Screening and Prevention of UTIs

Question 1

State the components of the full sexual health screen.

Answer 1

The full sexual health screen includes:

1) Blood test for:
• HIV 1+2 antibodies and p24 antigen
• Hepatitis B antigen
• Syphilis

2) Swabs or urine tests for: 
• chlamydia
• gonorrhoea
• Genital wart and HPV
• HIV
• candida (thrush) 
etc.

Question 2

Identify the causative pathogen of Chlamydia.

Answer 2

Chlamydia trachomatis

Question 3

What is the incidence of new Chlamydia cases per year in Europe ? What proportion of 15-25 have it in a typical developed country ?

Answer 3

• In Europe: incidence is 10 million new cases per year
• Typical developed country prevalence rate for 15-25 yr olds:
– 9% for females
– Slightly less for males

Question 4

How is Chlamydia transmitted ? Identify categories of persons especially at risk.

Answer 4

• Chlamydia can be transmitted during vaginal, anal, or oral sex. Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth.

At risk:

• Any sexually active person
• People with higher number of sexual partners
• Teenage girls and young women (because their cervix is not fully mature)
• MSMs

Question 5

What is the main issue in the following screening program:
All 21-23 yr olds (30,439 people) were offered home sampling test (part of 14 week public information campaign)
Materials for home sampling could be requested via internet or on answering machine.

What is a better strategy (which was actually implemented) ?

Answer 5

-Time consuming (need to fill in details etc.)

• mailed home sampling kit (without volunteering)
• reply card mailed to home address to order a kit

Question 6

According to studies on the issue, which of males or females were more likely to take up Chlamydia screening ?

Answer 6

Males

Question 7

According to studies on the issue, what was the proportion of negative results for Chlamydia after 2 weeks, and after24 weeks ? Why ?

Answer 7

When followed up, within 2 weeks, 88% were found not to be positive.
After 24 weeks, 2/3 become reinfected (only 1/3 not positive)
Likely because partner was infected but not tested, leading to re-infection of the subject.

Question 8

What proportion of the partners of + patients are themselves + ?

Answer 8

More than half of the partners of +ve patients are themselves +ve

Question 9

What is the main pro of partner notification ?

Answer 9

Huge saving in treatment costs if both partners are tested.

Question 10

Do GPs prefer to notify partners, or specialist partner notification ?

Answer 10

GPs prefer specialist partner notification

Question 11

What is a way to increase re-engagement for a screening program (e.g. if website sign up) ?

Answer 11

Reminder of screening invitation

Question 12

To what extent does screening actually prevent PID as a complication of Chlamydial infection ? What is a possible improvement to that ?

Answer 12

While screening and treatment of chlamydia infection might reduce the risk of clinical PID over 12 months, especially in women with chlamydia infection at the baseline, most cases of PID occurred in women who tested negative for chlamydia at the baseline, suggesting incident infection.

The effectiveness of a single chlamydia test in preventing PID over 12 months may have been overestimated.

Policy makers might consider focusing on more frequent testing of women at higher risk such as those with a recent change of sexual partner or history of chlamydial infection in the past three months.

Question 13

Why would women under 25 years NOT participate in screen when attending pharmacy for EHC?

Answer 13

-Embarrassing (don’t wanna stand in queue any longer than they have to for EHC already)

Question 14

Identify approaches to behavior change.

Answer 14

1) Motivational interviewing (more successful than education)
– Motivation to change may be low
– Process of increasing motivation when people are not thinking of change (e.g. ask patient what they would be willing to do, even if it means meeting them halfway) rather than them doing exactly what you want)
2) Problem-focused counselling
– Identifies causes of problems that prevent change
3) Modelling and rehearsal of change
– Improves skills and self-efficacy to achieve change

Question 15

Identify the main stages of change according to Prochaska and DiClemente.

Answer 15

1) Pre-contemplation
2) Contemplation
3) Preparation
4) Action
5) Maintenance

Question 16

Identify the correlates of Patient Change Talk.

Answer 16

Clinician Listen

Clinician Reframe

Question 17

Identify the correlates of Patient Resistance.

Answer 17

Clinician Confront, leading to:

• Patient argue
• Patient interrupt
• Patient negative
• Patient off-task

Question 18

Describe the flow of change talk.

Answer 18

Motivational Interviewing → Desire Ability Reasons Need → Commitment → Change

Question 19

Describe adolescent Doctor Communication about sex matters.

Answer 19

Many adolescents want to discuss sex-related topics but don’t know if they can trust doctors to be discreet

Question 20

An MI group with HIV risk was compared to a control group with HIV risk wrt various outcomes. Which was different between the two ?

Answer 20

The MI group showed greater:
• HIV knowledge
• Perception of HIV risk
• Intention to protect
• Communication with partner 

And significantly lower rates of:
• Unprotected intercourse
• Substance abuse before sex

Question 21

To what extent are behavioral interventions to reduce risk for sexual transmission of HIV among men who have sex with men (MSM) successful ?

Answer 21

They are successful

Question 22

Identify the main social aspects of screening.

Answer 22

• Screening on healthy individuals is ethically different from everyday medical practice.
• Emphasizing individual attributes of health imply a message of dependency on experts and technology (society become dependent and not thinking through their health issues themselves)
• Health aspects as belonging, competence, mastering and well-being may accordingly be disregarded, and the social emphasis of health determinants disappear.
• Backlash from the public regarding screening
- Organizers of screening programs are seen to be PATERNALISTIC

Question 23

In order to be ethically defensible, what are the requirements for health promotion and lifestyle advice ? Are these conditions usually met ?

Answer 23

To become ethically defensible health promotion and life style advice should:
– alter the natural history of diseases, and
– be approved by the patients.

According to some critics these conditions are often unmet in health promotion, and possible health gain is seldomly weighed against unwanted side effects in healthy populations.

Question 24

What are the main criticisms to screening interventions ? What is the answer to the criticisms received by screening interventions ?

Answer 24

CRITICISM:

1) Dependency on experts and tech (social emphasis of health determinants may disappear)
2) Paternalistic ?
3) May not alter the natural history of diseases/be fully approved by patients/lack unwanted side effects

Answer is to provide decisional aid
• Give people information to make an informed choice
• Provide pros and cons

(BUT effects of decisional aids are unknown and controversial)

Question 25

How is screening different to traditional forms of medical care ?

Answer 25

People are invited to undergo tests when there are few if any symptoms