Biomedical subjects

Hannelore M Götz

Publications and source records attributed to Hannelore M Götz.

12 recordsLinked to original sources

PubMed2007

Risk selection and targeted interventions in community-based control of chlamydia.

PURPOSE OF REVIEW: To describe recent developments in the community-based approach of high-risk groups for Chlamydia trachomatis infection, and to discuss the assessment of impact of selective systematic screening on the transmission of C. trachomatis in the community. RECENT FINDINGS: Two large home-based screening programs in Europe have recently shown that systematic postal screening for C. trachomatis infection is feasible, but certain high-risk groups are poor participators. This underscores the need for risk selection and targeted approaches. A prediction rule has been developed which can assist in identifying high-risk groups and can be used as a tool for (self) selection for screening. The Internet has been shown to be a promising medium to promote chlamydia testing. School-based programs also succeed in including high-risk groups in screening programs. Recently developed dynamic simulation models, which take into account transmission of C. trachomatis, can assist in the development and evaluation of targeted screening strategies. SUMMARY: Chlamydia will not likely be controlled by one standard approach. Risk selection strategies need further development and different systematic approaches at the community level, including postal screening, school-based screening, and the Internet may produce the desired public health effect of decreasing morbidity and reducing the transmission of C. trachomatis in the community.

Chlamydia Infections↗

PubMed2006

Population prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in the Netherlands. Should asymptomatic persons be tested during population-based Chlamydia screening also for gonorrhoea or only if chlamydial infection is found?

BACKGROUND: Screening and active case finding for Chlamydia trachomatis (CT) is recommended to prevent reproductive morbidity. However insight in community prevalence of gonococcal infections and co-infections with Neisseria gonorrhoea (NG) is lacking. METHODS: Nested study within a large population-based Chlamydia Screening Pilot among 21.000 persons 15-29 year. All CT-positive (166) and a random sample of 605 CT-negative specimens were as well tested for gonococcal infection. RESULTS: Overall Chlamydia prevalence in the Pilot was 2.0% (95% CI: 1.7-2.3), highest in very urban settings (3.2%; 95% CI: 2.4-4.0) and dependent of several risk factors. Four gonococcal infections were found among 166 participants with CT infection (4/166 = 2.4%; 95% CI: 0.1%-4.7%). All four had several risk factors and reported symptoms. Among 605 CT-negative persons, no infection with NG could be confirmed. CONCLUSION: A low rate of co-infections and a very low community prevalence of gonococcal infections were found in this population based screening programme among young adults in the Netherlands. Population screening for asymptomatic gonococcal infections is not indicated in the Netherlands. Although co-infection with gonorrhoea among CT-positives is dependent on symptoms and well-known algorithms for elevated risks, we advise to test all CT-positives also for NG, whether symptomatic or asymptomatic.

Adolescent↗

PubMed2006

Needlestick injury and accidental exposure to blood: the need for improving the hepatitis B vaccination grade among health care workers outside the hospital.

To describe the characteristics of needlestick injuries occurring to health care workers outside the hospital, a new case report form was implemented and analyzed after 12 months. A total of 144 incidents were reported. Of the needlestick injuries in nursing assistants, 84% involved an insulin needle or pen. Thirty-five percent of all health care workers and 47% of the nursing assistants were not vaccinated against hepatitis B. Hepatitis B vaccination grade in health care workers outside the hospital should be improved, in particular among nursing assistants.

Blood-Borne Pathogens↗

PubMed2006

Prediction of Chlamydia trachomatis infection: application of a scoring rule to other populations.

BACKGROUND: Active case finding is crucial to reduce transmission and consequences of Chlamydia trachomatis (CT) infections. We previously proposed the use of a prediction rule for CT infection for selective screening of high-risk individuals in a population. To support such an application, the prediction rule needs to be validated in other populations. METHODS: We studied participants aged 15 to 29 years in a population-based study in Amsterdam (n = 1,788) and an outreach screening project among high-risk youth in Rotterdam (n = 172). Validity was indicated by discriminative ability (area under the receiver operating characteristic curve [AUC]) and by calibration, which was visualized in plots and tested with the Hosmer-Lemeshow (H-L) goodness-of-fit test. Cutoffs of predicted risk were examined for their effect on sensitivity and the fraction of participants that would need to be screened. RESULTS: Discriminative ability was reasonable both for the Amsterdam study (AUC 0.66; 95% confidence interval [CI], 0.58-0.74) and for the Rotterdam study (AUC 0.68; 95% CI, 0.58-0.79). The observed CT prevalence was lower than predicted in Amsterdam (H-L P = 0.02) and nonsignificantly higher in Rotterdam (H-L P = 0.20). By screening 77% of the Amsterdam population, 93% of the cases would have been detected, whereas in the Rotterdam study, no cases would be missed by screening 75%. CONCLUSION: The chlamydia prediction rule showed a reasonable external validity in two studies. These findings support the use of the rule as a tool for selective chlamydia screening, although only a limited fraction of participants can be excluded when a high sensitivity is required.

Adolescent↗

PubMed2006

Incidence of sexually transmitted diseases and HIV infection in men who have sex with men related to knowledge, perceived susceptibility, and perceived severity of sexually transmitted diseases and HIV infection: Dutch MSM-Cohort Study.

BACKGROUND: This longitudinal study was conducted to investigate whether knowledge, perceived susceptibility, and perceived severity of HIV infection and sexually transmitted diseases (STDs) are associated with the incidence of STDs and new HIV infections among men who have sex with men (MSM). METHODS: A 3-year cohort study was conducted among 190 HIV-negative MSM. Data were collected on the incidence of STDs and new HIV infections, as well as on knowledge and perceived susceptibility to and perceived severity of HIV infection and STDs. Knowledge and perceptions were assessed in self-administered questionnaires. RESULTS: In the course of the 3-year study, six MSM (3.2%) HIV-seroconverted and 78 (41.1%) participants were diagnosed with at least one STD. MSM seemed to be better informed about HIV infection compared with STDs, and HIV infection was perceived as more severe than other STDs. In multivariable analyses, low perceived severity of HIV infection significantly (P = 0.025) predicted increased likelihood of infection with STDs or HIV, and the practice of anal intercourse was (marginally) associated with an increased risk of acquiring STDs or HIV (P = 0.052). CONCLUSIONS: A high perceived severity of HIV infection seems to induce sexual behavior that protects against STDs and HIV infection. More research is needed to establish the specific behaviors by which perceived severity of STDs/HIV influences the incidence of STDs and HIV.

Adolescent↗

PubMed2006

Lessons learned from a population-based chlamydia screening pilot.

We evaluated process organization and response optimization in a home-based Chlamydia trachomatis (Ct) screening project in the Netherlands among 15- to 29-year-old women and men. The method used was computer-supported data flow, from population sampling to informing participants of the result. A new test kit or a letter reminded non-respondents after six weeks. Fifteen-year olds required parental consent. Urine arrived at the laboratory within 29 days from invitation, and four (1-11) days after collection, indicating good specimen quality. Test kits had a higher response than letters (15 versus 10%). Response in 15-year olds was 33%; with 2% Ct infected sexually active 15 year olds. In Conclusion, purpose made computer software is essential for an efficient screening programme. Sending urine by mail does not impair diagnostics. Reminders are necessary and effective after four weeks. Necessary parental consent for under 16-year olds should not be a deterrent to offer Ct screening to this age group.

Adolescent↗

PubMed2005

A cluster of acute hepatitis C virus infection among men who have sex with men--results from contact tracing and public health implications.

OBJECTIVE: An acute hepatitis C virus (HCV) infection in an HIV-positive man who had sex with men (MSM) was notified. In the period of his seroconversion he was also diagnosed with a rectal lymphogranuloma venereum (LGV) infection, and was part of a cluster of 15 LGV cases in 2003. Our aim was to investigate HCV transmission and to search for potential spread among sexual contacts and known LGV patients. METHODS: Our case series included the index, two recent contacts, and 14 LGV cases. They were interviewed about parenteral exposure for HCV, history of sexually transmitted diseases(STDs), sexual behaviour and drug use. Laboratory investigations included anti-HCV antibodies, HCV-polymerase chain reaction, and HCV genotyping. RESULTS: Seven out of 17 MSM recently seroconverted for HCV (41%). Three genotypes were found. Parenteral risk factors were excluded. Six out of seven had LGV proctitis coinciding with HCV seroconversion, six (86%) were HIV infected. Unprotected anal contact was practised by both HCV uninfected and infected cases. Unprotected active and passive fisting was reported by all seven HCV infected men, compared with two of nine uninfected men (P = 0.003). Non-intravenous drug use during sexual activities was common among all MSM. Numerous, often anonymous, sexual contacts in various European countries were reported. CONCLUSIONS: A cluster of acute HCV infection is reported among mostly HIV-positive MSM, with multiple partners throughout Europe. Sexual techniques potentially leading to mucosal damage (fisting), concomitant STDs such as LGV and drug use seem facilitating factors for spread. Extensive case finding and partner tracing is advocated as well as targeted prevention messages.

Acute Disease↗

PubMed2005

Management of Chlamydia cases and their partners: results from a home-based screening program organized by municipal public health services with referral to regular health care.

BACKGROUND: We evaluated the management of Chlamydia trachomatis cases and partners found in a systematic home-based chlamydia screening project in the Netherlands among 15- to 29-year-old women and men, organized by the Municipal Public Health Services (MHS). METHODS: Infected participants (165/8339 = 2%) were referred to regular curative services. The treating physician provided feedback on treatment and partner notification. RESULTS: Including the effect of a reminder, the treatment rate of all index cases was 91% (150/165); among persons with non-Dutch ethnicity, 81% (25/31). The majority of cases (82%) consulted the general practitioner for treatment as opposed to sexually transmitted disease/MHS clinics (18%). Eighty-five percent of cases were treated within 2 weeks. The confirmed treatment rate of partners in the last 6 months was 49% (86/176); 57% (81/141) for current versus 14% (5/35) for other partners. Patient referral was advised in an additional 18% (25/141) of current partners and in 9% (3/35) of other partners (potential treatment). CONCLUSION: Home-based chlamydia screening and treatment through regular treatment facilities has proven to be effective in the Netherlands. The necessity of a reminder to increase treatment rate and the lower treatment rate in non-Dutch high-risk groups deserve attention. Low confirmed treatment rate of current partners carries the potential of reinfection, and patient-delivered treatment should be expanded.

Adolescent↗

PubMed2005

Acceptability and consequences of screening for chlamydia trachomatis by home-based urine testing.

OBJECTIVE: The objective of this study was to study the acceptability and consequences of home-based chlamydia (CT) screening by Municipal Health Services (MHS) among 15- to 29-year-old participants. STUDY: This study consisted of a cross-section of 156 CT-positives and 600 random sampled CT-negatives after receiving the result of their CT test. RESULTS: Thirty-eight percent of the men and 59% of the women responded. The screening method was well-accepted. Seventy percent (52) of the CT-positives were surprised about their result. Infected women more often than men reported a feeling of being dirty and of anxiety about infertility. Curiosity for the CT result was decisive for participation in 68% and perception of personal risk was poor. The willingness to be tested regularly was determined by present chlamydial infection, young age, multiple lifetime partners, short relationship, and earlier test for chlamydia. CONCLUSIONS: Chlamydia screening organised by MHS is acceptable for future screening. Participants with an elevated risk are interested in screening as long as test kits are easily available. Counseling with focus on effects of CT, especially on women, is essential. Alternative approaches are needed to motivate men and non-Dutch high-risk groups.

Adolescent↗

PubMed2005

Reinfections, persistent infections, and new infections after general population screening for Chlamydia trachomatis infection in the Netherlands.

OBJECTIVES: The objectives of this study were to determine the rate of new infections and reinfections or persistent infections with Chlamydia trachomatis to define appropriate screening intervals and to identify risk factors for reinfection. DESIGN: This was a cross-sectional study among a subsample of participants in a population-based screening. SETTING: This study was conducted in urban and rural areas in The Netherlands. PARTICIPANTS: A total of 21,000 15- to 29-year-old women and men were invited for home-based urine testing. One year after the study, a subsample of 299 participants were offered retesting. MAIN OUTCOME MEASURES: The authors studied the rate of infection with C. trachomatis. Serovar determination was used to potentially discriminate between new infections and reinfections or persistent infections. RESULTS: Nine C. trachomatis infections were found among 187 responders (4.8% confidence interval, 1.7-7.9). The prevalence was 10.4% (5 of 48) in previous positives and 2.9% (4 of 139) in negatives. Three of 5 repeatedly positive participants were infected with a different C. trachomatis serovar. CONCLUSIONS: Our study indicates that infected persons found in a systematic, population-based screening should be re-screened within 1 year. Optimal screening intervals still need to be determined.

Adolescent↗

PubMed2004

Resurgence of lymphogranuloma venereum in Western Europe: an outbreak of Chlamydia trachomatis serovar l2 proctitis in The Netherlands among men who have sex with men.

BACKGROUND: Lymphogranuloma venereum (LGV) is a sexually transmitted disease (STD) and is rare in the Western world. Recently, 3 men who have sex with men presented with LGV proctitis at the Erasmus Medical Center, Rotterdam, The Netherlands. We investigated a possible outbreak in a sexual network of men who have sex with men (MSM). METHODS: After active case finding, a total of 15 men presented and were investigated. Serum antibody titers to Chlamydia trachomatis were determined. Urine and rectum specimens were analyzed by polymerase chain reaction (PCR) for the presence of C. trachomatis. C. trachomatis-positive specimens were genotyped to detect the specific C. trachomatis serovars. All subjects underwent routine STD screening. Sociodemographic, clinical, and endoscopic characteristics were evaluated. RESULTS: Thirteen subjects had high immunoglobulin (Ig) G and IgA titers to C. trachomatis, suggesting an invasive infection. Rectal specimens of 12 subjects were PCR-positive for C. trachomatis. All urine specimens were negative. Genotyping revealed serovars L(2) (n=8) and L(1) (n=1). An ulcerative proctitis was found in all subjects obtaining sigmoidoscopy (n=9). Eleven of 13 subjects with an LGV diagnosis were seropositive for human immunodeficiency virus (HIV), 6 had another concomitant STD, and 1 had recently acquired a hepatitis C virus infection. Further sexual contacts were reported from The Netherlands, Germany, Belgium, the United Kingdom, and France. CONCLUSIONS: We revealed an outbreak of LGV proctitis among MSM in The Netherlands. The ulcerous character favors transmission of HIV, other STDs, and blood-borne diseases. From a public health perspective, it seems important to increase the awareness of possible LGV in MSM with symptomatic proctitis.

Adult↗

PubMed2004

Paired measurements of quantitative hepatitis B virus DNA in saliva and serum of chronic hepatitis B patients: implications for saliva as infectious agent.

BACKGROUND: After intensive source and contact tracing 20 % of acute Hepatitis B virus (HBV) infections remain unexplained. Saliva may be an unexpected vehicle of HBV DNA transmission. OBJECTIVE: To further explore this hypothesis we evaluated the quantitative levels of HBV DNA in saliva and compared these with the HBV DNA levels measured in serum. STUDY DESIGN: Serum and saliva were collected from 27 chronic HBV patients attending our outpatient clinic. RESULTS: There were 16 men and 11 women; 15 patients were HBeAg positive, anti-HBe negative and 11 patients were HBeAg negative, anti-HBe positive. One patient was HBeAg and anti-HBe negative. Samples of serum and saliva were collected on the same day. All saliva specimens were clear on inspection. HBV DNA in serum was measured by the Digene Hybrid Capture II microplate assay (Digene Diagnostics), the HBV Monitor assay (Roche Diagnostics) as well as an in-house developed HBV DNA TaqMan assay. The HBV DNA TaqMan assay was used for the quantitative measurement of HBV DNA in saliva. Median HBV DNA levels in serum were 2.10 x 10(5) geq/ml and ranged from 373 genome equivalents per ml (geq/ml) to 4.13 x 10(9) geq/ml; median HBV DNA levels in saliva were 2.27 x 10(4) geq/ml and ranged from 373 geq/ml to 9.25 x 10(6) geq/ml. A clear correlation was shown between HBV DNA in serum and saliva; log HBV DNA in saliva=1.01 + 0.56 x (log HBV DNA in serum). CONCLUSIONS: this is the first report of precise quantitative measurements of HBV DNA levels in saliva and the relationship with HBV DNA levels in serum. Our findings show that saliva is a source of HBV DNA. This finding may have implications in selected patients for the infectivity of saliva and offer further insight in the routes of transmission of HBV infection.

Antigens, Viral↗