Sexual health

“Do it yourself” tests for chlamydia could be missing around 80% of cases

October 5, 2010 No Comments

Commercially available home tests for chlamydia could be failing to identify between 75% and 83% of people infected when compared with the “gold standard” biochemical lab test, according to new research from the Netherlands.

The study of 772 women found that three “point of care” tests available on the internet and in pharmacies only correctly identified 17-25% of women who had chlamydia according to nucleic acid amplification testing commonly used by GPs and sexual health clinics.

Chlamydia is the most common sexually transmitted infection in the United Kingdom. More than 200,000 people were diagnosed in 2009, the majority of whom were aged 15-24. Around 50% of men and 70-80% of women who get chlamydia will have no symptoms, yet left undiagnosed chlamydia cause infertility.

Point of care tests for chlamydia usually involve the woman taking a vaginal swab herself and sending the sample to a laboratory to be tested, then going for an appointment with her doctor to get the result. Currently testing involves one doctor’s appointment to have a sample taken and a second 1-2 weeks to get the result, which is a much more time consuming approach.

The authors of this study assessed all women over the age of 16 who applied for a consultation at a sexual health clinic in Maastricht between September 2007 and April 2008. A total of 772 women with a median age of 23 were included in the final study.

When nucleic acid amplification testing was used, 11% of these women were found to be infected with Chlamydia trachomatis.

The authors then assessed whether three tests commercially available and certified in Europe – Handilab-C, Biorapid CHLAMYDIA Ag test, and QuickVue Chlamydia test – could identify which women had chlamydia.

The three tests only picked up 17.1-25.0% of women who had chlamydia (sensitivity) and correctly excluded 93.7-99.7% of those who didn’t (specificity). World Health Organization criteria indicate that point of care tests should have a sensitivity of between 43% and 65% and a specificity of 98%.

The sensitivity of two of the tests improved slightly if they were performed within 72 hours of the women taking a vaginal swab. As little as 19.8% of women who tested positive actually had chlamydia, although about 90% of those who tested negative were free from disease.

The results of this study indicate that many infections would have been missed had these point of care tests been used on their own, allowing women to go untreated and potentially spread the infection, and people with false positive results could have been treated unnecessarily.

On this basis the authors state: “In our opinion, the chlamydia point of care tests we have evaluated are not ready for widespread use.”

In an editorial on the topic, Dr Sue Skidmore from the Department of Microbiology at Princess Royal Hospital, Telford, agrees. “It is widely agreed that rapid tests for sexually transmitted infections with high sensitivity and specificity would provide advantages,” she writes, “although the introduction of their use, particularly for home use, needs to be rigorously evaluated and controlled with an assurance that robust quality assurance is in place when appropriate.”

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van Dommelen L et al. (2010) Alarmingly poor performance in Chlamydia trachomatis point-of-care testing. Sexually Transmitted Infections 86:355-359. DOI: 10.1136/sti.2010.042598

Sexual health

Backpackers in Australia are a sexual health risk

March 24, 2010 No Comments

Young people, especially Brits, famously head to Australia in their droves in search of travel, adventure, and, crucially, some hot weather. In 2009-09, 560,105 international backpackers visited Australia, representing 10.9% of all international visitors.

It seems that backpackers in Oz aren’t just looking for fun and sun though – according to a new study they’re also looking for flings, and are bringing sexually transmitted diseases with them.

Research published in the journal Sexually Transmitted Infections has found that international backpackers in Sydney had a higher number of sexual partners and drunk more alcohol than native Australians. Backpackers also had higher rates of chlamydia and more previous sexually transmitted infections than locals.

The authors of this study retrospectively looked through the medical records at the Sydney Sexual Health Centre and identified 5,702 backpackers – people who had been born outside of Australia and been in the country for less than two years – and 7256 comparison patients – natives or people who had lived in the country for longer than 2 years. The average age of the backpacker group was 25 and almost half had come from the UK.

Backpackers were twice as likely to report drinking alcohol at hazardous levels than were comparison patients. More than a quarter (27%) of female backpackers reported drinking more than 17.5 units of alcohol a week, equivalent to about eight glasses of wine, whereas only 14% of comparison women drank at this level. A total of 17% of male backpackers drank more than 35 units of alcohol a week, roughly 15 pints of beer, compared with 5% of comparison men.

About 40% of backpackers reported having had two or more sexual partners in the previous 3 months, compared with 30% of comparison patients. Interestingly, condom use was low in both the backpacker group and the comparison group: two thirds of each group reported having had unprotected sex.

When it came to rates of sexually transmitted infections, backpackers were more likely to be diagnosed with chlamydia (7% vs 5%) and have a history of sexually transmitted infections (15% vs 10%). However, locals were more likely to have genital warts.

The authors point out the public health implications of their findings – international backpackers are a potential risk population for either acquiring sexually transmitted diseases or transmitting them to other travellers or local residents. “Although we could not determine the extent of the risk of transmission to local residents from our study,” they say, “it has been demonstrated that being born overseas or having a partner from overseas was a risk factor for chlamydia infection in Sydney women.”

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McNulty A et al. (2010) The behaviour and sexual health of young international travellers (backpackers) in Australia. Sexually Transmitted Infections DOI: 10.1136/sti.2009.038737

Public health, Sexual health

A healthy life leads to a healthy sex life

March 16, 2010 No Comments

Being in good or excellent health increases the quality and quantity of sex for middle aged and older people, according to a big study that delved into the sex lives of 6,000 American adults aged 25-85. Plus being fit can keep you sexually active into a ripe old age, unlike your unhealthy peers.

The study also had a whole raft of other expected findings, some rather expected (e.g. men are more interested in sex) and others maybe less so (such as more than a third of men aged 75-85 are sexually active, as are 17% of women the same age).

The cross sectional study, published in the BMJ, looked at two large American health surveys: the national survey of midlife development in the United States (MIDUS), which assessed in 1995-6 adults aged 25-74, and the national social life, health and aging project (NSHAP), which in 2005-06 looked at people aged 57-85.

Overall, men were more likely than women to be sexually active and be interested in sex. Between 69% and 87% of men of all ages reported being sexually active in the past six months, compared with 43% to 76% of women, and men were significantly more likely to report being interested in sex than were women (66% versus 53% among those aged aged 25-74 and 62% versus 21% in those aged 57-85). These gender differences increased with age and were greatest in people aged 75-85 years: 38.9% of men compared with 16.8% of women were sexually active.

On the other hand, overall, sexual satisfaction was similar in the two genders: among sexually active respondents, about two thirds of men and women reported a good quality sex life. These proportions also changed as women aged though, so that only half women aged 57-85 who were sexually active reported a good quality sex life compared with nearly three quarters of men.

A novel aspect of this study was the use of a new measure devised by the authors called “sexually active life expectancy” – that is, the average number of remaining years a person could expect to remain sexually active.

At the age of 30, men had a sexually active life expectancy of 34.7 years (i.e., to within 10 years of the average life expectancy of 74.8 years) and women had 30.7 years (to 20 years less than their life expectancy of 80.6 years). This means that men spend 78% of their lives sexually active, compared with 61% for women. At 55, these figures changed to 14.9 remaining years for men and 10.6 years for women.

For me the most interesting finding was the link between good health and good sex. Men aged 25-74 who were in very good or excellent health were more than twice as likely to be sexually active than their less healthy counterparts, whereas women of the same age were 60% more likely to be sexually active.

Of those people who were sexually active, men and women who were in very good or excellent health were 70% more likely to report having a good quality sex life than those who were in less good shape, and were 40-80% more likely to be interested in sex.

Good health also increased how long people would remain sexually active compared with people reporting fair or poor health: men in very good health at age 55 were projected to gain on average 5-7 years of life as sexually active, whereas women were projected to gain 3-6 years.

It seems like good health keeps people keeping on in more way than one…
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Lindau S & Gavrilova N (2010) Sex, health, and years of sexually active life gained due to good health: evidence from two US population based cross sectional surveys of ageing. BMJ 340 (mar09 2). DOI: 10.1136/bmj.c810

Internet, Sexual health

British pharmacy offers morning after pill online

March 23, 2009 2 Comments

contraception-online Lloyds Pharmacy has become the first high-street chemist to offer the ‘morning after’ pill emergency contraception online.

The pharmacy’s website gives the option to buy between one and three emergency contraception pills online, so women can be prepared prior to any accident.

Users need to complete a confidential health questionnaire before completing an order, which is reviewed by a GP. By using this questionnaire system, the company hopes to avoid selling contraception to girls under 18.

Emergency contraception is most effective if taken within 3 days (72 hours) of unprotected sex, but can potentially prevent pregnancy if taken up to 5 days after.

The pills on the Lloyd’s website take 72 hours to arrive, however. This delay is deliberate so that women who have already had unprotected sex and need emergency contraception immediately head straight to a local pharmacy, GP or family planning clinic rather than risk missing the crucial efficacy period while waiting on the postman.

Instead, the idea of online ordering is to allow women to have an advance supply to ‘prepare for the unexpected’. Steve Marinker, spokesperson for Lloyds Pharmacy, explains that women might find an advanced supply of the morning after pill useful for circumstances where it might otherwise be difficult to get hold of contraception within the crucial 3-day time window. “Maybe something’s gone wrong with their normal contraception and it’s a Saturday night,” he added, “and they might be anxious about how long it will take them to get a morning after pill, and that they might have to wait until Monday morning.”

Users also have the option to order two pills in case they vomit after taking a pill – a not uncommon side effect of emergency contraception.

Emergency contraception contains high doses of female hormones: either levonorgestrel, a synthetic progestogen, or progestin, another type of synthetic progestogen, plus estrogen. The progestogen analogues cause changes in the mucus and lining of the cervix, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus. Estrogen, on the other hand, stops the ovaries from releasing eggs that can be fertilized by sperm.

As one might expect, the right wing press are up in arms about this development. The Daily Mail cites Fury as High Street pharmacy sells morning-after pill online, whereas The Daily Telegraph opts for Anger over ‘morning-after pill bulk-buy offer’. These publications are harping on the old fear that easy availability of the morning after pill will fuel promiscuity, which the current system prevents, they say, by involving an ‘uncomfortable’ interview with a pharmacist that may act as a deterrent to such behaviour.

Promiscuity surely is only a problem for society if it leads to unwanted pregnancies, whereas emergency contraception prevents this happening. More to the point, currently a woman could walk into a pharmacy three days in a row if she wanted to create a stockpile (how much of a deterrent can a disapproving pharmacist really be?), the online ordering system just makes this process more straightforward. I welcome Lloyd’s Pharmacy’s move as a good way of ensuring women can use emergency contraception as soon after unprotected sex as possible.

Sexual health

So you won’t go blind, but you might get prostate cancer

January 26, 2009 10 Comments

This one's a myth. You should be worried about your prostate gland instead.

Although the schoolyard rumours that masturbation causes blindness or hairy palms aren’t true, a new study published in BJU International has found that too much playing solo in your twenties and thirties can increase the risk of prostate cancer.

The study of more than 800 men found that a high level of sexual activity or masturbation before the onset of middle age was associated with subsequent development of prostate cancer.

The authors suggest that the elevated levels of sex hormones some men experience in their twenties and thirties could be responsible for both a high sex drive and a high risk of prostate cancer later in life.

This British study retrospectively studied the sexual habits of 431 men who had been diagnosed with prostate cancer before the age of 60 and compared their reported behaviour with that of 409 healthy controls.

The authors found that men with prostate cancer were more likely to be very sexually active in their twenties and thirties – that is, had intercourse or masturbated 20 times a month or more – than were controls. In fact, 40% of the men who had prostate cancer were categorized as being very sexually active in their twenties compared with 32% of men in the control group. This pattern pretty much persisted throughout the men’s thirties and forties, and the differences in sexual activity evened out in their fifties.

Men with prostate cancer were also more apt to masturbate frequently than were men in the control group, with the greatest difference observed when the men were in their twenties (34% versus 24%) and thirties (41% versus 31%).

“Overall we found a significant association between prostate cancer and sexual activity in a man’s twenties and between masturbation and prostate cancer in the twenties and thirties. However there was no significant association between sexual activity and prostate cancer in a man’s forties”, said lead author Dr Polyxeni Dimitropoulou.

“A possible explanation for the protective effect that men in their fifties appear to receive from overall sexual activity, and particularly masturbation, is that the release of accumulated toxins during sexual activity reduces the risk of developing cancer in the prostate area. This theory has, however, not been firmly established and further research is necessary.”

Prostate cancer is the most common cancer in men in the UK, accounting for nearly a quarter of all new male cancer diagnoses. Cancer Research UK estimates that one man is diagnosed with prostate cancer every 15 minutes in the UK.

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Dimitropoulou P et al. (2009) Sexual activity and prostate cancer risk in men diagnosed at a younger age. BJU International 103 (2): 178-185 DOI: 10.1111/j.1464-410X.2008.08030.x

Events, Sexual health

World AIDS Day roundup

December 1, 2008 No Comments

Today December 1st is World AIDS Day. As many as 33 million people worldwide are living with HIV, and there are 80,000 people with HIV in the UK. The aim of World AIDS Day is to raise awareness of the challenges and consequences of the epidemic – ultimately halting the spread of the HIV virus and improving the lives of people living with infection.

The UK theme for World AIDS Day 2008 is “Respect & Protect“. Many people living with HIV face discrimination – this year’s campaign hopes to highlight the responsibility everyone has to transform attitudes to HIV and encourage actions that stop its spread. You can show your support for the campaign by wearing a red ribbon, which you can get your hands on in Gap, H&M, Selfridges and Levi’s stores around the UK, as well as in Red Cross charity shops.

There is a whole selection of events and promotions worldwide to mark World AIDS day. For example, this weekend a flash mob descended on Glasgow town centre, “freezing” while handing each another red ribbons and condoms in the event organized by the British Red Cross.

South Africa is poised to grind to a halt for 15 minutes to talk about AIDS. This weekend the country received £15 million worth of support from the UK to tackle the HIV epidemic. In South Africa, 20–30% of the population is HIV positive and as many as 365,000 people have died unnecessarily thanks to the AIDS denialism of former president Thabo Mbeki.

Online, AIDS.gov has launched the “Facing AIDS for World AIDS Day” campaign. Participants are invited to take a photo of themselves wearing a red ribbon and, on World AIDS Day, put the photo on their social networking site, blog, Twitter page, or website. There is also a Flickr group and a Facebook group where supporters can upload their pictures.

Digital magazine (RED)Wire by Product (RED), the charity run by Bono to engage the private sector in AIDS programmes, launched today. For a monthly subscription fee of £4, half of which will go to the Global Fund to help people in Africa with HIV and AIDS, users can get world premieres of exclusive tracks from the likes of Elton John, Jay-Z and Coldplay.

Bloggers Unite, a movement that aims to “harness the power of the blogosphere to make the world a better place”, has invited bloggers to dedicate their blog posts today to issues related to HIV/AIDS, with the aim of reminding people that HIV/AIDS is still a critical issue and to promote HIV testing. You can follow World AIDS day on Twitter with the tag #WAD08.

There is also a World AIDS day Musical Festival in Second Life, which will feature HIV/AIDS presentations and displays, tours, writing workshops, and virtual red ribbons and t-shirts.

The Independent has an eyewatering but otherwise fascinating article about the use of circumcision in the fight against AIDS in Africa. The simple procedure has been shown to cut the risk of contracting HIV by about 60%.
An editorial in the New York Times highlights a thought experiment published last week in The Lancet. The authors used mathematical modelling to predict what would happen if the majority of adults and adolescents were tested for HIV each year and treated immediately with antiretroviral drugs. This strategy could practically eliminate transmission of the virus within the space of a decade.

Public health, Sexual health

You’ve got mail… or chlamydia

November 28, 2008 1 Comment

The young people’s sexual health charity Brook has teamed up with the NHS and the laboratory testing company Preventx to offer free chlamydia testing kits through the post.

By using the Freetest.me website, young people between the ages of 16 and 24 can order a postal home testing kit, return their urine sample or vaginal swab by post, and receive the results by text message, email or on the website’s tracking service.

According to Brook, chlamydia is the most common sexually transmitted infection, with 1 in 10 people affected. Up to 75% of women and 50% of men with chlamydia have no symptoms, but left untreated the disease can cause serious health problems such as pelvic inflammatory disease and scarring of the reproductive system, and can lead to infertility.

Chlamydia can be treated easily with antibiotics, but these drugs can stop the contraceptive pill or patch from working.

Endocrinology, Sexual health

Testosterone skin patches improve sex drive in postmenopausal women

November 17, 2008 No Comments

A considerable proportion of women – between 25% and 53% in fact – suffer from sexual problems, with libido taking a nosedive after the menopause as estrogen levels drop. Although low libido isn’t a health problem per se, it has been shown to have a negative effect on sexual relationships and overall wellbeing.

It has been known for several years that testosterone, administered as a skin patch, improves sexual function in postmenopausal women. Previous studies on sex drive in women have only looked at the effects of testosterone in females also taking estrogen therapy, as testosterone is thought to be ineffective without concurrent estrogen administration. Long-term estrogen therapy is, however, associated an increased risk of cardiovascular disease.

A recent study by Davis et al. has now shown that testosterone patches can improve libido in postmenopausal women taking no other hormone therapy. Sponsored by Procter & Gamble, the study found that use of the company’s Intrinsa testosterone patches doubled the number of satisfying sexual episodes a month in women with low libido.

The study – conducted at 65 centers in the US, Canada, Australia, the UK and Sweden – enrolled 814 women who had undergone natural or surgical (e.g. through hysterectomy) menopause and who were concerned about decreases in their levels of desire and sexual activity. These women were randomly assigned to receive daily placebo, 150 micrograms of testosterone a day or 300 micrograms of testosterone a day, which was administered via patches applied to the abdomen.

After 24 weeks of treatment, the increase in the number satisfying sexual episodes per month was greater in women receiving 300 micrograms of testosterone a day than in women receiving placebo (an increase of 2.1 episodes vs 0.7 episodes). The increase seen in women receiving 150 micrograms of testosterone a day, however, was not markedly greater than that in women on placebo (an increase of 1.2 vs 0.7 episodes). Both testosterone therapy groups showed a greater increase in sexual desire than the placebo group and a more notable decrease in libido-related personal distress.

The number of reported side effects throughout the 52-week study period was similar in all three groups, although there was a higher incidence of unwanted hair growth in the women receiving 300 micrograms of testosterone a day. Four women receiving testosterone were diagnosed with breast cancer compared with none in the placebo group, but at least one case was thought to have developed before the initiation of testosterone therapy and the other cases were put down to chance.

Speaking to CNN, Dr Sheryl Kingsberg, one of the coauthors of the study, said, “Although the change in activity is modest, that’s something that is appropriate and I think most women would be more than happy with it. They wanted to return to the level of desire they had in their premenopausal years, and that’s what they got.”

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Davis SR et al. for the APHRODITE Study Team (2008). Testosterone for Low Libido in Postmenopausal Women Not Taking Estrogen N Engl J Med 359 (19): 2005-2017 PMID: 18987368

Sexual health

The sexual health of Great Britain

November 2, 2008 No Comments

This week the Office for National Statistics released the results of their 2007/08 contraception and sexual health survey, which was undertaken as part of the National Statistics Omnibus Survey.

Over four months, 1,164 women aged 16-49 and 1,543 men aged 16-69 completed a questionnaire on contraception use, sexual health, and knowledge of sexually transmitted infections (STIs). The survey found that the majority of Brits are monogamous. Men still claim to have had more sexual partners than women but at least are mostly using condoms while they’re playing the field. Women, on the other hand, prefer the pill to any other form of contraception. We’re not too hot on emergency contraception but know our STIs better than we used to, gleaning most of our info from the TV.

As many as 75% of men and 78% of women reported having had only one sexual partner in the previous year. Within all age groups, a higher proportion of men than women reported multiple sexual partners and more women than men reported having had just one partner.

The pill was the most popular form of contraception, used by 28% of women employing such measures, and the condom was the second most popular method (24%). In total, 43% men and 50% of women had used a condom in the past year, with those who had had more than one sexual partner more likely to have used a condom than those who had only had one partner. More specifically, 80% of men and 82% of women who had multiple partners had used a condom in the past year.

Almost all women (91%) had heard of the morning after pill, but awareness of the emergency intrauterine device (IUD) had dropped from 49% in 2000/01 to 37% in 2007/08. Less than half (49%) of the women who had heard of emergency contraception knew that the morning after pill is effective up to 72 hours after intercourse, while less than 10% were aware that the emergency IUD was effective if inserted up to five days after sex. Only 6% thought that the morning after pill protected against pregnancy until the next period and less than 1% believed that it protected against sexually transmitted infections.

Nearly all respondents correctly identified that chlamydia is an STI (85% of men and 93% of women), far more than in 2000/01 (35% and 65%, respectively), and nearly all men and women knew that gonorrhoea is an STI (92% and 91%, respectively).

Alarmingly, half of all respondents reported making no changes to their behaviour as a result of what they had heard about HIV/AIDS and other STIs, but thankfully more than a third of men and women said they had increased their use of condoms.

Most respondents got their information on STIs from television programmes (31%), followed by TV adverts (22%), and newspapers, magazines or books (20%). On the other hand, the internet was rarely used as a source of information about STIs, even by young people (3% of those aged 16-24).