a sufficient quantity and quality of the data that can be used to guide the programmatic responses. We also mentioned other nine countries that have partially functioning HIV surveillance systems.
As described in the Methods section of our paper, the assessment of the quality of HIV surveillance systems was based on the questionnaire sent to National AIDS Programmes (NAPs) of the countries of the WHO Eastern Mediterranean Region (EMR) in 2009, 2010 and 2011, and not on the data presented in the paper by Garcia Calleja et al published in Sexually Transmitted Infections in 2010. As described in our paper, to assess the quality of HIV surveillance systems we adapted a method developed by WHO and UNAIDS.123
As one of the limitations, we outlined that data were provided by the NAPs, which might have missed data sources collected by other agencies that Haghodoost et al. mention, such as surveys in partners of IDUs. However, as planning of surveillance and programmatic responses is lead by the NAPs, we think that collecting data from NAPs gives an appropriate insight into the type and quality of data that the countries use for planning and evaluating the national HIV response. We are aware that many studies might be undertaken in the EMR, but their results are not disseminated, and this is particularly the case with studies done in groups at higher risk of HIV that are heavily stigmatized.
In relation to some other issues that the colleagues raised, surveys using respondent-driven sampling were done in many other countries in the Region (some of these are referenced in the paper) as well as Mode of Transmission studies.4
We have not reflected on the reasons for the improvements in HIV surveillance in North Africa and the Middle East, but we believe this has been due to greater availability of funding provided by the Global Fund to Fight AIDS, Tuberculosis and Malaria and capacity building efforts of numerous international and national agencies.
We agree with Dr Haghdoost and the colleagues that there are substantial improvements in HIV surveillance in Iran though significant challenges remain in bridging the gaps that the system still has. One of them is certainly in conducting studies on HIV and sexually transmitted infections in MSM and transgendered individuals, which due to prevailing stigmatization are still lacking throughout the Region.
1. Garcia Calleja JM, Jacobson J, Garg R, et al. Has the quality of serosurveillance in low- and middle-income countries improved since the last HIV estimates round in 2007? Status and trends through 2009. Sex Transm Infect 2010;86(Suppl 2):ii35-42
2. Walker N, Garcia-Calleja JM, Heaton L, et al. Epidemiological analysis of the quality of HIV sero-surveillance in the world: how well do we track the epidemic? AIDS 2001;15:1545-54
3. Lyerla R, Gouws E, Garcia-Calleja JM. The quality of sero- surveillance in low- and middle-income countries: status and trends through 2007. Sex Transm Inf 2008;84: i85-91.
4. Mumtaz G, Hilmi N, Zidouh A, El Rhilani H, Alami K, Bennani A, Gouws E, Ghys P, Abu- Raddad L. HIV Mode of Transmission Analysis. Rabat: Kingdom of Morocco. Ministry of Health, Department of Epidemiology and Disease Control, 2010.
Conflict of Interest:
Recent Advances of the HIV Surveillance System in Iran; Current Situation and Ways Forward
We very much enjoyed reading Dr. Bozicevic's paper about the recent developments in HIV Surveillance in MENA in a recent issue of your journal . Some topics discussed in that paper concern us and we would like to share a few opinions about the current HIV surveillance system in Iran and its recent advances. In the paper it is stated that only two countries in the region (Morocco and Sudan) have a partially functioning HIV surveillance; however, we assume this is based on the data presented in a study conducted in 2009  and at present, Iran has also a somewhat functioning HIV surveillance system. For example, Iran has done a pretty fine job in controlling the HIV infection among IDUs and monitoring the epidemic trend in pregnant women . Iran has been also conducting biannual bio-behavioral surveys among IDUs, FSWs, IDU partners, and prisoners . More recently, size estimation programs have been introduced to the system and we have conducted size estimation studies in estimating the size of at risk populations . On top of the above, Iran is one the only countries in the region that has conducted Respondent Driven Sampling as well as Mode of Transmission studies [3, 5]. What is more, the number of HIV/AIDS related publications in Iran (in PubMed database) has doubled in a five- year period which is also an evidence of improvement of the system . We think a number of reasons may have contributed to this progress. The role of the Regional Knowledge Hubs in HIV/AIDS Surveillance in educating healthcare providers and researchers as well as health policy makers cannot be ignored . These educations have been given through national and international workshops and sending out educational packages to different policy makers, from members of the parliament to those in the presidential office. We assume highlighting the burden of HIV/AIDS in the upcoming years has been successful in drawing policy makers' attention to the seriousness of the HIV epidemic across the country in a way that controlling HIV/AIDS throughout the country was a serious concern in the recent presidential debates. Despite all the achievements in addressing the HIV epidemic, there is still a lot to be done and the current system still suffers to a considerable extent. For example, likewise most countries in the region, MSM and transgendered populations have long been overlooked in the HIV surveillance system; ignorance mainly originated from the stigma surrounding such populations. We think one of the main challenges to be overcome is the pitfalls in the case finding and reporting system of Iran. The sensitivity of case finding in Iran is low and following up the HIV patients and assessing their adherence to therapy is a major challenge in front of healthcare providers [5, 8]. Although the case reporting system is not fully functioning, a national computer-based is being launched in the country that opens a window of hope in fixing the defects in the current reporting system. The Ministry of Health is really optimistic about this system; however, its effectiveness is yet to be evaluated.
References: 1. Bozicevic I, Riedner G, and Garcia Calleja JM. HIV surveillance in MENA: recent developments and results. Sex Transm Infect, 2013. online: p. 1-6. 2. Garc?a Calleja JM, Jacobson J, Garg R, et al. Has the quality of serosurveillance in lowand middle-income countries improved since the last HIV estimates round in 2007? Status and trends through 2009. Sex Transm Infect, 2010. 86 (Suppl 2): p. 35-42. 3. National AIDS Committee Secretariat and Ministry of Health and Medical Education. Islamic Republic of Iran AIDS Progress Report On Monitoring of the United Nations General Assembly Special Session on HIV and AIDS.2012, available at: www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/IRiran,1.PDF2012. 4. Shokuhi M, baneshi MR and haghdoost AA. Size Estimation of Groups at High Risk of HIV/AIDS using Network Scale Up in Kerman, Iran. Int J Prev Med, 2012 .3(7): p. 471-476. 5. Nasirian M, Doroudi F, Gooya MM, et al. Modeling of Human Immunodeficiency Virus Modes of Transmission in Iran. Journal of Reaserch in Health Sciences, 2012. 12(2): p. 81-87. 6. Saba HF, Kouyoumjian SP, Mumtaz GR, et al. Characterising the progress in HIV/AIDS research in the Middle East and North Africa. Sex Transm Infect, 2013. online: p. 1-5. 7. Mostafavi E, Haghdoost AA, mirzazadeh A, et al. Regional HIV knowledge hubs: a new approach by the health sector to transform knowledge into practice. Health Promotion International, 2012. online: p. 1-7. 8. Haghdoost AA, Mostafavi E, Mirzazadeh A, et al. Modelling of HIV/AIDS in Iran up to 2014. Journal of AIDS and HIV Research Journal of AIDS and HIV Research, 2011. 3(12).
Conflict of Interest:
Measures of risk do not discriminate between MSM tested for HIV within the previous 6 months and MSM tested 6 to 12 months previously: Data from Glasgow, Scotland, in 2010.
UK and USA guidelines recommend at least annual HIV testing for men who have sex with men (MSM), with more frequent testing for those at risk. Although measures of risk and regularity of HIV testing are essential for evaluating interventions, these are not yet standardised across the UK.1 Risk criteria could include recent unprotected anal intercourse (UAI), a high number of partners, unknown partners, and recent STI.2 From self- report data collected in Glasgow with a bar-based sample (excluding non- Scottish and HIV positive men, n = 683), we compared two groups on these risk criteria, in addition to demographic variables and psychosocial testing barriers. The groups were those reporting an HIV test within the previous 6 months (recent testers) and those reporting a test 6-12 months previously.
Recent testers (39.7%, n = 271) and those tested 6-12 months previously (17.6%, n = 120) differed significantly on the number of sexual partners reported in the previous year; those tested 6-12 months previously were more likely to report only 0-1 sexual partner, while recent testers were more likely to report 2-10 partners: ??2 (2) = 6.33, p = .042. However, the proportions of those reporting ?11 partners were almost identical: 22.5% and 22.9% respectively. The groups did not differ significantly on the numbers of UAI partners in the previous year. Among those with at least one UAI partner, the groups did not differ on status of partners (casual or regular), knowledge of the partners' HIV status, or whether those partners were HIV positive. There was a non- significant trend (p = .094) for recent testers to report STI in the previous year. The groups did not differ on demographic characteristics (age, employment, education, use of the gay scene) or barriers to HIV testing (benefits, fear, clinic barriers, attitudes to sex with HIV positive partners, testing norm).
Most measures of risk did not differentiate between the two groups of testers, suggesting further research on the measurement of risk and frequency or regularity of testing is warranted. We are exploring the utility of including measures of regularity and frequency of HIV testing in our surveys: one of the limitations of the analysis reported here (in addition to reliance on self-reported and cross-sectional data from a bar- based sample) was the use of a retrospective measure of the most recent HIV test.
ACKNOWLEDGEMENTS The survey was funded by NHS Greater Glasgow & Clyde, Ayrshire & Arran and Lanarkshire. The MRC funds Dr Lisa McDaid.
ETHICS APPROVAL Granted by the Psychology Ethics Subcommittee at Glasgow Caledonian University.
1. Desai M, Desai S, Sullivan AK, et al. Audit of HIV testing frequency and behavioural interventions for men who have sex with men: policy and practice in sexual health clinics in England. Sex Transm Infect. Published Online First: January 7, 2013. doi:10.1136/sextrans- 2012- 050679.
2. Katz DA, Dombrowski JC, Swanson F, et al. HIV intertest interval among MSM in King County, Washington. Sex Transm Infect 2013;89:32-37. doi:10.1136/sextrans-2011-050470.
Conflict of Interest:
Why is the Number of HIV/AIDS Related Publications Low in the MENA Region?
We enjoyed reading Dr. Saba's paper and would like to share some opinions about HIV/AIDS related publications in the Middle East and North Arica (MENA). This paper showed a positive trend in the number of annual HIV/AIDS related publications in the MENA, on the other hand, this paper suggests that this number is still very low considering the sharp upward trend of HIV new infections in this region. This gap might be due to several factors. The unsupportive dominant political climate as well as the stigma and sensitivity surrounding at- risk populations such as Men having Sex with Men is very high. Some of these countries have long been struggling with internal wars, uprisings, and terrorism; that may overshadow the importance of this infection in the minds of those in charge.
On the other hand, the dynamic of research have profound pitfalls in the region. The potential research capacity and the availability of funding do differ greatly across the region. Lack of a clear and comprehensive plan in several countries in this region might also be an influencing factor. Last but not least, scarce publications on HIV/AIDS related topics may stem from the policy of credited scientific journals in publishing the findings of researchers from this region. Most scientific journals stick to high international research standards (regarding methodology mainly), while reviewing manuscripts from the MENA region. Some barriers such as low sample size, presence of selection and information biases to some extent might convince journals to reject the papers from this region. However, implementation of high quality studies might be impossible in some of these countries. We think even simple descriptive data using even convenience sampling methods could be an important step forward in enriching the available data in the region. Out of the formerly mentioned factors, we assume changing the viewpoints of journal editors is one of the most feasible options we have ahead. Lastly, although publishing the findings of researches and studies across the region is of importance, the way and to the extent those findings are applied in the countries to make a change and better the situation is much more vital.
References: 1. Hanan F Saba, et al., Characterising the progress in HIV/AIDS research in the Middle East and North Africa. Sex Transm Infect, 2013(0): p. 1-5. 2. Ivana Bozicevic, Gabriele Riedner, and Jesus maria Garcia Calleja, HIV surveillance in MENA: recent developments and results. Sex Transm Infect, 2013(0): p. 1-6. 3. Ghina R Mumtaz, et al., Are HIV epidemics among men who have sex with men emerging in the Middle East and North Africa?: a systematic review and data synthesis. PLoS Med, 2011. 8(8): p. e1000444.
Conflict of Interest:
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 POPI (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 women's health study. We explained that only women aged 16-27 who were sexually experienced were eligible. Those who consented completed a questionnaire and provided a self-taken vaginal swab. We explained that as samples might not be tested for six months, it was participants' responsibility to get tested independently if they were at risk of STIs. Subjects were given a small honorarium (?5 and a lollipop) when they returned the samples.
Of 40 women approached, eight were aged >27 and seven refused: response rate 78% (25/32). Responders were broadly similar to non- responders in the proportion of black ethnicity (56%, 14/25 versus 86%, 6/7) but were younger (mean (sd) 19.3 (2.7) years versus 22.9 (3.5) years, p<0.01)). Unlike our difficulties in the POPI trial2, we recruited our target of 25 women in 90 minutes and had to turn away potential participants as we had run out of packs. Three women were later excluded as their questionnaire responses showed they had never had sex. Of the 22 sexually active women, 41% reported two or more sexual partners in the previous year and 45% were smokers. Mean age of sexual debut was 15.5 years (range 13 to 19). Four women reported a history of STI.
Within a week, samples were randomly allocated to immediate or deferred testing. Two of 16 participants in the immediate testing group were positive - one for chlamydia and one for gonorrhoea. They were easily contactable by mobile phone and email and referred for treatment. We will return to the college in six months to request a further vaginal swab and questionnaire from the 22 eligible participants. Although we need to ensure only those who are sexually experienced are recruited, our study suggests small financial incentives may be useful.
Ethics review: Bromley REC: 12/LO/0855
Acknowledgements: We thank students and staff at Lambeth College.
1. Jain A, Ison CA. Chlamydia point-of-care testing: where are we now? Sex Transm Infect 2013;89(2)88-89.
2. Oakeshott P, Kerry S, Aghaizu A et al. Randomized control trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial. BMJ. 2010;340:c1642
Conflict of Interest:
No condoms for prisoners: accumulating risks of HIV, STI but also Hepatitis transmission
Butler and colleagues report convincing results confirming that the availability of HIV prevention tools such as condoms in prisons does not increase sexual activity among inmates but rather increases safe sex. These results represent a major step towards negating the widespread belief that the general availability of prevention measures in prisons increases at-risk practices associated with HIV, Hepatitis and other sexually transmitted infections (STI). Indeed similar ad hoc studies regarding the availability of needles and syringes programs in prisons (NSP) showed no increase in injection but an increase in safe injecting practices. Despite such evidence, NSP continues to be banned in prisons in several countries.
Recommendations by the authors about breaking down the last barriers to condom availability in prisons are particularly significant and timely for several reasons. First, condoms are not always available in prisons and, paradoxically, this is particularly true in countries with a high prevalence of HIV among inmates. When "potentially" available, inmate access to condoms is not always easy both due to a lack of condom machines, and because inmates are reluctant to ask for them out of fear of stigmatization. Moreover, a French study has already shown that HIV post-exposure prophylaxis is neither known nor prescribed to prisoners and this is perhaps the case for many other correctional institutions. Second, the need for condoms in prisons is justified by the recent increase in industrialized countries of HCV permucosal transmission in HIV -positive men who have sex with men (MSM). This increase is concomitant with increased drug use and high risk sexual practices in this population. Additionally, HIV and other STI, which are frequent in prisoners, appear to be important cofactors in onward transmission of permucosally acquired HCV. Third, the criminalization of drug users and MSM in several countries contributes to promiscuity in prisons, facilitating transmission of HIV and Hepatitis B and C from one group to another. Though sexual violence was infrequent and underreported in the study by Butler et al., this may not be the case for other prisons where overpopulation may amplify such risks.
Assuring the same prevention interventions for prisoners as those enjoyed by the general population is not only a human right but a public health need.
1. Butler T, Richters J, Yap L, et al. Condoms for prisoners: no evidence that they increase sex in prison, but they increase safe sex. Sex Transm Infect. 2013 Jan 7.
2. WHO. Effectiveness of Interventions to Manage HIV in Prisons - Needle and syringe programmes and bleach and decontamination strategies (Evidence for Action Technical Papers). Geneva: WHO, UNAIDS, UNODC; 2007.
3. Michel L, Jauffret-Roustide M, Blanche J, et al. Limited access to HIV prevention in French prisons (ANRS PRI2DE): implications for public health and drug policy. BMC Public Health. 2011;11:400.
4. Bradshaw D, Matthews G and Danta M. Sexually transmitted hepatitis C infection: the new epidemic in MSM? Curr Opin Infect Dis. 2013;26(1):66- 72.
Conflict of Interest:
Re:Flow cytometry is a sensitive and rapid tool for ruling out NGU
Acute nongonococcal urethritis (NGU) is one of the commonest sexually transmitted infections affecting man and woman. The diagnosis of NGU has traditionally required microscopic evidence of urethritis. However, a significant proportion of patients with urethral symptoms do not have microscopic evidence of urethritis. A recently published article by Orellana MA et al  highlighted the low sensitivity of Gram stain in the diagnosis of urethritis in men, and the low negative predictive value of microscopic results in symptomatic patients. Whereas, we recently evaluated the analytical performance of the UF-1000i (Sysmex Co, Japan, Supplied by Dasit SpA, Cornaredo, Italy), a recently introduced fluorescence flow cytometer intended for urinalysis purposes , which provides new analytical features that seem particularly suitable for microbiological diagnostics, for ruling out NGU or predicting the presence of infection . The Sysmex UF-1000i is a flow cytometry analyzer capable of quantifying a lot of particles, including bacteria and white blood cells (WBCs). To evaluate the analytical performance of the UF-1000i as a method for ruling out NGU, we examined 200 urethral smear samples, collected in a liquid transport medium (Eswab, Copan, Brescia, Italy). We compared the UF-1000i results with microscopic Gram stain, and with results obtained from standard cultures and molecular methods available in our laboratory to detect NGU main pathogens (Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma urealyticum, Ureaplasma parvum, Mycoplasma hominis, Trichomonas vaginalis, Adenovirus, Herpes simplex) . With instrument cut-off values of 200 BACT x10^6/L and 500 WBCs x10^6/L, we obtained a sensitivity of 84%, a specificity of 82%, and a high negative predictive value (96%). Our data demonstrated that Sysmex UF-1000i represents a real tool for ruling out NGU, capable of improving the efficiency of NGU presumptive diagnosis, providing results in a few minutes, with a good value of sensitivity and, above all, a very high negative predictive value.
References 1. Orellana MA, Gomez-Lus ML, Lora D. Sensitivit? of Gram stain in the diagnosis of urethritis in men. Sex Transm Infect 2012; 88: 284-287. 2. Grosso S, Bruschetta G, Camporese A. Experimental evaluation of the Sysmex UF-1000i for ruling out non-gonococcal urethritis. Infez Med 2012; 20 (3):188-194. 3. De Rosa R, Grosso S, Bruschetta G, et al. Evaluation of the Sysmex UF1000i flow cytometer for ruling out bacterial urinary tract infection. Clin Chim Acta 2010; 411 1137-1142.
Conflict of Interest:
Do HIV POCT testing algorithms help in clinical practice?
HIV (Point of Care Tests) POCTs are increasingly popular and overcome many barriers to testing. Yet POCTs have false reactive results requiring confirmation. Teague et al,(2009) looked at using a second POCT as confirmation. The first line POCT was the INSTI? HIV-1/HIV-2 Rapid Antibody Test; the confirmatory test the Alere Determine. The serum of 91 individuals with a positive INSTI was retrospectively tested; Determine successfully identified all false reactive INSTIs.1 These data led us to introduce a testing algorithm using Determine (4th generation) as rapid confirmation for all reactive INSTIs alongside the standard laboratory test. This letter presents a review of its use from January to December 2010.
In this period, 220 INSTI reactive patients received both confirmatory tests: 213 of these were reactive on Determine and laboratory tests confirmed HIV infection. 7 had a negative Determine, with 5 proven to be false reactive by laboratory testing. However, 2 were found to be lab positive and were experiencing HIV seroconversion.
The results suggest reactive samples on both POCTs are extremely unlikely to be falsely positive. Although all false reactive INSTIs were identified by Determine, Determine missed 2 patients with HIV seroconversion. Determine now includes a p24antigen component. However, laboratory tests have a greater sensitivity so it is expected that Determine will miss some seroconverters; Rosenberg et al (2011) and Fox (2012) report the sensitivity of Determine in detecting acute HIV infection at 25% and 50% respectively.2 3 Our data goes further; indicating that while Determine is currently the only 4th generation POCT, there are instances where 3rd generation POCTs may detect infection earlier. However, our data cannot say whether Determine could detect some acute infections that INSTI may miss. Significantly, these data highlight the importance of running laboratory 4th generation tests in parallel with POCTs when clinical history suggests acute HIV infection, and when there has been significant risk of HIV acquisition within the window period.
1. Teague A, Rossi M, Gilmour C, et al. Use of two HIV-POCT tests to identify false reactives. International Journal of STD & AIDS 2009;20:808-9.
2. Fox J, Dunn H, O'Shea S. Low rates of p24 antigen detection using a fourth-generation point of care HIV test. Sexually Transmitted Infections 2011;87:178-9.
3. Rosenberg NE, Kamanga G, Phiri S, et al. Detection of Acute HIV Infection: A Field Evaluation of the Determine? HIV-1/2 Ag/Ab Combo Test. Journal of Infectious Diseases 2012;205(4):521-4.
Conflict of Interest:
Increasing STI testing
Khryanin and Reshetnikov describe screening men and women in Siberia for M.genitalium and C.trachomatis 1. They suggest falls in detection rates in 2010-11 may be due partly to the increasing numbers of healthy persons who had attended medical clinics for routine examination. We investigated whether it might be possible to increase frequency of STI testing among female students in London, UK. This is particularly important in those with a new sexual partner or recently treated for a STI who may be more at risk2;3.
In September 2012 for a medical student project we conducted a confidential questionnaire survey of consecutive female students aged 20- 24 in the common room areas at St George's, University of London. The response rate was 100% (50/50). The students described their ethnicity as Asian 42%, white 28%, black 22% or other 8%. Over half (56%, 28) said they would be willing to post self-taken vaginal swabs for STI screening every 6 months. Incentives are often used in STI research4, and 93% (26/28) of responders said that an Amazon voucher would make them more likely to return samples. We also asked about a proposed pelvic inflammatory disease (PID) hotline which women could telephone for advice if they thought they had symptoms of possible PID: pelvic discomfort, pain during sex, abnormal vaginal discharge or bleeding between periods. Forty women (80%) said they would use a PID hotline if available.
Although superficially encouraging, results from this small sample may not apply to students from other universities: and agreeing to return samples is very different from actually doing it. However, we agree with Khryanin and Reshetnikov1 that increasing use of online services and texting may also be useful in increasing screening and treatment of STIs.
Ethical review: The protocol, patient information leaflet and questionnaire were reviewed by Dr Phillip Sedgwick, Reader in Statistics and course organiser at St George's, University of London.
(1) Khryanin A, Reshetnikov O. Detection rates of Mycoplasma genitalium and Chlamydia trachomatis Sex Transm Infect 2012; 88(6):469.
(2) Woodhall SC, Atkins JL, Soldan K, Hughes G, Bone A, Gill ON. Repeat genital Chlamydia trachomatis testing rates in young adults in England, 2010 Sex Transm Infect 2012.
(3) Oakeshott P, Kerry S, Aghaizu A, Atherton H, Hay S, Taylor- Robinson D et al. Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial. Br Med J 2010; 340:1642.
(4) Walker J, Fairley CK, Urban E, Chen MY, Bradshaw C, Walker SM et al. Maximising retention in a longitudinal study of genital Chlamydia trachomatis among young women in Australia BMC Public Health 2011; 11:156.
Conflict of Interest: