P A Rogers

Institute for Child Health Policy (ICHP), London, Ohio, United States

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Publications (33)152.62 Total impact

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    ABSTRACT: To investigate factors associated with pelvic inflammatory disease (PID). A case-control study was used to investigate demographic and behavioural factors, and causative agents associated with PID. A total of 381 participants were recruited: 140 patients, and 105 and 136 controls in tubal ligation and general practice groups, respectively. When compared with a PID-free tubal ligation control group, increased risk of PID was associated with: age <25 years; age at first sexual intercourse <20 years; non-white ethnicity; not having had children; a self-reported history of a sexually transmitted disease; and exposure to Chlamydia trachomatis. When compared with a general practice control group, increased risk was associated with: age <25 years; age at first sexual intercourse <15 years; lower socioeconomic status; being single; adverse pregnancy outcome; a self-reported history of a sexually transmitted disease; and exposure to C trachomatis. Of the cases, 64% were not associated with any of the infectious agents measured in this study (idiopathic). A high proportion of cases were idiopathic. PID control strategies, which currently focus on chlamydial screening, have to be reviewed so that they can prevent all cases of PID. Behavioural change is a key factor in the primary prevention of PID, and potential modifiable risk factors were associated with PID.
    Sexually Transmitted Infections 12/2006; 82(6):452-7. DOI:10.1136/sti.2005.019539 · 3.08 Impact Factor
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    ABSTRACT: Studies have suggested that positivity can be used to estimate the prevalence of Chlamydia trachomatis in large-scale chlamydia screening programmes. A recent pilot of opportunistic screening in England estimated that the prevalence among 16-24-year-old women in Portsmouth and Wirral was 9.8% and 11.2%, respectively. This study assessed the continued validity of positivity as an approximate for prevalence. We re-analysed data from the Chlamydia Screening Pilot to estimate positivity,calculated as total positive tests divided by total tests, and compared these estimates with the previously reported prevalence, measured as the number of women testing positive divided by the total number of women screened. Overall positivity was 9.4% in Portsmouth and 11.0% in the Wirral; these estimates were not statistically different from prevalence, regardless of health-care setting, age group or symptoms. We conclude that positivity can be used as a proxy for prevalence.
    International Journal of STD & AIDS 05/2005; 16(4):323-7. DOI:10.1258/0956462053654249 · 1.04 Impact Factor
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    ABSTRACT: To evaluate the association between Mycoplasma genitalium, Chlamydia trachomatis, and pelvic inflammatory disease (PID) METHODS: A case-control methodology was used. Swab eluates were processed using the QIAamp DNA mini kit. Polymerase chain reaction (PCR) for M genitalium was carried out using a real time in-house 16S based assay. An endocervical swab was taken and tested for the presence of C trachomatis (ligase chain reaction, Abbott Laboratories), and a high vaginal swab was taken and tested for the presence of Neisseria gonorrhoeae and bacterial vaginosis. Of the PID cases 13% (6/45) had evidence of M genitalium infection compared to none of the controls (0/37); 27% (12/45) of the cases had C trachomatis infection compared to none of the controls; and 16% (7/45) of cases only had serological evidence of C trachomatis infection compared to 5% (2/37) of controls. Cases were more likely to present with M genitalium and/or C trachomatis than controls (p<0.001). This study indicates that there may be an association between M genitalium and PID, and that this relation is largely independent of C trachomatis. Future studies need to investigate the pathological basis of the relation between M genitalium and PID using samples from women with PID diagnosed using laparoscopy and endometrial biopsy. Little is known about the epidemiology of M genitalium: large scale epidemiological investigations are needed to determine the prevalence, incidence, and factors associated with this emerging infection.
    Journal of Clinical Pathology 08/2003; 56(8):616-8. DOI:10.1136/jcp.56.8.616 · 2.55 Impact Factor
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    Sexually Transmitted Infections 07/2003; 79(3):174-6. · 3.08 Impact Factor
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    ABSTRACT: Objective: To evaluate the association between Mycoplasma genitalium, Chlamydia trachomatis, and pelvic inflammatory disease (PID) Methods: A case-control methodology was used. Swab eluates were processed using the QIAamp DNA mini kit. Polymerase chain reaction (PCR) for M genitalium was carried out using a real time in-house 16S based assay. An endocervical swab was taken and tested for the presence of C trachomatis (ligase chain reaction, Abbott Laboratories), and a high vaginal swab was taken and tested for the presence of Neisseria gonorrhoeae and bacterial vaginosis. Results: Of the PID cases 13% (6/45) had evidence of M genitalium infection compared to none of the controls (0/37); 27% (12/45) of the cases had C trachomatis infection compared to none of the controls; and 16% (7/45) of cases only had serological evidence of C trachomatis infection compared to 5% (2/37) of controls. Cases were more likely to present with M genitalium and/or C trachomatis than controls (p<0.001). Conclusions: This study indicates that there may be an association between M genitalium and PID, and that this relation is largely independent of C trachomatis. Future studies need to investigate the pathological basis of the relation between M genitalium and PID using samples from women with PID diagnosed using laparoscopy and endometrial biopsy. Little is known about the epidemiology of M genitalium: large scale epidemiological investigations are needed to determine the prevalence, incidence, and factors associated with this emerging infection.
    Sexually Transmitted Infections 04/2003; 79(2). DOI:10.1136/sti.79.2.154 · 3.08 Impact Factor
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    ABSTRACT: To determine the acceptability of opportunistic screening for Chlamydia trachomatis in young people in a range of healthcare settings. An opportunistic screening programme (1 September 1999 to 31 August 2000) using urine samples tested by ligase chain reaction (LCR). Data on uptake and testing were collected and in-depth interviews were used for programme evaluation. General practice, family planning, genitourinary medicine clinics, adolescent sexual health clinics, termination of pregnancy clinics, and women's services in hospitals (antenatal, colposcopy, gynaecology and infertility clinics) in two health authorities (Wirral and Portsmouth and South East Hampshire). Main participants: Sexually active women aged between 16 and 24 years attending healthcare settings for any reason. Uptake data: proportion of women accepting a test by area, healthcare setting, and age; overall population coverage achieved in 1 year. Evaluation data: participants' attitudes and views towards opportunistic screening and urine testing. Acceptance of testing by women (16-24 years) was 76% in Portsmouth and 84% in Wirral. Acceptance was lower in younger women (Portsmouth only) and varied by healthcare setting within each site. 50% of the target female population were screened in Portsmouth and 39% in Wirral. Both the opportunistic offer of screening and the method of screening were universally acceptable. Major factors influencing a decision to accept screening were the non-invasive nature of testing and treatment, desire to protect future fertility, and the experimental nature of the screening programme. An opportunistic model of urine screening for chlamydial infection is a practical, universally acceptable method of screening.
    Sexually Transmitted Infections 03/2003; 79(1):16-21. DOI:10.1136/sti.79.1.16 · 3.08 Impact Factor
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    ABSTRACT: To determine the prevalence and treatment outcomes among young women screened opportunistically for genital Chlamydia trachomatis and to evaluate the impact of screening in those participating. An opportunistic screening programme (1 September 1999 to 31 August 2000) using urine samples, tested by ligase chain reaction (LCR). In-depth interviews were used for programme evaluation. Screening was offered in two health authorities at general practice, family planning, genitourinary medicine (GUM), adolescent sexual health, termination of pregnancy clinics and women's services in hospitals (antenatal, colposcopy, gynaecology and infertility clinics). Main participants: Sexually active women (16-24 years) attending for any reason. Screening data: prevalence of infection by age and healthcare setting; proportion of positive patients attending for treatment. Evaluation data: participants' attitudes and views towards screening and follow up. In total, 16 930 women (16-24 years) were screened. Prevalence was higher in younger women (16-20) than those aged 21-24 years and was highly variable at different healthcare settings (range 3.4%-17.6%). Prevalence was approximately 9% in general practice. The role of the project health advisers in managing results and coordinating treatment of positive individuals was essential; the vast majority of all positives were known to be treated. Women felt that screening was beneficial. Improving awareness and education about sexually transmitted infections is required to alleviate negative reactions associated with testing positive for infection. Prevalence of infection outside GUM clinics is substantial and opportunistic screening using urine samples is an acceptable method of reaching individuals with infection who do not normally present at specialist clinics.
    Sexually Transmitted Infections 03/2003; 79(1):22-7. DOI:10.1136/sti.79.1.22 · 3.08 Impact Factor
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    ABSTRACT: Monitoring injecting drug users risk behaviours is important because changes in these can rapidly increase blood-borne virus transmission rates. In England and Wales needle and syringe sharing in the previous month has been monitored through annual cross-sectional surveys since 1991. After declining in the early 1990s, the proportion sharing increased significantly between 1997 and 2000. This, and an apparent increase in hepatitis B transmission, indicates that injectors are at an increasing risk of infection with blood-borne viruses.
    AIDS 01/2003; 16(18):2494-6. DOI:10.1097/01.aids.0000042930.55529.cb · 6.56 Impact Factor
  • AIDS 12/2002; 16(18):2494-2496. DOI:10.1097/00002030-200212060-00022 · 6.56 Impact Factor
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    ABSTRACT: Individuals who repeatedly acquire sexually transmitted infections (STIs) may facilitate the persistence of disease at endemic levels. Identifying those most likely to become reinfected with an STI would help in the development of targeted interventions. To investigate the demographic and behavior characteristics of sexually transmitted disease (STD) clinic patients most likely to reattend with an STI. The proportion of patients attending three STD clinics in England between 1994 and 1998 who reattended for treatment of acute STI within 1 year was estimated from Kaplan-Meier failure curves. A Cox proportional hazard model was used to investigate the relation between rate of reattendance with an acute STI and patient characteristics. Of the 17,466 patients presenting at an STD clinic with an acute STI, 14% reattended for treatment of an STI within 1 year. Important determinants of reinfection were age, sexual orientation, and ethnicity: 20% of 12- to 15-year-old females (adjusted hazard ratio [HR], 1.90; CI, 1.13-3.18, compared with 20- to 24-year-old females), 22% of homosexual men (adjusted HR, 1.30; CI, 1.07-1.58, compared with heterosexual men), and 25% of black Caribbean attendees (adjusted HR, 1.87; CI, 1.63-2.13, compared with whites) reattended for treatment of acute STI within 1 year. In addition, 21% of those with a history of STI (adjusted HR, 1.42; CI, 1.28-1.59, compared with those with no history of STI) and 17% of individuals reporting three or more partners in the recent past (adjusted HR, 1.53; CI, 1.34-1.73, compared with those with one partner) reattended for treatment of an acute STI within 1 year. In this STD clinic population, teenage females, homosexual men, black Caribbean attendees, individuals with a history of STI, and those reporting high rates of sexual partner change repeatedly re-presented with acute STIs. Directing enhanced STD clinic-based interventions at these groups may be an effective strategy for STI control.
    Sex Transm Dis 08/2001; 28(7):379-86. · 2.75 Impact Factor
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    ABSTRACT: The HIV-1 infections detected in an ongoing national unlinked anonymous HIV surveillance program were subtyped and analyzed according to demographic and risk characteristics. Of the 893 anti--HIV-1--positive specimens allocated to an exposure group, 70% could be subtyped. Almost 25% of infections subtyped were non-B, mostly subtypes A, C, and D. Non-B infections were rare in homosexual and bisexual men and in drug injectors. Forty percent of infections in heterosexual men attending genitourinary medicine clinics were non-B subtypes; of these, 25% were subtype A infections and 59% were subtype C infections. For female clinic attendees, 61% were non-B subtype infections, of which 48% were subtype A infections and 42% were subtype C infections. Of the clinic attendees born in the United Kingdom and Europe, 14% of the men and 35% of the women were infected with non-B subtypes. In contrast, 78% of infections in antenatal patients were non-B subtypes, of which 61% were subtype A and 29% were subtype C. Extrapolation to the estimated 29,700 prevalent adult infections in the United Kingdom indicates that approximately 8,100 (27%) such infections are non-B subtypes and that these are found almost entirely in heterosexuals. The findings suggest spread of infection of non-B subtypes to heterosexuals born in the United Kingdom from individuals infected in regions of high prevalence.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 05/2001; 26(4):381-8. · 4.39 Impact Factor
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    M C Morris, P A Rogers, G R Kinghorn
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    ABSTRACT: To determine whether the risk factors associated with bacterial vaginosis (BV) are consistent with it being a sexually transmitted infection (STI) by comparing the characteristics of women with BV with those of women with infections recognised as being sexually and non-sexually transmitted. A prospective cross sectional study was conducted among female patients presenting for diagnosis at a genitourinary medicine clinic in Sheffield between January 1996 and September 1998. Demographic and behavioural characteristics were reported from patient records and a standardised questionnaire was administered. Risk factor models for BV, two STIs, and two non-STIs were compiled using a multivariable logistic regression analysis. Among the 8989 females under 45 years eligible for analysis, the prevalence of BV was 12.9%. Risk factors associated with BV included some in common with gonorrhoea and Chlamydia trachomatis and some that were not associated with these two STIs. Risk factors common to BV and the STIs included having had more than one sexual partner in the past 3 months, having a history of a bacterial STI, being of black Caribbean ethnicity, and living in a deprived area. However, BV had a contrasting age profile, being most prevalent among those over the age of 30. BV was also more common in those who were divorced. BV is associated with some factors related to the acquisition of gonorrhoea and Chlamydia trachomatis. However, infection is not only determined by those factors and therefore factors other than sexual activity may be important in the development of the condition.
    Sexually Transmitted Infections 03/2001; 77(1):63-8. DOI:10.1136/sti.77.1.63 · 3.08 Impact Factor
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    01/2001; Medical Devices Agency., ISBN: 1 84182 306 6
  • JAIDS Journal of Acquired Immune Deficiency Syndromes 01/2001; 26(4):381-388. DOI:10.1097/00126334-200104010-00017 · 4.39 Impact Factor
  • Sex Transm Dis 01/2001; 28(7):379-386. DOI:10.1097/00007435-200107000-00004 · 2.75 Impact Factor
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    BMJ Clinical Research 12/2000; 321(7272):1319-20. DOI:10.1136/bmj.321.7272.1319 · 14.09 Impact Factor
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    ABSTRACT: A laboratory method has been developed that detects recent HIV infection and allows incidence to be estimated by testing single stored antibody-positive specimens. A theoretical exploration of the method's surveillance utility was carried out. Using various data sources, HIV incidence rates were postulated. The confidence intervals (CI) for these postulated incidences were calculated using the expected number of recent infections for each postulated incidence, the actual number tested for HIV, and the known number of HIV-1 positives. A test for trend was used to determine when an important change in incidence could be recognized. If the incidence was 5% per annum (p.a.) in homosexual/bisexual men attending sexually transmitted diseases (STD) clinics in London, 64 recent infections would be expected in the 392 HIV-seropositive specimens and, if observed, would result in a 95% CI of 3.1-7.9% p.a. for the incidence rate. An incidence of 1% p.a. in pregnant women would be most unlikely as this would require detection of 193 recent infections, 26 more than the total 167 HIV-seropositive specimens found in 1997. In African women attending STD clinics in London, 30% of prevalent infections would be classified as recent if the incidence was 5% p.a. Further, if the incidence in homosexual/bisexual men were to fall by 50% over 3 years, a decrease of this magnitude would be recognized as significant within 2 years. The detuned assay will increase the information from HIV serosurveys even where prevalence and incidence are relatively low. Existing surveillance systems should be redesigned to take full advantage of the method.
    AIDS 12/2000; 14(16):2597-601. DOI:10.1097/00002030-200011100-00024 · 6.56 Impact Factor
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    ABSTRACT: To compare the risk factors for four common sexually transmitted infections (STIs) in attenders at three large urban genitourinary medicine (GUM) clinics in England. Clinical, demographic, and behavioural data on attenders at two clinics in London and one in Sheffield were collected. Risk factors associated with first episodes of genital warts and genital herpes simplex virus (HSV), and uncomplicated gonorrhoea and chlamydia were investigated using the presence of each of these STIs as the outcome variable in separate multiple logistic regression analyses. Using data on the first attendance of the 18,238 patients attending the clinics in 1996, the risk of a gonorrhoea or chlamydia diagnosis was strongly associated with teenagers compared with those aged over 34, with black Caribbeans and black Africans compared with whites, and increased with the number of sexual partners. The risk of genital warts or HSV diagnosis was lowest in black Caribbeans and black Africans compared with whites and was not associated with the number of sexual partners. While genital warts were associated with younger age, odds ratios were much lower compared with those for the bacterial infections. Genital HSV diagnoses were not associated with age. This study of GUM clinic attenders suggests a reduction in the incidence of bacterial STIs may be achievable through targeted sexual health promotion focusing particularly on black ethnic minorities, teenagers, and those with multiple sexual partnerships. Viral STIs were less clearly associated with population subgroups and a broader population based approach to sexual health promotion may be more effective in controlling these infections.
    Sexually Transmitted Infections 09/2000; 76(4):262-7. DOI:10.1136/sti.76.4.262 · 3.08 Impact Factor
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    ABSTRACT: A questionnaire based audit was used to evaluate the diagnosis and management of suspected pelvic inflammatory disease (PID) cases by general practitioners (GPs) in England and Wales. Responses were compared against a clinical management 'gold standard' devised by an independent group of GPs and specialists. Two hundred and ninety-seven (38%) of the 781 questionnaires were returned. Only 21 (7%) had all 'gold standard' sections correct. Diagnostic quality was significantly higher when the clinician was female compared with male (odds ratio [OR]=2.34; 95% confidence limits [CL]=1.19-4.63) and diagnostic quality increased with increasing socioeconomic deprivation. This is the first evaluation of the diagnosis and management of PID by GPs in England and Wales. The unusually poor response rate to a Medical Research Council General Practice Research Framework (MRC GPRF) study may reflect low disease awareness and sub-optimal management. This represents a fundamental obstacle to effective intervention and surveillance. Effective intervention will only be possible if diagnostic practice and management are improved substantially.
    International Journal of STD & AIDS 08/2000; 11(7):440-4. DOI:10.1258/0956462001916218 · 1.04 Impact Factor
  • The Lancet 06/2000; 355(9218):1907. DOI:10.1016/S0140-6736(00)02305-9 · 45.22 Impact Factor

Publication Stats

805 Citations
152.62 Total Impact Points

Institutions

  • 1999
    • Institute for Child Health Policy (ICHP)
      • Department of Epidemiology and Public Health
      London, Ohio, United States
    • The Bracton Centre, Oxleas NHS Trust
      Дартфорде, England, United Kingdom
  • 1997
    • International Society for Disease Surveillance
      Brighton, England, United Kingdom