Chlamydia trachomatis infections in Norway 2004-2006: Testing and treatment patterns among men and women
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Background: In Norway, the number of positive tests for Chlamydia Trachomatis (CT) is increasing. Patients with a positive CT test result should be immediately treated with oral antibiotics according to the treatment guidelines and are recommended to return for a control test not less than 4 weeks after treatment in order to avoid false positive test results. However little is known on CT treatment practices and treatment efficacy.Objective: To map treatment practices and to investigate testing pattern and treatment efficacy among men and women tested for CT.Material and methods: Laboratory data on all tests for CT in Sør-Trøndelag County 2004-2006 were retrieved and organized as a database with person (not test) as the unit of analysis. For all patients with a CT test, data on medication was retrieved from the Norwegian Prescription Database. The extent to which patients returned for control tests and treatment efficacy was investigated by using data from the CT database.Results: Follow-up from 2004 to 2006 included 43634 tests of 28252 patients among whom 3127 (8:5%) were CT-positive. The testing rates were four times higher in women than men (11.8 versus 3.1 per 100 inhabitant) while the proportion of CT-positive results were twice as high in men compared to women (15.5 versus 6.7). Only 82.8% of screened positive patients were treated, of whom 90:8% were treated with Azithromycin, 2.4% were treated with Doxycycilin, 1.7% received both Azithromycin and Doxycycilin and 5% received other types of antibiotics. However 17.2% of CT-positive patients remained untreated. Women were 2 times more likely to be treated with Azithromycin (odds ratio: 2.0, 95% CI: 1.7-2.3). Among positive screened patients, the age and type of treatment was significantly associated with time to treatment visit. Time to treatment visit was in general lower in men than women. Considering only gender, on average CT-positive patients were treated within two weeks after screening (95% CI: men: 1211-13.5 days, women: 12.8-13.7 days). Gender, age and type of treatment had an overall significant association with time to treatment visit of patients screened negative (pvalue< 0.05). CT-negative patients were treated within approximately three weeks after screening when gender were considered only (95% CI: men: 14.5-18.8, women: 22.9-24.2). Only 36:2% of CT-positive patients took a follow up test within 4 to 16 weeks after complected treatment of which 9% were re-infected. The microbial cure rate was significantly associated with gender and age (p-value < 0.05). The odds ratio of microbial cure was 2.7 times higher in women than men. The odds ratio of microbial cure of patients in young age, 15-19 and 20-24 years of age were 3.4 and 1.8 times, respectively, lower than patients older than 30 years of age. Conclusion: More young men and females need to be tested for CT. Patients should be encouraged to start their treatment as quick as possible to avoid spreading of the disease and complications. Men and women should be encouraged to return for a follow up test. Implementation of organized contact tracing programs within the public health system is necessary to increase treatment efficacy.