Papers

Home sampling versus conventional contact tracing for detecting Chlamydia trachomatis infection in male partners of infected women: randomised study

^a Research Unit and Department of General Practice, University of Aarhus, DK-8000 Aarhus C, Denmark, ^b Aarhus University Hospital, DK-8000 Aarhus C,

Correspondence to: Dr Andersen ba@alm.aau.dk

	Introduction

Top Introduction Subjects, methods, and results Comment References

Urogenital infections with Chlamydia trachomatis are widespread and usually asymptomatic. Major complications from infection include ectopic pregnancies and female infertility.¹ Although contact tracing reduces the prevalence of chlamydia infection,² the test rate among partners is often low, partly because male contacts have to have a urethral swab taken by a doctor.

As the polymerase chain reaction can successfully detect infection in urine samples,³ we investigated whether the test rate could be increased by asking the male contacts of infected women to send a urine sample directly from home to a laboratory instead of having a doctor take a urethral swab.

	Subjects, methods, and results

Top Introduction Subjects, methods, and results Comment References

Ninety six women with C trachomatis infection seen in general practices in Aarhus County, Denmark, were randomly divided according to their date of birth into an intervention group (45 patients) and a control group (51 patients). Women in the intervention group were asked to complete a questionnaire, including the number of male sexual partners over the preceding six months, and to supply their partners with an envelope containing a 10 ml sterile container, information on collecting the first urine sample of the morning, and a prepaid envelope for returning the sample to the laboratory at the Aarhus University Hospital. Envelopes supplied by the control group contained a request for the partner to visit his doctor as well as a contact slip and a prepaid envelope to be given to the doctor for returning a urethral swab sample.

Swab samples were examined by enzyme immunoassay (MicroTrak II, Behring, Germany). Specimens with an optical density greater than 30% of the recommended cut off point were confirmed by polymerase chain reaction assay (Amplicor, Roche, Switzerland).⁴ Urine samples were analysed by the same polymerase chain reaction. A sample was considered positive only if the result was confirmed on retesting.

The 1 shows the results of contact tracing. Forty four out of 65 (68%) partners were examined in the intervention group compared with 19 out of 68 (28%) in the control group (²=19.50; P<0.01). The difference in test rate was 0.4 (0.68 minus 0.28) (95% confidence interval 0.24 to 0.56). Although not significant, there were more new cases of C trachomatis per index case in the intervention group (0.27) than in the control group (0.14). The difference between the two groups was 0.13 (-0.03 to 0.29). Furthermore, there was a trend for partners of women in the intervention group to be tested earlier than those of women in the control group, with a mean delay time of 12.6 days and 17.7 days respectively. Thus the difference between the two groups was 5.1 days (-1.6 to 11.8). The prevalence of C trachomatis in samples from the intervention and control groups was 27% and 39% respectively.

	Comment

Top Introduction Subjects, methods, and results Comment References

Contact partners of women with C trachomatis infection may be deterred from seeking medical help because of the intimate nature of the infection and because a urethral swab is needed. Urine samples obtained at home provide a non-invasive and less time consuming alternative.

A similar procedure for contact tracing of female partners of men infected with C trachomatis should be considered as the organism has been detected in urine samples from women.⁵

	Acknowledgements

We thank the participating general practitioners.

Funding: University of Aarhus, Denmark and Nycomed DAK.

Conflict of interest: None.

	Notes

Contributors: BA coordinated the primary study hypothesis and the core ideas, designed the protocol, obtained approval from the ethics committee, coordinated inclusion of patients, scanned the data, and coordinated the interpretation of results and writing of the paper. LØ discussed the primary hypothesis, core ideas, analysis, and protocol design and participated in the interpretation of results and writing of the paper. JKM discussed the hypothesis and ideas, led the analysis of the samples obtained, participated in the interpretation of results, and edited the paper. OF discussed the hypothesis and core ideas and participated in the protocol design, coordination of contact with the general practitioners, the interpretation of results, and the writing of the paper. OF is the guarantor of the paper.

	References

Top Introduction Subjects, methods, and results Comment References

1. Cates W Jr, Wasserheit JN. Genital chlamydial infections: epidemiology and reproductive sequelae. Am J Obstet Gynecol 1991;164:1771-81. [Medline]
2. Ripa T. Epidemiologic control of genital Chlamydia trachomatis infections. Scand J Infect Dis Suppl 1990;69:157-67. [Medline]
3. Jaschek G, Gaydos CA, Welsh LE, Quinn TC. Direct detection of Chlamydia trachomatis in urine specimens from symptomatic and asymptomatic men by using a rapid polymerase chain reaction assay. J Clin Microbiol 1993;31:1209-12. [Abstract/Free Full Text]
4. Østergaard L, Møller JK. Use of PCR and direct immuno-fluorescence microscopy for confirmation of results obtained by Syva MicroTrak Chlamydia enzyme immunoassay. J Clin Microbiol 1995;33:2620-3. [Abstract]
5. Østergaard L, Møller JK, Andersen B, Olesen F. Diagnosis of urogenital Chlamydia trachomatis infection in women based on mailed samples obtained at home: multipractice comparative study. BMJ 1996;313:1186-9. [Abstract/Free Full Text]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

This article has been cited by other articles:

• Cameron, S.T., Glasier, A., Scott, G., Young, H., Melvin, L., Johnstone, A., Elton, R. (2009). Novel interventions to reduce re-infection in women with chlamydia: a randomized controlled trial. Hum Reprod 24: 888-895 [Abstract] [Full text]  
• Wayal, S, Llewellyn, C, Smith, H, Hankins, M, Phillips, A, Richardson, D, Fisher, M, on behalf of the Home Sampling Kit Project Steerin, (2009). Self-sampling for oropharyngeal and rectal specimens to screen for sexually transmitted infections: acceptability among men who have sex with men. Sex. Transm. Infect. 85: 60-64 [Abstract] [Full text]  
• Cook, R. L, Ostergaard, L., Hillier, S. L, Murray, P. J, Chang, C.-C. H, Comer, D. M, Ness, R. B, for the DAISY study team, (2007). Home screening for sexually transmitted diseases in high-risk young women: randomised controlled trial. Sex. Transm. Infect. 83: 286-291 [Abstract] [Full text]  
• Gotz, H M, van Bergen, J E A M, Veldhuijzen, I K, Broer, J, Hoebe, C J P A, Richardus, J H (2005). A prediction rule for selective screening of Chlamydia trachomatis infection. Sex. Transm. Infect. 81: 24-30 [Abstract] [Full text]  
• Ostergaard, L, Andersen, B, Moller, J K, Olesen, F, Worm, A-M (2003). Managing partners of people diagnosed with Chlamydia trachomatis: a comparison of two partner testing methods. Sex. Transm. Infect. 79: 358-361 [Abstract] [Full text]  
• Blake, D. R., Kearney, M. H., Oakes, J. M., Druker, S. K., Bibace, R. (2003). Improving Participation in Chlamydia Screening Programs: Perspectives of High-Risk Youth. Arch Pediatr Adolesc Med 157: 523-529 [Abstract] [Full text]  
• WATSON, E. J., TEMPLETON, A., RUSSELL, I., PAAVONEN, J., MARDH, P.-A., STARY, A., PEDERSON, B. S. (2002). The accuracy and efficacy of screening tests for Chlamydia trachomatis: a systematic review. J Med Microbiol 51: 1021-1031 [Abstract] [Full text]  
• Andersen, B., Ostergaard, L., Moller, J. K, Olesen, F. (2001). Effectiveness of a mass media campaign to recruit young adults for testing of Chlamydia trachomatis by use of home obtained and mailed samples. Sex. Transm. Infect. 77: 416-418 [Abstract] [Full text]  
• Orr, D. P., Johnston, K., Brizendine, E., Katz, B., Fortenberry, J. D. (2001). Subsequent Sexually Transmitted Infection in Urban Adolescents and Young Adults. Arch Pediatr Adolesc Med 155: 947-953 [Abstract] [Full text]  
• Bates, S M, Rogstad, K E (2000). Postal research: too many problems?. Sex. Transm. Infect. 76: 332-334 [Full text]  
• Pedersen, L. N., Kjær, H. O., Møller, J. K., Ørntoft, T. F., Ostergaard, L. (2000). High-Resolution Genotyping of Chlamydia trachomatis from Recurrent Urogenital Infections. J. Clin. Microbiol. 38: 3068-3071 [Abstract] [Full text]  
• Kjar, H O, Dimcevski, G, Hoff, G, Olesen, F, Ostergaard, L (2000). Recurrence of urogenital Chlamydia trachomatis infection evaluated by mailed samples obtained at home: 24 weeks' prospective follow up study. Sex. Transm. Infect. 76: 169-172 [Abstract] [Full text]  
• Morré, S. A., Van Valkengoed, I. G. M., Moes, R. M., Boeke, A. J. P., Meijer, C. J. L. M., Van den Brule, A. J. C. (1999). Determination of Chlamydia trachomatis Prevalence in an Asymptomatic Screening Population: Performances of the LCx and COBAS Amplicor Tests with Urine Specimens. J. Clin. Microbiol. 37: 3092-3096 [Abstract] [Full text]  
• Morré, S. A., van Valkengoed, I. G. M., de Jong, A., Boeke, A. J. P., van Eijk, J. T. M., Meijer, C. J. L. M., van den Brule, A. J. C. (1999). Mailed, Home-Obtained Urine Specimens: a Reliable Screening Approach for Detecting Asymptomatic Chlamydia trachomatis Infections. J. Clin. Microbiol. 37: 976-980 [Abstract] [Full text]  
• Østergaard, L., Andersen, B., Olesen, F., Møller, J. K (1998). Efficacy of home sampling for screening of Chlamydia trachomatis: randomised study. BMJ 317: 26-27 [Full text]  
• (1998). Home Chlamydia Testing Without the Penile Probe Promotes Compliance. JWatch Emergency Med. 1998: 22-22 [Full text]  
• (1998). Home Testing for Chlamydia in Male Partners. JWatch Women's Health 1998: 2-2 [Full text]