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Why are Chllamydia and H HPV major pubblic health pro oblems?
LETTER TTO THE EDITOR D : WHY ARE C HLAMYD DIA AND HPV H MAJOOR PUBLICC HEALTH PROBLEM MS? Dzintars Ozo olins Central laborratory of Pauls Stradins Clin nical Universitty Hospital, Prresident of the e Latvian Soci ety of Laboratory specialists ng author’s a address Correspondin Dzintars Ozo olins Central laborratory of Pauls Stradins Clin nical Universitty Hospital 13 Pilsonu Sttreet Riga Latvia LV V1002 Phone +371 67095318
INTRODUCCTION Chlamydia trrachomatis is a bacterium that is one of tthe most com mmon sexually y transmitted infections in E Europe. Ratess in sexually active young p people are com mmonly betw ween 5% and 10%. The num mber of diagnnosed cases iss increasing in n many Europeean countries, in part due e to increasedd testing and the use of m more sensitive tests. People e with genitall chlamydia m may experiencee symptoms o of genital tracct inflammatio on including u urethritis and cervicitis, butt the majorityy remains asym mptomatic. Chlamydia C is a a significant ppublic health problem because untreateed chlamydia a may lead to o pelvic inflam mmatory diseaase, subfertilitty and poor reeproductive o outcomes in ssome women.. Chlamydia a also facilitatess the transmisssion of HIV. The cost of treating t subfeertility due to o Chlamydia is high as it rrequires tubal surgery and d invitro fertiliisation. Altho ough inexpenssive and effe ctive treatme ent is available, control off Chlamydia is i challengingg since most people are asyymptomatic. A human pap pillomavirus (HPV) infection is the most common sexxually transmittted infectionn (STI) and hass been clearlyy established as the necesssary cause of o invasive ceervical cancer. More than n 30 to 40 tyypes of HPV are typicallyy transmitted tthrough sexual contact and d infect the a nogenital region. Some sexxually transmiitted HPV types may causee genital wartss. Persistent infection with h "high‐risk" HPV types—d different from m the ones thhat cause skin n warts—mayy progress to p precancerous lesions and in nvasive cance r.
PROBLEMSS OF EXISTIN NG EUROPE EAN SCREEN NING AND SU URVEILLANC CE PROGRA MMES Eighteen EU U Member Sttates indicate ed that no C hlamydia screening progrramme was iin place. In six s countries,, asymptomattic individuals may be teste ed for Chlamyydia when the ey attend other health servvices. The gro oups targeted d for such opp portunistic sccreening vary between andd within coun ntries. For exxample, in Iceeland Chlamyydia testing iss offered to women who haave an abortio on, in Estonia it is offered to o pregnant women and thoose who frequ uently changee sexual partneers; in Norway it is offered to women atttending for aan abortion orr antenatal ca re, young peo ople under 25 5 years with reecent partnerr change and partners of p atients with aan STI; in Den nmark, two coommunities re eceive annuall postal invitations for chlaamydia testing. Chlamydiaa screening prrogrammes were w introducced throughou ut England in n 2007 for sexxually active men and wo omen aged unnder 25 attending variouss clinical and non‐clinical settings (e.g.. universities aand sporting eevents). In the e Netherlandss a pilot progrramme of annual postal invvitation in thre ee regions forr
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Why are Chlamydia and HPV major public health problems?
16‐29 year olds was introduced in early 2008. A register‐based screening programme using mailed home‐collected specimens is planned in Norway. A further nine countries plan to introduce opportunistic Chlamydia screening programmes in the future. Although screening is widespread in Sweden, chlamydia control activities are funded and implemented by each county and are not coordinated nationally. High per capita rates of screening are also achieved in Norway despite the lack of a national programme. Pilot programmes using register‐based postal invitations are underway or planned in the Netherlands, Norway and Denmark. In European countries, a cervical Papanicolaou (Pap) test is used to detect abnormal cells which may develop into cancer. Although it is possible to test for HPV DNA, there are no approved HPV DNA tests for general screening in European Union. It appears that the organization of Chlamydia and HPV control varies widely. Activities classified as national programmes were identified in only two countries, England and the Netherlands. Similarly, there is variation in the recommendations between different guidelines, for example in the need for repeat testing. HPV infection is the most common STI and has been clearly established as the necessary cause of invasive cervical cancer. The vast majority of cervical cancer cases and deaths occur in East‐European