Chlamydia is the most prevalent bacterial sexually transmitted infection (STI) in the western world. In Ireland, the number of chlamydia notifications increased from 245 in 1995 to 6290 in 2008. While this may reflect a real rise in the burden of chlamydia infection, it also reflects an increase in provider awareness in chlamydia testing, test performance and the introduction of laboratory notification. The real burden (numbers of infection) is likely to be higher than reported as chlamydia is asymptomatic in approximately 70% of women and 50% of men and thus may remain undiagnosed. Prevalence studies in young Irish people (including students) have shown similar rates of infection to the UK and else where in Europe.
In view of the asymptomatic nature of chlamydia, especially in women, there is recognition that it is important to screen sexually active women aged less than 25 years. Two approaches are proposed: systematic, where all eligible young persons are systematically invited for screening, which requires the availability of a unique identifier for each individual to ensure all eligible persons are invited and not invited again except where indicated; and opportunistic, where eligible young persons that are visiting/utilising clinical and non-clinical settings are invited to take a test.
These issues highlight the need for additional strategies for screening that are free at the point of testing, easy to access, private and available in a variety of settings. Screening strategies need to be ‘youth friendly’ and available outside of traditional medical facilities.
Pee-in-a-Pot: acceptability and uptake of on-site chlamydia screening in a student population in the Republic of Ireland. (2010) BMC Infectious Diseases 10: 325 doi:10.1186/1471-2334-10-325
Background: The aim of the study was to explore the acceptability and uptake of on-campus screening using a youth friendly approach in two Third Level higher education institutions (HEIs). This study is part of wider research exploring the optimal setting for chlamydia screening in Ireland.
Methods: Male and female students were given the opportunity to take a free anonymous test for chlamydia during a one week programme of “pee-in-a-pot” days at two HEI campuses in the West of Ireland. The study was set up after extensive consultation with the two HEIs and advertised on the two campuses using a variety of media in the two weeks preceding the screening days. Screening involved the provision and distribution of testing packs at communal areas and in toilet facilities. In Ireland, chlamydia notifications are highest amongst 20-29 year olds and hence the screening criterion was aimed at 18-29 year olds. Urine samples were tested using a nucleic acid amplification test (NAAT). Following the screening days, qualitative in-depth interviews were conducted with participants about their experiences of the event.
Results: Out of 1,249 test kits distributed in two HEIs, 592 specimens were collected giving a return rate of 47.5%. Tests excluded (54) were due to labelling errors or ineligibility of participants’ age. Two thirds of those tested were females and the mean age was 21 years. Overall, 3.9% (21/538) of participants tested positive, 5% (17/336) among females and 2% (4/191) among males. Participant interviews identified factors which enhanced student participation such as anonymity, convenience, accessibility of testing, and the informal and non-medical approach to testing.
Conclusions: Screening for chlamydia using on-campus “pee-in-a-pot” days is an acceptable strategy in this population. This model can detect and treat asymptomatic cases of chlamydia and avoid many of the barriers associated with testing for sexually transmitted infections (STIs) in clinical settings.
Related:
Fifteen years ago, in a series of elegant studies, Hackstadt and colleagues showed that the obligate intracellular bacteria Chlamydia trachomatis save on their lipid needs by incorporating sphingomyelins (SMs) made by their host. Shortly after, Hatch and McClarty’s teams reported that several eukaryotic glycerophospholipids are also trafficked from the host to the bacteria, which replace host-synthesized straight-chain fatty acids by their own branched-chain fatty acids. Even cholesterol, a lipid rarely found in bacteria, was shown to accumulate in Chlamydia. As a result of this intense exploitation of host lipids, the composition of the bacterial membrane is closer to that of a eukaryotic cell than to that of a prokaryote.
