Monday, June 17, 2013

Chlamydia

1.0 Introduction Genital Chlamydia trachomatis simply referred to as Chlamydia, remains one of the most commonly diagnosed and treated sexually transmitted disease in the Britain (Appendix 1). According to MindMetre (2012) in the year 2010 an estimated 160,000 new Chlamydia infections were reported in the United Kingdom (Appendix 2). By the year 2012 the number of Chlamydia infection had increased and an estimated 186,000 new cases were reported. The most commonly affected age group by Chlamydia in the United Kingdom is the young people aged 15-24 who are sexually active (Public Health England, 2013). More over, an estimated one out of every 14 young people tested for Chlamydia turn out positive (Public Health England, 2013) (Appendix 3). MindMetre (2012, p. 3) claims that an estimated 65% of all the cases of Chlamydia reported in the year 2008 affected sexually active youths aged 16-24 years old. The greatest concern about Chlamydia infection is the propensity of the disease to be asymptomatic and consequently going undetected in a majority of its victims. It is for this reason that Chlamydia is also commonly referred to as the “silent disease”. Delvin (2012) asserts that in 2010 an estimated 216,000 (128,000 females and 88,000 males) received treatment for Chlamydia at British Genitourinary Medicine (GUM) (Appendix 5). Nevertheless, most of the women who test positive for the disease claim to have experienced mild pains in the lower abdomen, cystitis and a transformation in their vaginal discharges. Delvin (2012) points out that infected men may experience some slight discomfort on the head of their male organs as well as mild discharge. There are many health complications that individuals infected by Chlamydia are confronted with; these include infertility, pelvic inflammatory disease and ectopic pregnancies. Males infected with the disease may also experience joint inflammation which is very difficult to control medically (Delvin, 2012). 2.0 Chlamydia in the British Public According to McBean (1992) for any effective response to be formulated in response to Chlamydia prevalence in Britain it is important that the policy makers and authorities be aware of the process through which Chlamydia comes into the British public. According to the London Health Observatory (2010, p. 1) many of the sexually transmitted infections that are reported tin Britain tend to be associated with HIV/AIDs infections. People with HIV/AIDs have a propensity to report a myriad of other sexually transmitted infections which occur as opportunistic diseases. London is described as having the highest rates of sexually ill individuals with an estimated one in every diagnosis of HIV/AIDs being confirmed as having Chlamydia (London Health Observatory, 2010). As a matter of fact in 2004-2008 the new diagnosis of Chlamydia rose by 8% (Health Protection Agency, 2007). Another important aspect in the discussions of Chlamydia in the British public is the fact that Britain is characterized by poor and unequal access to sexual health medical services. This plays a very significant role in increasing the prevalence of Chlamydia and other sexually transmitted diseases. Social inclusion due to factors such as teenage pregnancy also tends to isolate the group of people who need sexual education most and thus supports the increase and frequency of Chlamydia infections in Britain (London Health Observatory, 2010). 3.0 Responses of Different Stakeholders As is to be expected owing to the frequency and degree at which Chlamydia infections are diagnosed and treated in Britain, the different stakeholders in have responded to the issue in different manners. (a) The Government According to the Department of Health (2004) there have been a number of government initiatives in Britain to respond to the issue of Chlamydia infections. These initiatives have mostly been fashioned to ensure that the National Health Service is transformed to respond to the Chlamydia issue more effectively. Since the beginning of the year 2013 the local authorities in different regions of Britain have been very involved in their emergent public health function of ensuring Chlamydia screening for the targeted age group. The government in Britain has also come up with initiatives such as the Young People’s Development Program that is aimed ate providing services to members of the target group suspected to be affected by mental incapacitations of substance abuse. The government supported the White Paper: Choosing Health by giving £300 million to be used in the promotion of sexual health in Britain. More over, according to the department of health (2006) the value added tax for condoms in Britain was decreased so as to encourage safe sex and reduce the number of new Chlamydia infections. The Department of Health (2008) claims that the Evaluation One Stop Shop framework of health delivery was formulated by the government to respond to the shortage of sexual health specialists in Britain. More over, the Department of health (2004) reveals that the British government is committed to responding to Chlamydia issue in Britain by responding to the health disparities that characterize the Nation of Britain. This is achieved by ensuring that youth from minority groups such as the disabled, blacks and those with little or no education are included in the health policy initiatives regarding Chlamydia as well as other sexually transmitted infections (Appendix 4). Although the government in Britain has indeed attempted to come up with strategies to respond to the issue of Chlamydia in Britain, Measor et al (2000) claims that these strategies have not been very effective due to the formulation of discrepant policies in different parts of Britain as well as the absence of a coherent national policy that can respond effectively to issues affecting the youth in Britain. Consequently, the messages being transmitted to the youth regarding sexuality tend to be very confusing. A majority of the youngsters in Britain disagree with the government regarding the amount of power and rights that their parents should exercise over them. (a) Health Department MindMetre (2012, p. 3) purports that the National Chlamydia Screening Program (NCSP) which was formed in the year 2003 has attained an estimated 100% increase in the rates of Chlamydia testing for sexually active youths in England who are aged 15-24. According to NCSP (2009) the number of persons in this age group who have been tested since the formation of NCSP increased from 18,000 in 2003-04 to an estimated 1.8 million youth in 2010-11. According to the Public Health England (2013) the Department of Public Health Outcomes framework (2013-2016) has come up with an indicator that used in evaluating the regions achievements and developments in the control of Chlamydia in young adults that are sexually active. According to this assessment indicator the target in local regions of Britain is to reduce the number of new Chlamydia infections to n estimated 2,400 Chlamydia diagnoses in every 100,000 sexually active youths aged 15-24 years old (Appendix 3). In the year 2005 the National Chlamydia Screening Program was rejuvenated in a joint effort with the Health Protection Agency so as to sensitize the target group on Chlamydia; the target group (15-25 years old) have since then been offered confidential testing as well as a website, www.chlamydiascreening.nhs.uk, which posts answers to frequently asked questions regarding Chlamydia. Triggle (2009) posits that despite the response by the NCSP to the issue of Chlamydia, there have been a number of setbacks. Audits conducted on the program by the National Audit office in the year 2009 alleged that NHS had not only duplicated efforts but also not accomplished its objectives of testing a great number of youths aged 25 years and below in England (Trigger, 2009). This is due to the fact that in 2007-8 only an estimated 5% of the target group had been screened for Chlamydia; this was short of the 15% set targets. More over, rather than costing the estimated £33 the screenings cost £56 as a consequence of efforts and resource duplication (Trigger, 2009). (b) Health Campaigners Response Different agencies in Britain that are particularly concerned with sexual health have put in their contributions in an effort aimed at reducing the levels of Chlamydia prevalence in Britain. A few years ago, the Family Planning Association, for instance, came up with the health Graffiti campaign aimed at sensitizing the public on Chlamydia. Graffiti and posters warning the public on the dangers of Chlamydia if untreated were posted in toilet cubes in an estimated 600 clubs and bars in Britain. The most common slogans included “Chlamydia is a Bitch” and “All Men are Tossers-If Only, then we wouldn’t have to Worry About Chlamydia”. In addition to this an estimated 250,000 postcards featuring a photo of a young man’s crotch in his jeans with the slogan “Chlamydia-Now Available in Easy to Open Packets” were also displayed all over Britain. (c) Media Response According to the World Health organization (2001) it is not a new phenomenon that the media has a tendency to influence and shape public views and behaviors, particularly in issues of public health. In recent years the media in Britain has been very influential in shaping the public perceptions and images of British health care systems as well as the policy alternatives that exist in the improvement of health care delivery systems. According to MindMetre (2012, p. 13) a great number of young adults gain awareness about issues of Chlamydia through media such as television, social networking media. The government has increased its collaboration with the media in Britain so as to increase the effectiveness of Chlamydia testing and awareness through government of health advertisements. Moreover, sexual health campaigners have increased their use of the social media so as to sensitize the youth in Britain about Chlamydia and other sexually transmitted infections that they should be wary of. MindMetre (2012) points out that there are an estimated 30 million Facebook users in Britain in the age group 15-25 years. 4.0 Data on Chlamydia As indicated in the Health Protection Agency (2008) there are many sources of data on Chlamydia in Britain. This data is usually gathered from surveys and investigative studies conducted in different regions of the nation. As indicated in Appendix 6, Chlamydia is the sexually transmitted disease which affects the highest number of people in Britain. The most affected regions are England, London as well as the southern and eastern parts (Appendix 7). 5.0 Letter To Newspaper Editor The issue of Chlamydia infections has been an issue of great concern in different regions of Britain. This is due to the fact that this sexual infection remains the most commonly diagnosed and with a higher incidence rates amongst youth aged 15-25 years. The fact that Chlamydia is a “silent disease” with not peculiar symptoms associated with it makes it even more difficult to control. The fact that the government health agencies in Britain have in the last one and a half decades attempted to respond effectively to the disease without attaining much success implies that important transformations need to be conducted on these strategies currently being applied to respond to Chlamydia in Britain. There are a number of strategies that can be applied in ensuring that the prevalence rates of Chlamydia in Britain decline considerably. Firstly, the NCPS agency needs to increase the collaboration that exists with the government and other strategic partners in responding to the Chlamydia issue in Britain. It is important to note that the main objective of the National Chlamydia Screen Program is the prevention and regulation of Chlamydia infections through early discovery and treatment of infected persons. If NCPS is able to attain a screening level that is higher than 35% the Chlamydia prevalence rates in Britain would reduce drastically. Another very significant recommendation is that Chlamydia testing should be made available for sexually active members in the target group (15-25 years) as part of their regular primary medical care and sexual consultation. This strategy would not only increase the frequency of discussions regarding the youths’ sexuality and sexual behavior but also ensure that Chlamydia infection is detected early and treated. As a consequence of the most commonly affected age group being the youth aged below 25 years of age, it is important that all initiatives towards the control of Chlamydia , for instance, Sex and Relationship Education (SRE) be directed to the age group 15-25. The levels of screening among the youth should be maintained so as to ensure a decline in the numbers of new Chlamydia infections. After screening, the persons that test positive should ne treated promptly and advised to refer their past sexual partners for sexually transmitted infections testing. In addition to this, integrating Chlamydia testing departments into the primary medical care services would increase the patients’ value for their money. Effective response to the Chlamydia issue in Britain also requires that the infected persona agree to be part of the Contract referral Program in Britain. This program is also commonly referred to as conditional referral and it refers to the practice of the health provider and Chlamydia patient agreeing that the patient-who has tested positive for Chlamydia- will, within a specified framework of time, notify all past sexual partners so that they may also get treated. 6.0 Conclusion As already indicated in this paper Chlamydia is the most commonly diagnosed and treated sexually transmitted infection in Britain with an estimated 1 out of every 14 people testing positive. Controlling Chlamydia is not an easy feat owing to the fact that the disease is a “silent infection” which has no symptoms and can thus unknowingly be transmitted from one person to the next. The most commonly affected age group in Britain is the sexually active youths aged 15-24 years old. There are a number of long term health complications that occur due to Chlamydia infection; the most common include pelvic inflammatory disease, infertility and ectopic pregnancies. It is interesting that despite the number of strategies, policies and programs that have been created by the government and health departments in Britain to respond to the issue of Chlamydia currently there is still a great need for behavior transformation in Britain. With a very high number of youths engaging in risky sexual tendencies it seems very unlikely that the issue of new Chlamydia infections will go away soon. 7.0 Appendices Appendix 1 (Health Protection Agency, 2010) Appendix 2 (Health Protection Agency, 2010) Appendix 3 (Health Protection Agency, 2010) Appendix 4 (Health Protection Agency, 2010) Appendix 5 (Health Protection Agency, 2010) Appendix 6 (Health Protection Agency, 2010) Appendix 7 (Health Protection Agency, 2010) Chlamydia Testing Data 2012/13 ENGLAND Chlamydia tests reported to the National Chlamydia Screening Programme (NCSP) (a) Laboratory reports of chlamydia tests outside of GUM not reported directly to NCSP (b) Positive tests reported from the NCSP and laboratory reports (c) Chlamydia tests GUM* (d) Positive tests from GUM* (e) Total Chlamydia Testing Data Total tests (a + b+ d) Percent of population tested (a + b + d / n)*100 Percent of young people testing positive ( c + e / a + b +d)*100 Diagnoses Rate per 100,000*** East Midlands 21,045 9,971 1,881 8,013 1,080 39,029 6.3 7.6 1915.3 East of England 21,155 7,469 1,780 9,471 1,032 38,095 5.3 7.4 1579.2 London 25,273 11,822 2,452 24,549 2,476 61,644 6.3 8.0 2022.2 North East 10,520 9,073 1,054 7,678 1,133 27,271 7.4 8.0 2375.2 North West 32,456 8,536 3,126 14,078 1,870 55,070 5.7 9.1 2079.0 South Central 14,837 3,764 1,008 8,032 760 26,633 5.1 6.6 1353.8 South East Coast 13,016 5,224 1,066 10,251 1,088 28,491 5.5 7.6 1649.0 South West 17,763 8,327 1,876 10,685 1,173 36,775 5.4 8.3 1796.6 West Midlands 21,304 8,776 2,045 12,136 1,486 42,216 5.8 8.4 1933.6 Yorkshire and the Humber 17,848 12,819 2,257 8,848 1,148 39,515 5.0 8.6 1739.6 ENGLAND TOTAL 195,217 85,781 18,545 113,741 13,246 394,739 5.7 8.1 1,850.4 8.0 References Delvin, D., (2012), Chlamydia, British Association for Sexual Health and HIV Department of Health, (2008), Evaluation of One- Stop Shop (OSS) Model of Sexual Health Provision, [Online] Available at: http://www.dh.gov.uk (Accessed 15th April 2012) Department of Health (2006), Condom Essential Wear, [Online] Available at: http://www.dh.gov.uk (Accessed 15th April 2013) Department of Health (2004), Choosing Health: Making Health Choices Easier, [Online] Available at: http://www.dh.gov.uk (Accessed 15th May 2013) Health Protection Agency, (2010), STI Annual Data Tables, www.hpa.org.uk/stiannualdatatables [Accessed on 15th April 2012] Health Protection Agency, (2008) Sexually Transmitted Infections and Young People in the United Kingdom, http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1216022460726?p=1249920575999, Health Protection Agency Centre for Infections Health Protection Agency, (2007), Health Protection Report, Weekly report Vol. 1, No. 35 London Health Observatory, (2010), Sexual Health, LHO Annual Update on Sexual Health Issues, pp. 1-7 McBean, S. (1992), Definition of Health And Health Promotion, Britain: The Open College Measor, L. Coralie, T., & Katrina M., (2000), Young Peoples Views On Sex Education, Education, Attitudes and Behavior, London: Routledge Falmer MindMetre, (2012), Simple Screening, A Research Study By MindMetre, pp. 1-19 NCSP, (200p), What is NCSP, http://www.chlamydiascreening.nhs.uk/ys/about.html, [Accessed on 15th April 2013] Public Health of England, (2013), Genital Chlamydia Trachomatis (Chlamydia) Retrieved from http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Chlamydia/ Triggle, N., (2009), Chlamydia Testing “Wasted Money”, Health reporter BBC News World Health Organization, (2001), Global Prevalence And Incidence Of Selected Curable Sexually Transmitted Infections: Overview And Estimates, Geneva: World Health Organization