Female chlamydia anorectal (chlamydia)
Regardless of the recent anal intercourse, infections are common.
We explored the role of anorectal infection in the transmission of chlamydia and evaluated the impact of interventions aimed at improving the detection and treatment of anorectal infection.
Methods we developed a zoning model for a pair of heterosexual patients aged 15-29 years in the STI clinic where women may be susceptible to infection or infection with urology and/or anal
By fitting the anatomical site, the probability of transmission per vaginal and anal behavior and the probability of automatic vaccination were estimated
Specific Prevalence data (14% urogenital;
11% anorectal prevalence).
We looked into 10-
The prevalence of chlamydia in women with interventions decreased year by year (
General anorectal examination for female STI clinic attendees or use of force-in-force for urinary and reproductive chlamydia)
Relative to the current ongoing care (
Indication of anorectal examination for anorectal and azithromycin of chlamydia in urinary reproduction and qianglipin).
Results The probability of transmission of each anal behavior was 5. 8% (IQR 3. 0–8. 3%)
Sex per vagina 2. 0% (IQR 1. 7–2. 2%)
And the probability of daily self-vaccination is 0. 7% (IQR 0. 5–1. 0%).
Compared with the recent anal intercourse, the infection of anorectal infection caused by self-vaccination is more.
Universal anorectal examinations have moderately reduced the prevalence of the population, with 8 people. 7% (IQR 7. 6–9. 7%)
However, the decline in the use of doxycycline for urinary and reproductive system infections is twice that of the former (4. 3% (IQR 3. 5–5. 3%))
Relative to the current ongoing care.
Conclusion self-vaccination between anatomical sites in females may play a role in maintaining high prevalence of chlamydia.
More anorectal examinations may be considered for female STI clinic participants (albeit modest)
Reduce the impact of prevalence.
Purpose: female chlamydia anorectal (chlamydia)
Regardless of the recent anal intercourse, infections are common.
We explored the role of anorectal infection in the transmission of chlamydia and evaluated the impact of interventions aimed at improving the detection and treatment of anorectal infection.
Methods we developed a zoning model for a pair of heterosexual patients aged 15-29 years in the STI clinic where women may be susceptible to infection or infection with urology and/or anal
By fitting the anatomical site, the probability of transmission per vaginal and anal behavior and the probability of automatic vaccination were estimated
Specific Prevalence data (14% urogenital;
11% anorectal prevalence).
We looked into 10-
The prevalence of chlamydia in women with interventions decreased year by year (
General anorectal examination for female STI clinic attendees or use of force-in-force for urinary and reproductive chlamydia)
Relative to the current ongoing care (
Indication of anorectal examination for anorectal and azithromycin of chlamydia in urinary reproduction and qianglipin).
Results The probability of transmission of each anal behavior was 5. 8% (IQR 3. 0–8. 3%)
Sex per vagina 2. 0% (IQR 1. 7–2. 2%)
And the probability of daily self-vaccination is 0. 7% (IQR 0. 5–1. 0%).
Compared with the recent anal intercourse, the infection of anorectal infection caused by self-vaccination is more.
Universal anorectal examinations have moderately reduced the prevalence of the population, with 8 people. 7% (IQR 7. 6–9. 7%)
However, the decline in the use of doxycycline for urinary and reproductive system infections is twice that of the former (4. 3% (IQR 3. 5–5. 3%))
Relative to the current ongoing care.
Conclusion self-vaccination between anatomical sites in females may play a role in maintaining high prevalence of chlamydia.
More anorectal examinations may be considered for female STI clinic participants (albeit modest)
Reduce the impact of prevalence.
Chlamydia (chlamydia)
It is the most common bacterial STI in the world, and if not treated, it may lead to serious long-term infection.
Long-term complications including pelvic inflammatory disease and infertility.
Chlamydia, like the infection of the urinary and reproductive system, can also cause anorectal infection, and the incidence of anorectal diseases is between the ages of 5. 6% and 17. 5%.
2 women with anorectal infection often suffer from chlamydia infection in the urinary and reproductive system at the same time (71–95%)
And vice versa (
33-83% have urinary and reproductive system infection with anorectal infection at the same time).
For women with anal symptoms or recent anal intercourse, anal examination of chlamydia is generally recommended as an indication.
3-5 studies on routine general-purpose anorectal examination consistently found that the prevalence of chlamydia anorectal in women with or without anorectal symptoms or anal history was similar.
6-8 this indicates that many Anal chlamydia infections were missed by testing only according to the indications.
In addition, when women are infected in both locations but do not have an anorectal infection test, they are treated with standard treatment for urinary and reproductive system infection, which is usually azithromycin.
A recent randomized controlled trial (RCT)
High efficacy of azithromycin was found (97%)
Qianglipin (100%)
Treatment of urinary and reproductive system infection
However, according to observational studies, there was no randomized controlled trial and recent systematic review of the efficacy of azithromycin and qianglipin in the removal of anorectal infections, and the efficacy of azithromycin in the treatment of chlamydia anorectal decreased compared with qianglipin (83% vs 99. 6%).
These findings suggest that many anorectal infections are poorly treated with azithromycin provided for chlamydia urological, which may be a potential barrier to controlling the spread of chlamydia and its complications. The high co-
The occurrence of female anorectal and urinary and reproductive system infections may indicate an automatic vaccination process in which an anatomical site is vaccinated with an infectious body from another site.
12 taking into account self-inoculation, it has been calculated that, compared with azithromycin, women have almost six times higher chances of chlamydia infection in the urinary and reproductive system after the treatment of qianglipin.
However, the role of self-vaccination in the transmission of chlamydia has not been quantified.
In order to optimize the testing and treatment guidelines, an in-depth understanding of the role of anal rectal infection in the transmission of chlamydia and possible self-vaccination pathways is required.
Mathematical modeling is a tool to understand the spread of infection in the population and to estimate the impact of interventions.
Here, the first objective is to establish a mathematical model to quantify the contribution of anorectal infection and self-vaccination to the transmission of chlamydia in women.
The second objective is to estimate the population.
Aim to reduce the level impact of the intervention measures for anorectal infection.
Methods dynamic propagation model we used a deterministic paired-room model to describe the pairing formation and separation of heterosexual men and women aged 15-29 who participated in STI clinics.
The model is based on the existing general population pair model.
Here, the model is expanded in two ways.
First, two anatomical sites of infection were included for women: the anorectal and the urinary and reproductive system.
Due to very few anal infections in heterosexual men, only the location of the male urinary and reproductive system was included.
Second, the model was extended to include two types of partnerships: one for anal and vaginal intercourse and the other for vaginal intercourse only.
Partnerships can be formed and broken at any time.
A detailed description of the model is given in the online Supplementary Text S1, and the parameters and their values are shown in Table 1 and online Supplementary Tables S1 and s2.
View this table: View the inline View pop-up table for the Model 1 parameters and corresponding values reflecting heterosexual populations of men and women aged 15-29
Not including the prodigal and prostitutes)
Criteria for receiving supplementary data [sextrans-2016-052786supp. pdf]
In short, the individual is either susceptible or infected at these two anatomical locations.
We assume that the natural removal of infection is
Specifically, this means that women can clear the infection at one anatomical location, but remain infected at another anatomical location.
After treatment or after treatment
With specific natural removal, individuals can become susceptible again.
There are three ways of infection.
First, include the probability of transmission of each vaginal sex, leading to infection of the urinary and reproductive system in men and women.
To limit the number of unknown parameters, we assume that male-to-
Women as womento-
Male communication.
Second, including the probability of transmission of each anal sex behavior, resulting in female anal infection and male urinary and reproductive system infection, similarly, the probability of transmission in any direction is the same.
Third, for women alone, the automatic vaccination process is listed as the daily probability of urinary and reproductive system infection caused by anal inflammation infection or anal inflammation infection, there is the same probability in either direction.
Empirical dataWe used data from female STI clinic visitors who participated in the South Limburg Public Health Service from May 2012 to July 2013, in which patients aged 18 and over received routine in two anatomical locations
Chlamydia was detected in 6 samples using nucleic acid amplification analysis (NAAT).
We used data from all straight women aged 18-29 (n=434)
Does not include sex workers or wobbles for access to the urinary and reproductive system, anorectal and concurrent (
Urology and anorectal)
Prevalence of infection and 95% CIs, and percentage of reported anal sex was obtained.
All other behavioral parameters come from all participants in STI clinics aged 15-29 or other relevant sources.
Three transmission probabilities (
Probability of transmission and self-vaccination per vaginal and anal sex)
Assuming that background women undergo 14% tests per year and 15 are partner notification probability 0, calibration is performed based on STI clinic data.
516 and standards of care in the Netherlands.
In this standard of care, participants in all STI clinics were tested for genital chlamydia, and only women who reported anal sex six months before the clinic visit were also examined for anal sex.
For the treatment of chlamydia, single dose of azithromycin (1u2005g)
For infection of the urinary and reproductive system, 7-day (
100 mg twice a day)
When an anorectal infection is detected through the test, force-in is used.
Details of the calibration procedure can be found in the online supplementary text s2.
Throughout the paper, only transmission probability sets that cause the prevalence of model points to be lower than the data 95% CIs were used.
For each of these parameter sets, we calculated the cumulative number of events that resulted in transmission between individuals and within individuals between anatomical sites.
We then calculated the event distribution for each anatomical site by dividing the cumulative number of infections caused by vaginal intercourse or automatic vaccination from the anorectal to the urinary reproductive site by the total cumulative number of urinary reproductive system infections
For anorectal location, we divide the cumulative number of infections caused by anal intercourse or automatic vaccination from the urinary reproductive system to the anorectal site by the total cumulative number of anorectal infections (
See online Supplementary Text S1).
All results are provided in the form of medians and IQRs.
We tested the effects of three different intervention scenarios (table 2).
This effect was defined as the relative difference in prevalence of chlamydia among female STI clinic visitors 10 years after the introduction of the intervention compared to continuing care standards.
First of all, we evaluated the effect of the widespread use of qianglipin, which means that all people who are positive for the detection of chlamydia in the urinary and reproductive system are receiving qianglipin.
Second, we estimate the effect of the general test on the two anatomical sites for the treatment of urinary and reproductive system infection with azithromycin alone, and the effect of the treatment of anorectal infection with force.
Finally, we tested the combined effects of the two interventions.
View this table: looking at the nursing standards included in the inline View popupTable2 model and the intervention scenario uncertainty analysis of the three studies we performed anal frequency on the effects of the intervention on various parameters including duration of anorectal infection, recently, the proportion of anal sex may be lower-
Reported, as well as the efficacy of azithromycin and qianglipin in the treatment of anorectal and urinary tract infections.
We have also studied a situation in which the standard care for treating anorectal infections is azithromycin (In USA4, for example)
And scenarios with high test usage (
In the 10 years obtained in the UK, it increased from 14% to 40%).
Finally, we fit the model to the other two data sources for general testing (
View online supplementary text S3 and figure S2).
7. 8 for each uncertainty analysis, we converted the model into data and used the transmission probability consistent with the data to analyze the impact of the intervention.
Dynamic propagation model we used a deterministic pair-room model that describes the formation and separation of heterosexual male and female pairs participating in STI clinics between the ages of 15-29.
The model is based on the existing general population pair model.
Here, the model is expanded in two ways.
First, two anatomical sites of infection were included for women: the anorectal and the urinary and reproductive system.
Due to very few anal infections in heterosexual men, only the location of the male urinary and reproductive system was included.
Second, the model was extended to include two types of partnerships: one for anal and vaginal intercourse and the other for vaginal intercourse only.
Partnerships can be formed and broken at any time.
A detailed description of the model is given in the online Supplementary Text S1, and the parameters and their values are shown in Table 1 and online Supplementary Tables S1 and s2.
View this table: View the inline View pop-up table for the Model 1 parameters and corresponding values reflecting heterosexual populations of men and women aged 15-29
Not including the prodigal and prostitutes)
Criteria for receiving supplementary data [sextrans-2016-052786supp. pdf]
In short, the individual is either susceptible or infected at these two anatomical locations.
We assume that the natural removal of infection is
Specifically, this means that women can clear the infection at one anatomical location, but remain infected at another anatomical location.
After treatment or after treatment
With specific natural removal, individuals can become susceptible again.
There are three ways of infection.
First, include the probability of transmission of each vaginal sex, leading to infection of the urinary and reproductive system in men and women.
To limit the number of unknown parameters, we assume that male-to-
Women as womento-
Male communication.
Second, including the probability of transmission of each anal sex behavior, resulting in female anal infection and male urinary and reproductive system infection, similarly, the probability of transmission in any direction is the same.
Third, for women alone, the automatic vaccination process is listed as the daily probability of urinary and reproductive system infection caused by anal inflammation infection or anal inflammation infection, there is the same probability in either direction.
Empirical dataWe used data from female STI clinic visitors who participated in the South Limburg Public Health Service from May 2012 to July 2013, in which patients aged 18 and over received routine in two anatomical locations
Chlamydia was detected in 6 samples using nucleic acid amplification analysis (NAAT).
We used data from all straight women aged 18-29 (n=434)
Does not include sex workers or wobbles for access to the urinary and reproductive system, anorectal and concurrent (
Urology and anorectal)
Prevalence of infection and 95% CIs, and percentage of reported anal sex was obtained.
All other behavioral parameters come from all participants in STI clinics aged 15-29 or other relevant sources.
Three transmission probabilities (
Probability of transmission and self-vaccination per vaginal and anal sex)
Assuming that background women undergo 14% tests per year and 15 are partner notification probability 0, calibration is performed based on STI clinic data.
516 and standards of care in the Netherlands.
In this standard of care, participants in all STI clinics were tested for genital chlamydia, and only women who reported anal sex six months before the clinic visit were also examined for anal sex.
For the treatment of chlamydia, single dose of azithromycin (1u2005g)
For infection of the urinary and reproductive system, 7-day (
100 mg twice a day)
When an anorectal infection is detected through the test, force-in is used.
Details of the calibration procedure can be found in the online supplementary text s2.
Throughout the paper, only transmission probability sets that cause the prevalence of model points to be lower than the data 95% CIs were used.
For each of these parameter sets, we calculated the cumulative number of events that resulted in transmission between individuals and within individuals between anatomical sites.
We then calculated the event distribution for each anatomical site by dividing the cumulative number of infections caused by vaginal intercourse or automatic vaccination from the anorectal to the urinary reproductive site by the total cumulative number of urinary reproductive system infections
For anorectal location, we divide the cumulative number of infections caused by anal intercourse or automatic vaccination from the urinary reproductive system to the anorectal site by the total cumulative number of anorectal infections (
See online Supplementary Text S1).
All results are provided in the form of medians and IQRs.
We tested the effects of three different intervention scenarios (table 2).
This effect was defined as the relative difference in prevalence of chlamydia among female STI clinic visitors 10 years after the introduction of the intervention compared to continuing care standards.
First of all, we evaluated the effect of the widespread use of qianglipin, which means that all people who are positive for the detection of chlamydia in the urinary and reproductive system are receiving qianglipin.
Second, we estimate the effect of the general test on the two anatomical sites for the treatment of urinary and reproductive system infection with azithromycin alone, and the effect of the treatment of anorectal infection with force.
Finally, we tested the combined effects of the two interventions.
View this table: looking at the nursing standards included in the inline View popupTable2 model and the intervention scenario uncertainty analysis of the three studies we performed anal frequency on the effects of the intervention on various parameters including duration of anorectal infection, recently, the proportion of anal sex may be lower-
Reported, as well as the efficacy of azithromycin and qianglipin in the treatment of anorectal and urinary tract infections.
We have also studied a situation in which the standard care for treating anorectal infections is azithromycin (In USA4, for example)
And scenarios with high test usage (
In the 10 years obtained in the UK, it increased from 14% to 40%).
Finally, we fit the model to the other two data sources for general testing (
View online supplementary text S3 and figure S2).
7. 8 for each uncertainty analysis, we converted the model into data and used the transmission probability consistent with the data to analyze the impact of the intervention.
The results were consistent with the visitor data from STI clinics in the Netherlands, and the model was able to produce chlamydia prevalence (figure 1A).
The prevalence of anal infection in women in the model was slightly higher than the data, but was still in the CIs of the data.
Download the new tabDownload powerpointFigure1 (A)
The prevalence of chlamydia in the female urinary system, anorectal and concurrent infections and the prevalence of the male urinary system were 95% CI for heterosexual persons aged 18-29 (
Do not include vagrant and sex workers)
Visit the STI clinic in South Limburg, Netherlands from May 2012 to July 2013 (squares)
Median prevalence from the model (open diamonds)
And 95% percentile for all runs. (B)
Calibration transmission probability of three different transmission routes. (C)
Distribution of female urinary and reproductive system infection (white)
Anorectal infection (grey)
Occurring through sexual intercourse or self-inoculation. In (B)and (C)
The result is shown as medians (black line)
, Where the boxes representing the IQRs and bars are the minimum and maximum values.
We found that the median transmission probability is 2. 0% (IQR 1. 7–2. 2%)
Vaginal sex from male to female, from female to male (figure 1B).
The probability of anal sex is more than twice that of vaginal sex, that is, 5. 8% (IQR 3. 0–8. 3%)
From men to women, from women to men.
The median probability of daily self-vaccination for women is low (0. 7%; IQR 0. 5–1. 0%)
Than the probability of transmission of each sexual act.
Using a calibrated probability of transmission, we calculated the proportion of female infections caused by sexual intercourse or autovaccination at each anatomical location (figure 1C).
In the model, there are more urinary and reproductive system infections caused by vaginal sex (57%; IQR 46–64%)
Than by automatic inoculation (43%; IQR 36–54%).
The contribution of self-vaccination in anorectal infection is much larger, that is, 87% (IQR 81–93%)
Compared with 13% (IQR 7–18%)
Through anal sex
The impact of impact intervention scenario intervention was calculated as a relative decrease in the prevalence of female STI outpatient visitors compared to continuing care criteria (
See online supplementary figure S1).
The use of qianglipin as a general therapeutic drug for all detected Chlamydia infection has little effect on the overall reduction (
Urinary and/or anorectal)
Prevalence of chlamydia among female STI outpatients: prevalence decreased by 4. 3% (IQR 3. 5–5. 3%)
Compared with the continuation of this 10-year standard of care, 10 years later (table 3).
In absolute terms, this means the total prevalence of chlamydia in this STI clinic population (15. 5%; IQR 16. 7–18. 2%)
Only slightly minus 0. 7% (IQR 0. 6–0. 9%).
The impact of the introduction of routine universal testing at two anatomical locations on the reduction of chlamydia prevalence has almost doubled (
A relative decrease of 8. 7% (IQR 7. 6–9. 7%)after 10u2005years).
In absolute terms, this reduction is relatively small and the prevalence is absolutely reduced by 1. 5% (IQR 1. 3–1. 6%).
The relative impact of the combination of the two interventions is the largest (9. 3%; IQR 8. 2%10. 3%)
10 years later, but the additional impact is negligible compared to a separate generic test.
For all interventions, the relative reduction in anorectal disease is slightly greater than that of the urinary and reproductive system disease, as the interventions aim to strengthen the detection and treatment of anorectal disease (
See online replenishment tables S3 and S4).
View this table: View the total relative decrease of inline View popupTable3 (
Urinary and/or anorectal)
10 years after the introduction of universal routine qianglipin therapy or universal routine anorectal examination or two interventions, the prevalence of chlamydia in female STI outpatient visitors, or with the continuation of the standard of nursing uncertainty analysis, the prevalence is robust for the hypothesis of testing (table 3;
See online replenishment tables S3 and S4).
However, when it is assumed that azithromycin is less effective in removing anorectal infections and that azithromycin is the standard care for treating anorectal infections, population prevalence estimates are significantly reduced.
In addition, for universal testing only, it is estimated that the prevalence will decrease significantly when the duration of anorectal infection is assumed to be longer.
We found that the median transmission probability is 2. 0% (IQR 1. 7–2. 2%)
Vaginal sex from male to female, from female to male (figure 1B).
The probability of anal sex is more than twice that of vaginal sex, that is, 5. 8% (IQR 3. 0–8. 3%)
From men to women, from women to men.
The median probability of daily self-vaccination for women is low (0. 7%; IQR 0. 5–1. 0%)
Than the probability of transmission of each sexual act.
Using a calibrated probability of transmission, we calculated the proportion of female infections caused by sexual intercourse or autovaccination at each anatomical location (figure 1C).
In the model, there are more urinary and reproductive system infections caused by vaginal sex (57%; IQR 46–64%)
Than by automatic inoculation (43%; IQR 36–54%).
The contribution of self-vaccination in anorectal infection is much larger, that is, 87% (IQR 81–93%)
Compared with 13% (IQR 7–18%)
Through anal sex
The impact of impact intervention scenario intervention was calculated as a relative decrease in the prevalence of female STI outpatient visitors compared to continuing care criteria (
See online supplementary figure S1).
The use of qianglipin as a general therapeutic drug for all detected Chlamydia infection has little effect on the overall reduction (
Urinary and/or anorectal)
Prevalence of chlamydia among female STI outpatients: prevalence decreased by 4. 3% (IQR 3. 5–5. 3%)
Compared with the continuation of this 10-year standard of care, 10 years later (table 3).
In absolute terms, this means the total prevalence of chlamydia in this STI clinic population (15. 5%; IQR 16. 7–18. 2%)
Only slightly minus 0. 7% (IQR 0. 6–0. 9%).
The impact of the introduction of routine universal testing at two anatomical locations on the reduction of chlamydia prevalence has almost doubled (
A relative decrease of 8. 7% (IQR 7. 6–9. 7%)after 10u2005years).
In absolute terms, this reduction is relatively small and the prevalence is absolutely reduced by 1. 5% (IQR 1. 3–1. 6%).
The relative impact of the combination of the two interventions is the largest (9. 3%; IQR 8. 2%10. 3%)
10 years later, but the additional impact is negligible compared to a separate generic test.
For all interventions, the relative reduction in anorectal disease is slightly greater than that of the urinary and reproductive system disease, as the interventions aim to strengthen the detection and treatment of anorectal disease (
See online replenishment tables S3 and S4).
View this table: View the total relative decrease of inline View popupTable3 (
Urinary and/or anorectal)
10 years after the introduction of universal routine qianglipin therapy or universal routine anorectal examination or two interventions, the prevalence of chlamydia in female STI outpatient visitors, or with the continuation of the standard of nursing uncertainty analysis, the prevalence is robust for the hypothesis of testing (table 3;
See online replenishment tables S3 and S4).
However, when it is assumed that azithromycin is less effective in removing anorectal infections and that azithromycin is the standard care for treating anorectal infections, population prevalence estimates are significantly reduced.
In addition, for universal testing only, it is estimated that the prevalence will decrease significantly when the duration of anorectal infection is assumed to be longer.
Discussing our results suggests that self-vaccination between the female urinary and reproductive system and the anorectal site may play an important role in the spread of chlamydia and the maintenance of high prevalence of chlamydia in women.
Although chlamydia is almost as common in the urinary and anal tract, we find that infection of the urinary and reproductive system is more due to vaginal sex than to anal infection.
This suggests that most female infections start with the urinary and reproductive system, are transmitted through vaginal sex and then through self-inoculation to the anorectal site.
We also found that in an environment that provides qianglipin for anorectal infections, compared with the general use of qianglipin for the treatment of urinary and anal infections, increasing the routine anorectal universal test for women is more effective in reducing the prevalence of women in STI clinics.
As far as we know, we are the first to dissect the site.
Specific chlamydia infection in the heterosexual population model.
One advantage of the model is that it clearly contains the duration of the partnership, which means that the infected partner in the partnership may be infected again.
Another advantage is that the model is validated using empirical data and enhances the usefulness of decision making.
The results are robust for data sources from different settings and for most deviations in the assumptions.
There are also limitations in this study.
First, the model does not consider other possibilities, other than sexual contact or self-inoculation, that is, how people are infected at the anorectal site, for example by oral sex through intestinal infection (
As suggested in animal models).
Second, we assume that all anal infections are also contagious.
CURRENT Diagnosis of chlamydia (NAAT)
It is impossible to distinguish between living and dead creatures to indicate possible contagious.
Bacterial load may provide some clues, and a recent study found that the Anal chlamydia load in women and men who have sex with men is within a similar range (MSM).
Finally, since the model is fitted according to STI clinical data, it contains a relatively high set of features --
Dangerous sexual behaviour and high prevalence of chlamydia were compared to the general population.
We speculate that more heterogeneity is added to the model (
That is, by including low
Risk individuals or allow high dispersion
Risk Behavior of visitors to STI clinics)
Interventions will be estimated to have less impact on reducing prevalence.
We set up a website.
Specific natural removal of infection, not individual-
Levels of infection cleared.
This means that when a woman is infected in two anatomical locations, she may clear the infection in one location, but not necessarily in the other.
She will then be able to re-infect herself, thus prolonging her contagious nature, which may lead to an overestimation of the probability of automatic vaccination.
And the possibility of the scene-
The specific clearance of chlamydia is not clear, and our hypothesis is consistent with a previous study that looks at the role of the site
Specific infection in leucorrhea transmission.
21 In addition, a study on the acquisition and removal of human HPV in men who have sex with men estimated different clearance rates between the positions of the anorectal and urinary and reproductive systems, suggesting that individuals-
No horizontal clearance required.
22 The probability of transmission of each vaginal sex found here is lower than that found in previous chlamydia models.
The transmission probability estimated by most paired models is between 6% and 17% 14,23, compared to 2% in our study.
This can be explained by the additional appeal generated by the self-vaccination process in the current model, where the probability of vaginal infection can be seen as a combination of the two probabilities.
Also, we assume that there is more sex per week compared to other models (
Because we simulate STI clinic visitors)
There is no immune duration, which leads to an equal duration of infection and a lower probability of automatic transmission of each vaginal sex.
We have a 9% chance of infection per week through vaginal sex or self-vaccination.
Our results suggest a process of self-inoculation of chlamydia between anatomical sites in women.
The support of the auto-vaccination theory is mainly derived from observational studies because of the lack of conclusive evidence of this theory.
For example, some studies have found that the rate of anorectal detection in women who do not report anal sex is high.
It is not clear whether other transmission routes besides self-vaccination can partially explain the detection of chlamydia anorectal.
A recent study found that anal use of fingers or toys had nothing to do with the detection of chlamydia anorectal, making this route of transmission unlikely.
6 Further observation evidence of the automatic vaccination process comes from urinary system infection, and bacteria with bacteria in the intestines invade the urinary system.
24 In addition, a large part of our results (43%)
Chlamydia infection in the urinary system site is caused by self-vaccination, which is also consistent with the study showing that the rate of chlamydia infection in the female urinary system is high.
14, 25 we estimate that the relative impact of routine universal testing on the reduction of chlamydia prevalence is almost twice as high as that of general-purpose force therapy.
An important factor affecting the effect of universal examination of anorectal is the proportion of single anal infection.
The prevalence of single anal infections in women is uncertain, resulting in published estimates ranging from 4% to 25%.
2 in the model, the prevalence of anorectal is slightly higher than the data (
But still within CIs)
, The percentage of single anal infection is slightly higher (22%).
However, this is within the scope of publication in the literature.
2 In addition, it is doubtful whether the universal anorectal examination is feasible in practice, because the cost of testing all female STI clinic visitors at two anatomical locations will be high.
Future studies should include an economic assessment of the clinical impact of interventions for anorectal infections, taking into account the long-term
By interrupting self-vaccination, repeated urinary and reproductive system infections are prevented, and long-term complications such as infertility and ectopic pregnancy are avoided.
With regard to the type of treatment for chlamydia in the urinary system, debate is currently under way, but a recent randomized controlled trial did not find that azithromycin was not
In the treatment of urinary and reproductive chlamydia, it is not as good as force.
We found that, compared to the continued use of azithromycin, the standard treatment for chlamydia as a urinary system only slightly reduced the prevalence of chlamydia among visitors to STI clinics.
It should be noted that when anorectal infection has been treated with dorsitin in the standard of care, the prevalence of chlamydia is reduced by a limited amount.
When azithromycin is the standard of care for anorectal infection (as in the USA)
, 4 through the introduction of qianglipin therapy, it is expected to have a greater impact on reducing prevalence.
In both cases, the use of qianglipin as a standard treatment for chlamydia, by preventing complications or producing antimicrobial resistance to Mycoplasma reproductive, may still be beneficial at the individual level
26. finding that the greatest impact of universal qianglipin therapy on the reduction of chlamydia prevalence is the low efficacy of azithromycin in the removal of anorectal infections, which highlights the need for randomized controlled trials to determine chlamydia anorectal
In conclusion, self-vaccination between anatomical sites in women seems to be possible, and may be important for the ongoing spread of chlamydia.
Continuing the use of qianglipin for the treatment of chlamydia anorectal, and turning to more anorectal examinations for female STI clinic participants, may consider the use of qianglipin (albeit modest)
Impact on lowering continuous highs
Epidemic of chlamydia in the crowd
Key Information studies on routine generic tests show that female anorectal infections are common regardless of reported anal sex.
Mathematical models have shown that infection of the urinary and reproductive system is usually caused by vaginal sex, while anorectal infections are rarely caused by anal sex.
Self-vaccination between the location of female urology and anorectal anatomy may play a role in maintaining high chlamydia prevalence.
More anorectal examinations may be considered for female STI clinic participants (albeit modest)
Reduce the impact of prevalence.
The author thanks Pippa Scott for his comments on the final version.
European Center for Disease Prevention and Control (ECDC).
2013 Annual Report on epidemiology.
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1093/cid/ciu220OpenUrlAbstract/FREE complete text script processing editor Jackie A cassellbeings JCMH designed this study, developed A mathematical model, carried out the modelGAFSvL, NHTMD-
Data were collected and analyzed.
NHTMDM and BHBvB contributed to the design of the study and contributed to the design of the mathematical model.
All authors contributed to the interpretation of the results and commented on the manuscript.
No one declared a competitive interest.
Obtain patient consent.
The study was approved by the medical ethics committee of the University of Maastricht (11-4-108).
Uncommissioned source and peer review;
External peer review.