Gonorrhoea: to screen or not to screen?

Ross, Jonathan

doi:10.1136/sti.2010.042804

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…NG culture samples were obtained at the GUM clinic according to a strict policy based on gender and sexual history rather than route of referral and thus differences in culture results are unlikely to be the result of different testing practice. Our results support the notion that NG-positive samples originating from community sites might more often represent low bacterial load or asymptomatic infection14 15 although this conclusion is limited by the low sensitivity of bacterial culture for gonorrhoea.…”

Section: Discussionsupporting

confidence: 81%

Comparison of patients diagnosed with gonorrhoea through community screening with those self-presenting to the genitourinary medicine clinic

et al. 2014

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ObjectivesTo compare the clinical, socioeconomic and demographic characteristics of individuals diagnosed with Neisseria gonorrhoeae (NG) in the community using a concomitant nucleic acid amplification test (NAAT, AptimaCombo2) as part of the (community-based) UK Chlamydia Screening Programme (CSP), with those diagnosed in hospital-based genitourinary medicine (GUM) services.DesignA retrospective case note review of all 643 patients treated for NG at a GUM in north west England (January 2007–April 2009).ParticipantsAll 643 treated for NG (including CSP cases, since all cases were referred to GUM for treatment). Limited data were available for 13 CSP cases who failed to attend GUM.Primary outcome measureWhether the case was detected in the community or GUM services. Predictors were demographics (age, gender, postcode for deprivation analysis), sexual history (eg, number of partners) and clinical factors (eg, culture positivity).Results131 cases were diagnosed by CSP (13 of whom did not attend GUM). A further four cases were contacts of these. The GUM caseload was thus inflated by 23% (from 521 to 643). Community cases were overwhelmingly female (85% vs 27% in GUM, p<0.001) and younger (87% females were <25 years vs 70% GUM females, p=0.001). Logistic regression analysis restricted to the target age of the CSP (<25 years) revealed that CSP cases, compared with GUM cases, were more likely to reside in deprived areas (adjusted OR=5.6, 95% CI 1.4 to 21.8 and 5.3, CI 1.7 to 16.6 for the most and second most deprived group respectively, compared with the averagely deprived group, p=0.037) and be asymptomatic (adjusted OR=1.9, CI 1.1 to 3.4, p=0.02).ConclusionsCommunity screening for NG led to a 79% increase in the number of infections detected in women aged <25 years. Screening is targeted at young people, and tends to disproportionately attract young women, a group under-represented at GUM. Screening also contributed further to case detection in deprived areas.

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Section: Discussionsupporting

confidence: 81%

Comparison of patients diagnosed with gonorrhoea through community screening with those self-presenting to the genitourinary medicine clinic

et al. 2014

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“…The National Chlamydia Screening Programme (NCSP), set up in England and Wales, UK in 2003, is a control and prevention programme for sexually active individuals under the age of 25. This programme perhaps explains the greater awareness of chlamydia than gonorrhoea amongst young people in our sample and it has been suggested that testing for gonorrhoea is added to the programme [29]. …”

Section: Discussionmentioning

confidence: 99%

Talking about links between sexually transmitted infections and infertility with college and university students from SE England, UK: a qualitative study

2013

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BackgroundSexually transmitted infections (STIs) such as chlamydia and gonorrhoea are largely symptomless diseases which, left untreated, can result in serious complications including infertility. Fertility problems currently affect approximately one in seven couples in the UK and there is increasing demand for couples seeking reproductive technologies. Young people are at greatest risk of contracting STIs, therefore this study aimed to identify young people’s knowledge and beliefs about the link between untreated STIs and infertility.MethodsFocus groups were conducted with participants aged 16–24 years old inclusive in college or university settings in the SE of England. Groups were quota sampled on the basis of age and gender. A topic guide was used. The data were analysed using a framework analysis approach.ResultsTen single-sex focus groups were conducted with sixty participants: six groups of college students and four groups of university students. Participants were generally aware of the link between STIs and potential infertility and considered the discussion of this subject very relevant at their age. Knowledge about how and why STIs potentially lead to fertility complications was poor. The issues of blame relating to infertility following an STI emerged, although most participants did not think that access to free reproductive technologies after an untreated STI should be limited.ConclusionsYoung people would benefit from more education in order to improve their understanding of the long-term consequences of untreated STIs, such as infertility. Participants in our sample felt these were extremely relevant and important issues for them to understand alongside current education about STIs.

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“…Gonorrhoea has always been considered an infection found primarily in large cities in individuals with increased number of sexual partners. The evolution of chlamydia NAATs to offer additional testing for gonorrhoea and the roll out of the National Chlamydia Screening Programme has fuelled the debate on who to screen or not to screen, as discussed by Ross,26 even though an evidence base to screen asymptomatic individuals is lacking. The reality is that dual NAATs for GC/CT are being used, and it is important that a robust system for the management of the patient is initiated and monitored, particularly in areas where gonorrhoea has not been traditionally diagnosed, as discussed by Downing et al 27…”

Section: Reducing Transmission Through Expanded Testingmentioning

confidence: 99%