Exchange with Tamaras bodily fluid which was negative did not reduce infection from initial infected sample but it infected her sample. After Tamaras sample became positive it infected every other sample it was mixed with, that is, Gabes and Chriss fluids.
This indicates that an encounter with an infected partners body fluids had a 100% chance of infection based on the conditions provided in the lab.
Patient zero in this case is the first person who was infected with Chlamydia trachomatis.
The graph shows that the number of infected patients multiplied by two after every period from one patient in the beginning week to eight patients in the third week. Therefore, the disease infections will multiply by two in every period thus growing the number of patients exponentially if no interventions are taken. It was very easy to identify Patient Zero simply because only one fluid was infected at the beginning of the experiment.
Epidemiologists could face a challenge in identifying the epidemic source because every infected patient has an equal chance of infecting other persons just as patient 1has. The most effective methods of intervention should be conducting regular screening, encouraging abstinence from sex as well as use of condoms during sexual intercourse.
The Chlamydia trachomatis DNA was extracted from culture stocks and fluid used in the experiment using the High Pure PCR Template Preparation Kit, which is a modified kit that is commercially available. The PCR and the sequencing primers used for the amplification and sequencing were designed according to the nucleotide sequence of various Chlamydia trachomatis strains found in the medium fluid. The protocol for extraction, amplification as well as sequencing was tested on reference of strains of the culture stocks in the laboratory and on the medium fluid sample collected in the study conducted to investigate the spread of Chlamydia trachomatis through mixture of infected bodily fluids and uninfected bodily fluids.
The Chlamydia gene was successfully amplified and sequenced from 15 laboratory Chlamydia trachomatis reference strains and from the 28 Chlamydia trachomatis samples collected from all of the students test tubes used in the study, only 8 samples tested positive. Among the positive samples, there were nine different genotypes of Chlamydia trachomatis: B (5, 4%), D (2, 10%), E (3, 5%), F (1, 11%), G (3, 2%), J (5, 3%) and K (4, 5%).
The mistakes made during the study were: some of the sample fluids were not mixed well after exchange with another fluid. As such, the bacteria were not uniformly distributed in five of the eight infected fluids.
This technique can be applied in research to determine spread of other epidemic diseases such as cholera that are transmitted through exchange of bodily fluids or waste for example urine. The experiment teaches us the importance of avoidance of encounter with other peoples bodily fluids a lesson that can be taken into practice by adults by ensuring that they abstain from sex, have one partner or use a condom during sexual intercourse. Failure to ensure safe sex would mean high probability of getting infected with Chlamydia trachomatis. Apart from that, nurses should observe high levels of hygiene such as washing hands and changing gloves after attending to every patient. Failure to change gloves could lead to transfer of Chlamydia trachomatis bacteria from one patient to another.
The article outlines and discusses the major facts about Chlamydia. These include how it infects people, symptoms, possible complications, diagnosis, treatment, and prevention. According to the article, Chlamydia is a sexually transmitted disease transmitted by the bacterium Chlamydia trachomatis (Centers for Disease Control and Prevention par1). It has the potential to damage the reproductive organs of a woman. In men, it causes certain discharges from the male reproductive organ. Transmission of Chlamydia occurs through sexual intercourse and from a mother to the baby during childbirth (Centers for Disease Control and Prevention par1). Oral sex, vaginal sex, and anal sex are all ways through which transmission occurs.
Symptoms of Chlamydia are not visible in most people and in cases of visibility, they appear 1 to 3 weeks after infection. In women, the cervix and the urethra are the first organs to be infected. Infected women release a vaginal discharge or experience a certain burning and uncomfortable feeling during urination (Centers for Disease Control and Prevention par3). The symptoms are different in most women. Other symptoms include abdominal pains, fever, nausea, painful sensation during sexual intercourse, pain in the lower back, and blood release between periods. In men, symptoms include penile discharge or a burning feeling during urination (Centers for Disease Control and Prevention par4). In addition, there is itching around the penal opening.
Chlamydia can result in serious health complications if not treated. In women, it can cause pelvic inflammatory disease in case it spreads to the fallopian tubes or the uterus. This can consequently lead to infertility, persistent pelvic pain, and ectopic pregnancies that occur outside the uterus (Centers for Disease Control and Prevention par5). In addition, Chlamydia may raise the chances of contracting HIV from sustained exposure.
Screening is a common recommendation for sexually active women to alleviate the risk associated with contracting Chlamydia. In men, health complications are not common. In severe cases, infections spread to the epididymis thus causing pain and sometimes fever. Unlike in women, Chlamydia rarely causes sterility in men. In very rare cases, Chlamydia leads to arthritis that causes lesions on the skin and eye and urethra inflammation.
Diagnosis of Chlamydia involves several laboratory tests. They involve urine or specimens from the penis and specimens from female genitals that include the vagina and the uterus. Treatment for Chlamydia involves the use of antibiotics (Centers for Disease Control and Prevention par6). The most commonly applied prescriptions include azithromycin and doxycycline. Treatment is similar for people infected with HIV and those that are not infected.
Sexually active people should go for regular testing and treatment. In addition, people infected with Chlamydia should not engage in sex after medication to prevent infecting their sexual partners. Women are at higher risks because failure to treat Chlamydia can lead to severe health complications as compared to men. It is important for any person undergoing treatment to take regular tests after every three months to counter incidences of re-infection.
The best way to prevent Chlamydia infection is to abstain from any form of sexual intercourse. In addition, it is important to maintain one sexual partner who is free from infection. In addition, condoms can help reduce chances of infection if used properly and every time one engages in sexual intercourse. The Center for Disease Control and Prevention (CDC) recommends annual testing (Centers for Disease Control and Prevention par 8). This is in addition to a risk assessment conducted by a health professional. Any observed symptom, such as unusual discharges, burning sensation during urination, or intense itching is a sign of a sexually transmitted disease. In that case, the individual should visit the doctor as soon as possible.
Why I chose the article
I chose the article because of several reasons. First, the article is so exhaustive and educative. It covers all aspects of Chlamydia that include its infection routes, symptoms, resulting in complications, treatment, and ways of prevention. It contains all the necessary information on Chlamydia. Secondly, it discusses the disease as it occurs in men and women. It does not generalize the topic. It outlines all symptoms observed in both women and men. The symptoms are different and well described and therefore, one can rely on the information from the article to check for Chlamydia infection before visiting a physician. In addition, the article simply presents the information by using simple medical terms. Very few complex medical terms are used and that makes it easy to grasp and comprehend.
Significance to Microbiology
The article is detailed and presents the information in a way that makes it relevant to the field of microbiology. The simple use of medical terminologies that are easy to understand even by readers who are not specialized in the field of microbiology is highly commendable. This is because Chlamydia infects many people and it is important to know the symptoms of its infection. This ensures that an infected person seeks early treatment before the disease advances to more severe medical complications, especially in women.
The study of Chlamydia is very important in the field of microbiology because of its medical importance. It has a diverse range of complications that result from failure to seek medical treatment. In women, it has the potential to spread to the womb and cause pelvic inflammatory diseases (Gibbs and Sweet 54). This leads to ectopic pregnancies and cervix inflammation. In men, it causes urethral inflammation epididymitis, and arthritis. Microbiology studies of diseases involve exploring the taxonomy, evolution, epidemiology, treatment, and prevention of diseases. All these aspects represent the basis for the study of Chlamydia and thus develop microbiological knowledge on the study of diseases.
In addition, the study of Chlamydia helps in the prevention of diseases that result from extended periods of Chlamydia infection without medical treatment (Gibbs and Sweet 56). Most of these complications are long-term and cause severe damage. For example, inflammation of the cervix for long periods can lead to cases of infertility in women (Boswell et al 34). It also develops scientific knowledge of other Chlamydia species that cause other medical complications associated with Chlamydia. This leads to better and more effective methods of treatment of such complications.
Conclusion
Chlamydia is a sexually transmitted disease transmitted by a bacterium known as Chlamydia trachomatis. It has the potential to damage the reproductive organs of a woman. In men, it causes certain discharges from the male reproductive organ. Chlamydia transmission occurs through sexual intercourse and from a mother to a baby during childbirth. The study of Chlamydia is very important in the field of microbiology because of its medical importance (Boswell et al 43).
It has a diverse range of complications that result from failure to seek medical treatment. In women, it has the potential to spread to the womb and cause pelvic inflammatory diseases. In men, it causes urethral inflammation epididymitis, and arthritis. In addition, the study of Chlamydia helps in the prevention of diseases that result from extended periods of Chlamydia infection without medical treatment. Most of these complications are long-term and cause severe damage.
Works Cited
Boswell Taylor, Alden, David and Irving Williams. Medical Microbiology. New York: Taylor & Francis, 2006. Print.
Chlamydia: CDC Fact Sheet. Centre for Disease Prevention and Control. Center for Disease Prevention and Control. 2012. Web.
Gibbs, Richard, and Ronald, S. Infectious Diseases of the Female Genital Tract. New York: Lippincott Williams & Wilkins, 2009. Print.
Exchange with Tamara’s bodily fluid which was negative did not reduce infection from initial infected sample but it infected her sample. After Tamara’s sample became positive it infected every other sample it was mixed with, that is, Gabe’s and Chris’s fluids.
This indicates that an encounter with an infected partner’s body fluids had a 100% chance of infection based on the conditions provided in the lab.
Patient zero in this case is the first person who was infected with Chlamydia trachomatis.
The graph shows that the number of infected patients multiplied by two after every period from one patient in the beginning week to eight patients in the third week. Therefore, the disease infections will multiply by two in every period thus growing the number of patients exponentially if no interventions are taken. It was very easy to identify Patient Zero simply because only one fluid was infected at the beginning of the experiment.
Epidemiologists could face a challenge in identifying the epidemic source because every infected patient has an equal chance of infecting other persons just as patient 1has. The most effective methods of intervention should be conducting regular screening, encouraging abstinence from sex as well as use of condoms during sexual intercourse.
The Chlamydia trachomatis DNA was extracted from culture stocks and fluid used in the experiment using the High Pure PCR Template Preparation Kit, which is a modified kit that is commercially available. The PCR and the sequencing primers used for the amplification and sequencing were designed according to the nucleotide sequence of various Chlamydia trachomatis strains found in the medium fluid. The protocol for extraction, amplification as well as sequencing was tested on reference of strains of the culture stocks in the laboratory and on the medium fluid sample collected in the study conducted to investigate the spread of Chlamydia trachomatis through mixture of infected bodily fluids and uninfected bodily fluids.
The Chlamydia gene was successfully amplified and sequenced from 15 laboratory Chlamydia trachomatis reference strains and from the 28 Chlamydia trachomatis samples collected from all of the students’ test tubes used in the study, only 8 samples tested positive. Among the positive samples, there were nine different genotypes of Chlamydia trachomatis: B (5, 4%), D (2, 10%), E (3, 5%), F (1, 11%), G (3, 2%), J (5, 3%) and K (4, 5%).
The mistakes made during the study were: some of the sample fluids were not mixed well after exchange with another fluid. As such, the bacteria were not uniformly distributed in five of the eight infected fluids.
This technique can be applied in research to determine spread of other epidemic diseases such as cholera that are transmitted through exchange of bodily fluids or waste for example urine. The experiment teaches us the importance of avoidance of encounter with other people’s bodily fluids a lesson that can be taken into practice by adults by ensuring that they abstain from sex, have one partner or use a condom during sexual intercourse. Failure to ensure safe sex would mean high probability of getting infected with Chlamydia trachomatis. Apart from that, nurses should observe high levels of hygiene such as washing hands and changing gloves after attending to every patient. Failure to change gloves could lead to transfer of Chlamydia trachomatis bacteria from one patient to another.
Every year people get infected with some diseases and do not where the infection comes from. One of the ways to get infected is the sexual life that requires attention and methods of protection from both partners.
Though the symptoms can be slight and not worth being noticed, people live with their infections and transmit those to their sexual partners without being aware of their disease. In this respect, tests available in health care centres and clinics enable the population to pass free tests and receive adequate treatment to prevent further spread of the infection.
Some people are ashamed to apply for professional help though they should take into account the number of serious complications that may affect them in case they do not treat the infection adequately. So, tests performed on regular bases enable people to learn about their health and problems with regard to effective methods of treatment.
Chlamydia Campaign Overview
General overview of the problem
Chlamydia campaign is considered as one of the most potentially effective methods for promoting the idea of healthy sexual life among sexually active young people in the age of 25 and younger who can potentially have this disease and transmit it to other partners without knowing either about the fact of having or about the outcomes of not treating it respectively.
Moreover, men and women can have this disease asymptomatically whereas only serious health problems make people apply for professional help of health care providers.
The results received in the study by Burstein et al. (2001, p. 28) suggest that 81% of women that took part in the research in the age <25 are infected with Chlamydia whereas the number of tested women offers that the percentage of infected women is even higher because women in the age of <25 are tested less frequently than women in the age of ≥25.
In this respect, this research provides a clear evidence of the necessity and importance of taking tests, especially when one has more than one partner or changes a sexual partner.
As reported by Dicker et al. (2000, p. 430), contemporary Chlamydia tests “…cost less, require less expertise to perform, specimens are easier to transport…”; this means that people can pass tests without spending much time, costs, and efforts. As results are received in relatively short period of time, people do not have to worry about complications that may occur while waiting for results of the test.
Aim and scope
As people can pass tests easily, they have to be informed about this opportunity and use it in order to prevent fertility problems and other serious complications that may occur when the disease is not treated correspondingly.
The main problem addressed by the group consists in the attempt to encourage people to pass the tests for Chlamydia and care more about their health and the health of their sexual partners. So, the group members are going to launch a campaign aimed at increasing the number o people who take Chlamydia tests and bring their partners to take that test as well.
A survey can help the group members to evaluate the effectiveness of the campaign by surveying people in the street about their awareness of such a campaign and the number of times they took Chlamydia tests. The main task of the group is to persuade people to take tests with the help of this promotional Chlamydia test campaign.
Resources Necessary For The Campaign
Cost management
Costs can be considered one of the most important resources of any project. “A detailed cost estimate will give an organisation a more accurate portrayal of actual and expected project cost” (Cleland and Ireland 2006, p. 280). Thus, project management strategies should be implemented while planning, organising, motivating, directing, and controlling the process (Cleland and Ireland 2006, p. 52).
In other words, cost limitations and the type of funding are essential for the type of organization and risk management procedures.
The costs can be saved due to application of the National Chlamydia Screening Programme under which all individuals in the age of <25 can be screened for Chlamydia and receive adequate treatment as well as their partners of any age. Alternatively, the group can collect costs for purchasing of Chlamydia test kits (manufactured by Clamelle Company) that cost £25.00 per a kit.
One of the possible sources for costs to base the campaign is a loan from the bank or some investments that can be done by charity organisations that deal with health care problems and care about the health of the population. In this respect, the first step in planning the campaign can be fundraising strategy so that group members could provide the campaign with sufficient funding.
So, a charity campaign can be held in association with other non-profit governmental or private organisations that are interested in promotion of health-targeted ideas among population including young people in the age of 15-25. This strategy can enable every individual to donate to the campaign fund hence becoming aware of the necessity and importance of taking Chlamydia tests.
Every aspect is important for the campaign including “the time required to complete a project, the availability and costs of key resources, the timing of solutions to technological problems…” (Mantel, Meredith, Shafer and Sutton 2007, p. 18) and a great number of other variables that can affect the project outcomes.
As soon as the group members obtain necessary costs for launching the campaign, they can start the production of T-shirts that will have slogans printed on them.
These slogans will encourage people to take tests and promote the idea of taking tests among their friends and, certainly, partner/partners (see Figure 1). In this respect, costs for production of T-shirts should be combined with costs to be paid to people that will distribute T-shirts and collect data concerning the position of respondents toward the test-taking.
Moreover, certain contingencies such as overall failure to convey the idea of taking Chlamydia tests can affect the entire concept of the project.
However, the idea with promoting the Chlamydia tests is really original and is worth being supported by charity and health care organisations and funds. The T-shirts can be purchased at discount from stocks and sales while further application of slogans can be made with the help of available resources.
Risk management
Risk is one of the integral parts of the project management. There is no guarantee that the project is sure to succeed or can have certain percentage of additional costs to be implemented. In this respect, it is necessary to assess the risk typical of the promotional campaigns and other non-profit events arranged on non-profit basis.
As reported by Huselid, Jackson and Schuler (1997, p. 177), it is possible to take “…risk-adjusted capital-market measure of performance that reflects both current and anticipated profitability…” In this case, the profitability is presented in the form of people that are eager to take Chlamydia tests in the shortest period of time after the campaign.
Besides, it is necessary to make sure that no other similar campaigns are operating in the same period or shortly before and after the Chlamydia test promotional campaign because this will influence the accuracy of data.
Moreover, risk can arise from health care promotional campaigns arranged and operated on the basis of health care institutions enabling people to donate blood and take tests immediately in the health care institution.
The risk management concerning the Chlamydia promotional campaign also includes the activity of people and the place chosen for distribution of T-shirts with encouraging slogans.
In this respect, the preliminary research on the most appropriate places for distribution and ways of assessing people’s activity in terms of test-taking should be conducted in order to exclude potential risk of failure. So, “the payback period is often considered a surrogate measure of risk to the firm: the longer the payback period, the greater the risk to the firm” (Mantel et al. 2007, p. 11).
In this case, the ‘payback period’ can refer to the period of time analysed by the group members in terms of the response on the Chlamydia promotional campaign. Thus, the longer the reported period is, the more likely the risk of ineffectiveness of the campaign can occur.
In other words, it is necessary to choose appropriate team and appropriate setting for launching of campaign in order to receive the most adequate and accurate results. A mobile laboratory can reduce the risk of ineffectiveness of the campaign bringing the number of non-respondents to the campaign to the minimum.
Timing and resources
Every project requires certain period of time for its completion. In this respect, the group members should assess the time necessary to arrange the launching of the campaign, effective presentation, and collection and evaluation of results.
As reported by Mantel et al. (2007, p. 28), it is necessary to “assess the resource demands on the organisation, indicated by the size, timing, and number of projects shown.” The charity organisations can provide the group with volunteers under the aegis of some health care programme.
We need a total number of about 10 people who can use graffiti spray (e.g. Montana Gold Clearance Pack that costs about £40 for 12 cans of different colours) to apply slogans on T-shirts for people to purchase. The campaign is expected to be held during 5 days including the end of the working week and the weekend.
In other words, organisation and assessment require certain time as well as the operation of the project hence making the arrangement and assessment stages of the project the most time-consuming compared with the campaign itself.
Every stage of the process requires a certain period of time and includes risk related to limitations imposed by other campaigns launched in this area hence leading to inability to collect data on the number of responses to the campaign efforts.
The resources for the Chlamydia campaign include human resources, costs, timing, manufacturing and distribution, collection and analysis of data. Besides, the preliminary stage also includes a research conducted on the number of tests taken by people in the age of 15-25 in a certain location.
This means that most efforts of the campaign should be aimed at promotion of encouraging materials nearby the health care institution or a mobile laboratory so that researchers could collect the data before and after the campaign and compare those.
To sum up, the T-shirts can be purchased at discount or via sales reducing the costs necessary for T-shirts production; volunteers can be invited from colleges and schools empowering them to use the data collected in their own researches; creation and application of slogans can be performed by group members to reduce the costs; overall support can be required from charity organisations that fight against health problems and try to reduce the number of people that suffer from sexually transmitted illnesses.
Target audience
People are encouraged to use condoms and other means of protection to make their sexual life safe and less complicated. A great number of infections are currently transmitted via sexual contacts due to inappropriate education of people and lack of information on the problem of sexually transmitted illnesses.
This gives a great freedom for a research because the main target audience of the proposed campaign includes young people in the age of 15-25.
This category of people includes individuals that have never had a sexual contact before and those who had more than one partner. In this respect, the T-shirts should be colourful and stylish so that they could meet the expectations of the respondents who would either purchase a T-shirt or take a test in a mobile laboratory immediately after being informed about the potential possibility of having Chlamydia.
Though a number of respondents is expected to demonstrate some portion of scepticism openly, it is also expected that a greater number of respondents would respond to the promotional campaign adequately by purchasing a T-shirt with encouraging slogans or by taking tests immediately.
However, both options are preferable and the researchers will try to encourage people to take tests, purchase T-shirts, and inform their friends on the necessity and importance of taking tests due to asymptomatic nature of the Chlamydia infection.
Moreover, the group members can take active part in the promotional campaign or can focus o the researching activity hence they might need more volunteers or get additional costs to ensure that the number of activists is sufficient in relation to the number of potential respondents.
Expected Outcomes
Benefits of the test
The test taken by individuals to find out if they have some sexually transmitted diseases can prevent further spread of the infection and guarantee a healthy sexual life in future.
Moreover, tests taken in time can result in adequate treatment of the disease and prevention of infertility as one of the serious complications. In this respect, the possible benefits of the tests taken due to being impacted by the Chlamydia test-taking promotional campaign are obvious with regard to the number of people that may potentially have Chlamydia.
Being a host organism of an infection, a person may fail to recognise the symptoms of the disease and receive appropriate treatment. In other words, accurate tests can enable people to think over their priorities and care more for their health and a healthy sexual life taking caring of their sexual partner as well.
A Chlamydia test is really important because of the asymptomatic nature of the disease caused by Chlamydia trachomatis infection. Though some people are sure about their health, others do not have a single sexual partner being in a group of risk to have Chlamydia. Thus, the number of people that want to take a Chlamydia test should be increased by at least 20% compared to the data before campaign.
Possible limitations. Possible limitations of the campaign include a great number of possibilities and risks imposed by the use of those possibilities in terms of costs and sources of funding. In this respect, it is possible to contact a private health care institution that requires advertising.
So, the group can create sanitary bulletins with advertisement of the private health care institution on one side and useful information about the Chlamydia infections and importance of taking tests on the other side of it.
This cooperation will provide the group with additional costs or with economising of costs because this cooperation can be conducted on the following bases: a private institution can enable the group to insert their information on one side of their advertisements requiring no costs though having the advertisements distributed by the group members or volunteers in the areas agreed upon by both sides.
In this respect, the group should choose the most appropriate way of creating materials and distributing those in order to receive the most effective results in terms of the increased number of people who want to take Chlamydia test. Besides, the group members can fail to choose the appropriate ways of distribution.
Conclusion
The number of people that may potentially have diseases caused by Chlamydia infection increases due to the number of unprotected sexual contacts and lack of desire of individuals to take tests influences the fertility and the overall health of the nation. These infections can be easily detected with the help of a simple test that can be taken in a mobile laboratory.
As the nature of the disease presupposes the lack or even absence of symptoms, most people that have the Chlamydia do not even think about their health due to inability to recognise the disease without symptoms whereas a test can make things clear.
In other words, the Chlamydia test-taking promotional campaign is aimed at encouraging people to take Chlamydia tests and inform their friends and sexual partners about necessity and importance of taking tests, especially when a person changes a sexual partner or has more than one partner.
The overall costs necessary for the campaign include £40 for graffiti spray (12 cans), £5000 for blank T-shirts (1000 items £5 for each that will be painted), £25/test kit (the total number of kits should be coordinated with the mobile laboratory that will perform tests).
Reference List
Burstein, G. R. et al., 2001. Predictors of repeat Chlamydia trachomatis infections diagnosed by DNA amplification testing among inner city females. Sexually Transmitted Infections, 77, pp. 26-32.
Cleland, D. I., and Ireland, L. R., 2006. Project management: strategic design and implementation. 5th ed. London: McGraw-Hill Professional.
Dicker, L. W. et al., 2000. Impact of switching laboratory tests on reported trends in Chlamydia trachomatis infections. American Journal of Epidemiology, 151 (4), pp. 430-435.
Huselid, M. A., Jackson, S. E., and Schuler, R. S., 1997. Technical and strategic human resource management effectiveness as determinants of firm performance. Academy of Management Journal, 40 (1), pp. 171-188.
Mantel, S. J., Meredith, J. R., Shafer, S. M., and Sutton, M. M., 2007. Project management in practice. 3rd ed. New York: John Wiley & Sons.
The Chlamydia Screening Studies was the analysis designed to receive the results of people’s reaction to the home-based screening for the sexually transmitted infection, Chlamydia trachomatis. 19773 participants were invited to send their urine samples or even vulvovaginal swabs. Later they received negative or positive answers, and some of them were asked to come for the interview. Qualitative research has shown that there are certain differences between the reactions of men and women and the prevalence of the infection in different age groups. Various qualitative tools, like Hospital Anxiety and Depression Scale and Rosenburg Self Esteem Scale, were used to summarize the findings.
Important issues
Four important issues were raised by the Chlamydia Screening Studies: most people encountered the feeling of discomfort for being invited to the research; most participants felt anxiety, especially when they received a positive answer, due to the stereotype that infected people have a certain stigma, or that they will have to inform their partner about the positive results. Many people had the fear of having undetected diseases or women – being infertile. All these factors have put certain limitations on the outcomes of the project, due to the low response rate some sex or age groups were under-presented. However, the majority of the participants did not regret the decision to take part in the Chlamydia Screening Studies. People, who received a negative response, were pleased about the answers, however, there is a negative tendency of connection between negative response and lack of interest in changing unhealthy habits or behaviors.
Cognitions
To sum up, these projects had much more advantages for their participants compared to the feeling of discomfort, this projects’ results should be applied in practice: for example, Health professionals should be well trained on how to inform their patients about Chlamydia and its possible outcomes, its treatment. There are researches which are similar to the one described above. For example, the study of the psychosocial correlates of heterosexual use of male condoms was done by Sheeran, Orbell, and Abraham. (2004) This study included more than one hundred twenty-one empirical studies, which contained forty-four correlates. To analyze the effect sizes Cohen’s guidelines were used. (1992) Four essential cognitions were found during the presented research. The first cognition(r =0.32) was the feelings towards the condoms. The attitudes to the use of condoms have changed over time: in Catholic schools, children are now educated about the importance of the usage of condoms, as stated in the article “The condom issue” by William F. Buckley Jr. (Buckley, 2004).
The second cognition is showing the attitude of other people to the usage of condoms (r =0, 37). As it is highlighted in the article “Health: Condoms: A Healthy Attitude towards Sex; Education Is the Only Way to Win the Battle with Aids”, people understand the importance of condom usage today and make them available as much as possible (Beattie, 1998).
The third cognition(r =0.43) was stating the intention of the usage of condoms. As the studies of The Crisis Pregnancy Agency (CPA) have shown, that approximately 25 percent of teen girls are not even intending to carry condoms with them, the reason for such behavior is the fear of prejudice from other people. (WYNNE, 2004).
The next cognition was the fear of pregnancy (r=0.37), and the last cognition –control over the actions (r=0.45). (Albarracin et al., 2001).
Summarizing the finding of these researches, it can be seen that certain factors made a significant impact on health-related behavior, and if the attitudes towards condoms’ usage are studied more carefully, later these findings will help in promoting a healthy future without serious infectious diseases. Unfortunately, stereotypes and prejudices come on the way to the deep research of this topic, many participants of the research refused to answer the questions or gave inaccurate information on the issue of usage of male condoms.
Amy Kaler research
Another research, which was conducted by Amy Kaler, with the support of the National Vulvodynia Association, interviewed more than one hundred women on the issue of vulvar pain. Women were invited to have an interview in person or through the website of this association and were asked to fill in the questionnaire on the problem stated above. It was found that 34 % of women during the consultations on this problem were said that their problems are “psychological”, or 6 % of them were advised to have surgery, and another 6 % were said they had misused the steroid creams. The research has shown, that majority of the participants with vulvar pain were said that they were frigid or sexually abnormal. Such diagnoses have made women feel depressed, with a feeling of certain stigma on them. However, vulvar pain and dyspareunia should be excluded from the category of sexual dysfunction and should be moved to the category of pain disorder. To outline, this research it is essential to highlight that the vast majority of women have received not accurate consultations, which affected their well being, lowered their self–esteem. (Kaler, 2005).
After the study of the researches described above it is important to work out possible solutions to the problems, which arose during the research and give relevant recommendations, which will be used in practice, to avoid these problems in the future. (Sheppard, 1991).
Recommendations
First of all, it is important to outline that the main issue all these researches have in common is the certain stereotypes towards certain diseases or infections. (Morrall, 2001) So, the first thing that should be done about these problems is to break these stereotypes. As written in the book “Sexual exploitation of patients by health professionals”, not all medical specialist are providing their patients with accurate information about their diseases and they do not educate their patients on the main health issues, breaking stereotypes this way. (Burgess et al.,1986). The feeling of discomfort because of chlamydia, the fear of prejudice while caring for the condoms, or having vulvar pains are problems closely related to the issue of sexual orientation. Sexual orientation is the choice of every person and people can not be judged for that, this is the main idea expressed in the book “The Psychology of Sexual Orientation, Behavior, and Identity”. (Diamant, 1995 ).
My next recommendation for these issues would be holding a series of consultations, which are run by reputable medical specialists. There are many seminars on the importance of the usage of condoms in terms of protection against HIV/AIDS. However, the integral part of a sexual health course is also infertility, and sexual dysfunction, as the state in the article “Nonvolitional Sex and Sexual Health”. (Kalmuss, 2004) I believe, there is a need for consultations on these problems too. These consultations should be free of charge and should cover all the problems of sexual health today. People, and especially women, should feel free to ask questions, so if necessary these consultations should be held in person. People should be notified of the centers and associations, which help them learn more about such diseases.
Conclusion
In the end, I would like to highlight the importance of the researches mentioned in this paper, once more stated in the article “A Study in Sexual Health Applying the Principles of Community-Based Participatory Research.”(Reece, Dodge, 2004). This research help study sexual health in practice, see the reaction patterns, learn about the feelings of the patient. (Andrews, 1997) Later, these researches can be of significant importance and can lead to further and deeper analysis of the patient. All these finds will help humanity in building a healthy and non-stereotyped society in the future.
References
Andrews, Joseph L. 1997. Health Meets Human Rights. The Humanist, 4.
Baum, Andrew, Tracey A. Revenson, and Jerome E. Singer. 2001. Handbook of Health Psychology. Mahwah, NJ: Lawrence Erlbaum Associates.
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Sexually transmitted infections (STI’s) are contracted through sexual contact. There are more than 25 such diseases that are spread through vaginal, anal, and oral sex (Womenshealth.gov, 2018). The main causes of the diseases are bacteria and viruses, which spread through unprotected sex with an infected person (Womenshealth.gov, 2018). According to Womenshealth.gov (2018), there are 20 million reported cases of STI’s every year and most of them are in the age group of 15-24. It is reported that women tend to have more serious problems form STI’s than men (Womenshealth.gov, 2018). Gonorrhea and chlamydia, if left untreated, can increase the risk for chronic pelvic pain, ectopic pregnancy, and infertility. This project is an attempt to reduce the incidence of STIs Gonorrhea/Chlamydia among Hispanic women. Its purpose is to reduce STI’s Gonorrhea/Chlamydia among Hispanic women in Michigan and to plan a culturally appropriate intervention to address this area of health.
Vulnerable Population Assessment
Quantitative Data
This section of the paper shows the steps and data that were gathered from a quantitative review of health information relating to the topic under investigation. The final data is also inclusive of the ethnic and cultural factors relating to the sexual health of Hispanic women.
Demographic Data
The population of Michigan (9,889,024), Berrien Co. (155,912), Cass Co. (52,001), Van Buren Co. (75,569) (Lakeland Community Needs Assessment, 2016).
Hispanics Women population of Michigan (214, 415) (Suburbanstats.org, 2017).
Caucasian Women population of Michigan (3,957,000) (Suburbanstats.org, 2017).
About 59% of Hispanic women are gainfully employed (CDC, 2016).
The median earnings of Hispanic women are $460 per week, thereby placing Michigan in position 45/50 states with the lowest earnings for women (CDC, 2017).
Hispanics have among the lowest rates of health insurance at 83% (CDC, 2017).
About 77% of Hispanic women are Christians (Paz & Massey, 2016).
Up to 50% of the population of Hispanic women do not speak English (Paz & Massey, 2016).
Only 15% of women have completed college or a higher education level, while the national average of women who have attained this education level is 18% (Paz & Massey, 2016).
Women only earn 64% of what men get in Michigan state, thereby putting them at risk of defaulting on their loans or on their health payment plans (Paz & Massey, 2016).
More than 50% of Hispanic women attend college on a part-time basis (Rhodes et al., 2015).
The life expectancy of Latinas is considerably shorter (77.1 years) compared to their Asian (86.8) and white counterparts (79.6 years) (Paz & Massey, 2016).
Immigrant Latino women have a 15%-20% lower mortality compared to US-born Latinos (Paz & Massey, 2016).
Hispanic women have twice the level of unemployment (7.7%) compared to their white counterparts (3.3%) (Paz & Massey, 2016).
Statistical Data about Health Issue
The total cases of Chlamydia reported in the US is 1.59 million cases (4.7% rate increase since 2015) (CDC, 2017).
The total cases of Gonorrhea reported in the US is 468,514 cases (18.5% rate increase since 2015) (CDC, 2017).
Michigan has Ranked 21st among the 50 states in Chlamydial infections 469.1 cases per 100,000 and ranked 26th in gonorrheal infections (104.2 per 100,000) (CDC, 2015).
The incidence of Gonorrhea reported in Michigan is 12,450, 125.5 per 100,000 population (CDC, 2015).
The incidence of Chlamydia reported in Michigan is 45,936, 462.9 per 100,000 (CDC, 2015).
Total cases of Chlamydia reported in the US among Hispanic women is (149,009) 532.4 per 100,000 population compared to Caucasian women at (272,126) 271.1 per 100,000 population (CDC, 2017).
The incidence of gonorrhea is 73.3 cases per 100,000 population in the US (1.9 times higher than the rate among Caucasian females) (CDC, 2017).
The incidence of Chlamydia is 380.6 cases per 100,000 population which is 1.9 times the rate among whites (CDC, 2017).
There are 365 cases (or a rate of 3.7 per 100,000 people) of gonorrhea reported in Michigan annually of primary and secondary syphilis (CDC, 2015).
There are 13 cases (or a rate of 11.4 per 100,000 people) of congenital syphilis in Michigan annually (Pflieger, Cook, Niccolai, & Connell, 2013).
The asymptomatic nature of chlamydial infections in about 85% of the cases affecting Hispanic women prevents them from going for screening (CDC, 2017).
Limited resources, lack of information, and concerns about other people’s view outline the barriers to STI screening in about 60% of Hispanic women (Paz & Massey, 2016).
Cultural Factors Contributing to STIs
Up to 60% of Hispanic women have not received any form of sex education from their parents (Samari & Seltzer, 2016; NHCSL, 2017; Vincent et al., 2016).
More than 65% of Hispanic men subscribe to the concept of machismo which accentuates attributes of male sexual dominance and superiority, which encourages some of them to have relationships outside their primary unions (Samari & Seltzer, 2016).
More than 50% of Hispanic households teach their children to uphold values of virginity, and no sex before marriage (Samari & Seltzer, 2016).
Fear of deportation impedes immigrant women from reporting risky sexual behaviors such as the exchange of sex for money or substance abuse (McCabe, Solle, Montano, & Mitrani, 2017).
Myths and misconceptions about sexually transmitted diseases in about 24% of the female population affect the ability of Hispanic women to gain the correct health knowledge (Rhodes et al., 2017).
Immigrant and less acculturated Hispanic women who comprise about 50% of the Hispanic population are less likely to engage in condom use and more likely to engage in risky sexual behaviors such as commercial sex work and the use of alcohol/drugs during intercourse (Paz & Massey, 2016).
Machismo and Marianismo cultures, which affect about 63% of the Hispanic population, pose a challenge to condom use because they undermine the power of women in negotiating for the same (Paz & Massey, 2016).
Qualitative Data
Windshield Survey
In this qualitative data segment, information relating to the community’s environment, people, attitudes, social functioning, and environment are explored.
Sight: Restaurants and retail shops were the most commonly visible businesses in the community. Detached houses, mobile homes, and townhouses were also commonly found in the area, with the most common types of health services being maternal and reproductive health treatments.
Sound: The noise made by moving cars was the most commonly heard.
Taste: Many people shop for food in grocery stores and in supermarkets. A loaf of bread costs about $1.44, a dozen eggs would be sold for $2.09, and one-quarter of mild sells for $3. Most of the products bought from the stores are fresh. Restaurants and pubs were the most common types of eateries in the community.
Smell: The smell in the community is generally pleasant. However, there were industrial emissions in some sections of the city, which also had some debris. Lastly, some garbage cans were visible.
Touch: Fences were used to define boundaries. In some instances, natural boundaries such as roads, trees, and even hedges demarcated certain sections of the community.
Interview with a Hispanic Person
The existence of alternative forms of medicine significantly impeded people’s resolve to seek mainstream medical services. Some botanical and herbal medicine shops existed in the community and some local healers operated in the underground scene by offering health services to a largely immigrant population. Planned health fairs and advertisements for health-related events in the community were visible in some sections of the community, but the efficacy in the use of health resources was subjective to the types of health services offered.
The family unit was at the center of the community’s societal structure. Although parents were the main guardians for children, it was common to find households with two generations living under the same roof. Drug abuse was a key social problem in the community. Environmental conditions were “generally good.” There were no serious cases of pollutants noted or nuisances such as insect infestations and the likes. In this regard, there were no serious environmental risks related to the health of the region.
An assessment of the community’s vitality showed that most members were vibrant. Women were often seen strolling on the streets with their children and people from multiple races dotted the landscape. Tourists also visited the locality and the community members had a good general appearance. However, some people appeared to be under the influence of alcohol and other substances. The use of health resources is below par. In addition, most community members are aware of the existence of several health care centers.
Analysis and Summary of Data
Risk for STIs
In this section of the report, an analysis of the qualitative and quantitative data highlighted above is done. For example, some key pieces of data that indicate the risk for sexually transmitted infections among the target population center on the cultural makeup of the community. This information has been discussed in the quantitative section of the report. Particularly, the lack of sex education among Hispanic women, which has been reported to affect up to 60% of the population, is worrisome because it means that most young women start having sex without having the accurate knowledge that would help them make informed decisions about their health (McCabe et al., 2017).
The retrogressive cultural practices that stem from dominant patriarchal systems in the Hispanic community further put women at risk of infections because it undermines their ability to negotiate for condom use (Haderxhanaj, Rhodes, Romaguera, Bloom, & Leichliter, 2015). In this regard, they are living in a community that has little regard for their opinions (especially regarding sexual health matters), thereby making them secondary decision-makers (subject to their opinions or wishes of the male sexual partners) (Haderxhanaj et al., 2015). This issue makes it difficult for women to take control of their sexual health. Furthermore, it creates a cyclic dependence trap for the female population because women have to constantly look up to their male partners for “direction” regarding sexual health matters.
The findings highlighted in this study have also shown that many Hispanic women are likely to be living in low-income communities relative to their white counterparts (Haderxhanaj et al., 2015). This situation makes them vulnerable to misinformation and the lack of proper access to sexual health care services because their communities often lack adequate health and education resources that would empower women to make sound health decisions or seek health services when there is a need to do so. To demonstrate their vulnerability, women who live in high-income neighborhoods often have good health outcomes because their socioeconomic determinants of health (such as education and adequate access to health care) provide them with the resources to make sound health decisions and seek appropriate health care services (McCabe et al., 2017). Thus, they are likely to experience low incidences of STI screening and reporting. They are similarly likely to gain access to contraceptive services, which would help them to prevent STI transmission, relative to their Caucasian counterparts.
Hispanic women are at risk of contracting sexually transmitted diseases because their low socioeconomic status exposes them to multiple risk factors that lead to the spread of such infections (McCabe et al., 2017). For example, the quantitative findings highlighted earlier showed that they are among the most underinsured populations in America (McCabe et al., 2017). This situation acts as a barrier to health care access. It is further worsened by the existence of a significant population of Hispanic females (about 50%) who are immigrants and cannot speak proper English (Samari & Seltzer, 2016). Their inability to communicate effectively also acts as a barrier to health care access because they cannot communicate well with health workers (NHCSL, 2017). Additionally, they would not want to reveal their immigration status to health officials because they could transfer the same information to authorities (Samari & Seltzer, 2016; NHCSL, 2017; Vincent et al., 2016). Their low economic status and volatile living conditions add to their vulnerable status because some of them are involved in commercial sex work to provide money for the families they leave at home, thereby increasing their exposure to sexually transmitted diseases (McCabe et al., 2017).
The qualitative data gathered from this review also show that reproductive health services are not commonly visible to the population because health centers offering these types of health services are not openly accessible to a majority of the population. Since some Hispanic women are vulnerable to violence from their male counterparts, the lack of open protective services in the community could abate the problem because many community members identified child protective services as being the most visible protective care in the community (McCabe et al., 2017; NHCSL, 2017; Vincent et al., 2016). This finding means that it may be difficult for some of the women to know where to seek help when they experience violence from their spouses or partners (Stockman, Hayashi, & Campbell, 2015). Collectively, these factors explain why a Hispanic woman is a vulnerable group.
Community Population Diagnosis
This community population diagnosis is developed according to the guidelines provided by Curley and Vitale (2012). A large immigrant population, high levels of underinsurance, low socioeconomic status, low ability to negotiate for condom use, prominence of myths and misconceptions about sexually transmitted diseases, low levels of sex education, and high numbers of non-English speaking women characterize the vulnerability of the target population to STIs (Villar-Loubet et al., 2016; Cipres et al., 2017).
This fact is evidenced by the high incidence of gonorrhea, which is 73.3 cases per 100,000 population (1.9 times higher than the rate among Caucasian females), a high incidence of Chlamydia, which is 380.6 cases per 100,000 population, and the high incidence of syphilis, which is 7.6 cases per 100,000 population (2.2 times the rate of whites) (CDC, 2017). Comprehensively, the above data provides a holistic picture of the population health incidence of STIs. The group factors highlighted in the assessment also explain why the target population is at risk of sexually transmitted diseases.
Goals and Objectives of the Intervention
By the year 2020, the program should reduce the incidence of newly diagnosed STIs in Michigan, by 45% to no more than 77 diagnoses for every population of 100,000 people.
To increase early access to STI prevention services by 20% in the year 2020 by increasing people’s awareness of available sexual reproductive health care services in the community.
Decrease STI disparities among Hispanic and Caucasian women by 25% to 26.6 cases per a population sample of 100,000 in the year 2020.
Review of Literature for Intervention Studies
Literature Search
Previous research studies that have promoted positive sexual health behaviors among immigrants highlight the need to formulate culturally appropriate interventions. For example, a study by Garbers et al. (2016) which targeted black and Latino minorities showed that a culturally appropriate intervention needed to be formulated to encourage them to be tested for STIs and HIV. A study by Teitelman, Calhoun, Duncan, Washio, and McDougle (2015) also emphasizes the importance of understanding individual and group dynamics when formulating interventions to encourage people to test for STIs.
According to McLellan-Lemal et al. (2013), public health workers should also know that many Hispanics are likely to be living in low-income communities (relative to their white counterparts). Therefore, they are likely to suffer from poor access to health care services. Studies by Lanier and Sutton (2013) also highlight the importance of understanding the diversity that exists among the Hispanic population, especially when targeting the population through elaborate sexual health interventions.
Comprehensively, the above studies show different recommendations made by researchers who have studied how to create effective public health interventions to improve sexual health outcomes among Hispanics. Their links are available in the annotated bibliography section. Nonetheless, the two articles below provide significant lessons in formulating the same interventions among minority groups. The information obtained from them will be useful in developing a program, which is highlighted in the last section of this report.
Intervention Articles
Rotblatt, Montoya, Plant, Guerry, and Kerndt (2013) and Sanchez et al. (2016) have developed two intervention articles that have investigated health programs aimed at decreasing the incidence of STIs among minority populations. They are discussed below.
First Article
The purpose of the article by Rotblatt et al. (2013) was to increase the rate of chlamydia and gonorrhea testing among Hispanic and African-American women in Los Angeles through a culturally sensitive program – No Place like Home. The research design was premised on a social marketing campaign intended to encourage women to order for testing kits online (Rotblatt et al., 2013). The cultural considerations acknowledged by the researchers were centered on providing bilingual services in Spanish and English. At the same time, the program’s design allowed the women to order for the tests anonymously, thereby safeguarding their privacy and protecting them from the social stigma of undertaking such tests with other people present. Lastly, the study outcomes suggested that the program’s scalability, morbidity, and high response rates made it an acceptable tool for controlling sexually transmitted infections (Rotblatt et al., 2013).
Second Article
Sanchez et al. (2016) prepared the second article selected for review. Its purpose was to evaluate the effectiveness of a culturally sensitive program – Health, Education, Prevention, Self-care (SEPA), which was aimed at preventing HIV and sexually transmitted diseases among Latina immigrants in the farmworker community of Miami, Florida. The intervention was premised on a community-based participatory research (CBPR) framework and its cultural considerations were based on the principles of acculturation and the role of the female gender in the Hispanic community (Marianismo) (Sanchez et al., 2016). The study outcomes indicated that the program was effective in increasing the knowledge of HIV and sexually transmitted diseases among the target population. It was also found to be useful in reducing sexually risky behaviors among the same population (Sanchez et al., 2016).
Key Cultural Interventions to Include in the Intervention Design
Promote collaborative relationships.
Skills building activities (identification of personal risk behaviors, and role-playing).
The inclusion of closed-ended questions to enable participant understanding.
Promote personal relevance to the health issue by tailoring questions to the specific context of the research participants.
Tailor questions to participants’ risk reduction and informational needs (Grau et al., 2013).
Program Plan and Evaluation
Goal
To reduce the incidence of STI among Hispanic women in Nile Michigan in two years by starting a school-based intervention known as CONCEPT that would teach adolescent girls about the importance of condom use as a strategy of promoting better sexual health behaviors.
Cultural Relevance
To align with the cultural practices of Hispanic women, people who are proficient in both Spanish and English would implement the program. The program coordinator must also be an indigenous member of the community and demonstrate adequate knowledge of the target population.
The Relevance of the Program
The CONCEPT program will be appropriate in boosting the STI fight in the Hispanic community because it will empower young girls to take firmer control of their sexual health by being more proactive and decisive in making sexual health decisions. The program will equip them with knowledge about how to negotiate with their partners about condom use and encourage them to be vigilant about sexual health matters. These measures will help them to protect themselves from sexually transmitted infections. Lastly, the program will also teach them about the importance of getting reproductive health services. Collectively, CONCEPT will support the STI fight by improving access to health care services and equipping young girls with knowledge about sexual health matters that will help them make informed health decisions in the future.
Program Evaluation Plan
The program will be evaluated every six months by the product coordination team. To do so, they will evaluate the incidence of STIs in Nile Michigan. A comparison will be made between the incidence of STIs among Caucasian and Hispanic women as an indicator of the existence of health discrepancies (or lack thereof). An application will be made for the program to be included in the Healthy People 2020 framework because it strives to improve community health outcomes by promoting the sexual health and well-being of minority populations.
Cipres, D., Rodriguez, A., Alvarez, J., Stern, L., Steinauer, J., & Seidman, D. (2017). Racial/ethnic differences in young women’s health-promoting strategies to reduce vulnerability to sexually transmitted infections. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 60(5), 556-562.
Curley, A., & Vitale, P. (2012). Population-based nursing: Concepts and competencies for advanced practice (2nd ed.). New York, NY: Springer Publishing Company.
Grau, L.E., Krasnoselskikh, T.V., Shaboltas, A.V., Skochilov, R.V., Kozlov, A.P., & Abdala, N. (2013). Cultural adaptation of an intervention to reduce sexual risk behaviors among patients attending an STI clinic in St. Petersburg, Russia. Prevention Science: The Official Journal of the Society for Prevention Research, 14(4), 400-410.
Haderxhanaj, L.T., Rhodes, S.D., Romaguera, R.A., Bloom, F.R., & Leichliter, J.S. (2015). Hispanic men in the United States: Acculturation and recent sexual behaviors with female partners, 2006–2010. American Journal of Public Health, 105(8), 126-133.
McCabe, B.E., Solle, N.S., Montano, N.P., & Mitrani, V.B. (2017). Alcohol misuse, depressive symptoms, and HIV/STI risks of US Hispanic women. Ethnicity & Health, 22(5), 528-540.
NHCSL. (2017). A growing concern: Latinas, HIV/AIDS, and other STDS. Web.
Paz, K., & Massey, K. P. (2016). Health disparity among Latina women: Comparison with non-Latina women. Clinical Medicine Insights. Women’s Health, 9(1), 71-74.
Pflieger, J.C., Cook, E.C., Niccolai, L.M., & Connell, C.M. (2013). Racial/ ethnic differences in patterns of sexual risk behavior and rates of sexually transmitted infections among female young adults. American Journal of Public Health, 103(5), 903-909.
Rhodes, S.D., Alonzo, J., Mann, L., Freeman, A., Sun, C.J., Garcia, M., & Painter, T.M. (2015). Enhancement of a locally developed HIV prevention intervention for Hispanic/Latino MSM: A partnership of community-based organizations, a university, and the Centers for Disease Control and Prevention. AIDS Education and Prevention: Official Publication of the International Society for AIDS Education, 27(4), 312-332.
Rhodes, S.D., Alonzo, J., Mann, L., Song, E.Y., Tanner, A.E., Arellano, J.E., Painter, T.M. (2017). Small-group randomized controlled trial to increase condom use and HIV testing among Hispanic/Latino gay, bisexual, and other men who have sex with men. American Journal of Public Health, 107(6), 969-976.
Rotblatt, H., Montoya, J.A., Plant, A., Guerry, S., & Kerndt, P.R. (2013). There’s no place like home: First-year use of the “I know” home testing program for chlamydia and gonorrhea. American Journal of Public Health, 103(8), 1376-1380.
Samari, G., & Seltzer, J.A. (2016). Risky sexual behavior of foreign and native-born women in emerging adulthood: The long reach of mother-daughter relationships in adolescence. Social Science Research, 60(1), 222-235.
Sanchez, M., Rojas, P., Li, T., Ravelo, G., Cyrus, E., Wang, W., … Kanamori, M. (2016). Evaluating a culturally tailored HIV risk reduction intervention among Latina immigrants in the farmworker community. World Med Health Policy, 8(3), 245-262.
Stockman, J.K., Hayashi, H., & Campbell, J.C. (2015). Intimate partner violence and its health impact on disproportionately affected populations, including minorities and impoverished groups. Journal of Women’s Health, 24(1), 62-79.
Suburbanstats.org. (2017). Population demographics of Michigan 2017-2018. Web.
Villar-Loubet, O., Weiss, S.M., Marks, G., O’Daniels, C., Jones, D., Metsch, L.R., & McLellan-Lemal, E. (2016). Social and psychological correlates of unprotected anal intercourse among Hispanic-American women: Implications for STI/HIV prevention. Culture, Health & Sexuality, 18(11), 1221-1237.
Vincent, W., Gordon, D.M., Campbell, C., Ward, N.L., Albritton, T., & Kershaw, T. (2016). Adherence to traditionally masculine norms and condom-related beliefs: emphasis on African American and Hispanic men. Psychology of Men & Masculinity, 17(1), 42-53.
Chlamydia is a sexually transmitted disease that affects both men and women. A microorganism known as Chlamydia trachomatis causes the disease. It infects reproductive organs such as the cervix, penis, vagina, and other body organs such as the eyes (Belland et al, 2004). Transmission occurs during any form of sexual intercourse. In addition, it can be transmitted to children during childbirth. The symptoms of the disease depend on the organ infected. A great percentage of women with cervitis do not show symptoms of infection (Moss & Woodland, 2007). Therefore, many of them do not seek treatment even though the disease is present in their bodies. Chlamydia causes different symptoms in men and women. In men, symptoms appear in case of urethral infection. If the disease is untreated, it causes damaging reproductive problems that have severe consequences on the health of victims (Belland et al, 2004).
Transmission
Chlamydia is transmitted from one person to another during sexual intercourse. This involves transfer of vaginal fluids or semen from an infected person to a healthy person. Transmission occurs mainly through unprotected sex and sharing sex objects (Beigi, 2012). If infected vaginal fluids or semen flashes into the eyes, infection occurs. Transmission of Chlamydia could also occur during birth. Infection cannot occur through kissing, hugging, or sharing objects such as cups and towels.
Signs and symptoms
According to research, 70 % of women and 50% of men do not show symptoms of Chlamydia infection (Belland et al, 2004). Signs and symptoms appear 7 to 21 days after infection, and are different in men and women. In women, they include pain when urinating, strange vaginal discharge, lower abdominal pain, and bleeding after sexual intercourse (Hiebach & Burton, 2007). In men, symptoms include testicular pain and unusual discharges from the reproductive organs. Some men experience severe pain when passing urine. Strange discharges and irritation are the most common symptoms observed in cases where Chlamydia infection spreads to the eyes (Moss & Woodland, 2007).
Diagnosis
Several tests are used for diagnosis of Chlamydia. They include polymerase chain reaction (PCR), DNA strand displacement amplification (SDA), and transcription mediated amplification (TMA) (Hiebach & Burton, 2007). These tests are types of nucleic acid amplification tests (NAAT). NAATs are accurate because they have a sensitivity of about 90% and specificity of 99% (Breguet, 2007). The tests have received scientific approval for testing urogenital specimens only. However, research has shown that they show some degree of accuracy on rectal specimens.
Treatment
The most effective treatment for Chlamydia is the use of antibiotics that have been shown to be 95% effective. Treatment involves administration of either a single dose or multiple doses over an extended period. Additional medication may be administered in case the disease causes other complications. Treatment is different for pregnant women because antibiotics interfere with pregnancies and breastfeeding (Breguet, 2007). Antibiotics such as erythromycin and amoxicillin are recommended during pregnancy because they have few side effects. For men, recommended antibiotics include ofloxacin, doxycycline, azithromycin, and erythromycin (Beigi, 2012). Research has not yet proved whether complementary therapy can be used to treat the disease.
Epidemiology
Research conducted in 2010 revealed that the disease affected approximately 215 million people around the world (Moss & Woodland, 2007). This number represented 3.1% of the world’s population. This implied that it is not very common compared to other infectious diseases. In 2010, the disease caused approximately 1,200 deaths. This was a drop from the 1,500 death cases reported in 1990 (Hiebach & Burton, 2007). According to the Center for Disease Control (CDC), 2.8 million cases are reported every year in the United States alone. On the other hand, Chlamydia is the most common sexually transmitted disease in the United Kingdom.
Pathophysiology
Chlamydiae reside and get nourishment from the cells of patients. When the host cells fail to receive essential nutrients such as amino acids and vitamins, the bacteria start to die. Research has revealed that many infections take a long time to clear because the bacteria can stay inactive for long periods (Breguet, 2007). They enter a persistent stage of rest during which reproduction ceases and the bacteria become aberrant by enlarging. They begin to reproduce and multiply when the environment of the host cells becomes conducive (Beigi, 2012).
Conclusion
Chlamydia is a sexually transmitted disease that infects both men and women. It is caused by Chlamydia trachomatis. The microorganism is found in semen and vaginal fluids. Transmission occurs during any form of sexual contact between two people, one of whom is infected. Symptoms vary depending on the type of organ that is infected. Common symptoms observed in men and women include unusual discharges from the reproductive organs and pain when passing urine. NAATs are used for diagnosis of the disease. Chlamydia is effectively treated using antibiotics. The choice of medication is different for breastfeeding and pregnant women. Pregnant women use erythromycin and amoxicillin because they have fewer side effects compared to other antibiotics. Early treatment is important for the management of the disease. However, if untreated, the disease causes reproductive problems that have severe consequences on the health of victims.
References
Beigi, R. (2012). Sexually Transmitted Diseases. New York: John Wiley & Sons.
Belland, R., Ojcius, D., & Byrne, G. (2004). Chlamydia. Nature Reviews Microbiology, 2(7), 530–531.
Breguet, A. (2007). Chlamydia. New York: Rosen Publishing group.
Hiebach, N., & Burton, R. (2007). Principles of Ambulatory Medicine. New York: Lippincott Williams & Wilkins.
Moss, T., & Woodland, A. (2007). Chlamydia: the Silent Disease. Chicago: Merit Publishing International, Incorporated.
The article outlines and discusses the major facts about Chlamydia. These include how it infects people, symptoms, possible complications, diagnosis, treatment, and prevention. According to the article, Chlamydia is a sexually transmitted disease transmitted by the bacterium Chlamydia trachomatis (Centers for Disease Control and Prevention par1). It has the potential to damage the reproductive organs of a woman. In men, it causes certain discharges from the male reproductive organ. Transmission of Chlamydia occurs through sexual intercourse and from a mother to the baby during childbirth (Centers for Disease Control and Prevention par1). Oral sex, vaginal sex, and anal sex are all ways through which transmission occurs.
Symptoms of Chlamydia are not visible in most people and in cases of visibility, they appear 1 to 3 weeks after infection. In women, the cervix and the urethra are the first organs to be infected. Infected women release a vaginal discharge or experience a certain burning and uncomfortable feeling during urination (Centers for Disease Control and Prevention par3). The symptoms are different in most women. Other symptoms include abdominal pains, fever, nausea, painful sensation during sexual intercourse, pain in the lower back, and blood release between periods. In men, symptoms include penile discharge or a burning feeling during urination (Centers for Disease Control and Prevention par4). In addition, there is itching around the penal opening.
Chlamydia can result in serious health complications if not treated. In women, it can cause pelvic inflammatory disease in case it spreads to the fallopian tubes or the uterus. This can consequently lead to infertility, persistent pelvic pain, and ectopic pregnancies that occur outside the uterus (Centers for Disease Control and Prevention par5). In addition, Chlamydia may raise the chances of contracting HIV from sustained exposure.
Screening is a common recommendation for sexually active women to alleviate the risk associated with contracting Chlamydia. In men, health complications are not common. In severe cases, infections spread to the epididymis thus causing pain and sometimes fever. Unlike in women, Chlamydia rarely causes sterility in men. In very rare cases, Chlamydia leads to arthritis that causes lesions on the skin and eye and urethra inflammation.
Diagnosis of Chlamydia involves several laboratory tests. They involve urine or specimens from the penis and specimens from female genitals that include the vagina and the uterus. Treatment for Chlamydia involves the use of antibiotics (Centers for Disease Control and Prevention par6). The most commonly applied prescriptions include azithromycin and doxycycline. Treatment is similar for people infected with HIV and those that are not infected.
Sexually active people should go for regular testing and treatment. In addition, people infected with Chlamydia should not engage in sex after medication to prevent infecting their sexual partners. Women are at higher risks because failure to treat Chlamydia can lead to severe health complications as compared to men. It is important for any person undergoing treatment to take regular tests after every three months to counter incidences of re-infection.
The best way to prevent Chlamydia infection is to abstain from any form of sexual intercourse. In addition, it is important to maintain one sexual partner who is free from infection. In addition, condoms can help reduce chances of infection if used properly and every time one engages in sexual intercourse. The Center for Disease Control and Prevention (CDC) recommends annual testing (Centers for Disease Control and Prevention par 8). This is in addition to a risk assessment conducted by a health professional. Any observed symptom, such as unusual discharges, burning sensation during urination, or intense itching is a sign of a sexually transmitted disease. In that case, the individual should visit the doctor as soon as possible.
Why I chose the article
I chose the article because of several reasons. First, the article is so exhaustive and educative. It covers all aspects of Chlamydia that include its infection routes, symptoms, resulting in complications, treatment, and ways of prevention. It contains all the necessary information on Chlamydia. Secondly, it discusses the disease as it occurs in men and women. It does not generalize the topic. It outlines all symptoms observed in both women and men. The symptoms are different and well described and therefore, one can rely on the information from the article to check for Chlamydia infection before visiting a physician. In addition, the article simply presents the information by using simple medical terms. Very few complex medical terms are used and that makes it easy to grasp and comprehend.
Significance to Microbiology
The article is detailed and presents the information in a way that makes it relevant to the field of microbiology. The simple use of medical terminologies that are easy to understand even by readers who are not specialized in the field of microbiology is highly commendable. This is because Chlamydia infects many people and it is important to know the symptoms of its infection. This ensures that an infected person seeks early treatment before the disease advances to more severe medical complications, especially in women.
The study of Chlamydia is very important in the field of microbiology because of its medical importance. It has a diverse range of complications that result from failure to seek medical treatment. In women, it has the potential to spread to the womb and cause pelvic inflammatory diseases (Gibbs and Sweet 54). This leads to ectopic pregnancies and cervix inflammation. In men, it causes urethral inflammation epididymitis, and arthritis. Microbiology studies of diseases involve exploring the taxonomy, evolution, epidemiology, treatment, and prevention of diseases. All these aspects represent the basis for the study of Chlamydia and thus develop microbiological knowledge on the study of diseases.
In addition, the study of Chlamydia helps in the prevention of diseases that result from extended periods of Chlamydia infection without medical treatment (Gibbs and Sweet 56). Most of these complications are long-term and cause severe damage. For example, inflammation of the cervix for long periods can lead to cases of infertility in women (Boswell et al 34). It also develops scientific knowledge of other Chlamydia species that cause other medical complications associated with Chlamydia. This leads to better and more effective methods of treatment of such complications.
Conclusion
Chlamydia is a sexually transmitted disease transmitted by a bacterium known as Chlamydia trachomatis. It has the potential to damage the reproductive organs of a woman. In men, it causes certain discharges from the male reproductive organ. Chlamydia transmission occurs through sexual intercourse and from a mother to a baby during childbirth. The study of Chlamydia is very important in the field of microbiology because of its medical importance (Boswell et al 43).
It has a diverse range of complications that result from failure to seek medical treatment. In women, it has the potential to spread to the womb and cause pelvic inflammatory diseases. In men, it causes urethral inflammation epididymitis, and arthritis. In addition, the study of Chlamydia helps in the prevention of diseases that result from extended periods of Chlamydia infection without medical treatment. Most of these complications are long-term and cause severe damage.
Works Cited
Boswell Taylor, Alden, David and Irving Williams. Medical Microbiology. New York: Taylor & Francis, 2006. Print.
Chlamydia: CDC Fact Sheet. Centre for Disease Prevention and Control. Center for Disease Prevention and Control. 2012. Web.
Gibbs, Richard, and Ronald, S. Infectious Diseases of the Female Genital Tract. New York: Lippincott Williams & Wilkins, 2009. Print.
The purpose of this epidemiological study is to describe the incidence of gonorrhea and chlamydia in primary medical clinics in the Mississippi Delta during the COVID-19 pandemic. The present section discusses the background and significance of the present study and states the research questions the study used. Finally, the section provides a brief overview of all the sections included in the present study.
Background
Epidemiologists and health care providers monitor disease incidences to make informed decisions and be prepared for new infections. Sexually transmitted infections (STIs) are prevalent with increasing incidence rates worldwide (World Health Organization [WHO], 2019). More than 1 billion STIs are acquired every day worldwide, including chlamydia, gonorrhea, syphilis, trichomoniasis, herpes simplex virus, and human papillomavirus (WHO, 2019). More than 2.5 million cases of chlamydia, gonorrhea and syphilis were reported in 2019 in the US (Centers for Disease Control and Prevention [CDC], 2021). The number of STI cases in the U.S. reached an all-time high for the sixth consecutive year in 2019, which implies STIs are a growing concern for the US healthcare system (CDC, 2021). The official data for the incidence of STIs in the US during the pandemic in 2020 has not yet been published.
Mississippi is one of the southern states in the U.S. The estimated population of Mississippi as of July 1, 2019, was 2,976,149, among which 59.1% were whites, 37.8% were blacks, 3.4% were Hispanics or Latinos, and 1.1% Asians (U.S. Census Bureau, 2019). The per capita income from 2014-2018 was $23,434, with a poverty rate of 19.6% (U.S. Census Bureau, 2019). Mississippi has 82 counties; 18 of these counties are located in the Mississippi Delta, which lies in the northwest section of the state. Fifteen counties in the Mississippi Delta are predominantly African Americans except for Desoto county (U.S. Census Bureau, 2019). The per capita income in the Mississippi Delta ranges between $13,924 to $23,793 (U.S. Census Bureau, 2019).
Gonorrhea is caused by a bacterium Neisseria gonorrhea, which grows in the reproductive tract of women and in the urinary tract in both men and women (Mississippi State Department of Health [MSDOH], 2020). Men have a burning sensation when urinating or a discharge from the urethra. Women can have a mild course but can lead to pelvic inflammatory disease, with a risk of infertility (MSDOH, 2020). Mother to the fetal transmission can occur during labor and delivery. Left untreated, gonorrhea can spread to the blood or joints and become life-threatening (MSDOH, 2020). Individuals who have gonorrhea are more likely to get HIV compared to individuals who are gonorrhea-free (CDC, 2021). This is because the same behaviors and circumstances that may put these individuals at risk for getting gonorrhea can also put them at greater risk for getting other STIs such as chlamydia and HIV (CDC, 2021).
Chlamydia, caused by a bacterium Chlamydia Trachomatis, is the most common STI in the US (CDC, 2021). The common symptoms include painful urination, discharge from the penis or vagina, painful sexual intercourse and bleeding between periods in women, and testicular pain in men (Zhou et al., 2019). Chlamydia can also infect the rectum with rectal pain, discharge, bleeding, or no signs (Zhou et al., 2019). CDC (2021) recommends chlamydia screening for sexually active women of 25 or younger, pregnant women, and women and men in risk groups. The common risk factors include having unprotected sex, multiple sexual partners, and men having sex with men (CDC, 2021). Chlamydia is more prevalent than gonorrhea (1.8 million cases against 616,392 cases in 2019 in the US); however, gonorrhea’s prevalence growth is higher than that of Chlamydia (CDC, 2021).
Significance
The significance of epidemiological studies is difficult to overstate. According to CDC (n.d.), “epidemiology is the study of the origin and causes of diseases in a community” (para. 1.). Epidemiological studies help to get to the root of health problems and disease outbreaks in communities (CDC, n.d.). Epidemiological studies gather information on demographics, prevailing symptoms, healthcare use, and treatments (CDC, n.d.). Epidemiological studies help to monitor the changes in disease prevalence and prevent future outbreaks of diseases (CDC, n.d.). Today, the importance of epidemiological studies is growing due to the COVID-19 pandemic. According to Lipsitch et al. (2020), the need for epidemiological studies is growing as the coronavirus is rapidly evolving. Such studies help to understand how the symptoms and transmission patterns are changing (Lipsitch et al., 2020). Additionally, such studies help to understand how the virus affects patients of different ages and races (Lipsitch et al., 2020). Thus, epidemiological studies are crucial during the pandemic.
The present study describes the incidence of gonorrhea and chlamydia during the COVID-19 pandemic in the Mississippi Delta. The study is expected to help trace the changes in the prevalence of these STIs in the community. Local authorities can use the information to understand if the epidemiology of the diseases under analysis is changing. In case there are concerning patterns in the epidemiology of gonorrhea and chlamydia, the authorities may consider creating prevention programs that would help to control the disease transmissions.
Research Questions
The present research was guided by two research questions listed below:
RQ1: What was the prevalence of gonorrhea and chlamydia among people screened for STIs between July 1, 2020, and September 1, 2020, in the Mississippi Delta?
RQ2: How did the prevalence of STIs among tested individuals between July 1, 2020, and September 1, 2020, in the Mississippi Delta compare to the prevalence of these STIs among tested individuals in previous years?
Paper Overview
The present paper consists of dour parts. First, a brief literature review is provided concerning the epidemiology of the diseases under analysis. Second, the methods used by the study are discussed, including the sampling strategy, data collection methods, and analysis procedures. Third, the results of the analysis are presented and discussed in a comprehensive manner. Finally, the conclusions are drawn from the study with recommendations for future research.
Literature Review
In the United States, the incidence of chlamydia increased from 2000 to 2012 but then decreased from 2012 to 2013. It increased from 708,698 cases (a rate of 251.2/100,000) in 2000 to 1,401,906 cases (443.3/100,000) in 2013 and 1,758,666 cases (a rate of 539.9 per 100,000 population) in 2018. In Mississippi, the incidence of various STIs remains extremely high. Mississippi is ranked 3rd in 2018 for chlamydia infections in terms of rate/100,000 population (CDC, 2021). In Mississippi, there were 22,086 cases reported to the CDC (a rate of 326.7 per 100,000 population) in 2018, up from 12,697 cases (a rate of 445.8/100,000 population) in 2000 (MSDH, 2020). Of these cases, 23.57% were reported from the Mississippi Delta (MSDH, 2020). CDC (2021) revealed that there were more women with chlamydia in Mississippi (15,325 cases with the rate of 996.3/100,000) compared to men with chlamydia (Mississippi: 6,723 cases, with a rate of 465/100,000). Thus, women at a higher risk of having chlamydia than men.
Chlamydia infections have been increasing in both men and women since 2013. Individuals within the age group 20-24 years have had the highest incidence since 2015, from 6,912 cases (a rate of 3,124.7/100,000 population) in 2015 to 8,519 cases (rate of 4,068.5/100,000 population) in 2018 (CDC, 2021). This is followed by individuals in the age group 15-19 years (7,186 cases, a rate of 3,493.3/100,000 population), then the age group 25-29 with 3,697 cases, then age group 30-34 with 1,295 cases, and then age group 35-39 with 592 cases (CDC, 2021). Cases seen in other age groups, though small in number, have also been steadily increasing since 2015 (CDC, 2021).
African Americans have always had the highest reported cases both at the national and state levels compared to other races/ethnicities, and in 2018 there were 484,785 cases (rate of 1192.5/100,000 population) reported in the US and 12, 031 cases (rate of 1077.7/100,000 population) in Mississippi (MSDH, 2020). Caucasians are next with 419,627 cases (rate of 212.1/100,000 population) in the US and 2,695 cases (rate of 159.3/100,000 population) in Mississippi in 2018 (MSDH, 2020). Despite surveillance and treatment availability, the prevalence of chlamydia is still growing, which increases the financial burden on the US healthcare system in general and Mississippi’s healthcare system in particular.
Gonorrhea is prevalent in the US. Although reported cases decreased from 2008 to 2009 and 2012 to 2013, and despite testing and treatments, it has steadily been increasing since 2013. Mississippi was ranked the highest in 2018 for the number of newly diagnosed cases of gonorrhea, with a rate of 326.7 per 1000,000 population (or 9,749 cases), consistently increasing since 2013 (CDC, 2021). Approximately 22.57% of these infections were reported from the Mississippi Delta Region. There were 4,888 cases, at a rate of 317.8/100,000 population in women, and 4,846 cases, a rate of 317.8/100,000 population in men (CDC, 2021). This implies that there were no significant differences in the prevalence of gonorrhea between men and women.
Gonorrhea infections were reported from different age groups. Individuals in the age group 20-24 have consistently reported the highest rate per 100,000 population since 2013, a rate of 1564.1/100,000 population (MSDH, 2020). This same age group also has the highest cases in the US, with 157,708 cases (rate of 3275/100,000 population) (CDC, 2021). Age group 25-29 years has the second-highest reported cases in the US with 129,385 cases but the age group 15-19 years has the second-highest in Mississippi with 2,202 cases (rate of 1067.4/100,000 population) (MSDH, 2020). Age group 25-29 has the 3rd highest reported cases in Mississippi, with 2,032 cases (MSDH, 2020). This trend was linked to the increasing number of young individuals who were engaging in risky sexual behaviors Advocates for Youth, 2016). Lower numbers were reported in older adults, but CDC (2021) stated that gonorrhea infections have been increasing since 2013 in all age groups. This is partly because of high rates of quinolone resistance, increasing azithromycin resistance, and emerging resistance to extended-spectrum cephalosporins (WHO, 2019). Drug resistance for gonorrhea is a major threat to reducing the impact of gonorrhea worldwide (WHO, 2019).
African American women reported greater substance abuse, more sexual partners, higher concurrency levels, and more transactional sex (MacCarthy et al., 2015). Mississippi, like most states in the Deep South, has disproportionately high rates of STIs and HIV, especially among African American sexual minorities, which include individuals who identified themselves as lesbian, gay, bisexual, men who have sex with men, or women who have sex with women (Alexander et al., 2015; MacCarthy et al., 2015). Additionally, in 2010, an estimated 1,582,360 people were living in rural Mississippi (Rural Health Info, 2021). Rural Mississippi overall has poorer health, higher poverty rates, an insufficient supply of medical care providers, and a cultural climate that likely contributes to the spread of STIs (Reif et al., 2017). Barger et al. (2018) report that people living in the Delta Region of Mississippi face significant disparities in the incidence of chlamydia, gonorrhea and syphilis” (p. 612). The reasons for these disparities are low investments in the area and an abnormally high prevalence of risky sexual behavior among young adults (Barger et al., 2018).
It is predicted that STIs will continue to increase exponentially because of the COVID-19 pandemic. This is because public resources have shifted to the COVID-19 pandemic response (Hellmann, 2020). Access to STD testing and treatment services is dwindling as the staff is reassigned or redeployed to respond to COVID-19 (Hellmann, 2020). Some clinics have closed down permanently. Clinics that remain open have reduced hours and services, limit appointments, no longer accepting walk-ins, and have suspended outreach programs for STIs prevention and treatment (Hellmann, 2020). Thus, patients will not be able to access health services, their infections will not be treated, and they will be predisposed to more transmission of STIs (Hellmann, 2020). Such concerns make it crucial to study the prevalence of STIs during the pandemic.
Methods
Study Design and Sample
This retrospective review of patients with a diagnosis of Chlamydia and or Gonorrhea will be collected from three medical clinics in the heart of the agricultural Mississippi Delta in December 2020. The Mississippi Delta is among the most socioeconomically disadvantaged areas in the country (McCausland, 2020). These clinics are busy private medical clinics located in Coahoma, Bolivar, and Quitman counties in the Mississippi Delta. The following demographics were collected for this study (age, sex, race/ethnicity). Chart of patients aged 11 and older who presented to clinics between July 1, 2020, through September 1, 2020, for STI screening were reviewed. Additionally, charts of patients aged 11 and older presenting to clinics between July 1, 2019, through September 2019 for STI screening were also reviewed. A total of 47 charts were reviewed for the analysis.
Selection of Subjects
Participants were identified using a search of diagnosis codes for gonorrhea (CPT code 87591) and chlamydia (CPT/diagnosis code 87491) who presented to the clinic from July 2020 through September 2020 and July 2019 to September 2019. All eligible candidates, age 11 years and over, were included regardless of race or gender. Each subject was given a unique code that will identify them for this study.
Variables and Data Analysis
The retrospective study included assessed eight variables, including year, site (clinic), age, race, gender, STIs tested, STI confirmed, and insurance. Additionally, the total number of patients seen in the identified periods was assessed for comparison purposes. The variables were analyzed using descriptive statistics, frequency tables, and chi-square to test if the proportion of people tested positively for STIs in 2020 was different from that in 2019. SPSS was used for data analysis results because it is recommended software for data transformation and analysis. The choice of SPSS for data analysis was informed by the ability to manage the collected data effectively (Cronk, 2019). By using SPSS, the data retrieved from patient records can be manipulated and interpreted without using additional means (Stehlik-Barry & Babinec, 2017).
Confidentiality and Ethical Considerations
Data were stored on a password-protected computer. Subjects were de-identified via the use of a separate document correlating subjects’ clinic medical record numbers with a study ID assigned for the sole purpose of this study. At the end of data collection, that key was destroyed. No social security numbers, names, addresses, or other personal information was recorded. IRB approval was received before the launch of the study. The informed consents were not needed for the retrospective chart review study.
Results and Discussion
Descriptive Statistics
A total of 47 records were reviewed for both years, among which 15 were made in 2020 and 32 were made in 2019. The mean age of all participants was 32.5, with a standard deviation (SD) of 11.5. The minimum age of all participants was 17, while the maximum age was 67. The median age for both years was 31. In 2019, the mean age of participants was 33.6, with an SD of 12.2. In 2020, the mean age of the sample was 30.1, with an SD of 10. The descriptive statistics for the age are provided in Table 1 below.
Table 1. Descriptive statistics of age by year
Variable
Year
N
Mean
SE Mean
SD
Minimum
Median
Maximum
Age
2019/2020
47
32.49
1.68
11.52
17
31
67
2019
32
33.63
2.15
12.16
17
31
67
2020
15
30.07
2.57
9.96
19
28
49
In 2019, the sample included 30 females and two males, while in 2020, the sample included eight females and seven males. I total, the samples included 38 females and nine males. In 2019, the sample included 26 (81.3%) African Americans, while the number of African Americans in 2020 was 9 (60%). The number of people who did not mention their race was six in both observed periods. In 2019, only one person had Trichomonas, while all the other people from the sample tested negative for STIs. In 2020, however, one out of 15 tested positive for chlamydia, two tested positive for gonorrhea, and one tested positive for trichomonas. In total, four out of 15 tested positive for STIs in 2020. As for the locations, the majority of cases were taken from Clinic 1. The detailed frequency distribution for five variables, including gender, race, confirmed STI, insurance, and site, is provided in Table 2 below.
Table 2. Frequency table of gender, race, and confirmed STIs
Year
Total
2019
2020
Gender
Female
30 (93.8%)
8 (53.3%)
38 (80.9%)
Male
2 (6.2%)
7 (46.7%)
9 (19.1%)
Race
AA
26 (81.3%)
9 (60%)
35 (74.5%)
Unknown
6 (18.7%)
6 (40%)
12 (25.5%)
Confirmed STI
Neg
31 (96.9%)
11 (73.3%)
42 (89.4%)
PA Chlamydia
0 (0%)
1 (6.7%)
1 (2.1%)
PA Gonorrhea
0 (0%)
2 (13.3%)
2 (4.3%)
PA Trichomonas
1 (3.1%)
1 (6.7%)
2 (4.3%)
Insurance
Ambetter
1 (3.1%)
0 (0%)
1 (2.1%)
BCBS
7 (21.9%)
8 (53.3%)
15 (31.9%)
Magnolia MS
6 (18.8%)
0 (0%)
6 (12.8%)
Molina MS
3 (9.4%)
0 (0%)
3 (6.4%)
MS Medicaid
2 (6.3%)
0 (0%)
2 (4.3%)
MS Medicare
2 (6.3%)
0 (0%)
2 (4.3%)
None
3 (9.4%)
6 (40%)
9 (19.1%)
UHC
8 (25%)
1 (6.7%)
9 (19.1%)
Site
Clinic1
29 (90.6%)
10 (66.7%)
39 (83%)
Clinic2
1 (3.1%)
0 (0%)
1 (2.1%)
Clinic3
2 (6.3%)
5 (33.3%)
7 (14.9%)
Inferential Statistics
A chi-square test was conducted to determine if the proportion of people with confirmed STIs in 2019 was different from that in 2020. In order to conduct the test, a dummy variable was created, where all participants that tested positively for any STIs were marked as “Yes,” and all others were marked “No.” The frequency distribution for the dummy variable is provided in Table 3 below. The Chi-Square test revealed that the proportion of people with confirmed STIs in 2019 was significantly lower than that in 2020 with 95% confidence (p = 0.046).
Table 3. Frequency distribution of the dummy variable
Year
N
Event
Sample proportion
2019
32
1
0.03125
2020
15
4
0.26667
Discussion
The results of the present answered the two research questions stated in the introduction to the present paper. First, the study revealed that the proportion of people with confirmed STIs during the pandemic was 26.7% among all screened individuals. Among all the tested individuals, 6.7% had chlamydia, and 13.3% had gonorrhea. Second, the prevalence of people with confirmed STIs among all tested individuals during the pandemic was higher than that before the pandemic in the same period. These findings are coherent with the overall growing prevalence of STIs in the US in general in Mississippi in particular (CDC, 2021, MSDH, 2020). Additionally, the findings supported the idea that the pandemic had a negative impact on the prevalence of STIs, which was mentioned by Hellmann (2020). In particular, the number of people screened for STIs in the observed clinics decreased by 53% during the pandemic, which was seen in the results of the present study. Such a tendency may be explained by the fact that clinics were overwhelmed with COVID-19 patients, which forced them to decrease the number of STI screenings (Hellmann, 2020). Lack of timely diagnosis and treatment due to inadequate screening procedures may unfavorably affect the situation with STI prevalence in the future (Hellmann, 2020).
Among other important findings, it is crucial to notice that the mean age of people tested for STIs decreased in 2020 in comparison with the same period in 2019. This can be explained by the recommendations made for older adults by CDC to stay at home during the pandemic. Additionally, it should be noticed that the proportion of people screened for STIs without insurance increased from 9.4% to 40%, which may demonstrate that many people lost their jobs and health insurance during the pandemic. This phenomenon can also partially explain the reduced number of people screened for STIs in 2020.
While the results of the present study are significant, it is crucial to acknowledge its limitations. The primary concern associated with the results of the present paper is the sample size. According to Andrade (2020), small sample sizes negatively affect the precision of estimations. Moreover, inadequate sample sizes may be unethical (Andrade, 2020). The sample size of the present study included a total of 47 observations, among which 32 were made in 2019 and 15 were made in 2020. These sample sizes are inadequate, which implies that the reliability of findings is small (Andrade, 2020). Another concern of the present study is that it does not demonstrate the prevalence of the STIs under analysis against the population of the cities/counties. Instead, the proportions of positively diagnosed patients against all screened patients is discussed. Finally, it should be acknowledged that the results are applicable only to the Mississippi Delta, as the sample was taken from this region. Thus, the generalizability of the results is limited.
Conclusion
The present research aimed at describing the incidence of gonorrhea and chlamydia in primary medical clinics in the Mississippi Delta during the COVID-19 pandemic. Data was collected from three clinics during the period between July and September in 2019 and 2020 and analyzed using SPSS. The results of the study revealed that there was an increased incidence of STIs, including gonorrhea and chlamydia, in 2020 in comparison with the same period in 2019. However, the differences in proportions can be explained by the decreased number of screenings due to the pandemic, increased number of people without insurance, and low precision due to inadequate samples sizes.
Future research should aim at addressing the weaknesses of the present study. In particular, the sample size can be increased to ensure higher reliability of results. This can be achieved by increasing the period of observations or by including information from more clinics in the analysis. Additionally, future research may focus on comparing the proportion of people diagnosed with STIs against the populations of the cities in which clinics are situated. Finally, clinics from other counties and states can be included in the analysis to increase the generalizability of findings.
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Barger, A. C., Pearson, W. S., Rodriguez, C., Crumly, D., Mueller-Luckey, G., & Jenkins, W. D. (2018). Sexually transmitted infections in the Delta Regional Authority: significant disparities in the 252 counties of the eight-state Delta Region Authority. Sexually Transmitted Infections, 94(8), 611-615.
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