What Is the Optimal Time to Retest Patients With a Urogenital Chlamydia Infection? (RCT)

Sex Transm Dis. 2018 Feb;45(2):132-137. doi: 10.1097/OLQ.0000000000000706.

BACKGROUND:

Chlamydia trachomatis is a common, often recurring sexually transmitted infection, with serious adverse outcomes in women. Current guidelines recommend retesting after a chlamydia infection, but the optimum timing is unknown. We assessed the optimal retest interval after urogenital chlamydia treatment.

METHODS:

A randomized controlled trial among urogenital chlamydia nucleic acid amplification test positive heterosexual clients of the Amsterdam sexually transmitted infection clinic. After treatment, patients were randomly assigned for retesting 8, 16, or 26 weeks later. Patients could choose to do this at home (and send a self-collected sample by mail) or at the clinic. Retest uptake and chlamydia positivity at follow-up were calculated.

RESULTS:

Between May 2012 and March 2013, 2253 patients were included (45% men; median age, 23 years; interquartile range, 21-26). The overall uptake proportion within 35 weeks after the initial visit was significantly higher in the 8-week group (77%) compared with the 16- and 26-week groups (67% and 64%, respectively, P < 0.001), and the positivity proportions among those retested were comparable (P = 0.169). The proportion of people with a diagnosed recurrent chlamydia infection among all randomized was similar between the groups (n = 69 [8.6%], n = 52 [7.4%], and n = 69 [9.3%]; P = 0.4).

CONCLUSIONS:

Patients with a recent urogenital chlamydia are at high risk of recurrence of chlamydia and retesting them is an effective way of detecting chlamydia cases. We recommend inviting patients for a re-test 8 weeks after the initial diagnosis and treatment.

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Two-drug HIV therapy just as effective as three-drug therapy

aidsmap/nam, 25 October 2016

SImplification of an antiretroviral treatment to a boosted protease inhibitor and the nucleoside analogue lamivudine (a dual regimen) is highly effective in people switching from a stable three-drug regimen, researchers reported on Monday at the International Congress on Drug Therapy in HIV Infection (HIV Glasgow).

Read more here 

Mirena IUD effective for seven years: new study

Dr Jennifer Gunter, September 10 2016

The Mirena intrauterine system (IUS), the IUD with the hormone levonorgestrel, is a highly effective method of contraception currently approved for five years. Some data suggests that it probably good for six years, but a new study tells us with a good degree of confidence that the Mirena is safe and effective for seven years. 

The study was funded by UNDP/ UNFPA/WHO/World Bank Special Programme of Research and published in the journal Contraception.

Patient choice in opt-in, active choice, and opt-out HIV screening: an RCT

BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.h6895 (Published 19 January 2016)

What is already known on this topic

  • Patients’ preferences are a hallmark of patient centered care, but little is known about how wording of offers of testing can influence perceived preferences

  • Opt-in and opt-out HIV testing have not been compared in a randomized controlled setting

  • US guidelines endorse opt-out HIV testing, and Europe has seen a trend toward this testing scheme

What this study adds

  • Opt-in and opt-out defaults had statistically and clinically significant effects on the likelihood of patients accepting tests

  • Patients reporting risk factors were more likely to accept testing in each testing regimen than were patients reporting no risk factors

  • Active choice is a distinct test regimen, with test acceptance patterns that may best approximate patients’ true preferences

STI screening interventions targeting men in football club settings

Sex Transm Infect 2015;91:106-110 doi:10.1136/sextrans-2014-051719

Background: Uptake of chlamydia screening by men in England has been substantially lower than by women. Non-traditional settings such as sports clubs offer opportunities to widen access. Involving people who are not medically trained to promote screening could optimise acceptability.