Transcript Estonia GP Pack- Part 1 - STI Training with CATTE

Genital chlamydia testing in general practice in
Estonia
Project
ChlamydiA Testing Training in Europe
(CATTE)
Participants:
– Estonia
– France
– England (lead)
– Sweden
Project aims
- to develop training packages for general practice staff delivering chlamydia
screening;
- to transfer an innovative chlamydia testing training package for GP staff
http://stitraining.eu/
Training sessions in Estonia
Department of Public Health, University of Tartu
in cooperation with
Department of Polyclinic and Family Medicine
• 5 training sessions + pilot
• 20 Tartu and Tartu county GP practices were randomly
selected
• Training sessions accreditation in Centre for Continuing Medical Education,
University of Tartu
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Introduction
Genital chlamydia
Microbiology, pathogenesis
Epidemiology
Clinical manifestations
Testing, diagnosis
Patient management
Prevention
Discussion ( videos, barriers)
Why chlamydia?
• Chlamydia remains the most common STI in Europe within the young adult
population, but testing rates are low
EU 175 cases per 100 000 person in 2011 (ECDC)
gonorrhea 12,6 cases 100 000
• Left untreated chlamydia can cause serious, permanent damage to a
woman's reproductive system, making it difficult or impossible for her to get
pregnant later on.
• Chlamydia screening and treatment is an important and useful intervention to
reduce the risk of PID among young women.
Combination of the testing and reporting
ECDC Number of reported chlamydia cases per 100,000 population, EU/EEA, 2011
Why to screen young adults aged 18-24?
• Young adults aged 18-24 are most at risk
¾ of reported cases are in age group 15-24 (ECDC)
ECDC 2012
Why GP staff?
• General practices are feasible place for screening:
– 71% of 16-24 years old adults in Estonia visit their GP per half a year
(Uuringu raport, 2012)
In case of health problems first advisor
Microbiology
Chlamydiaceae Family
(species that cause disease in humans)
Species (genus)
Disease
C. trachomatis
2 biovars, non-LGV
LGV
Trachoma, NGU, MPC, PID,
conjunctivitis,
Infant pneumonia,
LGV
C. pneumoniae
Pharyngitis, bronchitis,
pneumonia
C. psittaci
Psittacosis
Chlamydia trachomatis serovar D … K
• Obligatory intracellular bacteria
• Infect columnar epithelial cells
• Survive by replication that results in the death of the cell
• Takes on two forms in its life cycle:
– Elementary body (EB)
– Reticulate body (RB)
Chlamydia trachomatis
• C. trachomatis has an affinity for epithelial cells of
the cervix, upper genital tract in women, urethra,
rectum, and conjunctiva.
• C. trachomatis elementary bodies (EBs) enter cells
via receptor-mediated endocytosis. Receptors for
are restricted to nonciliated columnar, cuboidal, or
transitional epithelium.
Chlamydia trachomatis
Unique life cycle:
2 forms:
– Elementary
is the extracellular, infective form of
chlamydia
– Reticular
reproduces by binary fission and
depends on host cells for
metabolism.
Host cell death
Incubation period 7-21 days
Pathogenesis
• Immune response:
– primary immune response: PMN-neutrophils;
– lymphocytes, macrophages, eosinophiles
• Antibodies does not eliminate risk of reinfection
Chlamydia trachomatis bound to epithelial cells after
neutralization by antibodies against polymorphic membrane
protein D (PmpD).
Antimicrobial treatment
• C.trachomatis resistant to beta-lactam antibiotics
• C. trachomatis is sensitive to tetracyclines, macrolides, and some
fluoroquinolones
Azitromycine (suppress cell growth)
Doxycyline (suppress protein synthesis)
150
200
Incidence (reported cases) of STI in Estonia
119/100 000
50
100
◊
♦
0
►
●
2000
2002
2004
2006
2008
2010
2012
Aasta
●
►
◊
♦
Süüfilis (A50-A53)
Gonokokknakkus (A54)
Suguliselt levivad klamüüdiahaigused (A55- 56)
Immuunpuudulikkuse asümptomaatiline seisund (HIV-nakkus) (Z21)
Incidence (reported cases) of genital C. trachomatis infections be
gender, Estonia 2012
Men
Women
10-14
15-19
41.8
51.2
30-34
44.4
35-39
564.8
235.7
102.1
40-44
31.8
62.5
22
45-49
27.5
11.7
50-54
18.6
2.6
55-59
8.4
5.9
60-64
2.2
65+
1.3
.6
Total
43.4
300
1256.8
25-29
130.2
600
937.1
20-24
223.4
900
14.1
0
193.1
0
300
Rate (per 100,000 population)
600
900
1200
1500
Chlamydia prevalence
• Population-based prevalence study (Tartu county 2005)
• 18-35 years old - 5.4%
– 6.9% F
– 2.7% M
• 18-24 years old - 6,6%
– 10,2% F
(Uusküla A. 2008)
Risk factors
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•
•
•
•
•
Age (adolescence)
New or multiple sex partners
History of STIs
Presence of another STI
Hormonal contraception use
Lack of barrier contraception
Cervix, older female
Columnar epithelium
inside cervix
Cervix, younger female
Cervical ectopy
Transmission
• Transmission is sexual or vertical
• Highly transmissible
• Incubation period 7-21 days
• Significant asymptomatic reservoir exists in the population
• Re-infection is common
Clinical syndromes caused by C. trachomatis
Men
Women
Infants
Local Infection
Complication
Sequelae
Conjunctivitis
Urethritis
Prostatitis
Reiter’s syndrome
Epididymitis
Chronic arthritis (rare)
Infertility (rare)
Conjunctivitis
Urethritis
Cervicitis
Proctitis
Endometritis
Salpingitis
Perihepatitis
Reiter’s syndrome
Infertility
Ectopic pregnancy
Chronic pelvic pain
Chronic arthritis (rare)
Conjunctivitis
Pneumonitis
Pharyngitis
Rhinitis
Chronic lung disease?
Rare, if any
C. Trachomatis infections in women
• Cervicitis
– Majority (70%-80%) are asymptomatic
– Local signs of infection, when present, include:
• Mucopurulent endocervical discharge
• Edematous cervical ectopy with erythema and friability
• Urethritis
– Usually asymptomatic
– Signs/symptoms, when present, include dysuria, frequency, pyuria