Search

Background: Optimising the diagnostic work-up and treatment of genital chlamydia infection requires knowledge of the sampling patterns of those who order chlamydia tests. We wished to determine which groups of doctors collect specimens for chlamydia testing, and to examine the sex and age distribution of patients tested, and the proportion of positive tests, from general practitioners, gynaecologists in private practice, and youth health services., Material and Method: The study includes 43 465 specimens analysed for genital infection with Chlamydia trachomatis at Vestfold Hospital Trust over the period 1 January 2007 to 31 December 2011. Data from the laboratory information system were used to classify the test requisitioners., Results: General practitioners requisitioned 60 % of all chlamydia tests and 63 % of all positive tests. Youth health services requisitioned 13 % of all tests and 22 % of positive tests; gynaecologists in private practice, 12 % of all tests and 5 % of positive tests. Overall, 26 % of specimens were from women over the age of 30 with 2.2 % testing positive, and 82 % of these specimens were submitted by general practitioners or gynaecologists in private practice. Twenty-three per cent of specimens were from men, and 78 % of these were collected in general practice., Interpretation: Knowledge of who requisitions chlamydia testing and of whom is important for planning and improving chlamydia diagnosis, treatment and contact tracing. In this study from Norway, we found that doctors in general practice play a key role in diagnosing and treating chlamydia. The testing of women over the age of 30 by general practitioners and gynaecologists in private practice probably leads to unnecessary use of resources and should be reduced.

Background: Mycoplasma genitalium and Ureaplasma urealyticum cause sexually transmitted infections. While M. genitalium is an established aetiological agent, U. urealyticum is still controversial as a pathogen. Testing for these microbes is not yet widely available in Norway, and knowledge of their prevalence is limited. In this study we have investigated the prevalence of M. genitalium and U. urealyticum in a heterogeneous population from Vestfold and Telemark., Material and Method: Urine samples (n = 4,665) received by the laboratory for testing for Chlamydia trachomatis in the period from February 2011 to January 2012 were subsequently tested for M. genitalium and U. urealyticum. Samples were analysed using an in-house PCR protocol., Results: The prevalence of C. trachomatis, M. genitalium and U. urealyticum was 11.9%, 3.6% and 17.9% respectively. M. genitalium was found most frequently in women aged 20-24 years (5.1%), while the proportion of samples positive for U. urealyticum was greatest in persons aged 15-24 years (22.8%)., Interpretation: M. genitalium was highly prevalent in urine samples submitted for C. trachomatis testing. M. genitalium testing was requested for only a minority of the samples analysed, suggesting limited knowledge of this microbe. U. urealyticum was the most predominant microbe in the study, which may indicate that it is largely non-pathogenic.

Background: There is increasing interest in Mycoplasma genitalium as a sexually transmissible pathogen. The clinical picture resembles that of Chlamydia trachomatis infection, but the natural course has not yet been well defined. There are no guidelines regarding who should be examined for M. genitalium. Most of the prevalence studies have been carried out in patients attending clinics for sexually transmissible diseases. We have examined the prevalence in samples sent from general practice requesting analysis for C. trachomatis., Material and Method: During the period October 1 to December 31 2010, all samples sent to Molde Hospital, Norway, that queried C. trachomatis were examined also for M. genitalum. Both agents were examined using real time PCR. The PCR for C. trachomatis was performed using a CE labelled and IVD approved method from Roche. The PCR for M. genitalium was performed using an in-house method where the target gene is GAP., Result: A total of 950 patients were examined (Men n=225, women n=725). The prevalences of M. genitalium and C. trachomatis were 2.0 % and 10.0 % respectively (men 4.0 % and 15.1 %, women 1.4 % and 8.4 %)., Conclusion: Because of the low prevalence, we recommend selection of patients for examination for M. genitalium. The difference in prevalence between the sexes can reflect different indications for sample taking.

Background: According to Norwegian guidelines, infections caused by Chlamydia trachomatis should be treated rapidly with antibiotics and a control test should be offered after 5-6 weeks. The purpose of the present registry study was to investigate Chlamydia treatment and the use of control tests among men and women tested for Chlamydia in South Trøndelag county in the period 2004-2006., Material and Methods: Data on all Chlamydia tests from men and women 15-59 years of age resident in South Trøndelag County were retrieved from the Department of Medical Microbiology at St. Olavs Hospital. Information about Norwegian pharmacies' handling of prescriptions for antibiotics were obtained from the Norwegian Prescription Database (NorPD)., Results: 8.5% (3,127/36 590) of those tested for Chlamydia in the study period were positive. Among those who were positive 87% (1,681/1 920) of women and 74% (909/1,207) of men bought antibiotics from a pharmacy within 4 weeks after the test was analyzed. The average time from available test result to treatment was 13.1 days (95% CI 12.7-13.5). Among those who received antibiotics, 41% (689/1,681) of women and 27% (247/909) of men were registered with a control test 4-16 weeks after the prescription was handled., Interpretation: Compliance to guidelines for treatment and follow-up of people with a positive Chlamydia test is poor, especially among men.

Background: A mutant Chlamydia trachomatis variant (nvC trachomatis) has made it more difficult to diagnose chlamydia in Sweden. The proportion of nvC trachomatis has varied between Swedish counties (25-80 %) in the period 2006-07. Our goal has been to monitor nvC trachomatis among our patients from January 2007 and up to July 2008., Material and Methods: In this time period, all C trachomatis samples at Fürst Medical Laboratory, Norway were analyzed twice. Cobas TaqMan 48 (Roche Diagnostics) was used to detect C trachomatis in isolated DNA and real-time PCR methods developed by us were used to both detect and verify nvC trachomatis., Results: 61 patients of 23 726 patients were identified as carriers of nvC trachomatis. The proportion of C trachomatis carriers who were positive for nvC trachomatis increased from 1.0 % in the first quarter of 2007 to 3.2 % in the second quarter of 2008., Interpretation: Our results show a slow but steady increase in the proportion of nvC trachomatis positive tests. As compared to previous rates reported in Sweden (25-80 %), the occurrence of nvC trachomatis in our data is low. The epidemiology of this chlamydia mutant contributes to the understanding of mechanisms for spread of sexually transmitted infections and emphasize that you only find what you are looking for.

Background: CHLAMYDIA TRACHOMATIS: is the most prevalent sexually transmitted bacterial disease in Norway. The purpose of the present study was to describe testing patterns and prevalence of Chlamydia in a Norwegian county, with special focus on urine-based testing. :, Material and Methods: Data on all Chlamydia tests 1990 - 2006 for men and women 15 - 59 years old, living in Sør-Trøndelag County, were retrieved from a laboratory database. 243 671 Chlamydia test results were eligible for analysis., Results: Testing rates were considerably higher for men than for women in all age-groups throughout the study period. Urine-based testing was introduced for men in 2001 and for women in 2004. In 2006, urine-based testing comprised most of the test volume for men (15 - 19 year-olds: 87.9 %, 20 - 24 year-olds: 81.7 %), but far less for women (15 - 19 year-olds: 55.8 %, 20 - 24 year-olds: 26.5 %). The proportion of positive tests was higher for women with a urine-based test than for those with a sample from the cervix (2006: 15 - 19 year-olds: 18.0 % versus 13.5 %, 20 - 24 year-olds: 16.9 % versus 9.6 %)., Interpretation: Male testing rates have increased after urine-based testing for Chlamydia became an option. Young women delivering urine samples are more often positive than women with cervix samples.

Background: Free testing, treatment and extensive information campaigns are used to monitor and control the incidence of Chlamydia trachomatis infections in Norway. Most programmes have 15 to 25 year-olds as their target, because of the high incidence of infection in this age group. The potential role and effect of internet-based commercial testing has not previously been assessed in this context., Material and Methods: 1458 urine samples, taken by the patients themselves, were collected from March 2005 to September 2006 according to instructions given on the commercial web site www.testselv.no, and sent to a given address for analysis. Sex, age distribution and prevalence of Chlamydia trachomatis infection were assessed and all costs were paid by the patient buying the service., Results and Interpretation: More men than women used this service, in contrast to the sex distribution seen in public screening programs. The mean age was 28 years, the 25 % percentile and the 75 % percentile was 24 and 32 years, respectively. The prevalence of infection was high; 7.5 % in women and 12.5 % in men. Our study identifies a demographic group with a high incidence of Chlamydia trachomatis infection that has not been previously been targeted by public screening programmes.

Background: The prevalence of genital chlamydial infection is increasing in Norway. The condition is usually asymptomatic, and screening seems to be the best way of finding infected persons. Our aim was to establish the prevalence of genital chlamydial infection among senior high school pupils in a Norwegian municipality and to link individual results with information on sexual behaviour., Material and Method: All registrated 905 senior high school pupils in Baerum municipality were invited to participate in the study. Health care workers informed all classes about sexually transmitted infections, requested students to participate in the study, distributed anonymized questionnaires and laboratory requistions with containers for urine sampling and collected the urine samples; all on the same day in the different classes. The urinary samples were analysed for Chlamydia trachomatis by polymerase chain reaction. Pupils with positive results were contacted by mobile phone and given treatment and follow-up by the municipal medical officer., Results: 673 (74 %) of 905 invited pupils participated in the study and 571 (63 %) delivered a urine sample. Chlamydia infection was detected in 8 (1.4 %) pupils; 6 (2.2 %) girls and 2 (0.7 %) boys. The prevalence was 2.0 % among the 457 (69 %) who had had sexual intercourse. The sexual debut age was below the age of 17 for 53 % of the pupils., Discussion: This study showed a low prevalence of chlamydia infection among high school pupils, but much sexual activity and limited use of condom. The timing for giving information was therefore regarded as favourable. The participation rate was high, but lower than we had hoped for. Screening for chlamydia among high school pupils in Norway is feasible and may be a valuable tool for limiting the spread of genital chlamydia infections.

Background: Earlier Norwegian prevalence studies of genital C. trachomatis infection have mainly been carried out among women and in selected patient groups. We decided to do a population-based prevalence study among young men and women in Oslo. The study was done within the framework of the new Norwegian list patient system, in which each citizen is assigned to one particular doctor., Methods: Cross-sectional study. All patients 18-29 years old listed with a group practice in Oslo received a personal letter of invitation. We asked each person to submit a urine sample and fill in a questionnaire. The urinary samples were tested by means of a DNA amplification method. Non-respondents received one reminder., Results: 685 persons were invited to participate, 234 responded (36%); 169 females (43%) and 65 males (25%). A total of 6 respondents (3%, 95% CI 1.2-5.5) tested positively, 4 of them were males. At least 51% of the females and 25% of the males had previously been examined for C. trachomatis, and at least 18% of the females and 8% of the males had received treatment. A total of 70% stated that they would see their doctor if they suspected a genital chlamydial infection., Interpretation: Opportunistic testing for C. trachomatis infection should be offered more frequently to young men. A national prevalence study of genital chlamydial infection should be carried out. The new list patient system offers new opportunities for research in primary medical care in Norway.

Background: Chlamydia notification rates have increased in Norway over the recent years. The increase in notification cannot be interpreted as an increase in chlamydia prevalence since knowledge of testing patterns and prevalence of chlamydia by sex and age is virtually absent., Material and Methods: A data set, applying the woman as unit for analyses, comprising all test activity in one Norwegian county, was created for the period 1990-2003 (women 15-59 years old, resident in Sør-Trøndelag County, n = 56,220). Tests registered within 60 days from the previous test were excluded. Outcome measures are age-specific testing rates (first test), cumulative incidence of first test and incidence of repeated testing, proportion of positive first tests and cumulative incidence of being diagnosed with chlamydia before the age of 25, and 12-month incidence of chlamydia., Results: Testing rates were high among young women throughout the study period. By the age of 25, almost all women had been tested at least once for chlamydia (85-90%). By the end of the year following the first test, one in five women with a negative first test and one in three women with a positive first test had been tested for chlamydia at least once more. The proportion of positive tests was highest among the youngest women (9-11% for women 15-24 years from 2000). Cumulative incidence of diagnosed chlamydia by the age of 25 years was 15% for women born 1976-79. Incidence of chlamydia during the first year after the first test was 2-3%. The relative risk for being diagnosed with chlamydia after the first test was highest for women who initially tested positive, and for teenagers., Interpretation: The prevalence of chlamydia is high among young women. However, many women are not tested within a reasonable time after their first intercourse. Increased testing rates among teenagers can be achieved by focusing on easily available tests implying self-sampling methods.

Background: Increased testing rates for Chlamydia infection among young women can be achieved by more use of self-administered sampling methods. In this study, vulval swabs and urine are compared to conventional cervix samples., Materials and Methods: Vulval swabs, urine and cervix samples from 541 young, healthy women were tested for Chlamydia by polymerase chain reaction technique., Results: The prevalence of Chlamydia infection was 4.1% (22/541). The sensitivity (cervix 22/22, urine 21/22 and vulva 21/22) and specificity (no false negative results) were high for all sampling sites., Interpretation: Urine samples or vulval swabs can replace conventional cervix swabs for the detection of Chlamydia.

Background: The knowledge of testing patterns and prevalence of chlamydia among Norwegian men is sparse., Materials and Methods: Data on chlamydia tests for men were selected from the database at the only laboratory in a Norwegian county carrying out chlamydia tests. 12,633 men aged 15-59 at first test and resident in the county were included in the study., Results: Age-specific rates for first test for young men increased throughout the study period. By the age of 25, one in five men had been tested for chlamydia at least once. One in six of first tests was positive. Chlamydia prevalence at first test was highest among men 20-24 years old (21% in 2003). Men who initially had a positive test more often had a repeated test than men who initially had a negative test. Furthermore, 12-month incidence of chlamydia infection subsequent to the first test was higher among men who initially tested positive (12%) than among men who initially tested negative (7%)., Interpretation: Even though testing rates increased throughout the study period, the proportion of men who had been tested for chlamydia at the age of 25 was low. The prevalence at first test was high throughout the study period. Increased availability of urine-based testing will probably lead to more chlamydia testing among men.

Background: The purpose of this study was to explore pattern of testing and prevalence of C trachomatis among 16 to 19 year old Norwegian high school girls., Material and Methods: The study subjects were 827 girls who participated in a study of oral contraceptives prescribed by public health nurses. The first consultation was an interview about sexual behaviour and other characteristics. The participants were encouraged to test for C trachomatis with their general practitioners. We explored characteristics of those tested and predictors of genital C trachomatis infection., Results: Half of the study population was tested, either before (21%) or during the study period (26%). Girls with risk factors such as change of partner over the last six months, older partner or no regular partner were more likely to be tested than girls with no change of partner or a regular same-age partner. One out of four girls with high-risk behaviour (> or =3 partners) was never tested. The prevalence of infection at first test was 9%. The risk for having a positive test result was three times higher for single girls than for girls with a regular same-age partner., Interpretation: Too few young girls were tested for C trachomatis. Encouragement from public health providers had low influence on the pattern of testing. Alternative strategies such as implementation of do-it-yourself tests by urine or vulvovaginal sampling procedures have to be provided as a low-threshold service.

Background: We wanted to determine the prevalence of Chlamydia trachomatis in a sample of young women and to assess risk factors related to sexual behaviour that are predictive of such infection., Material and Methods: 898 healthy, non-pregnant women aged 16 to 24 years attending primary care centres over a two-year period (September 1998 to December 2000) were recruited for the study. Uterine cervix samples were tested for Chlamydia trachomatis and participants were interviewed about their sexual behaviour. Chlamydia test results from 881 samples were valid., Results: The prevalence of genital Chlamydia trachomatis infection was 2.4% (21/881). In univariable analyses, a high number of lifetime partners (four or more), smoking, previous pregnancy and a previous positive chlamydia test were factors predictive of a positive Chlamydia test. In multivariable analyses, previous pregnancy and a previous positive Chlamydia test were the only significant factors. The number of lifetime partners was higher among women who had been pregnant or previously had tested positively for Chlamydia., Interpretation: The prevalence of Chlamydia was low in this population. Risk behaviour (frequent change of partners) can be expressed by teenage pregnancy and positive Chlamydia test results and these factors can be used for identification of women who should be tested more frequently than others for Chlamydia infection in a low-prevalence population.

Background: The purpose of this study was to analyse trends for Chlamydia trachomatis infection in a population of women seeking termination of pregnancy, and to assess whether socio-demographic characteristics are predictive of such infections., Material and Methods: Since 1983 women seeking abortion in the university hospital in Trondheim have been systematically tested for Chlamydia trachomatis. Data on 11,376 abortions (1985-2000) were included in the study and results were analysed with logistic regression., Results: Age-adjusted prevalence of Chlamydia trachomatis decreased from 9.0% to 5.0% in 1999-2000. The prevalence was highest among the youngest women. Single and cohabiting women had a higher prevalence of chlamydial infections than married women., Interpretation: Women terminating their pregnancy are an excellent population for sentinel surveillance of Chlamydia trachomatis infection because of their young age, high proportion of singles, and relative inconsistent use of contraception. Even though the prevalence of Chlamydia trachomatis has decreased over the 16-year study period, it is still high for women seeking abortion, especially in the youngest age groups.

During the last 5-6 years our understanding of Chlamydia pneumoniae has changed radically. C. pneumoniae is no longer considered a dangerous, obligatory pathogen. Rather, it is a common, highly contagious intracellular opportunist, inducing poor immunity and with a tendency to repeated reinfections. At present, a possible role in the formation of atheromatous plaques is being discussed. There is a significantly higher prevalence of antibodies against C. pneumoniae in coronary heart disease patients than in controls. Another unsolved problem is that of therapy, since chronic lung infection resists long-term macrolide antibiotic treatment. Should additional treatment with cortisone be given? Here we clearly need clinical trials before we move in a totally new direction.

Bacterial vaginosis is the most common vaginal infection during the fertile period. The clinical diagnosis is based on three of Amsel's four criteria: thin, grey-white discharge, vaginal fluid pH above 4.5, a fishy odour on addition of 10% potassium hydroxide solution to the vaginal fluid, and the presence of clue cells on a saline wet mount. A probably more sensitive indicator of the diagnosis is based on Gram-stain, where the normal lactobacillus-dominated vaginal flora is changed to the lactobacillus deficient flora of bacterial vaginosis. The condition is probably associated with higher risk of complications in connection with pregnancy and gynaecological surgery. A prospective study of bacterial vaginosis based on microscopy of Gram-stained smears was conducted among 168 women applying for first trimester abortion. The prevalence of bacterial vaginosis was 24% and of Chlamydia trachomatis 8.4%. Four patients (10.3%) in the vaginosis group were treated with antibiotics for certain or suspected postabortal endometritis, as against six patients (5.4%) in the group without bacterial vaginosis.

Testing for Chlamydia trachomatis has become widely available in Norway during the last ten years. We have evaluated the number and yield of tests in Vestfold county. The number of performed tests increased from 0.6 per 100 inhabitants in 1984 to 6.5 in 1993, while the yield declined from 14.7% to 3.4%. The incidence of diagnosed infection declined from 4.0 per 1,000 person-years in 1988 to 2.2 in 1993. In 1991, 59.6% of the samples were taken from women aged 15 to 29 years. Male patients provided 7.1% of the samples. Between 40 and 50 tests were performed among every 100 Vestfold women in their twenties. More than three quarters of the positive tests were found in women under 25 years of age or in men. Women 30 years of age or older accounted for 32.4% of the tests, but only 9.3% of the positive tests; reaching a yield of less than 1.1%. We recommend that doctors perform fewer screening tests in women older than 25 years and more tests in men following notification by partner. This will increase the yield and reduce the number of false positive tests.

Laboratory testing for sexually transmitted Chlamydia trachomatis infection is widely used in Norwegian general practice. The yield of this testing is declining, since the prevalence of infection in the community has decreased. Thus, the cost-effectiveness of testing is reduced, and the risk of false positive results using non-culture methods has increased. In cooperation with a panel of medical microbiologists, gynaecologists, venerologists, general practitioners and public health specialists, we have reviewed the literature and drawn up a set of recommendations for the use of laboratory testing for genital C. trachomatis infection. We emphasize clinical testing of men and women, notification of partners in order to reach males, and screening of women under the age of 25 after each change of sexual partner.

The present study evaluates two strategies for partner notification among young women with genital Chlamydia trachomatis infection. The study included 443 women, aged 14-21 years, who visited one of 20 youth clinics during a two months period in 1991. The youth clinics were randomized to use patient referral or provider referral. In the latter group, 11 of 14 women with genital Chlamydia infection revealed their sexual partners. Only five of 24 sexual partners were notified by a letter, and six of 24 partners turned up for examination. In the patient referral group, 16 of 34 women asked to notify their partner, and ten of 31 partners were examined. Partner notification in young women with genital Chlamydia infection seems to be difficult.

The prevalence of Chlamydia trachomatis was investigated in a retrospective study of 17,215 women who requested termination of pregnancy at Ullevål and Aker hospitals in Oslo during the years 1985-89 and 1991. The overall prevalence of C trachomatis decreased from 11.3% (267/2,354) in 1985 to 3.8% (112/2,958) in 1991. The reduction was considerable from 1985 to 1989 but only slight at the end of the period. The prevalence was higher in younger women during the whole period. In women < 25 years old the prevalence decreased from 16.7% in 1985 to 6.3% in 1991, and in women > or = 25 years old from 5.9% in 1985 to 1.8% in 1991.

Specimens to test for Chlamydia trachomatis and Neisseria gonorrhoeae were collected as a routine from female patients undergoing gynecological examinations in general practice. In 3.9% of 517 non-pregnant women the culture for C trachomatis was positive. None were infected with N gonorrhoeae. C trachomatis was detected in ten of 138 (7.2%) women with genital symptoms, compared with ten of 379 (2.6%) without symptoms. The annual incidence rate for C trachomatis in asymptomatic patients was 0.3% for women older than 25 years, and 5.4% for women younger than 25 years. Routine testing for C trachomatis is recommended during gynecological examination in general practice of asymptomatic women younger than 25 years. Tests should be taken at minimum two-year intervals. Routine tests for N gonorrhoeae are not recommended.

In April and May 1991 all women requesting abortion in Norway were screened for Chlamydia trachomatis and Neisseria gonorrhoeae. During the study period 2,194 abortions were carried out. The study included 2,110 women with representative tests for C trachomatis from the cervix uteri. Only 1,702 women were tested for N gonorrhoeae. The prevalence of N gonorrhoeae was 0.5% (8:1,702), and of C trachomatis 5.4% (113:2,100). The prevalence of C trachomatis decreased from 9.1% among women less than or equal to 19 years to 2.0% among women greater than or equal to 35 years of age. Prevalence of C trachomatis was significantly lower among subjects resident in health region no. IV (mid-western part of Norway) than among candidates for abortion from the other four health regions. Being less than 25 years of age was the best single parameter for identifying chlamydia-positive cases. The prevalence of N gonorrhoeae among women seeking abortion in Norway is so low that screening is not recommended. However, the prevalence of C trachomatis is still high enough to recommend screening of all women less than 25 years of age who request abortion. Chlamydia-positive cases should be tested for N gonorrhoeae.

Notification of partner(s) is recommended as a measure to control the epidemic of genital chlamydial infection. We surveyed a random sample of Norwegian general practitioners and privately practising gynaecologists. Only one in five general practitioners initiated notification of partner(s) after diagnosing a patient with genital chlamydial infection. A proposed new Communicable Diseases Act will make it mandatory to notify the partner in the event of such infections. 49% of general practitioners are in favour of the proposal, 21% oppose it while 30% remain uncertain. After implementation of similar legislation, Sweden has experienced a decline in the incidence of genital chlamydial infection. We believe increased notification of partner would help to control the Norwegian epidemic.

Only one in five general practitioners in Norway initiates notification of partner(s) after diagnosing a case of genital chlamydial infection. In order to increase the use of this efficient case-finding method we review the aims of notifying partners and the judicial, ethical and economical aspects of the method. We describe both provider-referral and patient-referral methods. The first approach is chosen when the index patient wants to remain anonymous. General practitioners are advised not to give the index patient medication for the contacts. Instead, the contacts should be examined and informed by qualified personnel. Notification of partner will be a cornerstone in the struggle to control the current epidemic of genital chlamydial infection in Norway.