Journals Watch - PPIs and sexual health

No time to read the journals? Let Dr Gwen Lewis guide you through the latest research highlights.

Proton pump inhibitors and pneumonia Med J Aust 2009; 190: 114-6

Recent studies have suggested that use of proton pump inhibitors (PPIs) may be associated with increased risk of respiratory tract infections and pneumonia in adults and children.

Suppression of gastric acid production resulting in colonisation by ingested pathogens is considered a possible cause.
Hospitalisation for pneumonia may be associated with use of PPIs for suppression of gastric acid (photograph: ZEPHYR / SCIENCE PHOTO LIBRARY)

This was a retrospective cohort study of over 185,000 Australians aged 65 years or over. The study ran for five years with the primary endpoint being hospitalisation for pneumonia.

Secondary endpoints included hospitalisation for bacterial pneumonia and prescriptions of antibiotics for respiratory infections.

There was found to be a small but significant increased risk of hospitalisation for pneumonia in those exposed to PPIs and also an increased risk of antibiotic prescriptions observed in those taking PPIs.

There was no increase in the risk of bacterial pneumonia, which accounted for 8 per cent of the total number of pneumonia cases.

Although the increased risk is only small, PPIs are very widely used. We should be aware of a possible increase in pneumonia cases.

Screening pregnant women for chlamydia Sex Transm Infect 2009; 85: 31-5

Pregnant women with chlamydia are one and a half times more at risk of premature delivery and of preterm rupture of membranes. Screening in pregnancy could reduce these risks.

This study from Australia looked at risk factors for chlamydia in pregnant 16- to 25-year-old women - the peak age group for infection.

Over a 10-month period, women in this age group attending antenatal services in Melbourne were asked to complete a questionnaire about their lifestyle and to undergo urine chlamydia screening.

Of 1,180 eligible women, 1,044 (88 per cent) agreed to participate. The prevalence of chlamydia in this group was 3.2 per cent.

The major risk factor for chlamydia was more than one sexual partner in the previous 12-month period, whereas a course of antibiotics in the previous three months reduced the risk.

If screening was restricted to women with more than one sexual partner in the previous 12 months then 44 per cent of chlamydia infections would have been detected and would have required only 7 per cent of the women to be screened.

Selective screening obviously improves the yield of infections but will miss some infections with potentially serious consequences.

At my practice we do not screen any pregnant women for chlamydia. However, screening is offered to women requesting termination of pregnancy. Perhaps we should be looking to screen those most at risk.

STI risk-reduction in BME youth groups Sex Transm Infect online 2009 doi:10.1136/sti.2008.034645

Young black women in the UK have a higher incidence of STIs than their white contemporaries.

Effective interventions to address this are lacking. The Young Brent Project in north London carried out 37 one-to-one in-depth interviews and 10 focus groups involving men and women aged 15-27 years from different ethnic backgrounds recruited from youth and genito-urinary clinic settings in the area.

It was found that concurrent sexual partnerships and barriers to condom use contributed to STI risk exposure and to difficulties in implementing risk reduction strategies.

Negative perceptions of condoms and lack of control hindered condom use, and women experienced difficulty in requesting condom use, particularly with older male partners. Men made conscious decisions not to use condoms.

Often women attempted to achieve monogamy but actually experienced complex and fluid sexual partnerships.

At present, knowledge of STIs and of the use of condoms is poor. Interventions with young black women need to address relationship issues and awareness of risk attached to multiple partners.

Use of contraceptive services in the UK J Fam Plann Reprod Health Care 2009; 35: 9-14

Over 4,000 women and over 3,000 men aged 16-44 years were interviewed about their use of contraceptive services. General practice was the most commonly reported source of contraceptive supplies for women, with almost 60 per cent overall using their GP, while for men retail sources were most frequently used at 42.7 per cent.

Over 50 per cent of the youngest age group, those aged 16-17 years, were happy to use their GP as a source of contraceptive services. A strong age gradient was seen for community clinics with 33.7 per cent of 16-17-year-old women accessing these services.

Gynaecological ultrasound in sexual health clinics J Fam Plann Reprod Health Care 2009; 35: 35-7

We are considering purchasing an ultrasound machine for surgery use. I would have valued being able to take a scan today on a woman whose IUD threads I was unable to locate. Instead I had to send her to the local hospital for the scan.

This review of ultrasound use in sexual and reproductive health clinics in Southwark, London was timely.

Over a two-year period, a total of 258 women required a gynaecological scan, of which 70.2 per cent had problems relating to an IUD. The majority had lost threads, while the remainder had other gynaecological problems. Limitations to scanning within the community have to be realised, but it was estimated that the service saved 80 referrals to gynaecology clinics - the majority for 'lost' IUDs.

Problems exist, such as the initial cost of the equipment, initial and ongoing training of the ultrasonographer, and cost of running the service, but I believe the benefits to the patient in streamlining the service are worthwhile.

I was especially interested to read 'Using ultrasound in primary care' (GP, 6 February) about Dr John Doddy's experience of ultrasound.

  • Dr Lewis is a GP in Windsor, Berkshire, and a member of our team who regularly review the journals

The quick study

  • PPI use for gastric acid suppression is associated with a significant increased risk of hospitalisation for pneumonia.
  • Chlamydia screening should be considered for pregnant women.
  • STI exposure risk is high in young, black women due to concurrent sexual relationships and lack of condom use.
  • Contraception services were most commonly reported to be sought from a GP surgery.
  • Ultrasound scans in primary care can reduce referrals to gynaecology clinics.

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