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

Time last seen by Doctor %

Age at sexual debut %

Condom use Last intercourse with non-regular partner no 118 persons 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 % 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

Urethral discharge (males) STD status No discharge Mild discharge Moderate discharge negative N (%) 123 (96.9%) 3 (2.4%) 1 (0.8%) positive 18 (94.7) (5.3%)

Vaginal discharge STD status negative N (%) 118 (84.3%) 16 (11.4%) 6 No discharge Mild discharge Mod/severe discharge negative N (%) 118 (84.3%) 16 (11.4%) 6 (4.3%) positive 24 (88.9%) 1 (3.7%) 2 (7.4)

Number (%) without symptom STD status Abdominal pain Dyspraeunia Inter-menstrual bleed negative N (%) 127 (90.7%) 124 (89.9%) 126 (90.6%) positive 21 (80.8%) 24 (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