1. Risk Behaviour, Health Care Access and Prevalence of infection with Chlamydia trachomatis and Neisseria gonorrhoea in a population based sample of adults in Barbados
O.P. Adams, G. McIntyre, P. Prussia
The University of the West Indies,
Cave Hill, Barbados

2. Objectives To determine the prevalence
of urogenital infection with Chlamydia trachomatis and Neisseria gonorrhoea in persons 18 to 35 years of age

3. Objectives
To determine factors that could be used to identify infected persons
Risk factors
Health Care Access
Symptoms

4. Why Do This Study?
Infection with CT and NG have important health consequences especially for females
Pelvic inflammatory Disease
Ectopic pregnancy
Infertility

5. Why Do This Study? Males may have Epididymitis Urethral strictures
Newborns may have
Conjuctivitis
Pneumonia

6. Why Do This Study?
Non-ulcerative Sexually Transmitted Infections may enhance the spread of HIV

7. Why Do This Study?
Little was known about the prevalence of NG and CT in Barbados
Previous studies have used selected clinic populations
No published study has been done on a population based sample, or on males

8. Previous Studies - Barbados
Attapatu, Levett et al; Barbados 11.4% prevalence of asymptomatic chlamydia in women attending an O+G clinic
Rollock et al; SWSPC % prevalence in women attending an antenatal clinic with a 20.8% prevalence in 15 to 19 year olds

9. Method
Random sample of 18 to 35 year persons living in the St. Michael South East Electoral District
Questionnaire administered privately
Urine collected
Urine tested by PCR using the Roche Amplicor kit

10. Results 440 persons approached -216 males and 224 females
382 persons (86.8%) responded
-179 males and 203 females
321 had urine tests completed by laboratory males and 170 females

11. Usual source of Health Care

12. Time last seen by Doctor%

13. Age at sexual debut %

14. Condom use Last intercourse with non-regular partner no 118 persons
yes 119 persons
no 118 persons
No difference in prevalence of infection between the 2 groups (p=.515)

15. Knowledge Heard of chlamydia yes 29.4% (95%CI +4.9)
no 70.6% (95%CI +4.9)
Heard of gonorrhoea
yes 91.6% (95%CI +3.0)
no 8.4% (95%CI +3.0)

16. Chlamydia and Gonorrhoea Prevalence
NG +/or CT positive % (95%CI )
NG positive % (95%CI )
CT positive % (95%CI )

17. Prevalence of Chlamydia and Gonorrhoea%
Test result

18. Prevalence by Age group
18 to 20 years of age (n=72) % (95%CI +10.0)
21 to 35 years of age (n=248) % (95% CI +3.8) (p = .001)

19. Prevalence by Age group

20. Urethral discharge (males)
STD status
No discharge
Mild discharge
Moderate discharge
negative
N (%)
123
(96.9%) 3
(2.4%) 1
(0.8%)
positive 18
(94.7)
(5.3%)

21. Vaginal discharge STD status negative N (%) 118 (84.3%) 16 (11.4%) 6
No discharge
Mild discharge
Mod/severe discharge
negative
N (%)
118
(84.3%) 16
(11.4%) 6
(4.3%)
positive 24
(88.9%) 1
(3.7%) 2
(7.4)

22. Number (%) without symptom
STD status
Abdominal pain
Dyspraeunia
Inter-menstrual
bleed
negative
N (%)
127
(90.7%)
124
(89.9%)
126
(90.6%)
positive 21
(80.8%) 24
(92.3%)
(80.8)

23. Symptoms Baltimore study
< 5% of infected participants reported dysuria or genital discharge.
Handsfield 1974
Study of 2628 enlisted men
Gonnorhoea was detected in 59 men (2.2%)
40 of these asymptomatic

24. Summary
There is a high prevalence of urogenital Chlamydia trachomatis in both males and females in Barbados
Young persons have an extremely high prevalence of CT
Symptoms are neither sensitive or specific for the identification of infection

25. Summary
Most persons have never heard of chlamydia

26. Recommendations
Routine screening should be introduced especially for chlamydia in adults 18 to 20 years of age.
A similar study is needed for children 16 to 17 years of age.

27. Recommendations
Health care professionals and the public should be sensitised both to the prevalence and consequence of infection with chlamydia trachomatis.

28. Acknowledgements Funding CHRC Pfizer Roche
Laboratory testing facilitated by the Ministry of Health, Barbados

29. Acknowledgements Data collection Cynthia Clarke Data entry
Maxine Hinds
Laboratory testing
N. Adomakoh, A. Abayomi, S. Branch and other staff of the Lady Meade Reference Unit