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The 'Finnish new variant of Chlamydia trachomatis ' (FI-nvCT), escaping detection in the Aptima Combo 2 assay (AC2), is widespread across Norway. From June to August 2019, 84% (81/97) of available AC2/Aptima CT discordant samples from five laboratories were confirmed as FI-nvCT. Two additional CT variants (CT 23S rRNA C1514T and G1523A) also escaped AC2 detection. The high FI-nvCT proportion might indicate a long-term national spread and it cannot be excluded that FI-nvCT emerged in Norway.

Objectives: Risk judgements are key factors in adolescents' decisions related to sexual health. We examine the associations between self-perceived risk and prevalent chlamydia infection, and sexual behaviours related to risk perception in a general adolescent population in Norway., Methods: Population-based cross-sectional study among 1028 sexually experienced girls and boys, age 15-20 years (85% participation), including web questionnaires and urine samples for Chlamydia trachomatis PCR testing. Participants rated self-perceived risk as: no/low/medium/high/very high. We used binary and ordinal logistic regressions to examine associations with chlamydia prevalence and self-perceived risk, respectively, adjusting for potentially confounding variables., Results: Chlamydia prevalence increased with increasing risk perception. Although girls had twice the chlamydia prevalence of boys (7.3% vs 3.9%), their risk distribution was similar and 65% of both genders rated their risk as no/low with half of infections detected in this group. In multivariable analyses, reporting multiple sexual risk behaviours, non-steady relationship, previous chlamydia testing and treatment, and urogenital symptoms increased self-perceived risk. More boys overestimated their personal risk whereas more girls underestimated it (52% vs 30%, respectively, and 15% vs 31%, p<0.001). The main reasons for perceiving no/low risk were: 'I have a steady partner' and 'I trust my partner will tell me about an infection'., Conclusions: These sexually experienced adolescents acknowledged their chlamydia infection risk, but wrong beliefs were incorporated in their assessments, and more than half had incorrect risk perception. We suggest that sexually transmitted infection prevention programmes should be directed at closing the gap between perceived and actual risk and focus on how context may bias personal judgement., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objectives: Evidence is mixed as to whether meeting sexual partners online ('internet-partners') is associated with risky sexual behaviour and/or sexually transmitted infection transmission. Accordingly, we sought to estimate the prevalence of reporting various online romantic and sexual activities among Norwegian adolescents, including internet-partners, and the reason for meeting them and to examine differences in sexual behaviour, partnership characteristics and chlamydia infection prevalence among those reporting internet-partners versus those reporting only offline partners., Methods: Population-based cross-sectional survey among sexually experienced girls and boys, 15-20 years, using electronic questionnaires and collecting urine samples for Chlamydia trachomatis PCR testing (79% provided both, n=1023). We used logistic regression to examine associations, adjusting for potentially confounding variables., Results: Overall, 30% of both genders reported internet-partners (ever). Boys (but not girls) with internet-partners had higher chlamydia prevalence than those reporting meeting sexual partners only offline (8.1%, 95% CI 4.3% to 13.7% vs 1.6%, 0.5% to 3.7%). Two-thirds of girls and 37% of boys reported meeting their most recent internet-partner to start a romantic relationship, while the remainder did so with the specific intention of having sex. Among both genders, reporting sexual (vs romantic) reasons for meeting their most recent internet-partners was associated with reporting several risky sexual behaviours, including multiple recent sex partners (adjusted OR girls: 3.27, boys: 2.48) and three-fold higher chlamydia prevalence., Conclusions: This population-based study suggests that internet-partners are common among adolescents in Norway, and the reason for meeting them was more strongly associated with additionally reporting sexual risk behaviours and prevalent chlamydia infection than the internet itself as a meeting venue., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

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.

As genital Chlamydia trachomatis (chlamydia) infection is often asymptomatic, surveillance of diagnosed cases is heavily influenced by the rate and distribution of testing. In 2007, we started supplementing case-based surveillance data from the Norwegian Surveillance System for Communicable Diseases (MSIS) with aggregated data on age group and sex of individuals tested. In this report, annual testing rates, diagnosis rates and proportion positive for chlamydia in Norway between 1990 and 2013 are presented. From 2007, rates are also stratified by age group and sex. The annual testing rate for chlamydia culminated in the early 1990s, with 8,035 tested per 100,000 population in 1991. It then declined to 5,312 per 100,000 in 2000 after which it remained relatively stable. Between 1990 and 2013 the annual rate of diagnosed cases increased 1.5 times from ca 300 to ca 450 per 100,000 population. The proportion of positive among the tested rose twofold from ca 4% in the 1990s to 8% in 2013. Data from 2007 to 2013 indicate that more women than men were tested (ratio: 2.56; 95% confidence interval (CI): 2.56-2.58) and diagnosed (1.54; 95% CI: 1.52-1.56). Among tested individuals above 14 years-old, the proportion positive was higher in men than women for all age groups. Too many tests are performed in women aged 30 years and older, where 49 of 50 tests are negative. Testing coverage is low (15%) among 15 to 24 year-old males. Information on sex and age-distribution among the tested helps to interpret surveillance data and provides indications on how to improve targeting of testing for chlamydia. Regular prevalence surveys may address remaining limitations of surveillance.

Background: New cases of gonorrhoea (Neisseria gonorrhoeae) and chlamydia (Chlamydia trachomatis) infections have been steadily increasing in Scandinavian countries over the last decade. There is a particular urgency in reducing new infections as isolation of multiple drug resistant strains of gonorrhoea is becoming more frequent. The aim of this study was to determine the prevalence and sites of infection of common sexually transmissible infections (STIs) in men who have sex with men (MSM)., Methods: We have performed a retrospective analysis of the three major STIs, gonorrhoea, chlamydia and Mycoplasma genitalium in urogenital, anorectal and oropharyngeal samples from MSM that attended two STI clinics in Oslo., Results: One hundred and thirty-six men (6.0%) out of 2289 MSM tested were found to be positive for gonorrhoea using a porA gene targeted nucleic acid amplification test (NAAT). Of these, 106 (77.9%) would not have been identified through testing first-void urine alone. Two hundred and twenty eight (10.0%) patients from 2289 tested were found to be positive for chlamydia, 164 (71.9%) of which were identified through anorectal specimens. Ninety-one (5.1%) patients from 1778 tested were found to be positive for M. genitalium, with 65 (71.4%) identified through testing of anorectal specimens., Conclusions: Our results supports the European findings that the MSM population carries a high burden of STIs and that testing the anorectum and oropharynx will identify a significantly higher percentage of infected patients and reservoirs of STIs.

A specific real-time polymerase chain reaction followed by melt curve analysis was developed for the detection of the Swedish variant (nvCT) strain of Chlamydia trachomatis (CT). Surveillance was performed on 476 CT-positive clinical specimens obtained from 15 laboratories around the United States using nucleic acid amplification test assays, which would not miss the nvCT. All were negative for nvCT; thus, there is no evidence of the nvCT in the United States.

Background: As most genital Chlamydia trachomatis infections are asymptomatic, many patients do not seek health care for testing. Infections remain undiagnosed and untreated. We studied whether screening with information and home sampling resulted in more young people getting tested, diagnosed and treated for chlamydia in the three months following the intervention compared to the current strategy of testing in the health care system., Method: We conducted a population based randomized controlled trial among all persons aged 18-25 years in one Norwegian county (41 519 persons). 10 000 persons (intervention) received an invitation by mail with chlamydia information and a mail-back urine sampling kit. 31 519 persons received no intervention and continued with usual care (control). All samples from both groups were analysed in the same laboratory. Information on treatment was obtained from the Norwegian Prescription Database (NorPD). We estimated risk ratios and risk differences of being tested, diagnosed and treated in the intervention group compared to the control group., Results: In the intervention group 16.5% got tested and in the control group 3.4%, risk ratio 4.9 (95% CI 4.5-5.2). The intervention led to 2.6 (95% CI 2.0-3.4) times as many individuals being diagnosed and 2.5 (95% CI 1.9-3.4) times as many individuals receiving treatment for chlamydia compared to no intervention in the three months following the intervention., Conclusion: In Norway, systematic screening with information and home sampling results in more young people being tested, diagnosed and treated for chlamydia in the three months following the intervention than the current strategy of testing in the health care system. However, the study has not established that the intervention will reduce the chlamydia prevalence or the risk of complications from chlamydia.

Background: The prevalence of Mycoplasma genitalium and Ureaplasma genitalium in populations outside sexually transmitted infection clinics in Norway is unknown., Objective: To assess the prevalence of potential sexually transmitted organisms in a non-clinical setting, among college students in Northern Norway., Methods: In total 655 students, 449 men and 206 women, were tested for Chlamydia trachomatis, M. genitalium, and U. urealyticum by nucleic acid amplification testing of urine samples. All subjects completed questionnaires., Results: Among the included men, the prevalences of C. trachomatis, M. genitalium, and U. urealyticum were 4.2%, 1.1% and 8.9%, respectively. Prevalence among included women was 1.9%, 1% and 8.2%, respectively. In men, the number of sexual partners in the preceding 6 months was associated with prevalence of U. urealyticum and C. trachomatis., Conclusions: U. urealyticum appeared more prevalent than C. trachomatis and increased number of sexual partners was associated with increased risk of a positive test. M. genitalium had a low prevalence., (© 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology.)

Background: Early sexual behaviour has been shown to differ significantly between genders, but few studies have addressed this topic to explain the commonly observed differences in chlamydia rates between adolescent girls and boys. Our study aimed to determine chlamydia prevalence in adolescents aged 15-20 years in a high-incidence area in Norway, and to identify gender-specific early sexual behaviours associated with infection., Methods: A population based cross-sectional study was conducted among all high school students in five towns in Finnmark county in 2009, using a web-based questionnaire and real-time Chlamydia trachomatis PCR in first-void urine samples (participation rate 85%, 800 girls/818 boys, mean age 17.2 years). Crude and multivariable logistic regression models were applied with chlamydia test result as dependent variable., Results: Prevalence of chlamydia infection was 5.7% (95% confidence interval, CI, 4.4-7.3%). Girls were twice as likely to be infected as boys (7.3%, 5.3-9.7 vs 3.9%, 2.3-6.0). Girls reported earlier sexual debut, older partners, higher lifetime number of partners, and were poorer condom users. In girls, higher maternal education (odds ratio, OR, 2.2, 95% CI 1.1-4.4), ≥2 sexual partners past 6 months (OR 3.6, 1.8-7.3), and partner meeting venue at a private party, bar or disco (OR 5.0, 1.1-22.7) increased the odds of infection in the multivariable model. In boys, condom use at first intercourse (OR 0.06, 0.01-0.42) decreased the odds of infection, while having an older last sexual partner (OR 3.7, 1.3-11.0) increased the odds. In all participants, the risk of infection increased if residence outside the family home during school year (OR 2.0, 1.2-3.6), and decreased if condom was used at last intercourse (OR 0.2, 0.1-0.8)., Conclusions: We detected significant gender differences in chlamydia prevalence and sexual behaviours, and accordingly differing independent risk factors for chlamydia infection. We suggest that accumulation of essentially different experiences in the early sexually active years contribute to gender disparities in chlamydia risk in individuals this age. Gender-specific approaches may be the best alternative to control chlamydia infection in age group 15-20 years.

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: Natural history data on human papillomavirus (HPV) incidence and its risk factors have not been reported on from young women in Norway. We report on incidence and predictors of HPV-6, 11, 16, and 18; 6 or 11; 16 or 18; or all 4., Methods: A 48-month prospective study enrolled 898 women aged 16 to 24 between 1998 and 2000. HPV DNA polymerase chain reaction testing of genital tract specimens was performed and risk data collected every 6 months and HPV serology and genital Chlamydia trachomatis testing performed every 12 months. Cumulative incidence was estimated using the Kaplan-Meier method and covariates evaluated in Cox models., Results: Among the women who were HPV DNA- and serology-negative at entry, 48-month cumulative incidences (95% confidence interval) were as follows: HPV-6: 20.0% (17.1-23.4), HPV-11: 2.2% (1.3-3.5), HPV-16: 25.0% (21.7-28.8), HPV-18: 13.6% (11.3-16.4), HPV-6 or -11: 21.5% (18.5-25.0), HPV-16 or -18: 30.4% (26.7-34.5), and HPV-6, -11, -16, or -18: 37.8% (33.6-42.3). Younger age at first intercourse, being single, having no regular partner, reporting new partners, and genital C. trachomatis infection were independent risk factors of incident HPV., Conclusions: Proxies measuring new partnerships and genital C. trachomatis infection predicted incident HPV-6, -11, -16, or -18. Incidence of HPV-6, -11, -16, or -18 in young Norwegian women is high, with more than one-third becoming infected over 48 months.

Background: There has been an increasing number of diagnosed cases of Chlamydia trachomatis in many countries, in particular among young people. The present study was based on a growing request to examine urine as a supplementary or primary specimen in screening for Chlamydia trachomatis in women, with the Becton Dickinson ProbeTec (BDPT) Strand Displacement Assay (SDA). Urine samples may be particularly important in screening young people who are asymptomatic., Methods: A total of 603 women aged 15 and older were enrolled from the Sexually Transmitted Infection (STI) clinic at Haukeland University Hospital, Norway, in 2007. Only 31 women were older than 35 years. Cervical swabs and urine samples were tested with BDPT for all participants. In cases of discrepant test results from a given patient, both samples were retested by Cobas TaqManCT and a Polymerase Chain Reaction (PCR)-method (in-house). Prevalence of C. trachomatis, sensitivity, and specificity were estimated by latent class analysis using all test results available. Bootstrap BC confidence intervals (10,000 computations) were estimated for sensitivity and specificity, and their differences in cervix vs. urine tests., Results: A total of 1809 specimens were collected from 603 patients. 80 women (13.4%) were positive for C. trachomatis. Among these, BDPT identified 72 and 73 as positive in cervix and urine samples, respectively. Of the 523 C. trachomatis negative women, BDPT identified 519 as negative based on cervical swabs, and 514 based on urine samples. Sensitivity for cervical swabs and urine samples with the BDPT were 89.0% (95% CI 78.8, 98.6) and 90.2% (95% CI 78.1, 95.5), respectively. The corresponding values for specificity were 99.2% (95% CI 98.3, 100) and 98.3% (95% CI 96.4, 100)., Conclusions: This study indicates that urine specimens are adequate for screening high-risk groups for C. trachomatis by the SDA method (BDPT). Such an approach may facilitate early detection and treatment of the target groups for screening, and be cost-effective for patients and the health services.

Introduction: The number of Chlamydia trachomatis infections in Norway has been increasing for the last years. A new and enhanced surveillance system was implemented in 2005 to meet the challenges faced by the increasing number of cases., Methods: The new surveillance system is laboratory based. Data are collected once a year from all laboratories on the total number of test performed, and all diagnosed cases from the preceding year. For each case the following variables are reported: date of diagnosis, birth year, sex, and municipality of residence., Results: By 2006 all laboratories reported data as required. We have observed an increase in yearly diagnosed C. trachomatis cases in Norway during the last years. In 2006, the incidence was 4.6 per 1000 population. The proportion positive tests have increased from 6.0% in 2000 to 7.7% in 2006. In the same period the annual number of tests increased by 13.5%. Surveillance data from 2006 showed that the highest incidence rates were found in women between the ages of 15 to 24 in men aged 20 to 24 and in 2 northernmost regions of the country., Conclusion: The year 2006 had the highest level of diagnosed cases ever in Norway. To better interpret the observed trend, a voluntary system will be introduced in 2007 to collect test rates by age, gender and geography. There is a need to evaluate current and new strategies to target the group of asymptomatic and untreated young people.

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: Recent studies show divergent results concerning the risk of ectopic pregnancy following Chlamydia trachomatis (CT) infection., Goal: Our goal was to investigate future reproductive health outcomes (births and ectopic pregnancies) among women tested for CT., Methods: Our cohort consisted of 20,762 women born during 1970-1984 who were tested for CT during 1990-2003. We linked CT data to data on ectopic pregnancies and births during 1990-2004. Cox regression with time-dependent covariates was used to assess the association between CT history and births/ectopic pregnancies adjusted for age at first test. Analyses with ectopic pregnancy as outcome were also adjusted for parity., Results: We observed 9.6 births per 100 person-years of observation among women with negative tests only and 10.2 per 100 person-years among women with at least 1 positive test (hazard ratio adjusted for age at first test, 1.07; 95% CI, 1.01-1.12). Ectopic pregnancy incidence rates were higher for women with positive test(s) compared with women with negative test only (0.24 vs. 0.13 per 100 person-years; hazard ratio adjusted for age at first test and parity, 1.82; 95% CI, 1.27-2.60). Among women with at least 1 registered pregnancy, the adjusted hazard ratio was 2.03; 95% CI, 1.28-3.22)., Conclusion: Although women diagnosed with CT were at higher risk for ectopic pregnancy than women with negative test results only, our study suggest that their fertility prospects were better than they would have been had CT screening not been implemented in this population. Opportunistic CT screening is an appropriate method for maintaining female reproductive health.

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.

Objective: The study objective was to investigate Chlamydia trachomatis (CT) testing patterns, prevalence, and incidence among men and women in Sør-Trøndelag county, central Norway, 1990-2003., Goal: The goal of this study was to obtain data for recommendations regarding CT screening., Study Design: Laboratory data on CT tests for persons 15 to 24 years old were retrieved and analyzed., Results: Four percent of men and 44% of women had been CT tested at least once by the age of 20. By the age of 25, 44% of men and 84% of women had been tested. Prevalence at first test was at its peak in 2000-2002 (men: 15-19 years 18%, 20-24 years 23%; women: 15-19 years 11%, 20-24 years 9%). Incidence estimates were higher for persons with a positive first test than for persons with a negative first test., Conclusions: More men and more female teenagers need to be tested. Repeat testing is particularly important among people who have been diagnosed with CT.

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: A tuboovarian abscess (TOA) is a common complication of pelvic inflammatory disease (PID), occurring world-wide in 15-30% of women with PID. The aim of the study was to identify changes during the last 10 years in the number of women hospitalized with PID in Oslo, as well as a change regarding the frequencies of the subdiagnoses salpingitis and tuboovarian abscess., Methods: We performed a review of computerized diagnosis lists and manual check of the medical records of women hospitalized with PID in Oslo. The years 1990-92 and 2000-02 were included, resulting in information from two time periods 10 years apart. Cases were registered as salpingitis, oophoritis or tuboovarian abscess. Medical and demographic variables from the medical records of women diagnosed during 4 out of the 6 years were described in detail., Results: We identified 523 women with the diagnosis of PID hospitalized during 1990-92 and 2000-02. There was a 35% reduction in hospitalized cases of salpingitis over the period of 10 years, but the number of cases of tuboovarian abscesses among women admitted for PID remained unchanged from 1990-92 to 2000-02. We found low frequencies of Chlamydia trachomatis and Neisseria gonorrhoea infections, although documented bacteriological sampling was insufficient., Conclusions: Fewer patients were hospitalized in Oslo for PID during the time period of 2000-02 compared with 10 years earlier, but a higher percentage of patients had developed TOA compared with the first time period (43% compared with 26%, p = 0.013), indicating a changing clinical panorama of PID.

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.

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.

We describe the cases of three women who, in 1994, filed complaints of alleged false-positive diagnosis of Chlamydia infection with the Norwegian Patients' Association. They were living in mutually monogamous relationships, but had genital symptoms when they visited their doctor. The positive tests had adverse psychological and social consequences. Two women and their partners had negative repeat tests elsewhere, while one woman found that the laboratory, but not her doctor, had registered her primary test as negative. We suggest measures to reduce the number of false-positive tests and to prevent adverse psychological and social consequences of such tests. Patients should be involved in the decision to perform a Chlamydia test. The doctors should be aware of the possibility of false results, and must improve their information to patients with positive tests.

First-void urine samples from 392 Norwegian military conscripts were investigated for the presence of Chlamydia trachomatis by enzyme immunoassay (EIA) on day 1 and day 5 after collection. Positive samples were subsequently investigated by direct immunofluorescence (IF) microscopy for the presence of chlamydial elementary bodies (EBs) in the urine pellet, and urethral swab material taken from the EIA-positive individuals was cultured. 4.8% (19/392) of the urine samples were EIA-positive on day 1, and 5.4% (21/392) were positive on day 5, with a combined total of 6.6% (26/392). Twenty-four of the 26 urine samples were confirmed as positive on IF microscopy. Urethral swabs were taken from 21 EIA-positive individuals. Six of the swabs were positive on cell culture, whereas nine were positive on IF microscopy of swab material, suggesting that these techniques perform better in symptomatic cases than in male Chlamydia trachomatis carriers. In the urine samples a notable discrepancy in EIA results was seen when the same refrigerated samples were retested on day 5 compared to day 1. This discrepancy was probably due to storage-related factors.

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.

We surveyed routine practice among a random sample of 302 Norwegian general practitioners. 49% perform a test of cure in all the patients whom they treat for genital infection caused by Chlamydia trachomatis. 22% of the practitioners test "most" patients, 19% test "some" patients while 10% of the general practitioners test none of the patients after treatment for genital chlamydial infection. Female practitioners perform more tests of cure than male practitioners do. Most tests are performed 1-4 weeks after completion of treatment. Although test of cure has been a controversial topic, we believe it to be a useful measure against the epidemic of genital chlamydial infections. The purposes of the test are to establish whether or not the treatment has been effective and ensure that the patient has not been reinfected by a partner who did not receive treatment. The test of cure must be performed later than two weeks after completion of treatment, in order to avoid false positive tests as a result of residual chlamydial antigen in the genitalia.

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.

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.

During one year, 1928 of all 1958 neonates born in the county of Troms in Northern Norway were followed until 6 weeks of age, regarding the development of ophthalmia neonatorum. Conjunctivitis was found in 364 cases (189 per 1000 neonates), including mild and self-limiting cases. In 14.5 cases per 1000 neonates the ophthalmia neonatorum was recorded as severe. Boys were more often affected than girls (P = 0.001). The age of the mother and obstetric events did not significantly influence the occurrence of conjunctivitis. 31.4% of the neonates received silver nitrate instillation. The frequency of conjunctivitis in the group with and without prophylaxis was 15.9 and 20.3%, respectively (P = 0.023). The incidence of chlamydial ophthalmia was 8 per 1000 neonates. At present, chlamydial ophthalmia is a common disease in neonates. Efforts should be made to screen fertile women for chlamydial genital infection and to encourage prompt microbiological examination in cases of ophthalmia neonatorum.

In a population of 1928 neonates in Northern Norway, ophthalmia neonatorum was diagnosed in 18.9%, including mild and self-limiting cases. Sixteen out of 269 (6.0%) cultured cases were positive for Chlamydia trachomatis. No gonococcal ophthalmia was seen. In neonates whose symptoms began in the maternity wards, the distribution of the isolated microorganisms (mainly Staphylococcus aureus) was different from those in whom symptoms began after discharge (mainly S. aureus, Staphylococcus species (coagulase-negative), Streptococcus viridans and C. trachomatis). Growth of C. trachomatis was significantly associated with the intensity of conjunctivitis (P less than 0.001). However, no sequelae could be demonstrated in the eyes at the age of 6 months. 60% of the neonates with chlamydial ophthalmia also suffered from rhinitis. 31.4% of the neonates received silver nitrate instillation, which had no significant influence on the frequency of chlamydial ophthalmia. General practitioners are often faced with chlamydial ophthalmia. In cases of ophthalmia neonatorum, a microbiological examination is recommended, as a guide to appropriate antibiotic treatment. The result of microbiological examination may also indicate other infections in mother and child. In areas with a readily available health service, including an adequate microbiological laboratory service, prophylaxis in the eyes does not seem to be necessary.

Asymptomatic genital infection by Chlamydia trachomatis is common in women, and one or more consultations to test for cure is the routine practice. We have compared the economic implications of two post-treatment regimens: 1) no control, and 2) one control involving a single test for C trachomatis, with renewed treatment and another test for cure in women who were chlamydia-positive, etc. The costs of the control regimen were double those of the no-control regimen. With no control, 79 more cases of pelvic inflammatory disease, eight more cases of infertility requiring work-up and two more cases of ectopic pregnancy would occur per 10,000 patients. We conclude that routine post-treatment control of asymptomatic genital chlamydial infections is not cost beneficial.

Routine testing for Chlamydia trachomatis during gynecological visits, as well as treatment of those found positive, has been suggested as a preventive measure against the serious consequences of chlamydial genital infections, e.g., pelvic inflammatory disease (PID), infertility, and ectopic pregnancy. This article examines the cost and effectiveness of this practice. The study is based on a model that predicts how routine testing and treatment will affect the future number of cases of PID, infertility, and ectopic pregnancy. The costs of test and treatment are estimated, as are the savings resulting from prevention. Results indicate that although routine testing was not effective in reducing the overall morbidity caused by chlamydial infections, for women 18-22 years of age routine testing during regular gynecologic sessions can be a cost-effective personal health service.

To determine the microbiological agents in conjunctivitis in children and young adults, physicians outside hospitals were asked to obtain samples from the conjunctiva in patients presenting with conjunctivitis. Specimens from 194 patients and 177 healthy controls were cultivated for Chlamydia trachomatis. In 12 cases Chlamydia trachomatis was isolated (i.e. 4 neonates, 1 three-year-old child and 7 adults, aged 17 to 39 years), but in none of the controls. Of the specimens from patients 168 and all of the healthy controls were cultivated for both bacteria (including Chlamydia trachomatis) and viruses. The main micro-organisms, regarded as infectious, were Haemophilus influenzae (20), Streptococcus pneumoniae (18), Staphylococcus aureus (14) and Chlamydia trachomatis (9). Haemophilus influenzae (non-typable strains) were isolated more frequently in the age group below 5 years of age than in the age group 5-50 years. Herpes simplex virus (type II) was isolated in one neonate. Chlamydia trachomatis is among the most important infectious agents in conjunctivitis treated outside hospitals. As chlamydial infections need special attention regarding treatment and follow-up, physicians should be encouraged to obtain specimens for microbiological examination, including chlamydia, from the population at risk.

In a study at the University Hospital in Trondheim during 1983, the frequency of Chlamydia trachomatis among women terminating their pregnancies was 8.2%. Younger women were infected by C. trachomatis at a more frequent rate than older women (p less than 0.001). Treatment of chlamydia-positive women was initiated within the first two weeks after the abortion. However, among women readmitted to the hospital, chlamydia-positive women showed a higher frequency of salpingitis than chlamydia-negative women (p less than 0.08). Preabortion examination for C. trachomatis and treatment of chlamydia-positive women by practitioners before the abortion is carried out, may reduce the postabortal frequency of salpingitis.