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Kevin A Fenton

Publications and source records attributed to Kevin A Fenton.

At least 19 recordsLinked to original sources
PubMed2006

Incidence and reinfection rates of genital chlamydial infection among women aged 16-24 years attending general practice, family planning and genitourinary medicine clinics in England: a prospective cohort study by the Chlamydia Recall Study Advisory Group.

BACKGROUND: In England, screening for genital chlamydial infection has begun; however, screening frequency for women is not yet determined. AIM: To measure chlamydia incidence and reinfection rates among young women to suggest screening intervals. METHODS: An 18-month prospective cohort study of women aged 16-24 years recruited from general practices, family planning clinics and genitourinary medicine (GUM) clinics: baseline-negative women followed for incidence and baseline-positive women for reinfection; urine tested every 6 months via nucleic acid amplification; and behavioural data collected. Extra test and questionnaire completed 3 months after initial positive test. Factors associated with infection and reinfection investigated using Cox regression stratified by healthcare setting of recruitment. RESULTS: Chlamydia incidence was mean (95% CI) 4.9 (2.7 to 8.8) per 100 person-years (py) among women recruited from general practices, 6.4 (4.2 to 9.8) from family planning clinics and 10.6 (7.4 to 15.2) from GUM clinics. Incidence was associated with young age, history of chlamydial infection and acquisition of new sexual partners. If recently acquiring new partners, condom use at last sexual intercourse was independently associated with lower incidence. Chlamydia reinfection was mean (95% CI) 29.9 (19.7 to 45.4) per 100/person-year from general practices, 22.3 (15.6 to 31.8) from family planning clinics and 21.1 (14.3 to 30.9) from GUM clinics. Factors independently associated with higher reinfection rates were acquisition of new partners and failure to treat all partners. CONCLUSIONS: Sexual behaviours determined incidence and reinfection, regardless of healthcare setting. Our results suggest annual screening of women aged 16-24 years who are chlamydia negative, or sooner if partner change occurs. Rescreening chlamydia-positive women within 6 months of baseline infection may be sensible, especially if partner change occurs or all partners are not treated.

Adolescent↗
PubMed2006

Learning about sex: results from Natsal 2000.

To date, the focus of sex education research has tended to be on the effect of education on behavioral outcomes. There is little data on the felt needs of young people, how well they are met, and how provision might be improved. Here we report on main source of information about sexual matters, adequacy of knowledge, further needs, and preferred source of additional information, using data from a probability sample survey of people aged 16 to 44 years in Britain (Natsal 2000). A total of 11,161 participants (4,762 men and 6,399 women) were interviewed. The response rate was 65.4%. The results show that despite the assumed worldliness and sophistication of young people about sexual matters, there is a great deal of self-perceived ignorance among them. Parents and schools are the preferred source of further information. We need to enable parents to provide information to their children, especially their sons.

Adolescent↗
PubMed2006

Identification of individuals with gonorrhoea within sexual networks: a population-based study.

BACKGROUND: Molecular typing of Neisseria gonorrhoeae and contact tracing provide a combined approach for analysis of sexual networks in metropolitan areas, although there are some difficulties in application. Our aim was to examine the application of high-throughput molecular approaches that can identify individuals in linked sexual networks. METHODS: We characterised 2045 isolates of N gonorrhoeae from patients presenting at 13 major sexually transmitted infection clinics in London, UK, between June 1 and Nov 30, 2004. All isolates were assigned a sequence type (strain) on the basis of the sequences of internal fragments of two highly polymorphic loci, por and tbpB. These types were matched to demographic and behavioural data obtained at the clinic for each patient. We assessed the congruence in the demographic and behavioural characteristics of individuals infected with the same strain. FINDINGS: We identified 21 prevalent strains in this diverse gonococcal population, each infecting between 20 and 124 individuals. Seven of these strains were predominantly from men who have sex with men; the remaining 14 were predominantly from heterosexual people. No differences were recorded between the strains associated with men who have sex with men in the demographic or behavioural characteristics of infected individuals. By contrast, significant differences in age (p<0.0001), ethnicity (p=0.001), proportion of women (p=0.01), and HIV status (p=0.03) were noted between the 14 prevalent heterosexual-associated strains. Heterosexuals with strains not shared by others in the sample were significantly older (p=0.0005) and more likely to have had sex outside the UK (p<0.0001) than those sharing a strain with at least one other. INTERPRETATION: The discriminatory high throughput strain characterisation method applied here identified localised transmission networks and suggests little bridging between networks of men who have sex with men and heterosexual networks.

Adolescent↗
PubMed2006

First sexual partnerships--age differences and their significance: empirical evidence from the 2000 British National Survey of Sexual Attitudes and Lifestyles ('Natsal 2000').

PURPOSE: To describe variations in age differences (ADs) between partners at first heterosexual intercourse and to examine associations between this AD, sociodemographic characteristics, and circumstances of first heterosexual intercourse, by gender. METHODS: A total of 3277 men and 4734 women aged 25-44 years who reported ever having heterosexual intercourse in a probability survey of the British population to obtain an unbiased sample of ADs at first intercourse. Face-to-face interviews collected sociodemographic data and information on first intercourse. Gender-specific cumulative distributions of ADs categorized respondents reporting relatively younger first partners (below fifth percentile) and those reporting relatively older first partners (above 95th percentile). RESULTS: Relatively older first partners were six years older than men and 10 years older than women. Relatively younger first partners were three years younger than men and one year younger than women. Men and women with relatively older first partners were more likely to have just met their partner (odds ratios adjusted for sociodemographic characteristics [AOR] 1.8, 95% confidence interval [CI] 1.2-2.7, and 3.1, 95% CI 2.1-4.6, respectively); had a more willing first partner (AOR 2.1, 95% CI 1.2-3.8, and 1.6, 95% CI 1.2-2.2, respectively); not used condoms at first sex (AOR 1.9, 95% CI 1.2-3.0, and 1.5, 95% CI 1.1-2.0, respectively); and reported a non-autonomous reason for first sex (AOR 1.6, 95% CI 1.1-2.4, women only). Men with relatively younger first partners were more likely to regret the timing of the first occasion (AOR 2.1, 95% CI 1.0-4.5). CONCLUSIONS: First partnerships involving relatively older or younger partners are associated with adverse circumstances of first intercourse. Condoms and other reliable contraception are less likely to be used, and age differences may reflect unequal power relations. Promoting effective communication and negotiation skills may be particularly important for those with relatively older or younger first partners.

Adolescent↗
PubMed2006

Access to HIV care among migrant Africans in Britain. What are the issues?

In the UK, substantial numbers of new HIV diagnoses are within migrant communities, especially African communities. Current surveillance shows that despite health promotion efforts and advances in therapy these communities are accessing HIV care late. This paper explores the issues influencing the access and uptake of HIV care by migrant Africans in Britain. Using Kleinman's model of health care systems (Kleinman, 1980) as a theoretical framework, we highlight the importance of placing health within its broader context if we are to make significant improvement to the health of HIV-infected Africans in Britain.

Africa↗
PubMed2006

Epidemiological correlates of asymptomatic gonorrhea.

OBJECTIVES: To assess correlates of asymptomatic gonorrhea among patients attending Genitourinary Medicine Clinics participating in the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in England for 2001-2003. STUDY DESIGN: GRASP is a sentinel surveillance program that monitors antimicrobial resistance to Neisseria gonorrhoeae. Data collection occurs annually in June to August each year. RESULTS: Women with previously diagnosed gonorrhea had decreased odds of asymptomatic gonococcal infection, as did women diagnosed with other sexually transmitted infections (all except chlamydia, syphilis, herpes, and warts). Heterosexual men, but not women, coinfected with chlamydia had significantly higher likelihood of being diagnosed with asymptomatic gonorrhea, as did homosexual men coinfected with syphilis and warts. CONCLUSION: The heterogeneity in correlates of asymptomatic gonorrhea has implications for screening in clinical settings. Such findings also depend on the extent of testing on sexually transmitted infections from different sites of infection, which has particular relevance in homosexual men and would thus need to be investigated in other studies.

Adolescent↗
PubMed2005

Changing epidemiologic profile of quinolone-resistant Neisseria gonorrhoeae in London.

The percentage of quinolone-resistant Neisseria gonorrhoeae isolated in London increased between 2000 and 2003, from 0.9% to 7.9% of total isolates. This increase was investigated by genotyping resistant isolates and comparing demographic and behavioral data. In 2000, resistant isolates predominantly had unique sequence types (STs) that were associated with imported infection, whereas, in 2002 and 2003, large ST clusters of indistinguishable isolates were associated with endemic acquisition. Resistant isolates that belonged to these large clusters were typically from patients who had similar epidemiological characteristics (such as ethnicity and sexual orientation) and behavioral characteristics (such as multiple sex partners and previous gonorrhea). In London, quinolone resistance is no longer associated with importation from areas of high prevalence and is spreading endemically in high-risk groups.

Adolescent↗
PubMed2005

Reported sexually transmitted disease clinic attendance and sexually transmitted infections in britain: prevalence, risk factors, and proportionate population burden.

BACKGROUND: We examined attendance at sexually transmitted disease (STD) clinics and the prevalence, distribution, and associated demographic and behavioral factors of self-reported sexually transmitted infections (STIs) in a population survey of sexual attitudes and lifestyles. METHODS: We analyzed data from stratified probability sample surveys obtained through the British National Surveys of Sexual Attitudes and Lifestyles (Natsal), which was undertaken in 1990 (n=13,765) and 2000 (n=11,161) among men and women aged 16-44 years. National STD surveillance data for 1999 were used to determine disease- and risk factor-specific proportionate population burden (PPB). RESULTS: Between 1990 and 2000, the number of subjects who reported having attended an STD clinic during the past 5 years increased from 4.3% to 7.6% among men and from 3.3% to 6.6% among women. In 2000, 3.0% of men and 4.0% of women reported having received a diagnosis of an STI during the past 5 years; 77.6% of men and 60.3% of women with an STI had attended an STD clinic. Reported STI acquisition was independently associated with age, increasing numbers of sex partners, male homosexual partners, and partners from abroad (for women only). Of all reported STIs during the past 5 years (PPB, 10.2%), 10.2% were reported by the 2.9% of men who reported having had homosexual partners during the past 5 years. Of all reported STIs in the past 5 years (PPB, 41.6%), 41.6% were reported by the 4.0% of women who reported having > or =10 sex partners during that time. Analysis of national STI surveillance data showed that the PPB for new episodes of Chlamydia trachomatis diagnosed among homosexual men was 2.8%, that for gonorrhea was 17.4%, and that for syphilis was 32.1%. CONCLUSIONS: Numbers and types of sexual partnerships remain the dominant individual and population risk factors for STI acquisition. Combined population behavior and surveillance data demonstrate the high PPB for STIs attributable to key risk factors. PPB may be a useful indicator of epidemic "phase" and may help target resources and guide prevention strategies.

Adolescent↗
PubMed2005

Investigating the relationship between HIV testing and risk behaviour in Britain: National Survey of Sexual Attitudes and Lifestyles 2000.

OBJECTIVES: To estimate the prevalence of, and identify factors associated with, HIV testing in Britain. DESIGN: A large, stratified probability sample survey of sexual attitudes and lifestyles. METHODS: A total of 12,110 16-44 year olds completed a computer-assisted face-to-face interview and self-interview. Self-reports of HIV testing, i.e. the timing, reasons for and location of testing, were included. RESULTS: A total of 32.4% of men and 31.7% of women reported ever having had an HIV test, the majority of whom were tested through blood donation. When screening for blood donation and pregnancy were excluded, 9.0% of men and 4.6% of women had had a voluntary confidential HIV test (VCT) in the past 5 years. However, one third of injecting drug users and men who have sex with men had a VCT in the past 5 years. VCT in the past 5 years was significantly associated with age, residence, ethnicity, self-perceived HIV risk, reporting greater numbers of sexual partners, new sexual partners from abroad, previous sexually transmitted infection diagnosis, and injecting non-prescribed drugs for men and women, and same-sex partners (men only). Whereas sexually transmitted disease clinics were important sites for VCT, general practice accounted for almost a quarter of VCT. CONCLUSION: HIV testing is relatively common in Britain; however, it remains largely associated with population-based blood donation and antenatal screening programmes. In contrast, VCT remains highly associated with high-risk (sexual or drug-injecting) behaviours or population sub-groups at high risk. Strategies to reduce undiagnosed prevalent HIV infection will require further normalization and wider uptake of HIV testing.

Adolescent↗
PubMed2005

Increasing rates of sexually transmitted diseases in homosexual men in Western europe and the United States: why?

The recent increases in acute STDs among MSM must be viewed in the context of a post-AIDS era that is characterized by demographic shifts,changing sexual attitudes, and rapidly changing social contexts. A key driver seems to be the growing prevalent pool of HIV-positive MSM for whom the crucial motivator for safer sex (primary HIV prevention) no longer exists and where, given the prevalence of seroconcordant sexual mixing, consider-able uncertainty and conflicting advice regarding the rationale and benefits for continued safer-sex practice are unclear [105,106]. Although it is tempting to ascribe these changes to increases in risk behavior, it is essential that the contexts in which the changes are occurring are also considered. It may also be appropriate to contemplate whether further changes to the social environment (eg, structural interventions) are a suitable adjunct to our traditional prevention activities that operate largely in isolation from each other. It seems natural to advocate that interventions that adopt holistic approaches to the sexual health of MSM and that address upstream factors such as mental health, drug use, discrimination, and internalized homophobia should be included in the efforts to create more healthy environments for MSM. However, there is still some way to go in identifying which of these upstream interventions are effective, how they may be implemented within or alongside existing health care systems, and what impact, if any, they are likely to have on STD transmission. Such interventions are also likely to belong on implementation time, require consider political will, and be extremely hard to evaluate, and the benefits may not be seen within the same generation in which they are implemented. Therefore, there must be confidence that this is the appropriate route of travel. The consistency of findings from across industrialized countries confirms an increasing connectivity within the global MSM community;a community that is decreasingly defined by geographic boundaries and, in the era of the Internet and easier foreign travel, increasingly linked by shared interests and social and sexual networks. This is powerfully demonstrated in the near-simultaneous syphilis and LGV outbreaks among MSM in Europe and the United States [29]. In this regard, greater collaboration between researchers and providers working with MSM indifferent countries is now required. More specifically, consideration should be given to creating closer partnerships between sentinel cities, such as London, New York, San Francisco, Berlin, Paris, and Amsterdam, that have large MSM populations and are likely to be emerging, or rapid diffusion sites for new social and sexual trends that may impact on disease transmission. There are many benefits to such cross-national working,including earlier recognition and improved response to emerging threats,sharing innovative practice, avoiding duplication of effort, and creating a united front for dealing with what must be considered a cause for concern domestically and globally.

Europe↗
PubMed2005

The re-emergence of syphilis in the United Kingdom: the new epidemic phases.

OBJECTIVE: The objective of this study was to characterize the resurgence of infectious syphilis in the United Kingdom between 1997 and 2003. STUDY: The authors conducted a retrospective analysis of routine surveillance data from genitourinary medicine clinics and data collected through enhanced surveillance. RESULTS: Between 1997 and 2002, diagnoses of primary, secondary, and early latent syphilis made at genitourinary medicine clinics increased by 213% in heterosexual males, 1412% in men who have sex with men (MSM), and 22% in females. These increases have been driven by a series of outbreaks, the largest of which were seen in Manchester (528) and London (1222) up to the end of October 2003. All the outbreaks have been geographically localized and the majority of cases occurred in MSM. A high percentage of concurrent HIV infection was reported, and oral sex was often reported as a route of transmission. CONCLUSIONS: Syphilis has re-emerged in response to behavior change, probably driven by changes in the HIV epidemic. The future course of the epidemic is difficult to predict and control remains elusive.

Adolescent↗
PubMed2005

Chlamydia trachomatis testing in the second British national survey of sexual attitudes and lifestyles: respondent uptake and treatment outcomes.

BACKGROUND: Noninvasive molecular tests for bacterial sexually transmitted infections (STIs) provide new opportunities for testing in nonclinical settings. Little information is available on the outcomes when applied to asymptomatic sex survey participants. OBJECTIVE: The objective of this study was to examine patient treatment preferences and partner notification outcomes among Chlamydia trachomatis-positive cases identified in the 2000 national survey of sexual attitudes and lifestyles (Natsal 2000), and factors associated with providing a urine sample. METHODS: The authors conducted a stratified probability sample survey of 11,161 men and women aged 16 to 44 years residing in Britain using computer-assisted self-interviews. Urine testing was performed for C. trachomatis offered to a random half of sexually active respondents aged 18 to 44 using ligase chain reaction. Notification, treatment, and follow up of ligase chain reaction-positive respondents were undertaken. RESULTS: A total of 5105 respondents were invited to provide a urine sample. A total of 3628 (71%) agreed and 3608 samples were successfully tested. Willingness to provide a urine sample was significantly higher among those reporting previous homosexual experience, heterosexual anal sex, and STI diagnosis. Seventy-three respondents (31 men and 42 women) were diagnosed with genital chlamydial infection. Sixty-five (89%) responded to notification of their infection and were recommended for treatment and partner notification. Fifty (77%) respondents preferred to be seen by their general practitioner and 15 (23%) by their local genitourinary medicine clinic. Although physician feedback on treatment and partner notification outcomes was obtained for only half (n = 34) of respondents, follow-up respondent interviews confirmed that a total of 49 (75%) respondents underwent this process. INTERPRETATION: In this community-based survey, the rate of provision of urine samples was high, and those who provided samples were found to be at somewhat greater risk of infection on average. This was accounted for in estimating population chlamydia prevalence. The authors found that treatment and partner notification of newly diagnosed infections can be successfully achieved in STI prevalence studies.

Adolescent↗
PubMed2005

Divergent approaches to partner notification for sexually transmitted infections across the European union.

OBJECTIVE: The objective of this study was to characterize partner notification (PN) policy and practice for sexually transmitted infections (STIs) in the European Union (EU) and Norway. GOAL: The goal of this study was to promote European good practice in PN. STUDY: This study consisted of a cross-sectional survey using a structured questionnaire to national STI surveillance leads. RESULTS: Considerable heterogeneity exists in approaches to PN. In 2 countries, PN is compulsory for notifiable STIs; and in 13, it is voluntary. Most countries use patient referral but 5 of 15 also offer provider referral. Activity level varies by country and disease. Etiologic treatment of contacts is most common; 5 usually offer epidemiologic treatment and patient-expedited treatment is unusual. Similarities exist with provision mainly by specialized STI treatment services for bacterial STIs. CONCLUSIONS: This divergence in approach calls for the setting of minimum standards for PN delivery together with mechanisms for establishing and sharing best practice. Further research must identify monitoring systems for inclusion in routine surveillance.

Contact Tracing↗
PubMed2005

Changes in the circumstances of young mothers in Britain: 1990 to 2000.

OBJECTIVES: To assess changes between 1990 and 2000 in the circumstances of women who became mothers before the age of 18. DESIGN: Two cross sectional probability sample surveys of the general population carried out in 1989-1991 (Natsal 1990) and 1999-2001 (Natsal 2000). SETTING: British households. PARTICIPANTS: Women aged 18 to 27 years at time of survey (Natsal 1990: 2575, Natsal 2000: 1757). MAIN OUTCOME MEASURES: Educational attainment, participation in education/work or training, living in social housing, social class, living as lone adult, parity, ill health, and health related behaviours at the time of the interview. RESULTS: The proportion of women who were sexually active before 18 increased between 1990 and 2000 from 58.9% to 71.3% (p<0.0001). There was no significant change in the proportion who had a child before the age of 18 (4.7% in 1990, 5.3% in 2000, p=0.390). The proportion who had attained no educational qualifications and were not participating in education/work or training was significantly lower in 2000 than in 1990 for all women aged 18-27, but higher among those who were mothers before age 18, although the relative difference was not statistically significant. The proportion living in social housing or reporting a recent long term illness at time of interview was higher and this trend was more pronounced among women who did not experience motherhood before 18 than those who did, but the differences between these groups of women were not statistically significant. CONCLUSION: Motherhood before the age of 18 continues to be related to a variety of adverse circumstances in adult life, including lack of educational attainment, not being in education/work or training, lone parenthood, and a reduced likelihood of home ownership. There is little evidence of improvement in the circumstances of young mothers between 1990 and 2000 despite improvements in life chances among young women in general.

Adolescent↗
PubMed2004

Increasing prevalence of male homosexual partnerships and practices in Britain 1990-2000: evidence from national probability surveys.

OBJECTIVES: To estimate the prevalence and timing of homosexual experience among British men; to explore the patterns of sexual practices and partnerships in 2000, and behavioural and attitudinal changes between 1990 and 2000 among men who have sex with men (MSM). DESIGN: Two large, stratified probability sample surveys of the general population. METHODS: Trained interviewers administered a combination of face-to-face and self-completion questionnaires to men aged 16 to 44 years resident in Britain (n = 6000 in 1990 and n = 4762 in 2000). RESULTS: In 2000, 2.8% of British men reported sex with men in the past 5 years. 46.0% of MSM reported five or more partners in the past 5 years, and 59.8% reported unprotected anal intercourse in the past year. A total of 33.0% of MSM reported one or more female partner(s) in the past year. In comparison with 1990, there was a significant increase in the proportion of MSM in the population in 2000, and among these men, in the proportion reporting receptive anal intercourse in the past year [age-adjusted odds ratio (OR), 2.08; 95% confidence interval (CI), 1.08-4.00], but no significant change in self-perceived HIV-risk (age-adjusted OR, 1.11; 95% CI, 0.49-2.51) or HIV testing in past 5 years (age-adjusted OR, 1.14; 95% CI, 0.57-2.25). CONCLUSIONS: Evidence of increasing prevalence of homosexual intercourse among the British male population coupled with increases in some HIV-risk behaviours among MSM suggests overall increasing numbers at risk in the population. Although these changes may partly reflect an increased willingness to report these behaviours, our results are consistent with increasing incidence of sexually transmitted infections and behavioural surveillance data.

Adolescent↗