How to increase chlamydia testing in primary care: a qualitative exploration with young people and application of a meta-theoretical model.

OBJECTIVE: The objective of this study was to explore young people's perspectives barriers to chlamydia testing in general practice and potential intervention functions and implementation strategies to overcome identified barriers, using a meta-theoretical framework (the Behaviour Change Wheel (BCW)). METHODS: Twenty-eight semistructured individual interviews were conducted with 16-24 year olds from across the UK. Purposive and convenience sampling methods were used (eg, youth organisations, charities, online platforms and chain-referrals). An inductive thematic analysis was first conducted, followed by thematic categorisation using the BCW. RESULTS: Participants identified several barriers to testing: conducting self-sampling inaccurately (physical capability); lack of information and awareness (psychological capability); testing not seen as a priority and perceived low risk (reflective motivation); embarrassment, fear and guilt (automatic motivation); the UK primary care context and location of toilets (physical opportunity) and stigma (social opportunity). Potential intervention functions raised by participants included education (eg, increase awareness of chlamydia); persuasion (eg, use of imagery/data to alter beliefs); environmental restructuring (eg, alternative sampling methods) and modelling (eg, credible sources such as celebrities). Potential implementation strategies and policy categories discussed were communication and marketing (eg, social media); service provision (eg, introduction of a young person's health-check) and guidelines (eg, standard questions for healthcare providers). CONCLUSIONS: The BCW provided a useful framework for conceptually exploring the wide range of barriers to testing identified and possible intervention functions and policy categories to overcome said barriers. While greater education and awareness and expanded opportunities for testing were considered important, this alone will not bring about dramatic increases in testing. A societal and structural shift towards the normalisation of chlamydia testing is needed, alongside approaches which recognise the heterogeneity of this population. To ensure optimal and inclusive healthcare, researchers, clinicians and policy makers alike must consider patient diversity and the wider health issues affecting all young people.

Primary care integration of sexual and reproductive health services for chlamydia testing across WHO-Europe: a systematic review.

OBJECTIVE: To identify current uptake of chlamydia testing (UCT) as a sexual and reproductive health service (SRHS) integrated in primary care settings of the WHO European region, with the aim to shape policy and quality of care. DESIGN: Systematic review for studies published from January 2001 to May 2018 in any European language. DATA SOURCES: OVID Medline, EMBASE, Maternal and Infant Care and Global Health. ELIGIBILITY CRITERIA: Published studies, which involved women or men, adolescents or adults, reporting a UCT indicator in a primary care within a WHO European region country. Study designs considered were: randomised control trials (RCTs), quasi-experimental, observational (eg, cohort, case-control, cross-sectional) and mixed-methods studies as well as case reports. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened the sources and validated the selection process. The BRIGGS Critical Appraisal Checklist for Analytical Cross-Sectional Studies, the Mixed Methods Appraisal Tool 2011 and Critical Appraisal Skills Programme (CASP) checklists were considered for quality and risk of bias assessment. RESULTS: 24 studies were finally included, of which 15 were cross-sectional, 4 cohort, 2 RCTs, 2 case-control studies and 1 mixed-methods study. A majority of the evidence cites the UK model, followed by the Netherlands, Denmark, Norway and Belgium only. Acceptability if offered test in primary healthcare (PHC) ranged from 55% to 81.4% in women and from 9.5% to 70.6% when both genders were reported together. Men may have a lower UCT compared with women. When both genders were reported together, the lowest acceptability was 9.5% in the Netherlands. Denmark presented the highest percentage of eligible people who tested in a PHC setting (87.3%). CONCLUSIONS: Different health systems may influence UCT in PHC. The regional use of a common testing rate indicator is suggested to homogenise reporting. There is very little evidence on integration of SRHS such as chlamydia testing in PHC and there are gaps between European countries.

Effect of rectal douching/enema on rectal gonorrhoea and chlamydia among a cohort of men who have sex with men on HIV pre-exposure prophylaxis.

OBJECTIVES: Rectal douching/enema (RD) is a common practice among men who have sex with men (MSM) in preparation for sex. RD can break down the rectal mucosal barrier and potentially affect the rectal microbiome. The objective of this study was to understand if RD is associated with acquiring rectal infections (RI) with rectal gonorrhoea (NG) and/or chlamydia (CT). METHODS: From 2013 to 2015, 395 adult HIV-uninfected MSM were enrolled in a randomised controlled study for pre-exposure prophylaxis (PrEP) adherence with routine sexual risk survey and testing. Using data from this cohort, baseline differences by RI were assessed using Pearson's χ² and Wilcoxon-Mann-Whitney test. Association between RD and RI was modelled using multivariable logistic regression adjusted for potential confounders (sexual behaviour, substance use and age) selected a priori. Effect modification by number of male partners and sensitivity analysis to rule out reverse causality were also conducted. RESULTS: Of 395 participants, 261 (66%) performed RD and 133 (33%) had at least one NG/CT RI over 48 weeks. Number of condomless anal receptive sex (med: 4, p<0.001), male partners (med:6, p<0.001) and substance use (any of methamphetamine/hallucinogens/dissociative/poppers) (p<0.001) were associated with increased odds of RI. Controlling for potential confounders, odds of prevalent RI were 3.59 (p<0.001, 95% CI 1.90 to 6.78) and incident RI 3.87 (p=0.001, 95% CI 1.78 to 8.39) when douching weekly or more compared with not douching. MSM with more than six male partners had 5.34 (p=0.002, 95% CI 1.87 to 15.31) increased odds of RI when douching weekly or more compared with not douching. CONCLUSION: Rectal hygiene with RD is a common practice (66%) among HIV-uninfected MSM on PrEP in this study, which increases the odds of acquiring rectal NG and/or CT independent of sexual risk behaviour, substance use and other factors. This suggests interventional approaches targeting rectal hygiene products and practices could reduce sexually transmitted infections.

Understanding the health and production impacts of endemic Chlamydia pecorum infections in lambs.

Lamydia pecorum is a globally recognised livestock pathogen that is capable of causing severe and economically significant diseases such as arthritis in sheep and cattle. Relatively little information is available on the clinical progression of disease and the long-term effects of asymptomatic and symptomatic chlamydiosis in sheep. Recent studies in calves indicate that endemic C. pecorum infections may reduce growth rates. To investigate the clinical health parameters and production impacts of endemic C. pecorum infection in an Australian commercial lamb flock, we performed bimonthly sampling and clinical health assessments on 105 Border Leicester lambs from two to ten months of age. Chlamydial status was investigated via serology and species-specific quantitative PCR. Throughout the study period, conjunctivitis remained a persistent clinical feature while signs of arthritis (e.g. palpable synovial joint effusions) resolved in a subset of lambs while persisting in others. Clinical disease and C. pecorum infection were highest at six months of age (weaning). As previously reported, peak seroconversion tends to occur two months after the onset of clinical symptoms (6 months of age), with lambs clearing chlamydial infection by 10 months of age, despite ongoing disease still being present at this time. Notably, the presence of chlamydial infection did not affect lamb mass or growth rates throughout the study. At necropsy, C. pecorum was not detected within the joints of lambs with chronic arthritis. Molecular analysis of the strains in this flock suggest that the infecting strains circulating in this flock are clonal C. pecorum pathotypes, denoted ST 23, commonly associated with conjunctivitis and polyarthritis in Australian sheep. This study provides a platform for further research in the epidemiology and disease transmission dynamics of C. pecorum infections in sheep.

The low diverse gastric microbiome of the jellyfish Cotylorhiza tuberculata is dominated by four novel taxa.

Cotylorhiza tuberculata is an important scyphozoan jellyfish producing population blooms in the Mediterranean probably due to pelagic ecosystem's decay. Its gastric cavity can serve as a simple model of microbial-animal digestive associations, yet poorly characterized. Using state-of-the-art metagenomic population binning and catalyzed reporter deposition fluorescence in situ hybridization (CARD-FISH), we show that only four novel clonal phylotypes were consistently associated with multiple jellyfish adults. Two affiliated close to Spiroplasma and Mycoplasma genera, one to chlamydial 'Candidatus Syngnamydia', and one to bacteroidetal Tenacibaculum, and were at least one order of magnitude more abundant than any other bacteria detected. Metabolic modelling predicted an aerobic heterotrophic lifestyle for the chlamydia, which were found intracellularly in Onychodromopsis-like ciliates. The Spiroplasma-like organism was predicted to be an anaerobic fermenter associated to some jellyfish cells, whereas the Tenacibaculum-like as free-living aerobic heterotroph, densely colonizing the mesogleal axis inside the gastric filaments. The association between the jellyfish and its reduced microbiome was close and temporally stable, and possibly related to food digestion and protection from pathogens. Based on the genomic and microscopic data, we propose three candidate taxa: 'Candidatus Syngnamydia medusae', 'Candidatus Medusoplasma mediterranei' and 'Candidatus Tenacibaculum medusae'.

[Infective endocarditis caused by Chlamydia pneumoniae after liver transplantation. Case report]. / Chlamydia pneumoniae okozta infektív endocarditis májtranszplantációt követoen.

The incidence of infective endocarditis is underestimated in solid organ transplant recipients. The spectrum of pathogens is different from the general population. The authors report the successful treatment of a 58-year-old woman with infective endocarditis caused by atypical microorganism and presented with atypical manifestations. Past history of the patient included alcoholic liver cirrhosis and cadaver liver transplantation in February 2000. One year after liver transplantation hepatitis B virus infection was diagnosed and treated with antiviral agents. In July 2007 hemodialysis was started due to progressive chronic kidney disease caused by calcineurin toxicity. In November 2013 the patient presented with transient aphasia. Transesophageal echocardiography revealed vegetation in the aortic valve and brain embolization was identified on magnetic resonance images. Initial treatment consisted of a 4-week regimen with ceftriaxone (2 g daily) and gentamycin (60 mg after hemodialysis). Blood cultures were all negative while serology revealed high titre of antibodies against Chlamydia pneumoniae. Moxifloxacin was added as an anti-chlamydial agent, but neurologic symptoms returned. After coronarography, valvular surgery and coronary artery bypass surgery were performed which resulted in full clinical recovery of the patient.

[Optimization of complex treatment in ocular toxoplasmosis and concurrent infections].

137 patients (177 eyes) with verified toxoplasmic uveitis, retinitis, chorioretenitis were observed. Among them 65 patients had concurrent infections: tuberculosis, herpes simplex and chlamydia. Routine ophthalmologic, clinical and laboratory examination was performed. The results of intensive treatment in acute and chronic phases are presented, the staged drug pathogenic treatment including methods of specific therapy, based on differential approach to anti-inflammatory agents use, was provided. Early diagnosis and appropriate management including combined treatment of concurrent infections improves treatment efficacy and allows to achieve excellent results.

Investigations concerning the prevalence of Coxiella burnetii and Chlamydia abortus in sheep in correlation with management systems and abortion rate in Lower Saxony in 2004.

The intracellular bacteria Coxiella (C) burnetii and Chlamydia (Chl) abortus induce abortion in sheep and also affect humans. While Chl. abortus only infrequently infects humans, C burnetii is the aetiological agent of numerous Q fever outbreaks during the last decades. There is only limited knowledge about the prevalence of both pathogens in sheep, although sheep are involved in almost all Q fever outbreaks in Germany. The aim of our study was to investigate the prevalence of both pathogens in flocks located in Lower Saxony, Germany, in correlation to the management form and abortion rate. Serum samples of 1714 sheep from 95 flocks located in Lower Saxony were investigated by ELISA. 2.7% of these samples were positive, 1.3% showed inconclusive results in the C. burnetii-ELISA. Elevated intra-flock seroprevalences were only detected in three migrating flocks. Chlamydia-specific antibodies could be detected in 15.1% serum samples of mainly shepherded and migrating flocks. In one of these flocks with a high intra-flock seroprevalence for C burnetii (27%) and Chlamydia (44.9%), C burnetii was detected in 21.6% of the placenta samples of normal births and in 12.5% of the colostrum samples by PCR. Aborted fetuses and the corresponding placentas were negative in C burnetii-PCR, but in most of them and also in many other placenta samples Chl. abortus could be detected by PCR and DNA microarray. This survey shows a low overall prevalence of C. burnetii in sheep in Lower Saxony in the year 2004. However, three migrating flocks with a high intra-flock prevalence are localized in the southern parts of Lower Saxony. Spreading of C burnetii could occur, because of the large radius of grazing of all three flocks.

[Ozone therapy for protracted pneumonias].

After 3 weeks or more of treatment, 36 patients who were found to have X-ray signs of pneumonia (pulmonary infiltrative changes, fever, productive cough, weakness) were randomized into two matched groups (a study group and a control one). 77.7 and 55% of control and study group patients changed and continued antibacterial therapy. The study group patients were additionally given intravenous infusions of 400 ml of ozonized sodium chloride solution (pO3) containing 1.6 microg/ml of O3 twice weakly for 21 days. Blood ozonization considerably accelerated the resolution time of X-ray infiltrative changes so that they were undetectable in all study group patients by week 4 while they were only in 61.1% of the control groups. Blood ozonization used in combination with antibiotics permitted caused a sputum negative reaction against Chlamydia and Mycoplasma 2-3 weeks earlier. Infusions of pO3 just after the first ozonization made it possible to eliminate a clinical sign of chronic infection, such as weakness, to accelerate productive cough relief on day 10, and to reduce the number of fever patients. Ozone therapy for protracted pneumonias substantially enhances the efficiency of antibiotic treatment.

Frequency of apolipoprotein E (APOE) allele types in patients with Chlamydia-associated arthritis and other arthritides.

Genetic background is important in determining whether certain infecting bacteria disseminate to the joint and cause arthritis. We assessed whether APOE genotype is associated with the presence of DNA from Chlamydia or other bacteria in synovial tissues of patients with various arthritides. Nucleic acids from synovial tissues of 135 patients were screened by PCR for DNA from Chlamydia trachomatis, C. pneumoniae and other bacteria (pan-bacteria). APOE genotype was determined by a PCR-based method for all patients in each of four resulting groups comprised of about 35 individuals each, positive for C. trachomatis only, C. pneumoniae only, other bacteria, or no bacteria. RT-PCR was used to assess synovial APOE expression. The latter assays confirmed that APOE mRNA is present in synovial tissue. Determination of APOE genotype showed that patients PCR-negative in all assays, and those positive in the C. trachomatis - and pan-bacteria- (excluding Chlamydia) directed assays, had distributions of the APOE epsilon2, epsilon3 and epsilon4 alleles mirroring those of the general population (i.e. about 8%, 79% and 13%, respectively). In contrast, 68% of patients with C. pneumoniae DNA in synovium possessed a copy of the epsilon4 allele. These results indicate that no association exists between APOE genotype and synovial presence of C. trachomatis or other bacteria. However, individuals bearing at least one copy of the APOE epsilon4 allele may be at increased risk for synovial infection by C. pneumoniae.

Rol de la laparoscopía en el diagnóstico de los procesos inflamatorios pélvicos / Role of the laparoscopy in the diagnosis of pelvic inflammatory process

Se presentan los resultados de laparoscopías diagnósticas realizadas en 278 pacientes que ingresaron al Servicio de Ginecología y Obstetricia del Hospital Regional de Temuco, durante el período comprendido entre enero de 1993 y marzo de 1994. Se realiza laparoscopia diagnóstica y se certifica el diagnóstico de procesos inflamatorio pelviano utilizando los criterios de Hager. Se confirma el diagnóstico de proceso inflamatorio sólo en el 74 por ciento de los casos. Los hallazgos son concordantes con lo señalado en varias publicaciones en cuanto a otorgar un rol significativo a la laparoscopia diagnostica en los procesos inflamatorios pélvicos, con lo cual se logra un mejor diagnóstico diferencial. Se analizan las propiedades de sensibilidad y especificidad para los diferentes elementos clínicos y de laboratorio considerados en el diagnóstico de PIP. El test de inmunofluorescencia para Clamidias fue positivo en el 40,7 por ciento de las pacientes. Los gérmenes aerobios más frecuentemente encontrados corresponden a E. coli

Protein profiles of dense-centered forms of five chlamydial strains of animal origin.

Purified dense-centered form of 1 bovine strain (LW613) and 3 ovine strains (B577, 034-EYE, and 047-EYE) of Chlamydia psittaci and 1 murine strain of Chlamydia trachomatis (MoPn) were dissociated in the presence of sodium dodecyl sulfate (SDS) and 2-mercaptoethanol. The number of polypeptides detected in the 5 strains varied between 17 and 20, with a molecular weight range of 29,000 to 120,000. Two polypeptides predominated and comprised approximately a third of the total protein in each of the 5 strains. The average molecular weights of the 2 polypeptides were 89,000 and 85,250 for 4 of the strains, and the polypeptide molecular weights were 100,000 and 98,000 for the ovine abortion strain (B577). Molecular weights and proportional composition of the polypeptides permitted differentiation of the chlamydial strains. The 3 strains from naturally occurring conjunctivitis or polyarthritis (LW613, 034-EYE, and 047-EYE) had similar polypeptide profile in the 75,000 to 100,000 molecular weight range. The polypeptides of the ovine abortion strain (B577) differed significantly from these 3 strains. Eight of the polypeptides of this strain had a molecular weight of 100,000 or greater, and 3 of the predominant polypeptides were in excess of 100,000. In contrast, some of the polypeptides of the murine strain had lower molecular weights than the 4 other strains. Three predominant polypeptides had molecular weights below 50,000.