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
import...
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.
Reference List
(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.
The recently published editorial by Ingham highlights the importance
of ascertaining etiologies of misuse of condoms to plan and implement
effective public health interventions1.
Crosby et al. outline a prospective study demonstrating the
effectiveness of condoms when used consistently and properly to
considerably lower the acquisition of non-viral sexually transmitted
diseases. The authors also address the gl...
The recently published editorial by Ingham highlights the importance
of ascertaining etiologies of misuse of condoms to plan and implement
effective public health interventions1.
Crosby et al. outline a prospective study demonstrating the
effectiveness of condoms when used consistently and properly to
considerably lower the acquisition of non-viral sexually transmitted
diseases. The authors also address the global problem of incomplete and
improper use of condoms requiring targeted education for improvement2.
Another recently published article discusses inconsistency of condom
use and its ramifications. Goyal et al. have focused on high risk
behavior and sexually transmitted infections among U.S. Active Duty
Servicewomen and Veterans. The authors state that the group of unmarried,
young and new to military service, in particular, inconsistently use
condoms resulting in greater probability of acquisition of sexually
transmitted infections. Potential barriers to condom use for these women
have been proposed and include being stigmatized as promiscuous if
requesting condoms and evidence of violation of the military policy
prohibiting sexual intercourse during deployment. Binge drinking by women
in the military may also be resulting in inconsistent use of condoms with
resulting unwanted pregnancies and greater incidence of sexually
transmitted infections. The rate of Chlamydial infection in female active
duty soldiers is significantly greater than in comparative groups of women
in the general population3.
Ingham and Crosby et al. substantiate that the etiology of improper
and inconsistent use of condoms must be identified to plan and implement
effective public health interventions to eradicate the global problem of
sexual transmission of infection. It is likewise imperative that the
etiologies of risky sexual behavior of young women in the military be
understood. This vulnerable group should have targeted education to
prevent unwanted pregnancies and sexually transmitted infections. Clearly
U.S. Active Duty Servicewomen and Veterans face unique and difficult
challenges regarding their reproductive health and this issue needs more
focus1-3.
References
1. Ingham R. Condoms, bloody condoms; yet more problems. Sex Transm
Infect. 2012;8 :479-480. Published Online First: 23 October 2012
doi:10.1136/sextrans-2012-050793
2. Crosby RA, Chamigo RA, Weathers C, et al. Condom effectiveness
against non-viral sexually transmitted infections: a prospective study
using electronic daily diaries. Sex Transm Infect. 2012;88:484-489.Doi:
10.1136/sextrans-2012-050618.
3. Goyal V, Mattocks KM, Sadler AG. High Risk Behavior and Sexually
Transmitted Infections Among U.S. Active Duty Servicewomen and Veterans. J
of Women's Health. 2012; 21:1155-1169.DOI: 10.1089/jwh.2012.3605.
The recently published editorial by Ingham highlights the importance
of ascertaining etiologies of misuse of condoms to plan and implement
effective public health interventions1.
Crosby et al. outline a prospective study demonstrating the
effectiveness of condoms when used consistently and properly to
considerably lower the acquisition of non-viral sexually transmitted
diseases. The authors also address the gl...
The recently published editorial by Ingham highlights the importance
of ascertaining etiologies of misuse of condoms to plan and implement
effective public health interventions1.
Crosby et al. outline a prospective study demonstrating the
effectiveness of condoms when used consistently and properly to
considerably lower the acquisition of non-viral sexually transmitted
diseases. The authors also address the global problem of incomplete and
improper use of condoms requiring targeted education for improvement2.
Another recently published article discusses inconsistency of condom
use and its ramifications. Goyal et al. have focused on high risk
behavior and sexually transmitted infections among U.S. Active Duty
Servicewomen and Veterans. The authors state that the group of unmarried,
young and new to military service, in particular, inconsistently use
condoms resulting in greater probability of acquisition of sexually
transmitted infections. Potential barriers to condom use for these women
have been proposed and include being stigmatized as promiscuous if
requesting condoms and evidence of violation of the military policy
prohibiting sexual intercourse during deployment. Binge drinking by women
in the military may also be resulting in inconsistent use of condoms with
resulting unwanted pregnancies and greater incidence of sexually
transmitted infections. The rate of Chlamydial infection in female active
duty soldiers is significantly greater than in comparative groups of women
in the general population3.
Ingham and Crosby et al. substantiate that the etiology of improper
and inconsistent use of condoms must be identified to plan and implement
effective public health interventions to eradicate the global problem of
sexual transmission of infection. It is likewise imperative that the
etiologies of risky sexual behavior of young women in the military be
understood. This vulnerable group should have targeted education to
prevent unwanted pregnancies and sexually transmitted infections. Clearly
U.S. Active Duty Servicewomen and Veterans face unique and difficult
challenges regarding their reproductive health and this issue needs more
focus1-3.
References
1. Ingham R. Condoms, bloody condoms; yet more problems. Sex Transm
Infect. 2012;8 :479-480. Published Online First: 23 October 2012
doi:10.1136/sextrans-2012-050793
2. Crosby RA, Chamigo RA, Weathers C, et al. Condom effectiveness
against non-viral sexually transmitted infections: a prospective study
using electronic daily diaries. Sex Transm Infect. 2012;88:484-489.Doi:
10.1136/sextrans-2012-050618.
3. Goyal V, Mattocks KM, Sadler AG. High Risk Behavior and Sexually
Transmitted Infections Among U.S. Active Duty Servicewomen and Veterans. J
of Women's Health. 2012; 21:1155-1169.DOI: 10.1089/jwh.2012.3605.
I think there has also to be some consideration of NHS resources in
deciding where STI testing takes place.
To do take a full sexual history, contact history, then perform an
intimate examination, take swabs, then explain examination findings to the
patient while throughout respecting the patients dignity does not fit into
a ten minute slot.
If there is an issue of contact tracing this certainly goes bey...
I think there has also to be some consideration of NHS resources in
deciding where STI testing takes place.
To do take a full sexual history, contact history, then perform an
intimate examination, take swabs, then explain examination findings to the
patient while throughout respecting the patients dignity does not fit into
a ten minute slot.
If there is an issue of contact tracing this certainly goes beyond
the remit of a GP.
This might be desirable for a significant proportion of patients -
but GP's can only take on extra work like this is they have the training,
support, and time to do so.
A GP service might be offered as a LES - but it would need to be
adequately resourced, it certainly could not be expected to be a service
the practice provides free of charge.
Dr Martin Rankin,
GP Partner and LMC Member.
Conflict of Interest:
I am a GP partner and member of the Plymouth Sub Committee of Devon LMC
In their stratified random probability survey of 411 men aged 18-35
years, Saunders and colleagues found that 29% had been tested for a STI,
mainly in genitourinary medicine (GUM) clinics (53%) or general practice
(17%)1. In September 2012, for a medical student project, we conducted a
questionnaire survey of young men and women at Lambeth Further Education
College in south London. Lambeth is an area with one of the high...
In their stratified random probability survey of 411 men aged 18-35
years, Saunders and colleagues found that 29% had been tested for a STI,
mainly in genitourinary medicine (GUM) clinics (53%) or general practice
(17%)1. In September 2012, for a medical student project, we conducted a
questionnaire survey of young men and women at Lambeth Further Education
College in south London. Lambeth is an area with one of the highest rates
of STIs in the UK with 9.9% of 15-24 year olds screened testing positive
for chlamydia in 2011 to 20122. Our aim was to find out how many students
had been tested for chlamydia in the past year, where they had been tested
and why they were tested. To make our findings comparable with Saunders
and colleagues we focus mainly on results from male respondents.
The response rate was 79% (89/112). The mean age of participants was
23 years (range 16-54) and 67% were male. The 59 male responders described
their ethnicity as black 55%, (comprising black-Caribbean 22%, black other
17%, black-African 16%), white 25%, Asian 3% and 14% other ethnicities.
Most male responders (80%, 47/59) said they were sexually active of whom
55% (26/47) reported being tested for chlamydia in the past year. Half of
them (50%, 12/24) said they had been tested at a GUM clinic, 17% in
general practice, 12.5% at a Brook clinic, 8% at school, 8% at Tooting Bec
Lido and 4% at a Walk-in clinic. Reasons for testing (n=22) included "for
a check-up" (35%), "out of choice" (50%), "one night stand" (5%), "free
condoms" (5%) and "unprotected sex" (5%).
The proportion of young men in our study who were tested in GUM clinics
and general practice was similar to results from the national survey by
Saunders and colleagues1. In line with NCSP reports3, they point out that
young men are perceived as hard to reach for STI screening1. Based on the
high rates of reported testing found in our small survey of young,
sexually active, mainly black males, we agree there may be potential to
increase STI screening rates.
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.
Acknowledgements:
The authors would like to thank Dionne Konstantinious and staff and
students at Lambeth College for their help with this research.
References:
1. Saunders JM, Mercer CH, Sutcliffe LJ, et al. Where do young men
want to access STI screening? A stratified random probability sample
survey of young men in Great Britain. Sex Transm Infect. 2012 88(6): 427-
432 doi: 10.1136/sextrans-2011-050406
2. National Chlamydia Screening Programme. Chlamydia Testing Data
2011/12 [data tables]. NHS;2012. Available from URL:
http://www.chlamydiascreening.nhs.uk/ps/resources/data-tables/CTD-Q1-4-
2011_2012.pdf
3. National Chlamydia Screening Programme. National Chlamydia
Screening programme data [media information pack]. NHS;2010. Available
from URL:
http://www.chlamydiascreening.nhs.uk/ps/assets/pdfs/press/NCSP_media_pack_2010.pdf
Recently, Gayet-Ageron and colleagues published a systematic review
and meta-analysis to evaluate the diagnostic values of T. pallidum PCR,
and concluded that PCR is a useful additional diagnostic tool.1 However,
the data on examining diagnostic performance of PCR-based methods for
early syphilis are still limited in China although a few studies with the
indirect data from China were included in the literature review.1...
Recently, Gayet-Ageron and colleagues published a systematic review
and meta-analysis to evaluate the diagnostic values of T. pallidum PCR,
and concluded that PCR is a useful additional diagnostic tool.1 However,
the data on examining diagnostic performance of PCR-based methods for
early syphilis are still limited in China although a few studies with the
indirect data from China were included in the literature review.1
During April to September 2009, we conducted a survey among patients
with suspected primary or secondary syphilis recruited from a STI clinic
in Nanjing, China to evaluate the performance of PCR assay for early
syphilis diagnosis. Following ethical review by the CAMS Institute of
Dermatology, all eligible patients who agreed to participate in the survey
were requested to be interviewed with a simple questionnaire and provide
serum specimens for syphilis serologic testing of treponemal (TPPA) and
non treponemal (RPR) antibodies and swab specimens for dark-field
microscopy (DFM) and PCR detection of T. pallidum. We used polA gene for
PCR assay which has been verified and suggested by the US CDC.2
The response rate was 94.8% (110/116), and the median age of
participants was 40 years old with interquartile range of 30 to 47. Out of
110 participants, all provided venous blood, and 62 (56.4%) and 48 (43.6%)
provided samples from chancres and condyloma lata, respectively. PCR had a
higher positive rate than DFM (78.2%, 86/110 vs. 67.3%, 74/110; ?2=6.722,
p=0.008). However, PCR and serological test did not reach a significant
difference (78.2%, 86/110 vs. 76.4%, 84/110; ?2=0.125, p=0.727). We used
combination of clinical sign, positive DFM and/or active serological test
as reference criteria.3 The sensitivity and specificity of PCR assay for
early syphilis were 83.3% and 92.9%; the positive and negative predictive
values were 96.8% and 68.4%; and the positive and negative likelihood
ratios were 11.7 and 0.2. Two specimens from patients who had suspected
clinical signs were positive for amplifications of polA gene, but negative
for both DFM and serological tests. We speculated they were in the very
early stage of the disease.
We agree with Gayet-Ageron and colleagues that PCR can be used as a
complementary tool for diagnosis of early syphilis, especially for those
without serological conversion and visible skin lesions, in settings with
a high prevalence of syphilis. However, the limitations in scaling-up of
this facility-dependent technology may be a concern, especially in those
resource-limited areas with epidemic of syphilis infection.
Funding
This work was supported by the National Institute of Allergy and Infectious Diseases, Sexually Transmitted Infections and Topical Microbicide Cooperative Research Center (5U19AI031496-18).
Reference
1. Gayet-Ageron A, Lautenschlager S, Ninet B, et al. Sensitivity,
specificity and likelihood ratios of PCR in the diagnosis of syphilis: a
systematic review and meta-analysis. Sex Transm Infect. Published Online
First: 28 Sept 2012, doi:10.1136/sextrans-2012-050622.
2. Liu H, Rodes B, Chen CY, et al. New tests for syphilis: rational
design of a PCR method for detection of Treponema pallidum in clinical
specimens using unique regions of the DNA polymerase I gene. J Clin
Microbiol. 2001;39:1941-6.
3. Centers for Disease Control and Prevention. STD Surveillance Case
Definitions. http://www.cdc.gov/std/stats10/CaseDefinitions2010.pdf.
We will try to answer the questions reported by Doctors Taylor-
Robinson and Horner.
i) This study was carried out in a Primary Care Laboratory, not in a
Sexually Transmitted Infection Clinic. This fact could explain the less
percentage of patients with ?5 PMNLs and the difference with other studies
(1-3). The mean age of patients analyzed was 34 years old with a range
between 16- 76.
ii) The symptoms were: pain (17%), di...
We will try to answer the questions reported by Doctors Taylor-
Robinson and Horner.
i) This study was carried out in a Primary Care Laboratory, not in a
Sexually Transmitted Infection Clinic. This fact could explain the less
percentage of patients with ?5 PMNLs and the difference with other studies
(1-3). The mean age of patients analyzed was 34 years old with a range
between 16- 76.
ii) The symptoms were: pain (17%), discharge (40%), itching (21.5%),
dysuria (39.3%) and penile irritation (5.7%). The patients were submitted
to the laboratory, by their doctors, with the diagnosis of urethritis; and
therefore they were included in the study. When these patients attended to
the laboratory, 9.2% of them reported not to have symptoms, but they had
risk sexual relationship or infection in partner.
iii) We did not include this information because we had lacking of this
information in a high percentage of patients.
iv) When the samples were collected, the swabs were listed from 1 to 4 and
number 1 was used for Gram stain.
v) In fact, we used the number of ?5 PMNLs per high-power field in ?5
fields like standard practice (4-5).
vi) We found ?5 PMNLs in 62.7% of men with discharge and 2.1% in men
without discharge.
vii) The study was conducted over two years. For one year and a half, C.
trachomatis detection was performed by immunochromatography (ICT) and the
last 6 months by PCR. Of the 34 C. trachomatis detected, 4 were by ICT and
30 by PCR. One sample of four by ICT had ?5 PMNLs (25%) and 6 of 30 (20%)
by PCR.
viii) Really, urethritis is defined by the presence of urethral
inflammation and as you expose, C. trachomatis and Ureaplasmas do not
always elicit urethral inflammation in men. We decided to use the culture
like reference method, because we wanted to asses the role of isolated
microorganisms, considered unlikely to be causal agents of urethritis and
to compare the number of PMNLs in Gram stain, with the isolation of these
microorganisms in culture.
References
1. Falk L, Fredlund H, Jensen JS. Symptomatic urethritis is more
prevalent in men infected with Mycoplasma genitalium than with Chlamydia
trachomatis. Sex Transm Infect 2004; 80 :289-93.
2. Horner PJ, Thomas B, Gilroy CB et al. Do all men attending departments
of genitourinary medicine need to be screened for non-gonococcal
urethritis? Int J STD AIDS 2002; 13: 667-73.
3. Janier M, Lassau F, Casin I et al. Male urethritis with and without
discharge: a clinical and microbiological study. Sex Transm Dis 1995; 22:
244-52.
4. Shahmanesh M. 2007 UK National Guideline on the Management of
Nongonococcal Urethritis: updated December 2008. http://www bashh
org/guidelines 2008 Available from: URL:http://www.bashh.org/guidelines
5. Shahmanesh M, Moi H, Lassau F, Janier M. 2009 European Guideline on
the Management of Male Non-gonococcal Urethritis. Int J STD AIDS 2009; 20
:458-64.
Patel and colleagues describe an audit of antenatal screening in
pregnant women with positive syphilis serology to ensure associated STIs
were diagnosed and treated(1). In July 2012 we conducted a brief audit of
opinions of consecutive pregnant women attending an antenatal clinic at St
Georges' Healthcare NHS Trust. They were asked a single oral question
about whether they would be willing in principle to provide a self-t...
Patel and colleagues describe an audit of antenatal screening in
pregnant women with positive syphilis serology to ensure associated STIs
were diagnosed and treated(1). In July 2012 we conducted a brief audit of
opinions of consecutive pregnant women attending an antenatal clinic at St
Georges' Healthcare NHS Trust. They were asked a single oral question
about whether they would be willing in principle to provide a self-taken
vaginal swab for a study of infection and miscarriage.
The response rate was 96% (24/25). The mean age of responders was
31.5 years (range 18-38), and 60% described their ethnicity as white, 24%
black and 16% as Asian. Of the 25 women, 88% (22) said that they would
agree in principle to provide a self-administered vaginal swab. Most women
were extremely supportive of the prospect of further research into
infections and miscarriage: 72% were women with higher risk pregnancies,
including 40% who had previously had mid-trimester miscarriages. Only two
women said they would not be willing to provide a sample. One said she
would not feel comfortable with performing a self-administered swab and
the other that taking part in a study about miscarriage would be too
distressing.
Current guidelines advise antenatal screening for asymptomatic
bacteriuria, hepatitis B, HIV, rubella and syphilis, as well as Chlamydia
trachomatis in women under 25 years of age (2). Self-taken vaginal swabs
are an economical and efficient method of testing for genital infection.
Our findings are in line with previous studies (3) demonstrating the
acceptability of self-administered vaginal swabs during pregnancy. Patel
and colleagues highlight the importance of coordinated service provision
in engaging high-risk women in antenatal screening. Similarly, the
willingness of pregnant women to provide genital samples could be crucial
for future research on infections and miscarriage.
Eleanor Southgate, Academic Foundation Year 2 Doctor
Pippa Oakeshott, Reader in General Practice
Division of Population Health Sciences and Education, St George's
University of London, Cranmer Terrace, London SW17 0RE
1. Patel S, Aroney R, Bird M. et al. P126 Improving the management of
antenatal women with positive syphilis serology within a genitourinary
medicine service. Sex Transm Infect 2012 88:A51-52
2. National Institute for Health and Clinical Excellence. NICE
Clinical Guideline 62. Antenatal Care: Routine care for the healthy
pregnant woman. March 2008
3. Oakeshott P, Hay P, Hay S, Steinke F, Rink E, Kerry S. Is
bacterial vaginosis or chlamydial infection associated with miscarriage
before 16 weeks gestation? A prospective community based cohort study.
BMJ 2002;325:1334-1336
I read with interest, horror, amazement and a whole myriad of
feelings, an article in the Sunday Times Magazine (July 22 2012) on the
morning after pill in the UK.[1] It prompted me to do a search of your
journal, for research on this issue. Again I felt surprise, at the few
publications on this topic. I tried different search terms, "emergency
contraception", "morning after pill" and "Levonelle" but it yielded only...
I read with interest, horror, amazement and a whole myriad of
feelings, an article in the Sunday Times Magazine (July 22 2012) on the
morning after pill in the UK.[1] It prompted me to do a search of your
journal, for research on this issue. Again I felt surprise, at the few
publications on this topic. I tried different search terms, "emergency
contraception", "morning after pill" and "Levonelle" but it yielded only
one research article by Evans et al. in 1996[2] and two recently published
posters.[3,4]
The Sunday Times article by Eleanor Mills brings many issues to the
fore. The availability of emergency contraception (EC) over the counter
means that the age old problem of unwanted pregnancy is addressed.
However, there has been a change in how and why emergency contraception is
used and if the new attitude prevails, undoubtedly the incidence of STIs
will increase. In 1996, Evans et al.[2] reported that 66% of the 150
women receiving EC in London GUM clinics used it because of contraceptive
failure at the time of last intercourse. However, Mills article [1]
reports on a whole new attitude, the use of EC as an 'easy' option. In
her article, she quotes Sophie, age 17 and taking her A levels, "I've
taken the morning after pill loads, sometimes three times in one cycle.
I've been with my boyfriend for four years, so sometimes it's easier to
have sex and then take it the next day...I hate condoms. Taking the
morning after pill is a really good way of not having to use them". The
attitude amongst her friends is similar. While taking the pill is
convenient for these girls, Mills also reports from the Respond Academy,
established to educate the hardest to reach kids through the arts,
Hastings, South East England. The main discussion amongst the girls here
is the pressure from male partners to have sex, especially because EC is
available. "If you say, but you haven't got a condom, they say, go down
the clinic and get the morning after pill tomorrow".
The availability of emergency contraception over the counter is a
relatively new departure for contraceptive services. Mills' article isn't
an epidemiological study, but the warning signs are there. Studies are
undoubtedly required to assess its usage. Education, it would seem, for
both males and females is a key factor in preventing the use of EC as an
'easy' option. Let's address this issue before it gets out of control and
its consequences become a significant burden on the health service, if
they haven't already become one.
References
1. Mills E. The morning after... The Sunday Times Magazine 2012;July
22:14-19
2. Evans JK, Holmes A, Browning M, Forster GE. Emergency hormonal
contraception usage in genitourinary medicine clinics attenders.
Genitourin Med 1996;72:217:219.
3. Habel M Leichliter JS. The sex lives of emergency contraceptive
users in the USA, 2006-2008. Sex Transm Infect 2011;87:Suppl1 A261-A262.
4. Varma R. Women requiring emergency contraception are a high risk
group for sexually transmitted infections in future. Sex Transm Infect
2012;88:Suppl 1 A42.
The paper by Hopkins et al suggests that repeat testing for C
trachomatis (CT) and N gonorrhoeae (NG) is unnecessary.1 This issue has
long been debated 2,3,4 and currently, with many laboratories having to
reduce costs, the view put forward in this paper seems attractive. We
would, however, like to make the following points. Repeat testing for CT
using the same platform is not recommended for the purpose of
confirmation...
The paper by Hopkins et al suggests that repeat testing for C
trachomatis (CT) and N gonorrhoeae (NG) is unnecessary.1 This issue has
long been debated 2,3,4 and currently, with many laboratories having to
reduce costs, the view put forward in this paper seems attractive. We
would, however, like to make the following points. Repeat testing for CT
using the same platform is not recommended for the purpose of
confirmation. Confirmation must be by a second assay with similar
performance power to the initial assay. Repeat testing was initially
introduced to help identify any mismatch errors due to the significant
manual intervention required in the early testing platforms. Although
advances in technology have reduced this, repeat testing does also serve
to identify issues with contamination which, because of the high volume of
samples being tested, can be significant. This remains a consideration and
so, if repeat testing is stopped, robust IQA measures must be put in place
together with a strict cleaning and decontamination regimen.
In addition, many young people may be happy to receive unnecessary
antibiotic treatment, as stated in the paper, but we are constantly being
warned about the overuse of antibiotics and this must be taken into
account.
For NG testing, BASHH guidelines (http://www.bashh.org/guidelines ) state
that reactive results should be confirmed to ensure that PPV is >90%
and it is essential that the confirmatory test is robust with respect to
target selection as well as the usual statistical performance
characteristics as per CT. The best strategy to use for an STI is to
employ a sensitive test which ensures that no cases are missed followed by
confirmation to verify the true result. This paper looked at Genitourinary
Medicine patients and established the PPV for this group although there
were only 2 patients with equivocal results to investigate. In
laboratories using dual testing on samples from the NCSP programme where
the prevalence of infection may be much lower, it would be prudent to use
the suggested confirmatory algorithm unless extensive validation work has
shown that it is not required. We agree that a PPV of >95% for
screening should be the standard for both infections as the authors
suggest.
1. Hopkins MJ, Smith G, Hart I et al. Screening tests for Chlamydia
trachomatis or Neisseria gonorrhoeae using the cobas 4800 PCR system do
not require a second test to confirm: an audit of patients issued with
equivocal results at a sexual health clinic in the Northwest of England,
UK. Sex Transm Infect 2012
2. Schachter J, Chernesky MA. Routine Confirmation of Positive
Nucleic Acid Amplification Test Results for Neisseria gonorrhoeae is Not
Necessary. J Clin Microbiol 2012; 50:208
3. Tabrizi SN, Hjelmevoll SO, Garland SM et al. Reply to above. J
Clin Microbiol 2012; 50:209-10
4. Schachter J, Chow JM, Howard H et al. Detection of Chlamydia
trachomatis by nucleic acid amplification testing: our evaluation suggests
that CDC-recommended approaches for confirmatory testing are ill-advised.
J Clin Microbiol 2006; 44: 2512-7
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 import...
The recently published editorial by Ingham highlights the importance of ascertaining etiologies of misuse of condoms to plan and implement effective public health interventions1.
Crosby et al. outline a prospective study demonstrating the effectiveness of condoms when used consistently and properly to considerably lower the acquisition of non-viral sexually transmitted diseases. The authors also address the gl...
The recently published editorial by Ingham highlights the importance of ascertaining etiologies of misuse of condoms to plan and implement effective public health interventions1.
Crosby et al. outline a prospective study demonstrating the effectiveness of condoms when used consistently and properly to considerably lower the acquisition of non-viral sexually transmitted diseases. The authors also address the gl...
I think there has also to be some consideration of NHS resources in deciding where STI testing takes place.
To do take a full sexual history, contact history, then perform an intimate examination, take swabs, then explain examination findings to the patient while throughout respecting the patients dignity does not fit into a ten minute slot.
If there is an issue of contact tracing this certainly goes bey...
In their stratified random probability survey of 411 men aged 18-35 years, Saunders and colleagues found that 29% had been tested for a STI, mainly in genitourinary medicine (GUM) clinics (53%) or general practice (17%)1. In September 2012, for a medical student project, we conducted a questionnaire survey of young men and women at Lambeth Further Education College in south London. Lambeth is an area with one of the high...
Recently, Gayet-Ageron and colleagues published a systematic review and meta-analysis to evaluate the diagnostic values of T. pallidum PCR, and concluded that PCR is a useful additional diagnostic tool.1 However, the data on examining diagnostic performance of PCR-based methods for early syphilis are still limited in China although a few studies with the indirect data from China were included in the literature review.1...
We will try to answer the questions reported by Doctors Taylor- Robinson and Horner. i) This study was carried out in a Primary Care Laboratory, not in a Sexually Transmitted Infection Clinic. This fact could explain the less percentage of patients with ?5 PMNLs and the difference with other studies (1-3). The mean age of patients analyzed was 34 years old with a range between 16- 76. ii) The symptoms were: pain (17%), di...
Patel and colleagues describe an audit of antenatal screening in pregnant women with positive syphilis serology to ensure associated STIs were diagnosed and treated(1). In July 2012 we conducted a brief audit of opinions of consecutive pregnant women attending an antenatal clinic at St Georges' Healthcare NHS Trust. They were asked a single oral question about whether they would be willing in principle to provide a self-t...
I read with interest, horror, amazement and a whole myriad of feelings, an article in the Sunday Times Magazine (July 22 2012) on the morning after pill in the UK.[1] It prompted me to do a search of your journal, for research on this issue. Again I felt surprise, at the few publications on this topic. I tried different search terms, "emergency contraception", "morning after pill" and "Levonelle" but it yielded only...
The paper by Hopkins et al suggests that repeat testing for C trachomatis (CT) and N gonorrhoeae (NG) is unnecessary.1 This issue has long been debated 2,3,4 and currently, with many laboratories having to reduce costs, the view put forward in this paper seems attractive. We would, however, like to make the following points. Repeat testing for CT using the same platform is not recommended for the purpose of confirmation...
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