Showing papers in "Sexually Transmitted Diseases in 2011"
TL;DR: Rates of HPV vaccine initiation were higher among parents who at baseline perceived lower barriers to getting HPV vaccine, anticipated greater regret if their daughters got HPV because they were unvaccinated, did not report “needing more information” as the main reason they had not already vaccinated, intended to get their daughters the vaccine, or were not born-again Christians.
Abstract: Background:Human papillomavirus (HPV) vaccine uptake is low among adolescent girls in the United States. We sought to identify longitudinal predictors of HPV vaccine initiation in populations at elevated risk for cervical cancer.Methods:We interviewed a population-based sample of parents of 10- to 1
251 citations
TL;DR: Disclosure of sexual orientation is associated with several patient-related and provider-related characteristics and efforts to promote discussion ofSexual orientation within the primary health care setting should be directed toward both PCPs and MSM.
Abstract: Background: Men who have sex with men (MSM) have unique health risks and needs. Providers who assume patients to be heterosexual may be providing suboptimal care. This study sought (1) to describe primary care provider (PCP) knowledge of patients’ sexual orientation and the demographic and provider-related factors associated with such knowledge; and, (2) to assess whether PCP knowledge of sexual orientation was associated with appropriate recommendations for preventive and diagnostic health care services. Methods: A total of 271 MSM completed a cross-sectional survey. We measured MSMs’ disclosure of their sexual orientation and demographic information, and PCP recommendations for preventive health services. Results: Most participants’ PCPs (72%) knew the participants’ sexual orientation. Participants with female, gay, and/or younger PCPs were more likely to have disclosed their sexual orientation. Black men, men from rural areas, and men with incomes under $15,000 per year were less likely to have disclosed their sexual orientation. PCP knowledge of sexual orientation was associated with a higher likelihood that PCPs recommended disease screening and preventive health measures: 59% versus 13% for human immunodeficiency virus testing, 32% versus 16% for hepatitis A or B vaccination. Inconsistencies were found between participants’ selfreported risk behaviors and PCP recommendations. Conclusions: Disclosure of sexual orientation is associated with several patient-related and provider-related characteristics. Lack of disclosure to providers significantly decreased the likelihood that appropriate health services were recommended to participants. Efforts to promote discussion of sexual orientation within the primary health care setting should be directed toward both PCPs and MSM.
211 citations
TL;DR: A high prevalence and incidence of asymptomatic sexually transmitted infections was identified among men and women in a wide variety of settings, especially among women, young adults, those with multiple partners, those repeatedly infected, and particularly those at risk without symptoms.
Abstract: Sexually transmitted infections (STIs) are a major health problem in most countries of the world, but especially in developing countries where the resources and technology to diagnose and treat them are limited.1 Currently, many countries, including China, are experiencing a resurgence of STIs, because of limited control efforts.2,3
In many of these countries, the major strategy for control of STIs has been through sexually transmitted disease clinics for the management of symptomatic genitourinary infections for individuals seeking treatment. However, an emphasis on this strategy has several limitations. First, because of the stigma associated with STIs, a high proportion (often 60 + %) of individuals with symptomatic STIs are reluctant to seek treatment from government clinics.4 Second, these symptomatic individuals often seek treatment in pharmacies and from indigenous providers, where treatment is often inadequate, partner treatment is not offered, and no record of their treatment is kept.5,6 Third, this strategy relies on individuals seeking treatment. Those who are asymptomatic are unlikely to seek any kind of treatment, and may have a long duration of infection, repeatedly exposing their regular partners and/or new partners to infection. For these reasons, studies of asymptomatic STIs require investigation of populations who do not seek care on the basis of symptoms. Several studies have reported high proportions of laboratory-confirmed Chlamydia trachomatis- and Neisseria gonorrhoeae-infected individuals who are asymptomatic, especially in women.7–13 However, the proportions of asymptomatic C. trachomatis and N. gonorrhoeae infections may differ between different countries and groups.
The National Institute of Mental Health sponsored a trial of a community-level intervention based on the “popular opinion leader model” to prevent HIV/STIs among selected populations in 5 countries, China, India, Peru, Russia, and Zimbabwe.14,15 The populations in this study were selected on the basis of reported sexual risk behaviors and/or prevalence of STIs in their respective countries, and therefore, the ages are not comparable. In some countries, the individuals at highest risk for STIs were young, whereas in other country settings, were older and had more discretionary income. As part of the assessment of the trial, a baseline and 2 follow-up surveys at 12 and 24 months were conducted, in which symptoms of STIs were solicited, and participants were tested for the presence of several STIs, including C. trachomatis and N. gonorrhoeae, using sensitive nucleic acid amplification tests. Because of the large sample size, this study provided an excellent opportunity to study the prevalence and incidence of both symptomatic and asymptomatic infections in community settings among individuals not selected on the basis of symptoms or high-risk activities. We report herein the prevalence and incidence of laboratory-confirmed C. trachomatis and N. gonorrhoeae in these 5 diverse populations, the proportions of those reporting symptoms by several demographic characteristics, and predictors of symptomatic and asymptomatic infection. This information should be useful for decision makers in these countries attempting to control the epidemics of STIs in their populations. The study was approved by the institutional review boards of the institutions in each of the 5 countries, and by those at each of the American academic institutions.
181 citations
TL;DR: Main reasons for not testing for HIV vary considerably by age, race/ethnicity, UAI, and use of the internet for HIV information, and programs should expand interventions and services tailored to address this variation.
Abstract: Background:Correlates of main reasons for not HIV testing, HIV testing intentions, and potential use of an over-the-counter rapid HIV test (OTCRT) among men who have sex with men who have never tested for HIV (NTMSM) are unknown.Methods:We evaluated these correlates among 946 NTMSM from 6 US cities
137 citations
TL;DR: Targeted HIV prevention interventions including regular STI screening, voluntary HIV testing and counseling, condom promotion, and counseling for reducing alcohol use are urgently needed in this population of women involved in high-risk sexual behavior in Kampala.
Abstract: BACKGROUND: Uganda has long been successful in controlling the HIV epidemic; however there is evidence that HIV prevalence and incidence are increasing again Data on the HIV/STI epidemic among sex workers are so far lacking from Uganda This paper describes the baseline epidemiology of HIV/STI in a newly established cohort of women involved in high-risk sexual behavior in Kampala Uganda METHODS: Women were recruited from red-light areas in Kampala Between April 2008 and May 2009 1027 eligible women were enrolled Sociodemographic and behavioral information were collected; blood and genital samples were tested for HIV/STI Risk factors for HIV infection were examined using multivariate logistic regression RESULTS: HIV seroprevalence was 37% The prevalence of Neisseria gonorrhoeae was 13% Chlamydia trachomatis 9%; Trichomonas vaginalis 17%; bacterial vaginosis 56% and candida infection 11% Eighty percent had herpes simplex virus 2 antibodies (HSV-2) 21% were TPHA-positive and 10% had active syphilis (RPR+TPHA+) In 3% of the genital ulcers Treponema pallidum (TP) was identified Haemophilus ducreyi in 6% and HSV-2 in 35% Prevalent HIV was independently associated with older age being widowed lack of education sex work as sole income street-based sex work not knowing HIV-status using alcohol and intravaginal cleansing with soap HIV infection was associated with N gonorrhoeae T vaginalis bacterial vaginosis HSV-2 seropositivity and active syphilis CONCLUSIONS: Prevalence of HIV/STI is high among women involved in high-risk sexual behavior in Kampala Targeted HIV prevention interventions including regular STI screening voluntary HIV testing and counseling condom promotion and counseling for reducing alcohol use are urgently needed in this population
127 citations
TL;DR: The findings confirm the association of some LGTI with APO and suggest that timing of LGTI screening may affect outcomes, and represent a critical opportunity to target interventions aimed at improving pregnancy outcomes.
Abstract: Background:Studies in antenatal care clinics suggest that lower genital tract infections (LGTI) may be associated with adverse pregnancy outcomes (APO). We sought to characterize antenatal care patterns and determine whether LGTI are independently associated with preterm birth and/or low-birth weigh
111 citations
TL;DR: HIV and STI infection rates were high among SWs working in various settings; freelancers had highest risk and ATS use was associated with incident STI.
Abstract: Objectives: To estimate prevalence and incidence of HIV and sexually transmitted infections (STI) and associated risk factors among young women working as sex workers (SWs) in Phnom Penh, Cambodia. Methods: A prospective study of young (29 years) women working as SWs in brothels, entertainment establishments, and freelance. Sociodemographics, sexual risk, and use of amphetamine-type stimulants (ATS) (“yama” and “crystal”) were assessed by self-report. HIV and STI (Chlamydia trachomatis and Neisseria gonorrhoeae) testing were conducted on blood and urine specimens, respectively. Results: Baseline prevalences of HIV, C. trachomatis, and N. gonorrhoeae were 23%, 11.5%, and 7.8%, respectively. HIV incidence was 3.6 per 100 person-years (95% confidence interval [CI], 1.2%– 11.1%); STI incidence was 21.2 per 100 person-years (95% CI, 12.6%– 35.8%). At baseline, 26.5% reported recent ATS use. HIV infection was associated with freelance SW (adjusted odds ratio, 5.85; 95% CI, 1.59 –21.58) and younger age of first sex (15 years; adjusted odds ratio, 3.06; 95% CI, 1.01– 8.46). Incident STI was associated with duration (per year) of SW (adjusted hazard ratio, 1.1; 95% CI, 1.1–1.2) and recent yama use (adjusted hazard ratio, 3.9; 95% CI, 1.5–10.3). Conclusions: HIV and STI infection rates were high among SWs working in various settings; freelancers had highest risk. ATS use was associated with incident STI. Venue of sex work and drug prevention should be considered in prevention programs.
105 citations
TL;DR: There is an urgent need for implementation of effective public health interventions to curb the spread of HIV infection among MSM across China, especially in the Southwest.
Abstract: BACKGROUND AND METHOD: Multiple studies reported a fast-spreading human immunodeficiency virus (HIV) epidemic among men who have sex with men (MSM) in China. This study aimed to estimate the magnitude and time trends of HIV prevalence among MSM in different geographical regions of China through a systemic review and meta-analysis. RESULTS: A total of 94 articles were identified (25 in English and 69 in Chinese) and analyzed. National HIV prevalence among Chinese MSM has increased over this period from 1.4% (95% confidence interval [CI]: 0.8%-2.4%) in 2001 to 5.3% (95% CI: 4.8%-5.8%) in 2009. MSM in Southwest China have the highest HIV prevalence of 11.4% (95% CI: 9.6%-13.5%) in comparison with other regions which range 3.5% to 4.8%. CONCLUSION: Significant increases in HIV prevalence among MSM were consistently observed across all Chinese regions. There is an urgent need for implementation of effective public health interventions to curb the spread of HIV infection among MSM across China especially in the Southwest.
99 citations
TL;DR: The Treponemal-First option costs slightly more and results in more unnecessary treatment than the standard algorithm, which was a function of the specificity of the EIA/CA and the lack of independence of EIA /CA and TP-PA.
Abstract: Background:The introduction of automated treponemal enzyme immunoassays and chemiluminescence assays (EIA/CA) tests has led some laboratories in the United States to use new syphilis screening algorithms that start with a treponemal test. We compared the economic and health outcomes of this new algo
91 citations
TL;DR: In a retrospective analysis of asymptomatic men who have sex with men visiting an urban municipal sexually transmitted disease clinic, 83% of chlamydial and gonococcal infections would have been missed by urethral screening, compared with 9.8% by screening the rectum and pharynx.
Abstract: In a retrospective analysis of asymptomatic men who have sex with men visiting an urban municipal sexually transmitted disease clinic, 83.8% of chlamydial and gonococcal infections would have been missed by urethral screening, compared with 9.8% by screening the rectum and pharynx. Extragenital screening is critical to the provision of comprehensive sexual health services for men who have sex with men.
86 citations
TL;DR: The definition of PID used has a major effect on the rate and trends over time, and there was heterogeneity in rates of definite/probable PID by age and region, but homogeneity with regard to a trend of declining rates.
Abstract: Background:Pelvic inflammatory disease (PID) is difficult to define and diagnose; therefore, a standardized methodology for identifying and monitoring PID diagnoses is required. We estimated the rate of PID in general practice in England, and investigated variations by definition of PID, time, age,
TL;DR: Concurrency is a common partnership pattern among those youth with multiple partners, especially men, and for women, having concurrent relationships may be associated with relationship power imbalances and less ability to protect against HIV.
Abstract: Researchers have increasingly focused on concurrent sexual partnerships as a critical factor in the spread of human immunodeficiency virus (HIV).1–4 Few published studies have documented the prevalence of concurrency among general populations in Sub-Saharan Africa, specifically among young adults, the age group at highest risk for HIV.5–7
Concurrency has been conceptualized and studied as both an individual and network or population-level risk factor. On a population level, researchers have argued that concurrency may help explain regional variation in HIV epidemics, particularly the enormous HIV burden in east and southern Africa.3,1 Modeling studies have shown that with the same number of partners, a higher proportion of concurrency in a network can greatly increase the rate of spread of sexually transmitted infections (STIs).8,9 Furthermore, the heightened infectivity associated with primary HIV infection10,11 increases the risk associated with concurrency; concurrency creates links that allow the virus to “travel” throughout a network, increasing the probability that an individual will be connected to someone recently infected.12,3
Empirical studies suggest that engaging in concurrency increases the chances that an individual will transmit STIs.13,14 Researchers using a population-based sample of blacks in the rural southern United States concluded that concurrent partnerships increase HIV risk in that population.15 A network level study found that among members of sexual networks in highrisk areas in San Francisco, those whose recent partners reported concurrency were at increased risk for chlamydia and gonorrhea.16
Most of the increased individual-level risk of acquiring HIV associated with concurrency results from having a partner who engages in concurrency and thus increases an individual’s potential exposure to primary HIV infection by “connecting” that individual to an expanded sexual network.12,17 However, researchers have also documented an increased individual-level risk of acquiring STIs associated with engaging in concurrency oneself.18–21 Studies conducted in the United States among STI clinic attendees established that even after controlling for number of partners, both adolescents18 and adults19 who engaged in concurrency were at increased risk for STIs. In addition, a national survey of adults in the United States indicated that having had concurrent partners was associated with a history of an STI,20 and a survey of Seattle residents found that concurrency was associated with STI risk independent of partner number.21
Studies conducted outside the United States have yielded similar results.22–24 Researchers found an association between having current concurrent partners and Herpes among male bar and hotel workers in Moshi, Tanzania.25 In contrast, researchers did not find an association between concurrency and HIV in 5 urban communities in sub-Saharan Africa.5 However, there were important limitations to this study, including a failure to account for circumcision.26 Studies have generally not assessed why having partners concurrently would increase an individual’s risk for acquiring HIV after controlling for number of partners.
In this study, we document the sexual partnership patterns of a general population of youth in South Africa using a nationally representative sample and using multiple measures of concurrency. We test the hypotheses that (1) having concurrent partners or (2) perceiving that partner has concurrent partners are associated with HIV infection, and we describe and compare the behaviors and attitudes of those engaged in different patterns of sexual partnerships. We also measure mean length of sexual relationship overlap of concurrent partnerships.
TL;DR: Inclusion of oropharyngeal and anorectal tests in the STD screening protocol was associated with a percentage increase in prevalence of chlamydia by 9.5% and gonorrhea by 31%, relative to tests for endocervical tests alone.
Abstract: Background: The relevance of screening of oropharynx and anorectum in addition to endocervical tests for detection of Chlamydia trachomatis and Neisseria gonorrhoeae infection is unclear in women, while there is a documented benefit of this approach in men who have sex with men. Methods: Female visitors to the sexually transmitted disease (STD) clinic were asked about their sexual practice as a part of the routine electronic patient file. In addition to tests for endocervical infection, swabs were taken from the oropharynx and anorectum to test for C. trachomatis and N. gonorrhoeae based on the history of sexual contact. Routinely, all electronic patient files are anonymously included in a database for surveillance purposes. In this observational study, we analyzed all consultations in the database over an 18 months period. Results: A total of 4299 consultations were registered; 10% of women had endocervical chlamydia and 1.1% had gonorrhea. The detection rates for C. trachomatis and N. gonorrhoeae from oropharyngeal samples were 1.9% and 0.8%, and from anorectal samples 8.7% and 1.7%, respectively. Except for 2 cases of pharyngeal gonorrhea, all oropharyngeal and anorectal infections were asymptomatic. Inclusion of oropharyngeal and anorectal tests in the screening protocol was associated with a percentage increase in prevalence of chlamydia by 9.5% and gonorrhea by 31%, relative to tests for endocervical tests alone. The percentage increase in prevalence was higher than that for the symptom-based approach (3.7% and 10.4%, respectively). Conclusions: Inclusion of oropharyngeal and anorectal tests in the STD screening protocol increases the prevalence of chlamydia and gonorrhea in women. Screening of anatomical sites based on sexual history is preferred over a symptom-based protocol.
TL;DR: The HIV/sexually transmitted infections burden in this group of HIV-negative, nonpregnant female sex workers was high and HIV prevention and family planning interventions are needed.
Abstract: BACKGROUND: Measurement of human immunodeficiency virus(HIV) incidence among female sex workers in Rwanda is a key part of preparing for HIV prevention trials. METHODS: HIV-negative nonpregnant female sex workers (N =397) were tested for HIV-1 sexually transmitted infections and pregnancy quarterly for 12 months and again at a 1-time year 2 visit. Additional women (N=156) were tested for HIV at baseline and 6 to 12 months thereafter in a parallel study. RESULTS: A total of 19 participants seroconverted during follow-upwith 13 in the first 12 months. The 12-month HIV incidence rate (IR)was 3.5 (95% confidence interval: 1.6 5.4) per 100 person-years (PY).There was a nonsignificant downward trend from 4.6/100 PY (1.6 7.7)in the first 6 months to 2.2 (0.1 4.4) in the second 6 months (IR ratio:2.1 [95% confidence interval: 0.7 7.8]). The year 2 IR was 2.1 (0.43.7) and the HIV IR in the parallel study (in the absence of frequent study visits) was 3.3/100 PY (0 7.0). HIV testing history lifetime pregnancies recent initiation of sex work gonorrhea syphilis and change in reproductive intentions were associated with incident HIV infection. Incidence of pregnancy herpes simplex virus-type 2trichomoniasis gonorrhea chlamydia and syphilis per 100 PY were as follows: 26.3 (21.9 30.7) 8.7 (4.0 13.4) 16.9 (12.7 21.1) 12.1 (8.215.9) 8.1 (5.1 11.2) and 6.2 (3.7 8.7). CONCLUSIONS: The HIV/sexually transmitted infections burden int his group was high. HIV IR was highest in the first 6 months of the cohort and in the parallel study in which there were no risk-reduction procedures. HIV prevention and family planning interventions are needed.
TL;DR: NGU is a heterogeneous condition and pathogen detection was associated with a variety of traditional risk factors and clinical features; whereas, idiopathic cases tended to be diagnosed among lower-risk men.
Abstract: Background:Nongonococcal urethritis (NGU) is common, yet up to 50% of cases have no defined etiology. The extent to which risk profiles and clinical presentations of pathogen-associated and idiopathic cases differ is largely unknown.Methods:Urethral swabs and urine specimens were collected from 370
TL;DR: AAWSWM, as a subgroup, may demonstrate heightened sexual risk-taking behaviors and higher STI rates compared with exclusive AAWSW, and should take into account partner gender heterogeneity when counseling and screening for STI.
Abstract: Objective:We sought to determine the prevalence of infection with Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, syphilis, and HIV among African American women who have sex with women (AAWSW), and compare sociodemographics, sexual risk behavior characteri
TL;DR: The burden of anogenital warts is substantial and should be considered by physicians and public health officials when making recommendations about HPV vaccination.
Abstract: Background:The burden of anogenital warts will be a determining factor when making decisions about the type of human papillomavirus (HPV) vaccine to be used (bivalent or quadrivalent) and whether to vaccinate males. We conducted a multicenter prospective study to (1) describe the impact of anogenita
TL;DR: Vinal concentration of certain BV-associated bacteria, vaginal intercourse during treatment, and the presence of endogenous L. crispatus at enrollment predict colonization with probiotic lactobacilli are found to be significantly associated with a reduced odds of colonization with CTV-05.
Abstract: Objective
Several fastidious bacteria have been associated with bacterial vaginosis (BV), but their role in lactobacilli recolonization failure is unknown. We studied the effect of seven BV-associated bacterial species and two Lactobacillus species on vaginal colonization with L. crispatus CTV-05 (LACTIN-V).
TL;DR: EIA screening facilitates identification of probable latent syphilis and earlier serological detection of infectious syphilis, but may transiently cause increases in testing and indirectly suggests that physicians' interpretation of RPR(−) serology may lead to partner testing.
Abstract: Background: In 2005, syphilis screening in the Greater Toronto Area of Canada moved from the rapid plasma reagin (RPR) to a treponemal enzyme immunoassay (EIA). We sought to understand the consequences of this change on laboratory results and testing patterns with a population-based retrospective study of laboratory-based diagnoses of syphilis. Methods: Samples positive under RPR (1998―2005) and EIA (2005-2008) screening were confirmed with an alternate treponemal test, and during the latter period underwent RPR testing. We compared monthly rates and the forecasting relationship between positives and future submissions with time-series methods, and assessed risk factors for EIA(+)/RPR(-) results using Poisson regression. Results: A total of 3,092,938 submissions were included. Following EIA implementation, confirmed positive rates increased by 10.3 per 100,000 population (P 50 years (IRR: 2.4, 95% CI: 1.6-3.5) than those with EIA(+)/RPR(+) results. We detected a significant positive feedback loop between positive tests and subsequent submissions. This relationship was only transiently evident for EIA(+)/RPR(-) results up to 1 year following the changeover. Conclusions: EIA screening facilitates identification of probable latent syphilis and earlier serological detection of infectious syphilis, but may transiently cause increases in testing and indirectly suggests that physicians' interpretation of RPR(-) serology may lead to partner testing. In the absence of a true gold standard, implementation of EIA screening warrants careful communication regarding serological interpretation.
TL;DR: Recurrent pelvic inflammatory disease was associated with an almost 2-fold increase in infertility and more than 4- fold increase in CPP, but not infertility.
Abstract: PEACH trial data were used to evaluate the relationship between subsequent sexually transmitted infection and recurrent pelvic inflammatory disease on infertility and chronic pelvic pain (CPP). Recurrent pelvic inflammatory disease was associated with an almost 2-fold increase in infertility and more than 4-fold increase in CPP. Subsequent sexually transmitted infection was associated with CPP, but not infertility.
TL;DR: Genital HPV prevalence was typically higher among MSWM than among MSM or MSW for groups of HPV genotypes including nononcogenic types, and multiple types, but number of male anal sex partners was not associated with genital HPV among MSM and MSWM.
Abstract: Background
Comparative studies of genital human papillomavirus (HPV) among men having sex with men (MSM), men having sex with women and men (MSWM), and men having sex with women (MSW) have not been conducted; however, such comparisons may be important for planning prevention strategies like vaccination.
TL;DR: Sensitivity and specificity of HSV-2 tests used in sub-Saharan Africa vary by setting, and are lower than reported from studies in the United States and Europe.
Abstract: Background:Several commercial type-specific serologic tests are available for herpes simplex virus type 2 (HSV-2) Poor specificity of some tests has been reported on samples from sub-Saharan AfricaMethods:To summarize the performance of the tests using samples from sub-Saharan Africa, we conducted
TL;DR: Women experiencing abnormal flora during a 3-month span appear to have significantly increased risk of acquiring TV infection, and women of reproductive age in low-resource settings found to have abnormal vaginal flora should be assessed for TV.
Abstract: Background:Bacterial vaginosis (BV) and Trichomonas vaginalis (TV) have been estimated to affect one-quarter to one-third of sexually active women worldwide, and are often found concurrently. Few studies have examined this relationship longitudinally to better understand the direction and temporalit
TL;DR: Although the majority of HIV-diagnosed adults in England, Wales, and Northern Ireland attended HIV-services regularly, cumulatively nearly 1 in 5 adults were lost to follow-up between 1998 and 2007.
Abstract: AIM: To assess the extent to which human immunodeficiency virus (HIV)-diagnosed adults attending HIV-services in England, Wales, and Northern Ireland are lost to follow-up or attend services intermittently.
METHODS: A cohort of HIV-diagnosed adults was created by linking records across the 1998 to 2007 national annual Survey of Prevalent HIV Infections Diagnosed. The records were also linked to the national HIV and acquired immune deficiency syndrome New Diagnoses Database (n = 61,495) and to Office for National Statistics death records. Patterns of HIV-service attendance were analyzed.
RESULTS: On average, 90% of adults attending HIV-services in any one year attended the following year. Nearly 5% of adults attending services in any one year were lost to follow-up, a further 4% subsequently attended services intermittently, whereas less than 2% died. Cumulatively, 19% of adults seen for HIV care between 1998 and 2006 were lost to follow-up by the end of 2007. Factors associated with loss to follow-up included being the following: female; aged 15 to 34 years; black-African or "other" ethnicity; not on antiretroviral therapy; recently diagnosed; and infected outside the United Kingdom.
CONCLUSIONS: Although the majority of HIV-diagnosed adults in England, Wales, and Northern Ireland attended HIV-services regularly, cumulatively nearly 1 in 5 adults were lost to follow-up between 1998 and 2007. Innovative strategies focusing on those most likely to drop out of regular care should be developed to maintain regular service engagement and to ensure optimal care.
TL;DR: Changing screening protocols to use improved diagnostic tools and applying universal screening resulted in increased case finding for T. vaginalis among high-risk women.
Abstract: Background: Trichomonas vaginalis is a sexually transmitted infection, which is largely underestimated because of ineffective screening protocols and lack of public health attention. Methods: Two studies were conducted to assess the frequency of missed diagnosis of T. vaginalis when using current routine practices for T. vaginalis screening in high-risk female populations. The first study compares the rate of positivity detected using wet preparation microscopy to the number of cases found using polymerase chain reaction (PCR) using residual samples from women attending a public health sexually transmitted disease clinic. The second study compares universal to targeted screening of symptomatic women using PCR on vaginal samples from women screened for sexually transmitted disease at a correctional facility. Results: In the first study, a 5-fold increased incidence of T. vaginalis infection was detected when PCR was performed instead of wet mount microscopy in a sample of 222 women screened at a sexually transmitted disease clinic. The second study detected a 5-fold increase in cases among a sample of 471 incarcerated women when universal screening was implemented. Conclusions: Improving detection of T. vaginalis is critical, given that when left untreated, T. vaginalis increases susceptibility to coinfections including human immunodeficiency virus. Changing screening protocols to use improved diagnostic tools and applying universal screening resulted in increased case finding for T. vaginalis among high-risk women. The prevalence of T. vaginalis coupled with its negative impact on health necessitate greater public health attention is needed in order to reduce incidence rates, improve diagnosis, and to better understand this important, yet underestimated, pathogen.
TL;DR: The patterns of sexual behavior among London's gay men between 1998 and 2008 were dynamic and complex and suggest that HIV risk with a main partner and HIV testing among couples should be given greater priority by health promotion programmes.
Abstract: Objectives: To examine changes in the sexual behavior of London gay men between 1998 and 2008.
Methods: Gay men using London gyms were surveyed annually between 1998 and 2005, and again in 2008 (n = 6064; range, 482–834 per year). Information was collected on human immunodeficiency virus (HIV) status of the respondent, unprotected anal intercourse (UAI) in the previous 3 months, type (main or casual) and HIV status of partner for UAI. Nonconcordant UAI (ncUAI) was defined as UAI with a partner of unknown or discordant HIV status. Concordant UAI (cUAI) was defined as UAI with a partner of the same HIV status (“serosorting”).
Results: Between 1998 and 2008, the percentage of men reporting UAI increased from 24.3% to 36.6% (P = 0.07). This overall increase concealed important differences between nonconcordant and concordant UAI. While the percentage of men engaging in cUAI increased steadily between 1998 and 2008 (9.8%, 20.8%; P = 0.01), the percentage reporting ncUAI increased between 1998 and 2001 (14.5%, 23.7%; P < 0.001), decreased between 2001 and 2005 (23.7%, 15.6%; P < 0.001), and then leveled off between 2005 and 2008 (15.6%, 15.7%; P = 0.2). However, the percentage of men reporting ncUAI with a main partner increased between 2005 and 2008 for HIV-positive men (2.5%, 8.1%; P < 0.05) and HIV negative men (2.1%, 5.5%; P = 0.06). While the percentage of HIV negative men who reported cUAI with a main partner (i.e., serosorting) increased between 1998 and 2008 (12.4%, 21.1%; P < 0.05), less than half established seroconcordance by testing together.
Conclusions: The patterns of sexual behavior among London's gay men between 1998 and 2008 were dynamic and complex. Our data suggest that HIV risk with a main partner and HIV testing among couples should be given greater priority by health promotion programmes.
TL;DR: Clinical and microbiologic cure rates were higher for women who were treated in accordance with the recommendation provided after in vitro testing compared with those who received a lower dose or a different drug.
Abstract: Background:Antimicrobial resistance is one of the causes of treatment failure in women after standard nitroimidazole therapy for Trichomonas vaginalis infections. The Centers for Disease Control and Prevention provides drug susceptibility testing and guidance for treatment failures but the efficacy
TL;DR: 4 case reports show that HIV-infection is not an absolute prerequisite for sexual HCV transmission in MSM, and HIV-negative MSM with ulcerative sexual transmitted infection, those who engage in rough sexual practices or report a HCV-positive sexual partner, should be regularly screened for HCV.
Abstract: Hepatitis C Virus (HCV) has recently emerged as sexual transmitted infection among (human immunodeficiency virus) HIV-positive but not HIV-negative men who have sex with men (MSM). We present 4 case reports showing that HIV-infection is not an absolute prerequisite for sexual HCV transmission in MSM. HIV-negative MSM with ulcerative sexual transmitted infection, those who engage in rough sexual practices or report a HCV-positive sexual partner, should be regularly screened for HCV.
TL;DR: This study shows a high prevalence of CT infection among young pregnant women in Brazil and suggests that CT screening should be included as part of antenatal care routine in this group in Brazil.
Abstract: Background: Chlamydia trachomatis (CT) is a sexually transmitted infection having repercussions on reproductive health and impact on the fotus. Our goal was to estimate the prevalence of and risk factors for CT in young parturient women in Brazil.
Methods: A national cross-sectional study of parturient women, aged 15 to 24 years, attending Brazilian public hospitals was performed in 2009. Participants answered a questionnaire including demographic, behavioral, and clinical data. A sample of urine was collected and screened for CT and Neisseria gonorrhoeae (NG), using polymerase chain reaction COBAS Amplicor CT/NG (Roche Molecular Systems, Branchburg, NJ).
Results: A total of 2400 women were selected and 2071 (86.3%) participated in the study. Mean age was 20.2 years (standard deviation = 2.7). Prevalence rates of CT and NG were 9.8% (95% confidence interval [CI]: 8.5-11.1) and 1.0% (95% CI: 0.6%-1.4%), respectively. Four percent of women infected with CT also had NG infection. CT associated factors were: being younger (15-19 years old) (odds ratio [OR] = 1.6 [95% CI: 1.15-2.17]); first sexual intercourse before 15 years of age (OR = 1.4 [95% CI: 1.04-6.24]); having more than 1 sexual partner in lifetime (OR = 1.6 [95% CI: 1.13-2.26]); Pap smear screening more than 1 year (OR = 1.5 [95% CI: 1.08-2.05]); and NG infection (OR = 7.6 [95% CI: 3.05-19.08]).
TL;DR: A direct comparison of both substances confirms the previously obtained mathematical data, that imiquimod 5% cream and podophyllotoxin 0.5% solution have an identical beneficial effect on anogenital warts and are associated with identical and acceptable side effects.
Abstract: Background: Anogenital warts are a common sexually transmitted disease caused by human papillomaviruses. Despite the fact, that imiquimod and podophyllotoxin represent common topical agents, direct comparative studies lack. This work compares the effectiveness and safety of self-applied imiquimod 5% cream and podophyllotoxin 0.5% solution. Methods: Within 2 years, consecutive patients presenting with untreated anogenital warts were included in a randomized, open label trial. The primary endpoint was complete clearance at the end of treatment (4 weeks after the start with podophyllotoxin, 16 weeks after the start of imiquimod therapy). Side effects were evaluated as a secondary endpoint. Results: A total of 45 patients, 7 women and 35 men, of whom 5 were circumcised, concluded the treatment and were eligible for evaluation. The rates of clearance of baseline warts among treatment groups were 72% (95% confidence interval [CI], 52%-86%) in the podophyllotoxin group and 75% (95% CI, 53%-98%) in the imiquimod group. Statistically, clearance rates were identical (P = 1). The differences in side effects between treatment groups were statistically not significant (P = 0.24). Conclusions: The current study, a direct comparison of both, confirms the previously obtained mathematical data, that imiquimod 5% cream and podophyllotoxin 0.5% solution have an identical beneficial effect on anogenital warts and are associated with identical and acceptable side effects. Both substances constitute effective and safe treatments of untreated anogenital warts in immunocompetent individuals.