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Kevin A Fenton

Publications and source records attributed to Kevin A Fenton.

29 records · Page 2Linked to original sources
PubMed2004

Rapid sequence-based identification of gonococcal transmission clusters in a large metropolitan area.

In large metropolitan areas, which typically have the highest rates of gonorrhea, the identification of chains of transmission by use of partner notification is problematic, and there is an increasing interest in applying molecular approaches, which would require new discriminatory high-throughput procedures for recognizing clusters of indistinguishable gonococci, procedures that identify local chains of transmission. Sequencing of internal fragments of 2 highly polymorphic loci, from 436 isolates recovered in London during a 3-month period, identified clusters of antibiotic-resistant and antibiotic-susceptible isolates with indistinguishable genotypes, the vast majority of which were also identical or closely related by other methods, and defined groups of individuals who typically had similar demographic characteristics. This discriminatory sequence-based approach produces unambiguous data that easily can be compared via the Internet and appears to be suitable for the identification of linked cases of gonorrhea and the timely identification of transmission of antibiotic-resistant strains, even within large cities.

Alleles↗
PubMed2004

Management of genital chlamydial infections at termination of pregnancy services in England and Wales: where are we now?

OBJECTIVE: To determine the range of policies and practices related to the management of genital chlamydial infection employed at termination of pregnancy services in England and Wales. DESIGN: Cross-sectional descriptive study. SETTING: England and Wales. POPULATION: Termination of pregnancy providers. METHODS: Survey questionnaire administered to termination of pregnancy providers. MAIN OUTCOME MEASURES: Policies and practices for the management of genital chlamydial infection in women seeking termination of pregnancy with comparison to the national guidelines of the chief medical officer (CMO) and the Royal College of Obstetricians and Gynaecologists (RCOG). RESULTS: One hundred and thirty-eight (48%) practices responded to the survey, with representation across England and Wales. Policies for screening and/or treatment of chlamydial infection existed for 70% of providers. We found three practice patterns for the management of genital chlamydial infection among termination of pregnancy attenders: 70% of providers tested their own attenders prior to termination and treated if necessary; about 25% of providers administered prophylaxis without testing; and a small number of providers (< 5%) neither tested nor treated attenders. CONCLUSION: These patterns may be the result of differences in the CMO and RCOG guidelines. Given the impact of untreated genital chlamydial infection in women attending for termination, consistent recommendations from the CMO and RCOG may encourage uniform practice for the management of chlamydial infection in this vulnerable population.

Abortion, Induced↗
PubMed2004

A multilevel approach to understanding the resurgence and evolution of infectious syphilis in Western Europe.

Nearly eight years after an outbreak of infectious syphilis was first reported in Bristol, England, successive outbreaks have occurred in most western European countries. In this issue of Eurosurveillance we take a look at the recent resurgence and evolution of infectious syphilis in seven European countries in order to critically review our understanding of its epidemiology, and to examine opportunities for directing interventions in the near future. The papers also provide some insight into the multilevel, multifactorial causation of syphilis epidemics, and how this may be changing over time in the presence of preventive interventions.

Communicable Diseases, Emerging↗
PubMed2004

Barriers to opportunistic chlamydia testing in primary care.

BACKGROUND: Opportunistic testing and screening for genital chlamydia infection in sexually active women under the age of 25 years can lead to a reduction in chlamydia infection and its related morbidity. AIMS: To explore the barriers to testing for genital chlamydial infection in primary care. DESIGN OF STUDY: Qualitative study with focus groups. SETTING: Rural and urban general practice in Southwest England. METHODS: Focus groups were held with randomly selected high- and lowtesting general practices in Herefordshire, Gloucestershire and Avon. The high- and low-testing practices did not differ in their age/sex make-up, or by deprivation indices. Open questions were asked about the management of genitourinary symptoms and opportunistic testing for chlamydia. Data were collected and analysed concurrently until saturation occurred. RESULTS: Although staff from high test rate practices were much more aware of the evidence for opportunistic chlamydia testing and screening, none of the practices were happy to discuss chlamydia in a consultation unrelated to sexual health. The greatest barriers to opportunistic chlamydia testing and screening were lack of knowledge of the benefits of testing, when and how to take specimens, lack of time, worries about discussing sexual health, and lack of guidance. Healthcare staff stated that any increased testing should be accompanied by clear, concise primary care trust guidance on when and how to test, including how to obtain informed consent and perform contact tracing. Staff felt that testing could be undertaken at family planning clinics or with cervical smears if patients received information before the consultation. Alternatively, in larger practices specific chlamydia clinics could be held. CONCLUSION: The Department of Health needs to be aware of the extreme pressures that primary care staff are under, and the potential barriers to any screening implementation. Efforts to increase chlamydia screening in this setting should be accompanied by clear guidance and education. Any chlamydia clinics or increased testing must have appropriate financial and staff resources. Genitourinary medicine (GUM) clinics, or level three practices with GUM expertise, will need to be increased in parallel with testing in primary care to provide appropriate contact tracing and follow-up.

Attitude to Health↗
PubMed2003

Ciprofloxacin resistance in Neisseria gonorrhoeae in England and Wales in 2002.

The Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) monitors trends in antimicrobial resistance in consecutive gonococcal isolates from 26 genitourinary medicine clinics in England and Wales. In 2002, 2204 gonococcal isolates were tested, and the overall prevalence of ciprofloxacin resistance (minimum inhibitory concentration > or =1 mg/L) was 9.8%, compared with 3.1% in 2001 and 2.1% in 2000. Between 2001 and 2002, prevalence of ciprofloxacin resistance increased two to three-fold, irrespective of recent sexual contact overseas, sex, or residence within or outside of London. These findings suggest that national and local treatment guidelines need to be reviewed urgently.

Anti-Infective Agents↗
PubMed2003

Researching sensitive issues and ethnicity: lessons from sexual health.

Researchers are generally familiar with the need to adapt their research methods in order to minimise the impact of sensitivity. However, are different considerations required for studies of ethnicity or with ethnic minority respondents? This paper provides insight into strategies used by the authors to tackle sensitivity in qualitative and quantitative research studies of sexual health and ethnicity. Drawing on examples from these studies, the paper demonstrates the relevance of Lee's model of sensitivity, and examines ways in which ethnicity may add further dimensions to our ability to understand, identify and limit sensitivity in the research process. The paper identifies techniques available to researchers for handling sensitivity in general, as well as those that may be useful for researching sensitive topics among ethnic minority populations. The paper concludes that, given the transitional and contextual nature of ethnicity and sensitivity, formulaic approaches for tackling the latter are inappropriate. Instead, strategies are best developed in collaboration with the study communities.

Cultural Characteristics↗
PubMedDate not supplied

Ethnic variations in sexual behaviour in Great Britain and risk of sexually transmitted infections: a probability survey.

BACKGROUND: Ethnic variations in the rate of diagnosed sexually transmitted infections (STIs) have been reported in many developed countries. We used data from the second British National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) to investigate the frequency of high-risk sexual behaviours and adverse sexual health outcomes in five ethnic groups in Great Britain. METHODS: We did a stratified probability sample survey of 11161 men and women aged 16-44 years, resident in Great Britain, using computer-assisted interviews. Additional sampling enabled us to do more detailed analyses for 949 black Caribbean, black African, Indian, and Pakistani respondents. We used logistic regression to assess reporting of STI diagnoses in the past 5 years, after controlling for demographic and behavioural variables. FINDINGS: We noted striking variations in number of sexual partnerships by ethnic group and between men and women. Reported numbers of sexual partnerships in a lifetime were highest in black Caribbean (median 9 [IQR 4-20]) and black African (9 [3-20]) men, and in white (5 [2-9]) and black Caribbean (4 [2-7]) women. Indian and Pakistani men and women reported fewer sexual partnerships, later first intercourse, and substantially lower prevalence of diagnosed STIs than did other groups. We recorded a significant association between ethnic origin and reported STIs in the past 5 years with increased risk in sexually active black Caribbean (OR 2.74 [95% CI 1.22-6.15]) and black African (2.95 [1.45-5.99]) men compared with white men, and black Caribbean (2.41 [1.35-4.28]) women compared with white women. Odds ratios changed little after controlling for age, number of sexual partnerships, homosexual and overseas partnerships, and condom use at last sexual intercourse. INTERPRETATION: Individual sexual behaviour is a key determinant of STI transmission risk, but alone does not explain the varying risk across ethnic groups. Our findings suggest a need for targeted and culturally competent prevention interventions.

Adolescent↗