What is needed to guide testing for anorectal and pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae in women and men? Evidence and opinion

Dukers-Muijrers, Nicole H. T. M.; Schachter, Julius; Liere, Geneviève A F S van; Wolffs, Petra; Hoebe, Christian J. P. A.

doi:10.1186/s12879-015-1280-6

Cited by 87 publications

(89 citation statements)

References 85 publications

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“…14 Self-collection of rectal and vaginal samples is accurate, may be preferable to provider collection, and may be one way to further increase screening. 27–29 …”

Section: Discussionmentioning

confidence: 99%

Gonorrhea and Chlamydia Case Detection Increased When Testing Increased in a Multisite US HIV Cohort, 2004–2014

Raifman

Gebo

Mathews

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objectives Annual screening for gonorrhea (NG) and chlamydia (CT) is recommended for all sexually-active persons living with HIV (PLWH) but is poorly implemented. Studies demonstrating no increases in NG and/or CT (NG/CT) case detection in clinics that successfully expanded NG/CT screening raise questions about this broad screening approach. We evaluated NG/CT case detection in the HIV Research Network during 2004–2014, a period of expanding testing. Methods We analyzed linear time trends in annual testing (patients tested divided by all patients in care), test positivity (patients positive divided by all tested), and case detection (the number of patients with a positive result divided by all patients in care) using multivariate repeated measures logistic regression. We determined trends overall and stratified by men who have sex with men (MSM), men who have sex exclusively with women (MSW), and women. Results Among 15,614 patients (50% MSM, 26% MSW, 24% women), annual NG/CT testing increased from 22% in 2004 to 60% in 2014 (adjusted odds ratio [AOR] per year 1.22 [1.21, 1.22]). Despite the increase in testing, test positivity also increased (AOR per year 1.10 [1.07, 1.12]), and overall case detection increased from 0.8% in 2004 to 3.9% in 2014 (AOR per year 1.20 [1.17, 1.22]). Case detection was highest among MSM but increased over time among all three groups. Conclusions NG/CT case detection increased as testing expanded in the population. This supports a broad approach to NG/CT screening among PLWH in order to decrease transmission and complications of NG/CT and of HIV.

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“…14 Self-collection of rectal and vaginal samples is accurate, may be preferable to provider collection, and may be one way to further increase screening. 27–29 …”

Section: Discussionmentioning

confidence: 99%

Gonorrhea and Chlamydia Case Detection Increased When Testing Increased in a Multisite US HIV Cohort, 2004–2014

Raifman

Gebo

Mathews

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…As well as urogenital infections, chlamydia can also cause anorectal infections, with anorectal prevalences found between 5.6% and 17.5%. 2 Women with anorectal chlamydia infection often have a concurrent urogenital chlamydia infection (71-95%) and vice versa (33-83% with a urogenital infection have a concurrent anorectal infection). 2 Anorectal testing for chlamydia is often advised on indication in women with anal symptoms or recent anal sex.…”

Section: Introductionmentioning

confidence: 99%

“…2 Women with anorectal chlamydia infection often have a concurrent urogenital chlamydia infection (71-95%) and vice versa (33-83% with a urogenital infection have a concurrent anorectal infection). 2 Anorectal testing for chlamydia is often advised on indication in women with anal symptoms or recent anal sex. [3][4][5] Studies on routine universal anorectal testing consistently found similar anorectal chlamydia prevalence in women with or without anal symptoms or history of anal sex.…”

Section: Introductionmentioning

confidence: 99%

What explains anorectal chlamydia infection in women? Implications of a mathematical model for test and treatment strategies

et al. 2016

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ObjectivesFemale anorectal Chlamydia trachomatis (chlamydia) infections are common irrespective of recent anal sex. We explored the role of anorectal infections in chlamydia transmission and estimated the impact of interventions aimed at improved detection and treatment of anorectal infections.MethodsWe developed a pair compartmental model of heterosexuals aged 15–29 years attending STI clinics, in which women can be susceptible to or infected with chlamydia urogenitally and/or anorectally and men urogenitally. Transmission probabilities per vaginal and anal sex act, together with an autoinoculation probability, were estimated by fitting to anatomic site-specific prevalence data (14% urogenital; 11% anorectal prevalence). We investigated the 10-year reduction in female chlamydia prevalence of interventions (universal anorectal testing of female STI clinic attendees or doxycycline use for urogenital chlamydia) relative to continued current care (anorectal testing on indication and doxycycline for anorectal and azithromycin for urogenital chlamydia).ResultsThe transmission probability per anal sex act was 5.8% (IQR 3.0–8.3%), per vaginal sex act 2.0% (IQR 1.7–2.2%) and the daily autoinoculation probability was 0.7% (IQR 0.5–1.0%). More anorectal chlamydia infections were caused by autoinoculation than by recent anal sex. Universal anorectal testing reduced population prevalence modestly with 8.7% (IQR 7.6–9.7%), yet the reduction was double that of doxycycline use for urogenital infections (4.3% (IQR 3.5–5.3%)) relative to continued current care.ConclusionsAutoinoculation between anatomic sites in women might play a role in sustaining high chlamydia prevalence. A shift to more anorectal testing of female STI clinic attendees may be considered for its (albeit modest) impact on reducing prevalence.

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“…3 Importantly, up to 20% of cases of the HELLP syndrome develop in women without previous onset of hypertension. 4 The area under the curve in the receiver-operating-characteristic analysis for prediction of preeclampsia or the HELLP syndrome within 1 week Since publication of their article, the authors report no further potential conflict of interest. …”

Section: Doi: 101056/nejmc1602338mentioning

confidence: 99%

“…3 Such infections are also common in women, although with additional testing for rectal and oropharyngeal infection, the increment is less. 4 Many anecdotal reports have indicated that azithromycin is less effective than doxycycline for the treatment of rectal, oropharyngeal, or genital infection. For example, in a retrospective cohort study, 23 of 136 men (17%) tested positive for chlamydia infection 14 to 60 days after treatment with azithromycin, and 0 of 36 men tested positive 14 to 60 days after treatment with doxycycline.…”

Section: Azithromycin Versus Doxycycline For Chlamydiamentioning

confidence: 99%

The sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia

2016

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1 showed that a ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) of 38 or lower ruled out preeclampsia with a negative predictive value of 99.3% within 1 week in women with clinical suspicion of it. Critical in this study are the inclusion criteria used to define "impending" preeclampsia. In medicine, a definition of suspected preeclampsia is lacking, and the inclusion of patients at low risk may artificially increase the negative predictive value of a test by diluting the weight of false negative events. Only 41.5% of the women in the validation cohort had new-onset hypertension or an exacerbation of preexisting hypertension. Other clinical symptoms considered as inclusion criteria are often described in women with overt preeclampsia and used to define its severity, but in the absence of an elevated blood pressure, they lose their clinical importance. We wonder whether the simple inclusion of blood pressure instead of the angiogenic ratio in the evaluation of symptomatic patients would have yielded the same figure for the negative predictive value. DOI: 10.1056/NEJMc1602338The authors reply: In PROGNOSIS (Prediction of Short-Term Outcome in Pregnant Women with Suspected Preeclampsia Study), pregnant women were enrolled on the basis of signs and symptoms of preeclampsia or the HELLP syndrome (characterized by hemolysis, elevated liver-enzyme levels, and low platelet counts), including high blood pressure, as described in clinical guidelines. 1,2 The prevalence of preeclampsia in our cohort was 19.0%, as compared with 2 to 5% among all pregnant women (indicating that women with a high risk of preeclampsia were included in the study). Blood pressure is limited in predicting adverse pregnancy outcomes (e.g., the HELLP syndrome and eclampsia). 3 Importantly, up to 20% of cases of the HELLP syndrome develop in women without previous onset of hypertension. 4 The area under the curve in the receiver-operating-characteristic analysis for prediction of preeclampsia or the HELLP syndrome within 1 week was 0.

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What is needed to guide testing for anorectal and pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae in women and men? Evidence and opinion

Cited by 87 publications

References 85 publications

Gonorrhea and Chlamydia Case Detection Increased When Testing Increased in a Multisite US HIV Cohort, 2004–2014

Gonorrhea and Chlamydia Case Detection Increased When Testing Increased in a Multisite US HIV Cohort, 2004–2014

What explains anorectal chlamydia infection in women? Implications of a mathematical model for test and treatment strategies

The sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia

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