Chlamydia prevalence in young attenders of rural and regional primary care services in Australia: a cross-sectional survey (original) (raw)
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BMC Family Practice, 2008
Background: A survey of Western Australia's general practitioners' (GPs') knowledge and practices relating to genital chlamydia infection was conducted in mid-2005, prior to a multi-media campaign which encouraged 15-24 year olds to seek chlamydia testing through their general practitioner (GP). The survey aimed to raise GPs' awareness of chlamydia in preparation for the campaign and to establish a baseline measure of their chlamydia-related knowledge and practices.
BMC Family Practice, 2013
Background: ACCEPt, a large cluster randomized control trial, aims to determine if annual testing for 16 to 29 year olds in general practice can reduce chlamydia prevalence. ACCEPt is the first trial investigating the potential role of practice nurses (PN) in chlamydia testing. To inform the design of the ACCEPt intervention, we aimed to determine the chlamydia knowledge, attitudes, and testing practices of participating general practitioners (GPs) and PNs. Methods: GPs and PNs from 143 clinics recruited from 52 areas in 4 Australian states were asked to complete a survey at time of recruitment. Responses of PNs and GPs were compared using conditional logistic regression to account for possible intra cluster correlation within clinics. Results: Of the PNs and GPs enrolled in ACCEPt, 81% and 72% completed the questionnaire respectively. Less than a third of PNs (23%) and GPs (32%) correctly identified the two age groups with highest infection rates in women and only 16% vs 17% the correct age groups in men. More PNs than GPs would offer testing opportunistically to asymptomatic patients aged ≤25 years; women having a pap smear (84% vs 55%, P<0.01); antenatal checkup (83% vs 44%, P<0.01) and Aboriginal men with a sore throat (79% vs 33%, P<0.01), but also to patients outside of the guideline age group at the time of the survey; 26 year old males presenting for a medical check (78% vs 30%, P = <0.01) and 33 year old females presenting for a pill prescription (83% vs 55%, P<0.01). More PNs than GPs knew that retesting was recommended after chlamydia treatment (93% vs 87%, P=0.027); and the recommended timeframe was 3 months (66% vs 26%, P<0.01). A high proportion of PNs (90%) agreed that they could conduct chlamydia testing in general practice, with 79% wanting greater involvement and 89% further training. Conclusions: Our survey reveals gaps in chlamydia knowledge and management among GPs and PNs that may be contributing to low testing rates in general practice. The ACCEPt intervention is well targeted to address these and support clinicians in increasing testing rates. PNs could have a role in increasing chlamydia testing.
Opportunistic screening for chlamydia in young men
Australian family physician, 2009
Information on prevalence of genital Chlamydia trachomatis in young men attending Australian general practices is scarce. We aimed to estimate the prevalence of chlamydia in this group; establish behaviours associated with infection, and evaluate general practitioner follow up of positive cases. Sexually active men (aged 15-29 years) attending 10 general practices in Perth, Western Australia, were tested for chlamydia and completed a self report questionnaire concerning sexual practices and symptoms. Prevalence of chlamydia was 3.7% (95% CI: 2-6%, n=14/383). High rates of risky sexual practices were observed in both chlamydia positive and negative participants. The association between chlamydia status and risky sexual practices however, was not statistically significant. Treatment and notification of positive cases were usually undertaken, but GPs did not always check that patients had contacted sexual partners. We found little relationship between reported sexual behaviour and chla...
Chlamydia testing in general practice in Australia
Sexual Health, 2010
Objectives: We aimed to ascertain how frequently Australian general practitioners (GPs) test patients for chlamydia and to determine GP, patient and encounter characteristics where tests occurred. Methods: We identified all GP, patient and encounter characteristics associated with higher testing rates, April 2000 to March 2007, using the Bettering the Evaluation and Care of Health data. Multiple logistic regression was used to measure the effect of each GP, patient and encounter characteristic. Results: Data were available for 689 000 encounters from 6890 GPs, of which 2236 were test encounters. Testing rates increased significantly between 2000 and 2007 (P < 0.0001). The rate of testing was higher for female patients (4.2 per 1000, 95% confidence interval (CI): 3.8-4.5) than males (2.0; 95% CI: 1.8-2.2). Predictors of higher chlamydia testing were: female GP (adjusted odds ratio (AOR): 1.84; 95% CI: 1.60-2.1); GP age (<35 v. 55+, 2.17; 95% CI: 1.65-2.85); practice in a major city (1.34; 95% CI: 1.18-1.52); large practice (5+ GP practice v. solo, 1.69; 95% CI: 1.27-2.25); graduated in Australia (1.22; 95% CI: 1.04-1.44); patient sex and younger age, being new to the practice (1.65; 95% CI: 0.47-1.86), Indigenous (3.46; 95% CI: 2.64-4.54), late in the study (twice as likely in 2006-07 than in 2000-01) and 'opportunity to test' (AOR: 32.25; 95% CI: 27.25-38.16). Conclusions: Chlamydia testing rates have increased in general practice in Australia, with higher rates in females. Initiatives to overcome barriers to testing (especially for male patients and older male GPs) need to be established and evaluated.
Chlamydia testing and retesting patterns at family planning clinics in Australia
Sexual health, 2013
National guidelines recommend opportunistic chlamydia screening of sexually active 16- to 29-year-olds and encourage retesting 3-12 months after a diagnosed chlamydia (Chlamydia trachomatis) infection. We assessed chlamydia testing patterns at five Australian family planning clinics (FPCs). Using routine clinic data from 16- to 29-year-olds, we calculated chlamydia testing and positivity rates in 2008-2009. Reattendance, retesting and positivity rates at retesting within 1.5-4 and 1.5-12 months of a positive result were calculated. Over 2 years, 13?690 individuals aged 16-29 years attended five FPCs (93% female). In 2008, 3159 females (41.4%,) and 263 males (57.0%) were tested for chlamydia; positivity was 8% and 19%, respectively. In 2009, 3178 females (39.6%) and 295 males (57.2%) were tested; positivity was 8% and 23%, respectively. Of 7637 females attending in 2008, 38% also attended in 2009, of which 20% were tested both years. Within 1.5-4 months of a positive test, 83 (31.1%)...
Young, male, and infected: the forgotten victims of chlamydia in primary care
Sexually transmitted infections, 2005
To identify current levels of testing men for chlamydia and establish levels of knowledge relating to chlamydia infection among practice nurses in primary care in one north Wales local area health group (LHG) as part of a study to improve delivery of sexual health services in primary care. Anonymous confidential self completed postal questionnaires were sent to 46 practice nurses employed at 22 GP practices within one north Wales LHG. On return of the questionnaires and analysis of the data using SPSS, semistructured interviews with seven practice nurses were undertaken. Responses were obtained from 33/46 (71.7%) practice nurses. The majority, 30 (90.9%), do not examine male genitalia and 18 (54.5%) have never tested male patients for chlamydia infection. 28 (84.8%) practice nurses do not consider contact tracing as part of their role. Primary care has a pivotal part to play in reducing prevalence of chlamydia. The paucity of male testing for chlamydia and a lack of consistent unifo...
Australian and New Zealand Journal of Public Health, 2003
C hlamydia trachomatis is the commonest bacterial sexually transmissible infection (STI) in Victoria, with the number of notifications increasing threefold in the past eight years from 1,287 in 1994 to 3,977 in 2001. 1 Infection with chlamydia may lead to signif icant complications particularly in women, including pelvic inflammatory disease (PID) and tubal infertility. 2 The infection is easily diagnosed and treated with self-administered tests and single-dose treatments being readily available. The population prevalence of genital chlamydia is unknown in Victoria, but a recent study among general practitioner attendees in Queensland reported a prevalence of 5% for 18 to 24-year-old men and women. 5 Reported risk factors include y oung age (<25 years), recent change in partner and symptoms such as discharge. 6,7 Several inter national studies have established that screening for chlamydia in combination with treatment and follow-up of partners reduces the prevalence of infection and the rate of Abstract Objective: This ecological study analyses routinely collected chlamydia notification and testing data to investigate any patter ns.
BMJ Open, 2022
Introduction The sexually transmitted infection chlamydia can cause significant complications, particularly among people with female reproductive organs. Optimal management includes timely and appropriate treatment, notifying and treating sexual partners, timely retesting for reinfection and detecting complications including pelvic inflammatory disease (PID). In Australia, mainstream primary care (general practice) is where most chlamydia infections are diagnosed, making it a key setting for optimising chlamydia management. High reinfection and low retesting rates suggest partner notification and retesting are not uniformly provided. The Management of Chlamydia Cases in Australia (MoCCA) study seeks to address gaps in chlamydia management in Australian general practice through implementing interventions shown to improve chlamydia management in specialist services. MoCCA will focus on improving retesting, partner management (including patient-delivered partner therapy) and PID diagnosis. Methods and analysis MoCCA is a non-randomised implementation and feasibility trial aiming to determine how best to implement interventions to support general practice in delivering best practice chlamydia management. Our method is guided by the Consolidated Framework for Implementation Research and the Normalisation Process Theory. MoCCA interventions include a website, flow charts, fact sheets, mailed specimen kits and autofills to streamline chlamydia consultation documentation. We aim to recruit 20 general practices across three Australian states (Victoria, New South Wales, Queensland) through which we will implement the interventions over 12-18 months. Mixed methods involving qualitative and quantitative data collection and analyses (observation, interviews, surveys) from staff and patients will be undertaken to explore our intervention implementation, acceptability and uptake. Deidentified general practice and laboratory data will be used to measure pre-post chlamydia testing, retesting, reinfection and PID rates, and to estimate MoCCA intervention costs. Our findings will guide scale-up plans for Australian general practice. Ethics and dissemination Ethics approval was obtained from The University of Melbourne Human Research Ethics Committee (Ethics ID: 22665). Findings will be disseminated via conference presentations, peer-reviewed publications and study reports.
Trends in genital chlamydia infection in the Mid-West of
A retrospective analysis of 2,087 laboratory-confirmed GCT patient episodes from 2001 to 2006 in the Mid-West of Ireland was undertaken in conjunction with statutorily notifiable data that were reported by the Sexually Transmitted Disease/Genito-Urinary Medicine (STD/GUM) services in the region and used in national surveillance. Data were analysed by year, source, sex and age. The annual incidence of GCT in the Mid-West is increasing. A substantial proportion of GCT infections were diagnosed in the non-STD/GUM setting. The issue of sexually active young people seeking STI screening is a sensitive one, and delays increase the potential for transmission and the possibility of long-term complications when the disease is not treated. Based on this sample, national surveillance would significantly underestimate the burden of disease in Ireland, due to under-reporting. This would have implications for any national chlamydia screening programme. Among those who sought testing, women aged 15 to 19 years are five times more likely to be found positive than men in the same age group. Of those diagnosed in the non-STD/GUM setting, 83% were women. General practitioners and clinicians might consider targeting those aged 15 to 29 years for opportunistic screening and sexual health advice. Contact tracing and follow-up in the non-STD/GUM setting, as well as access for general practitioners to ongoing education on STIs are challenges to be addressed.