Risk Behaviour, Health Care Access and Prevalence of infection

							  Risk Behaviour, Health Care Access
      and Prevalence of infection
                 with
        Chlamydia trachomatis
                  and
         Neisseria gonorrhoea
in a population based sample of adults
              in Barbados

     O.P. Adams, G. McIntyre, P. Prussia
       The University of the West Indies,
             Cave Hill, Barbados
         Objectives
To determine the prevalence
of urogenital infection with
Chlamydia trachomatis and
Neisseria gonorrhoea in persons
18 to 35 years of age
         Objectives
To determine factors that could be
used to identify infected persons

 Risk factors
 Health Care Access
 Symptoms
    Why Do This Study?
Infection with CT and NG have
important health consequences
especially for females
    Pelvic inflammatory Disease
    Ectopic pregnancy
    Infertility
    Why Do This Study?
Males may have
 Epididymitis
 Urethral strictures

Newborns may have
  Conjuctivitis
  Pneumonia
    Why Do This Study?
Non-ulcerative Sexually Transmitted
Infections may enhance the spread of
HIV
    Why Do This Study?
Little was known about the prevalence
of NG and CT in Barbados

Previous studies have used selected
clinic populations

No published study has been done on a
population based sample, or on males
Previous Studies - Barbados
Attapatu, Levett et al; 1999 Barbados
   11.4% prevalence of asymptomatic
   chlamydia in women attending an
   O+G clinic

Rollock et al; 2002 SWSPC
   9.8% prevalence in women attending
   an antenatal clinic with a 20.8%
   prevalence in 15 to 19 year olds
              Method
Random sample of 18 to 35 year
persons living in the St. Michael South
East Electoral District
Questionnaire administered privately
Urine collected
Urine tested by PCR using the Roche
Amplicor kit
             Results
440 persons approached
   -216 males and 224 females
382 persons (86.8%) responded
   -179 males and 203 females
321 had urine tests completed by
laboratory
    - 151 males and 170 females
Usual source of Health Care

50      43.9         42.7

40

30

20                                13.4

10

0

       Polyclinic   Private GP   Other
     Time last seen by Doctor
    50               45.7

    40
                              27
    30
                                        22.5
%   20

    10                                              4.8

    0
                                   %

         <6 months     6-12 months     >12 months     can't recall
         Age at sexual debut

    60                   52.3
    50
    40
                                        25.8
    30       22
    20
%
    10
    0
                    Age (years)

                  <15   15-17     18+
             Condom use
Last intercourse with non-regular
partner

  yes 119 persons
  no   118 persons

  No difference in prevalence of infection between
  the 2 groups (p=.515)
          Knowledge
Heard of chlamydia
  yes 29.4% (95%CI +4.9)
  no    70.6% (95%CI +4.9)

Heard of gonorrhoea
  yes 91.6% (95%CI +3.0)
  no     8.4% (95%CI +3.0)
Chlamydia and Gonorrhoea
      Prevalence
NG +/or CT positive
       14.3% (95%CI 10.5-18.2)

NG positive
        2.2% (95%CI 0.6-3.8)

CT positive
        12.8% (95%CI 9.1-16.4)
Prevalence of Chlamydia and
        Gonorrhoea
16          15.4

14                                      13.1
     12.4
                                 11.8
12
10
%8                                             Male
                                               Female
 6
 4
                    2   2.4
 2
 0
     Total +ve     +ve NG         + CT

                   Test result
 Prevalence by Age group
18 to 20 years of age (n=72)
             26.4% (95%CI +10.0)

21 to 35 years of age (n=248)
             10.9% (95% CI +3.8)

                     (p = .001)
     Prevalence by Age group

30           26.4

25
20
15                         10.9
10
 5
 0
                    %
        18-20 years     21-35 years
  Urethral discharge (males)
  STD          No         Mild     Moderate
 status    discharge   discharge   discharge

negative     123           3           1
 N (%)     (96.9%)      (2.4%)      (0.8%)
positive      18           1
 N (%)      (94.7)      (5.3%)
           Vaginal discharge
  STD           No         Mild     Mod/severe
 status     discharge   discharge   discharge

negative       118         16           6
 N (%)       (84.3%)    (11.4%)      (4.3%)
positive        24          1           2
 N (%)       (88.9%)     (3.7%)       (7.4)
Number (%) without symptom
  STD      Abdominal Dyspraeunia    Inter-
             pain                  menstrual
 status
                                    bleed

negative     127        124          126
 N (%)     (90.7%)    (89.9%)      (90.6%)
positive      21         24          21
 N (%)     (80.8%)    (92.3%)      (80.8)
           Symptoms
Baltimore study
– < 5% of infected participants reported
  dysuria or genital discharge.

Handsfield 1974
– Study of 2628 enlisted men
– Gonnorhoea was detected in 59 men
  (2.2%)
– 40 of these asymptomatic
             Summary
There is a high prevalence of urogenital
Chlamydia trachomatis in both males
and females in Barbados
Young persons have an extremely high
prevalence of CT
Symptoms are neither sensitive or
specific for the identification of infection
           Summary
Most persons have never heard of
chlamydia
      Recommendations
Routine screening should be introduced
especially for chlamydia in adults 18 to
20 years of age.

A similar study is needed for children 16
to 17 years of age.
      Recommendations
Health care professionals and the public
should be sensitised both to the
prevalence and consequence of
infection with chlamydia trachomatis.
      Acknowledgements
Funding
CHRC
Pfizer        Roche

Laboratory testing facilitated by the
Ministry of Health, Barbados
     Acknowledgements
Data collection
Cynthia Clarke
Data entry
Maxine Hinds
Laboratory testing
N. Adomakoh, A. Abayomi, S. Branch
and other staff of the Lady Meade
Reference Unit