bluuebunny/crossref_metadata_2025 huggingface dataset:
P1-S1.48 Prevalence of syphilis in antenatal clinic attenders and associated risk factors
Authors: Adu-Sarkodie Y , Mensah P , Opoku B K , Mayaud P , Peeling R
Published: July 2011

Background

Maternal syphilis can adversely affect pregnancy outcomes. This can be averted if women are tested and treated adequately during pregnancy. As part of a programme towards the introduction of routine syphilis testing and treatment in pregnancy in Ghana, the prevalence of syphilis in pregnant women attending a tertiary facility (also used as primary facility by pregnant women) was carried out. Associated risk factors for syphilis seropositivity was also determined.

Methods

841 pregnant women were tested for syphilis using a Rapid Plasma Reagin kit (Immutrep Carbon Antigen, Omega Diagnostics, UK). All sero-reactive samples were confirmed with a TPHA assay (Immutrep TPHA, Omega Diagnostic, UK). A questionnaire seeking socio-demographic information, history of previous pregnancy outcomes, and history sexually transmitted infections was administered to the enrolled women.

Results

6 out of the 841 (0.71%) women were seropositive for syphilis (RPR reactive, TPHA positive), out of which one had a high RPR titre (1:8), one a RPR titre of 1:4 and four had low RPR titres of 1:2. None of the risk factors studied were associated with syphilitic infection.

Conclusion

A low prevalence of maternal syphilis was found in this urban population. This is low in comparison with a national prevalence of 6.5% among pregnant women, and high prevalences in rural settings in Ghana. This may be due to a low prevalence of syphilis in this urban area or better access to STI testing and treatment in this area which the women take advantage of due to the National Health Insurance Policy. Even with this low prevalence, studies indicate that testing and treatment is still cost -effective.
P3-S6.06 Does the concept of early and late latent syphilis hold well in today's scenario?
Authors: De D , Kanwar A
Published: July 2011

Background

Latent syphilis refers to the asymptomatic stage in the natural evolution of syphilis in a patient not treated or inadequately/inappropriately treated for syphilis. Latent syphilis has been categorised as early latent and late latent for therapeutic purposes. Indiscriminate and inadequate over the counter use of antibiotics (happenstance) and HIV co-infection in present day scenario tends to change natural evolution of syphilis. Even though some patients remain asymptomatic without any historical evidence of clinical manifestation of syphilis, serologically they continue to reflect the ongoing infection process; the so called syphilis of unknown duration.

Objective

To determine the sero-epidemiological characteristics of patients with syphilis of unknown duration registered to a sexually transmitted disease (STD) clinic in an Institute setting.

Patients and Methods

Clinic records of patients registered to the STD clinic between 2006 and 2010 were retrieved. For study purposes, syphilis of unknown duration was defined as positivity withTreponema PallidumHaemagglutination assay (TPHA) irrespective of Venereal Disease Research Laboratory (VDRL) titre in patients who did not have any clinical sign of syphilis including neurological and cardiac, during clinic entry; had no features to suggest syphilis in the past and had not been treated with parenteral penicillin.

Results

Of the 76 patients registered during the study period, 52 (68%) satisfied the diagnosis of syphilis of unknown duration. Age of patients was between 20 and 56 years (mean 29.76, standard deviation 8.32). Males outnumbered females by a ratio of 2.25:1. Majority (33, 63.4%) of the patients were direct walk-in with positive serology results done in private laboratories, mostly in patients who are habituated to unprotected extramarital sexual intercourse. Others were referred from obstetric clinics (15.4%), private practitioners (15.4%), HIV clinic (1.9%), transfusion medicine (1.9%) and urology clinic (1.9%). Majority patients (31, 59.61%) showed low titre VDRL (upto 1:8) positivity while 5 (9.6%) were VDRL non-reactive.

Conclusion

In majority of syphilis patients, duration of latency could not be determined due to lack of history of clinical lesions of early syphilis or reliable history of time of acquisition of infection. Consequently, the categorisation of latent syphilis to early and late phases in present day scenario appears redundant.
P3-S7.04 Candida susceptibility to antifungals in Gomel region (Belarus)
Authors: Khaikova A
Published: July 2011

Candidiasis is a fungal infection that often affects urogenital tract. About 75% of women had at least one episode of vulvovaginal candidiasis. Recent times chronic cause of candidiasis is prevalent in the clinical picture of the disease in Belarus. Along withCandida albicansother yasts (Candida crusei,Candida tropicans,Candida glabrata, Candida parapsilosis, etc) play a role in pathogenesis of the disease. Wide use of fluconazole in Belarus as well as prophylactic treatment during prolonged antibiotic use caused the grow of the resistance to the drug. Aim of our study was to reveal the incidence of urogenital candidiasis in patients who where checked up for STI in Gomel dermatovenereal hospital (Belarus), to study the resistance ofCandida spp.to nystatin, clotrimazole, and fluconazole in vitro.

Materials and Methods

We observed 4397 patients using clinical examination, microscopy, and cultural examination. Susceptibility to antifungal was studied by cultured method in vitro in 187 samples from the patients.

Results

Urogenital candidiasis clinically and was diagnosed in 473 patients (10.8%) and confirmed by laboratory tests. Susceptibility to nystatin was founded in 183 cases (97.8%), to clotrimazole—in 125 cases (66.8%). Susceptibility to fluconazole was much lower and was registered only in 37 cases (19.8%).

Conclusions

Candidiasis is a current problem for gynaecologists and venreologists in Belarus. Its rate reaches 10% among all patients coming for follow-up for STI. Effective treatment for candidiasis should be developed. Wide use of fluconazole should be reevaluated because of its low susceptibility.
P1-S1.49 Syphilis prevalence and risk factors in Brazilian Armed Forces conscripts, 2007
Authors: Ribeiro D , Pinto V M , Rezende E , Espinosa A , Pereira G
Published: July 2011

The aim of this study was to describe the syphilis prevalence by geographic region and frequency of behaviours and symptoms related to STDs. A cross-sectional study was performed with Brazilian Armed Forces draftees in 2007. They answered a self-administered questionnaire on sociodemographic issues, sexual practice and condom use, STD symptoms and had a blood sample collected for syphilis test. A total of 35 460 draftees answered the questionnaire and 75.5% of these had already had sexual intercourse. Overall syphilis prevalence was 0.53% (95% CI 0.45% to 0.61%). By geographic region—North (0.85%), Northeast (0.82%), being almost double the Midwest region (0.49%) and more than double the Southeast (0.34%) and Southern region (0.26%). Being 17 years old [OR=1.3 (95% CI 1.05 to 1.73)], having completed primary education [OR=1.5 (95% CI 1.03 to 2.22)], living in the North/Northeast region of the country [OR=1.2 (95% CI 1.04 to 1.36)], reporting a history of STD [OR=2.7 (95% CI 1.03 to 6.99)], being MSM [OR=4.5 (95% CI 2.59 to 7.81)], and reporting genital ulcer disease [OR=2.6 (95% CI 1.59 to 4.26)] were associated with syphilis. Addressing the young at the time of military enlistment may be a good moment to consider new strategies for accessing and counselling this population, thus allowing the implementation of a more appropriate healthcare policy.
P3-S7.08 Clinical evaluation of the APTIMA®Trichomonas vaginalisassay on the TIGRIS®DTS®system in asymptomatic and symptomatic female subjects
Authors: Schwebke J , Hobbs M , Taylor S , Chapin K , Catania M , Weinbaum B , Getman D , Gaydos C
Published: July 2011

Background

This study evaluated the clinical performance of the APTIMA®Trichomonas vaginalis(ATV, Gen-Probe Incorporated) Assay, a nucleic acid amplification test for the diagnosis ofTrichomonas vaginalis(TV) infection, in asymptomatic and symptomatic women.

Methods

This prospective, multicenter clinical trial enrolled 1025 women attending US OB-GYN, adolescent, family planning, or sexually transmitted disease clinics. Four specimen types were collected from each subject: physician-collected vaginal swab, endocervical swab, ThinPrep specimen, and first-catch urine. Of three vaginal swabs collected from each subject, one was used for wet mount microscopic examination, one for culture, and one for molecular testing for TV. The order of collection for each vaginal swab sample was rotated to minimise sampling bias. Each specimen was tested by ATV assay using the automated TIGRIS DTS system. ATV assay performance in each sample type was determined by comparing ATV assay test result to the patient infected status (positive in saline wet mount and/or culture) for each sample.

Results

Of 933 subjects included in the analysis, 59.9% were symptomatic. Compared to patient infected status, ATV assay clinical sensitivities and specificities were 100% and 99.0%, respectively, from vaginal swabs; 100% and 99.4%, respectively, from endocervical swab; 100% and 99.6%, respectively, from ThinPrep specimens; and 95.2% and 98.9%, respectively, from patient-collected urine samples. ATV assay performance was similar in asymptomatic and symptomatic patients, by age group (14–17 years and 18 years or older), and was consistent between testing sites. The ATV assay also demonstrated superior performance compared to wet mount microscopic examination and TV culture, regardless of the specimen type utilised.

Conclusions

This study provides clinical validation of the ATV assay for the intended uses of detecting TV rRNA in asymptomatic women, and/or to aid in the diagnosis of trichomoniasis in symptomatic women, in a US population. The use of highly accurate, fully-automated molecular tests such as the ATV assay for testing easily obtained vaginal swab and urine samples should facilitate large-scale screening for TV in the US.
P3-S7.10 Composition of vaginal microbiota in bacterial vaginosis patients and healthy women: basis for genetic diagnosis of bacterial vaginosis?
Authors: Unemo M , Fahlen A , Datcu R , Hallen A , Fredlund H , Jensen J , Engstrand L
Published: July 2011

Background

Bacterial vaginosis (BV) is the most common vaginal infection/disorder. BV is characterised by imbalance in the normal vaginal microbiota with a shift towards higher bacterial diversity and increased pH. The aim of the present study was to describe the differences in vaginal microbiota composition in women suffering from BV compared to healthy women, using massive parallel 454 pyrosequencing.

Methods

163 vaginal samples were collected from women diagnosed with characteristic BV (n=73), women with intermediate BV (n=11), and from healthy women on their regular check-ups (n=79). DNA from the samples was isolated and the bacterial compositions as well as the relative abundance of these bacteria were analysed using 454 pyrosequencing, with GS Titanium amplicons kit (Roche Inc.), of the hypervariable region V4 on the 16S rRNA gene. Finally, 17 different species-specific PCRs were used to verify the species of bacteria found in the 454 pyrosequencing.

Results

Extensive imbalance of the vaginal microbiota of women with BV compared to healthy controls was revealed. The dominating taxons of the 73 BV cases were Gardnerella, Atopobium, Prevotella, Lactobacillus, Megasphera and Sneathia, while most of the 79 healthy controls had a microbiota totally dominated by Lactobacillus with the BV associated taxons hardly detectable. Furthermore, the 11 patients with intermediate BV predominantly had a mix of the BV associated taxon Gardnerella as well as Lactobacillus. A few of the healthy controls seemed to have a microbiota changing towards the intermediate microflora. Gardnerella may be the first bacteria to establish in the transition from healthy vaginal flora towards a BV associated flora.

Conclusions

A clear difference in the composition of the vaginal microbiota between individuals suffering from BV and healthy controls was identified. The present findings are important steps towards the determination of valid potential bacterial markers for BV, are shedding light upon why some women develop BV, as well as show how the microbiota is involved in the development of BV. Knowledge of the composition of the vaginal microbiota is crucial in the development of a BV diagnostic tool and for elucidating appropriate treatment for use in clinical practice.
P3-S7.12 Infections and interventions in pregnant women at high risk of preterm birth: a cohort study
Authors: Wilson J , Okpaluba I , Simpson N
Published: July 2011

Background

Preterm birth (PTB) accounts for 65% neonatal deaths and 50% neurological disability in children. Prior spontaneous PTB is the highest risk factor for subsequent PTB and is usually associated with sub-clinical infection, possibly due to genetic polymorphisms of proinflammatory cytokines. Bacterial vaginosis (BV) has been implicated in PTB and early treatment may reduce it but less attention has been paid to other infections. We assessed the infective and obstetric complications in a group of pregnant women at high risk of PTB and the interventions to reduce PTB.

Methods

Study group: Pregnant women at high risk of PTB Interventions: Microbiological screening for infections from beginning of second trimester then 4-weekly until 28 weeks gestation with treatment of infections found; 2-weekly ultrasound assessment of cervical length during second trimester with cerclage and progesterone injections if needed. Outcome: Gestational age at delivery.

Results

We have managed 104 pregnancies in 95 multiparous women who had at least one previous mid-trimester miscarriage (MTM), PTB or stillbirth due to chorioamnionitis. 21% had two previous MTM and/or PTB; 5% had three; 4% had four and 1% had five MTM/PTB. 75% were of white ethnicity, 7% asian, 18% black. One or more infection was identified in 51 (49%) of the pregnancies; Group B streptococcal infection (GBS) in 21%, BV in 16%,S aureusin 3%, heavy growth vaginal or urinary coliforms in 16%. Prevalence of infections was more frequent in black (68%), than white (48%), than asian (14%) women. Pregnancy outcome: Exact gestational age unknown in 4 due to transfer to different hospital when >28/40 gestation so outcomes for 100 pregnancies. Four resulted in MTM leaving 96 viable pregnancies. Gestational age at delivery: 24–27/40 in 3%; 28–31/40 in 3%; 32–37/40 in 13%, term in 81%. There was no association with treated infection and pregnancy outcome, infections had been identified and treated in 39% of PTBs and 50% of term births.

Conclusions

In this group of women with high risk pregnancies, 49% had infections known to be associated with PTB which were treated in the second trimester. The overall PTB rate was 19% with 6% extremely or very preterm. There was no association between treated infection in pregnancy and PTB. Although the PTB rates are higher than the normal obstetric population they are significantly lower than would be predicted for such high risk pregnancies.
P3-S7.14 The association ofUreaplasma urealyticumwith male non-gonococcal urethritis
Authors: Frølund M , Lidbrink P , Cullberg M , Wikström A , Ahrens P , Jensen J S
Published: July 2011

Background

The aetiology of non-gonococcal urethritis (NGU) is unexplained in 30–50% of cases. The role of ureaplasmas is not clear. We detectedUreaplasma urealyticum(Uu) andU parvum(Up) by quantitative PCR in the urine of men with and without NGU to show a possible association with urethritis.

Methods

Urine samples from 158 male STD-clinic attendees with symptomatic NGU (>5 PMNL/hpf) and 77 asymptomatic men without NGU (<5 PMNL/hpf) were collected. The patient's age and number of partners within the previous 6 months were recorded. All samples were tested forNeisseria gonorrhoeae(Ng),Chlamydia trachomatis(Ct),Mycoplasma genitalium(Mg), Uu, Up,Trichomonas vaginalis(Tv), herpes simplex virus (HSV) 1 and 2, and adenovirus by real-time PCR.

Results

Ct and Mg were found in 22 and 30% of NGU, respectively, and were associated with NGU (p<0.0001 both). Three had dual Ct and Mg infection. Uu was detected in 13% of NGU cases and 12% of controls (p>0.99). The median Uu bacterial DNA load was higher in men with NGU than in men without (223 genome equivalents (geq) and 10 geq, respectively; p=0.002). Using ROC-curve analysis to determine the optimal cut-off, patients with >53 geq were more likely to have urethritis (p=0.02). In men with NGU of unknown aetiology, there was no difference in the rate of Uu detection when compared to controls (p=0.26). The corresponding median Uu bacterial DNA load were significantly higher in this group than in controls (p=0.01), and using a cut-off of >53 geq, men with NGU of unknown aetiology were more likely to harbour Uu (14%) than were men from the control group (1%), (p=0.005). Up was detected in 14% of NGU cases and 19% of controls (p=0.34). There was no difference in the detection rate of Up or in the median Up bacterial load in any of the groups. HSV-1 was detected in 3% of cases and 1% of controls. HSV-2 was found in 2% of NGU cases. All urine samples were negative for adenovirus. Cases and controls had similar median number of partners within 6 months (2 partners) and age (28 and 29 years, respectively).

Conclusion

The bacterial load ofU urealyticumin men with NGU and in men with NGU of unknown aetiology was higher than in men without NGU, and the presence of >53 geq of Uu was associated with urethritis in both groups. In accordance with other studies,U parvumwas not associated with urethritis. (Preliminary results were presented at the ASM general meeting, San Diego 2010).
P3-S7.16 Lactobacillus crispatuscolonisation reduces risk of Bacterial Vaginosis (BV) acquisition
Authors: Antonio M , Petrina M , Meyn L , Hillier S
Published: July 2011

Background

Longitudinal studies have found that vaginal colonisation by hydrogen peroxide-producing strains of lactobacilli is associated with a reduced risk of BV acquisition. SeveralLactobacillus spp.includingL crispatus,L jensenii, andL gasserican produce hydrogen peroxide, but no longitudinal studies to date have assessed whether all hydrogen peroxide producing species are equally protective. The objective of this study was to determine which species of Lactobacillus were associated with a reduced risk of BV acquisition.

Methods

In this secondary analysis of women enrolled in a vaccine trial, 112 women aged 18–40 who had Gram stain Nugent scores <6 at study entry were followed bimonthly for up to 18 months for acquisition of BV. Vaginal and rectal swabs were collected at each visit for culture identification of lactobacilli. Species identification was performed by repetitive sequence PCR, and if necessary, 16S rRNA gene RFLP or sequencing. Cox proportional hazards models were used to assess the association between Lactobacillus colonisation at the prior visit and BV acquisition.

Results

There were 40 BV acquisitions detected during 486 follow-up visits over 65.3 woman-years for an incidence of 61 per 100 woman-years. As shown in Abstract P3-S7.16 table 1, women colonised byL crispatuswere 53% less likely to acquire BV at a subsequent visit (p=0.023).

Abstract P3-S7.16 Table 1

Association betweenLactobacilluscolonisation in the vagina and acquisition of bacterial vaginosis (BV)

Lactobacillusspp.# BV acquisitions per woman-yearsRate Per 100 woman-yearsUnadjusted HR (95% CI)p ValueL crispatus Present14/35.5390.47 (0.24 to 0.90)0.023 Absent26/29.887L jensenii Present18/22.6801.42 (0.76 to 2.66)0.270 Absent22/42.752L gasseri Present11/16.1681.08 (0.54 to 2.17)0.820 Absent29/49.359L iners Present13/20.2641.13 (0.60 to 2.13)0.695 Absent27/45.160

Conclusions

L crispatuswas the only species protective against BV acquisition. Since neitherL jenseniinorL gasserireduced the risk of BV despite their capacity to produce hydrogen peroxide, other characteristics ofL crispatusmay be more critical then peroxide production in protecting from BV acquisition.
P1-S1.05 The detection rate ofChlamydia trachomatisandMycoplasma genitaliuminfections in STD clinics in Novosibirsk, Russian Federation
Authors: Khryanin A , Reshetnikov O
Published: July 2011

Background

Currently, in Russia, the incidence of syphilis, gonorrhoea, chlamydia, trichomoniasis, urogenital herpes, and anogenital warts are officially registered. However, statistical records and reporting forms do not include mycoplasma infections (eg,Mycoplasma genitalium).

Methods

The aim of the present study was to evaluate the detection rates ofChlamydia trachomatisandM genitaliuminfections in patients who had attended to STD clinics in Novosibirsk in 2009–2010. A total of 9208 and 13 006 patients were examined forM genitaliumandC trachomatis, respectively, in different settings (antenatal clinics, hospitals, health centers, STI clinics). Both infections were tested in urethral and/or cervical swabs with nucleic acid amplification techniques (“Litex” and “DNA technology”, Russia).

Results

The detection rates ofM genitaliumandC trachomatishad not changed over 2009 and 2010, accounting to 12.6–12.6%, and 12.9–13.0%, respectively. Coinfection was observed in only 0.55% of examinies. However, seasonal variations showed different patterns for these two infections (Abstract P1-S1.05 figure 1). Statistical analysis by month revealed that the highest rates ofM genitaliumwere reported in February and March, and the lowest ones—in July. Monthly analysis found even distribution of infection withC trachomatisalong a year, while the lowest incidence was found in July.

Abstract P1-S1.05 Figure 1

Detection rates ofMycoplasma genitaliumandChlamydia trachomatisaccording to the attendance data (by month in %).

Conclusions

The incidence rates ofC trachomatisandM genitaliumare approximately the same and account for 12–13% among men and women, equally. The combination of these infections is rare (0.55%). During 2009–2010, there are parallel trends in the detection of these two infections, but in September the reciprocal event was shown. This discrepancy may be due to the peculiarities of various microorganisms, and the clinical signs of the infection—chlamydia can cause non-gonococcal urethritis, which is the reason for examination, and mycoplasma infection is mainly symptomless. Nevertheless, a hypothesis of various patterns of infections prevalence around a year in northern countries (ie, Canada, Alaska, Scandinavia, Russia) needs further clarification. The post-holiday period (September–October) may be a crucial point in the activity of the infectious process.
P1-S1.50 A decade of early syphilis in East and inner city London
Authors: Anderson H , Williams A , Zirngibl M , Fatima J , Symonds M , Goh B
Published: July 2011

Background

Following a rise in cases of early syphilis in the UK, a programme of national enhanced surveillance (ES) was commenced in 2001 by the Health Protection Agency with the aims of establishing case distribution and trends in behaviour groups. Local analysis of data acquired via the ES has led to changes to our services in targeting specific high risk groups through increased outreach and community based screening and improvement in health promotion interventions. These include screening for syphilis in all patients attending STI/HIV clinics, dedicated MSM and CSW clinics and outreach work to gay saunas and CSW. The purpose of this study is to look at the epidemiology of infectious syphilis in East and Inner City London over the past decade to provide data on the burden of infection and to further inform local strategy as a measure of outbreak control.

Methods

Data were obtained from patients with infectious syphilis attending the Royal London and St Bartholomew's Hospitals in the City and East London from 2001 to 2010. The data were collated and analysed from the ES form.

Results

Of 778 patients, 39% had primary syphilis, 37% secondary syphilis and 24% had early latent syphilis; 94% were male, 6% female, 51% white British and 12% were Afro-Caribbean. Of the male, 85% were MSM. Three cases were age <16, 27% 17–30 years and 34% were >40 years of age. 257 (32%) were HIV positive. The main reasons for attendance at clinic were for routine screen (24%), symptom management (46%), consequent of partner notification (6%). 18% had one partner, 58 % had 2–9 partners, 19% had 10–99 partner, and 2% had ≥100 partners past 3 months. 82% acquired their syphilis in London, 4% acquired elsewhere in UK, and 8% in Europe. 4% were female sex workers and 6% acquired their infection through sex workers. 10% acquired their infection in gay saunas, 21% acquired through clubs and 14% via the internet. There were 21 cases in 2001, 115 in 2006 and 44 cases in 2010.

Conclusions

(1) The syphilis outbreak peaked in 2006 and has decreased by 62% in 2010 indicating that intervention strategy which is still in place, is having an effect. (2) More preventive work need to be done in clubs and on internet dating. (3) HIV coinfection is common and is a cause for concern as syphilitic ulcers enhanced transmission of HIV and HIV coinfection can lead to more severe syphilis manifestation. (4) 21% had 10 partners past 3 months, mainly untraceable, and sex abroad will continue to fuel the outbreak.
P4-S1.01 Role ofChlamydia trachomatisheat shock proteins 60 and 10 in induction of apoptosis in endocervical epithelial cells
Authors: Mittal A S N , Jha R , Salhan S
Published: July 2011

Background

Chlamydiae are known to modulate host cell to escape from immune response and prolong their persistence to cause fallopian tube damage, ectopic pregnancy and infertility. In addition, Chlamydiae have been reported to elicit both the induction of host cell death, or apoptosis, under some circumstances and actively inhibit apoptosis under others. Chlamydial heat shock proteins (cHSPs) have been known to be responsible for proinflammatory pathologic manifestations of human chlamydial disease in the reproductive tract. Moreover, cHSP60 has been shown to induce apoptosis, in vitro, in primary human trophoblasts, placental fibroblasts, and the JEG3 trophoblast cell line. However, no study has been dedicated to their potential role in apoptosis of primary cervical epithelial cells that are privilege target for chlamydial infection. In the present study, we investigated the ability of cHSP60 and cHSP10 to induce apoptosis in primary cervical epithelial cells.

Methods

Primary cervical epithelial cells were stimulated with cHSP60 and cHSP10 for 4 h. Quantitative measurements of apoptosis have been performed by cytofluorometry and apoptosis-related genes were analysed by microarray, real-time PCR and western blotting. Further, levels ofd proinflammatory cytokines (IL-18 and IL-1ß) were determined by semi-quantitative RT-PCR.

Results

Treatment with cHSP60 significantly increased the mean percentage of apoptotic cells (57.4±5.9 % vs 9.3±1.2 % in control cells, p <0.05). Similarly, treatment with cHSP10 significantly increased the mean percentage of apoptotic cells (47.8±4.8 % vs 9.3±1.2 % in control cells, p <0.05). A cDNA microarray study showed significant (p <0.05) upregulation of interleukin (IL)-1 ß-convertase, caspase-3, -8 and -9 genes were confirmed in real-time RT-PCR in cHSP60 and cHSP10 stimulated than in control cells. The transcript levels of IL-1ß and IL-18 in cells treated with cHSP60 and cHSP10 was found to be significantly (p <0.05) higher in stimulated than in control cells.

Conclusions

In women with persistent chlamydial infection, the release of extracellular cHSPs may lead to cell apoptosis and to an inflammatory response involved in fibrosis and scarring of female genital tract that may contribute severe tubal pathologies including infertility.
P4-S1.05 Polymerase chain reaction-based typing of penA genes exhibiting elevated MIC values to cephalosporins in Isolates of Neisseria gonorrhoeae
Authors: Trees D , Burroughs M , Harris S , Johnson S
Published: July 2011

Objective

Develop a PCR based assays for rapid analysis of isolates that exhibit elevated MIC values to penicillin and cephalosporins (MICs of 0.015–0.06 ug/ml to ceftriaxone). These primers were designed to detect mosaic and nonmosaic sequences in the penA gene.

Methods

Two sets of primer pairs were generated that allowed the detection of mosaic-type and nonmosaic-type penA gene sequences in isolates ofN gonorrhoeaethat exhibited elevated MIC values to three cephalosporins. Additional primer sets were generated that detected the presence of an inserted aspartic acid residue in nonmosaic penA genes involved in resistance and to detect base substitutions to distinguish between two different mosaic penA genes. DNA sequences were determined as necessary by standard sequencing or pyrosequencing.

Results

PCR analysis of 28 isolates, exhibiting elevated MIC values to cephalosporins and from different geographic areas, that used these primer sets in combination allowed for the detection of mosaic penA genes in 12 isolates. The remaining isolates possessed nonmosaic genes. Not all of the 12 isolates contained complete mosaic-type sequences with five of the isolates indicating mosaic sequences present in the 5′ region of the penA gene with wild type DNA sequence replacing the last 120 bp of the gene. Another isolate contained nonmosaic penA sequences with an aspartic acid insertion (after aa 345) in the 5′ region of the gene but mosaic sequences in the 3′ end. Finally, mosaic-related sequences were detected by PCR and confirmed by DNA sequencing in the last 106 base pairs of the penA gene of a penicillin sensitive strain isolated prior to 1976.

Conclusion

PCR can be used to easily detect the presence of mosaic penA genes in isolates ofN gonorrhoeae. This study has shown the 3′ region of the gene may contain mosaic, partial mosaic and nonmosaic-type sequences and that mosaic-type sequence has been encountered in the 3′ region of penA in a sensitive strain. We have also observed isolates with increased MICs to cephalosporins that do not contain mosaic sequences. Finally, isolates that possess mosaic penA genes have been detected in dispersed geographic regions in the US, which is of concern due to the evidence mosaic-type penA alleles are involved in the process of increasing gonococcal MICs to cephalosporins.
P4-S1.06 High-resolution Multilocus Sequence Typing (MLST) ofChlamydia trachomatisfrom three catchment areas in North and Central Norway
Authors: Herrmann B , Christerson L , Gravningen K , Stahlsten A , Ödman K , Nguyen D , Isaksson J , Furberg A S , Simonsen G S
Published: July 2011

Background

TheC trachomatisincidence rate in the county of Finnmark in North Norway is twice as high as in the rest of the country. This study genetically characterises theC trachomatisstrains in Finnmark and compares them with strains from two other counties in Norway.

Methods

DNA sequencing of ompA, which encodes the major outer membrane protein MOMP, and a high-resolution multilocus sequence typing (MLST) system, which is based on PCR amplification and DNA sequencing of five highly variable genetic regions (not housekeeping genes as in conventional MLST), were used. In total, 80 specimens from adolescents mainly aged 15–19 were collected in five high schools (n=60) and in the laboratory routine (n=20) in Finnmark (extended county with sparse population in minor municipalities) and compared to 80 laboratory specimens from Tromsø county (capital of North Norway) and 88 laboratory specimens from Trondheim in Central Norway.

Results

Sequencing of ompA detected 11 genotypes in these 248 specimens. The MLST analysis displayed 50 sequence types (STs), providing five times higher resolution than ompA. Thirty-one (62%) of the STs were novel. The study revealed overlapping STs between the different counties, but 64% of the STs were unique for specific counties (Abstract P4-S1.06 figure 1). The MLST genetic diversity was lower in Finnmark (0.26 ST per specimen compared to 0.34 in Tromsø and 0.32 in Trondheim, respectively), but the geographical differences were not statistically significant.The common ompA genovar E predominated in Tromsø and Trondheim (55%) whereas genovar G (36%) was most frequent in Finnmark.

Abstract P4-S1.06 Figure 1

Distribution of sequence types (n=50) of 248C trachomatiscases in the counties of Finnmark (n=80), Tromsø (n=80), and Trondheim (n=88).

Conclusions

Our MLST provided a significantly higher differentiation capacity than conventional ompA typing, which has predominated genotyping ofC trachomatisfor decades. Thus high-resolution MLST is a useful tool for molecular epidemiology of chlamydial infections.
P4-S2.01 A cross-sectional survey of Hepatitis B virus infections and natural immunity against Hepatitis B virus infections among HIV discordant heterosexual couples in Kisumu, Kenya
Authors: Ondondo R
Published: July 2011

Background

HIV and hepatitis B virus (HBV) share transmission modes. HIV infected people are thought to be at increased risk of HBV acquisition, chronic HBV infection and HBV disease. Chronic HBV infection may pose a challenge among HIV infected individuals' eligible for antiretroviral therapy, increasing their risk of rapid HIV-disease progression. Early prevention of HBV infection by vaccinating HIV infected people is recommended. However, in most poor countries HBV vaccination is not routine and those opting for vaccination are rarely tested before vaccination. We sought to determine the prevalence of HBV infection and natural immunity against HBV infection among HIV discordant couples.

Methods

The first 949 discordant heterosexual couples screened for eligibility into an HIV pre-exposure prophylaxis study had HBV surface antigen (HBsAg) and anti-HBs status determined. CD4 count was also performed for HIV infected potential subjects. None of these participants reported HBV vaccination history. SPSS version 17 software was used for statistical analysis.

Results

Of 949 HIV positive subjects, 34.7% (329) were men thus women were more likely to be the HIV-positive spouse in these HIV-discordant relationships (p<0.001). 99 of 1898 subjects were positive for HBVsAg, resulting to 5.2% HBV prevalence, with men being more likely to be HBV infected compared to women (p<0.05). 40% (758) of 1898 subjects tested for anti-HBs were immune to HBV, with men being more likely to possess natural protective antibodies against HBV compared to women (p<0.05). Among HIV infected subjects, those with a CD4 count >250 cells/ml were more likely to possess immunity against HBV compared to those with a CD4 count <250 cells/ml (p<0.001). However, HIV status was not associated with either HBV infection (p=0.302) or immunity against HBV (p=0.512).

Conclusion

Scaling-up routine vaccination after anti-HBs screening in resource limited settings could be cost-effective and easy to roll-out in HIV endemic Sab-Sahara Africa. This is because 40% of individuals are already immune to HBV. Validation of Anti-HBs rapid screening tests is urgently needed in this population.
P4-S2.02 Regulatory T cells and Fox P3 levels in naive and HAART treated HIV-1 infected patients in Thailand
Authors: Sukwit S , Srisurapanon S , Chuenchitra T , Horthongkham N , Sutthent R
Published: July 2011

Background

The frequency and expression levels of FoxP3 in regulatory T-cells (T-regs) from advanced-stage HIV-infected patients are controversial. Thus, the aims of this study were to compare these parameters of T-regs from HIV infected patients and from healthy controls.

Methods

T-reg population and expression levels of FoxP3 were assessed from 43 HIV-1 infected individuals and 12 healthy controls by using FACs flow cytometry.

Results

Minor decrease in frequencies of T-regs was found in both infected groups (naïve and treated) compared with those from healthy controls (p=0.02, p=0.01, respectively). In contrast, a significantly increase in the ratios of T-regs: CD4 cells from HIV-infected patients was observed (p=0.001). In addition, FoxP3 expression levels in both treated and untreated HIV-1 infected patients were significantly higher than those in healthy controls (p<0.001 and 0.01 respectively).

Conclusions

The decreased number of T-regulatory cells and the increased levels of FoxP3 in T-regs from HIV infected patients were associated with advanced stage of AIDS disease.
P4-S2.03 Calculating BMI in HIV+ female adolescents: a case of shaping the health of adolescents in Zimbabwe: Shaz! plus project
Authors: Nhamo D
Published: July 2011

Background

Body Mass Index (BMI) is a statistical measure which compares a person's weight and height. It is used to estimate a healthy body weight based on a person's height. This measure is pertinent to use in HIV positives since weight loss is used as a proxy measure for clinical progression of HIV disease in that more weight loss is associated with advancing disease and often precedes clinical symptoms. We sought to measure BMI among HIV+ female adolescents to see if this is the best tool to use in immune-compromised populations.

Methods

Data were pulled out from an ongoing RCT entitled SHAZ! Plus. (N=650). It enrols HIV +ive female adolescents who are out of school. Data were collected at baseline, 6, 12 and 18-month follow-up visits, with the project facilitating ongoing care, ART and support to those in need of it. BMI was calculated using Adolphe Quetelet BMI calculator of weight in kg over height in m2(kg/m2). BMI prime 25 was also calculated and used to compare the BMI results. Sample of xx used.

Results

64.5% of the cohort had BMIs falling within normal ranges 18.5 to 25. 33.8% had BMIs of <18.5 and 0.16% had a BMI of >25. 64.5% had BMI prime that fell within normal ranges of 0.74 and 0.99. 33.8% had BMI prime of <0.74 and 0.16% had a BMI prime of >1.00. The average BMI at baseline was 19.35 Weight ranged from 25 to 70 at baseline, average was 47.71.

Conclusion

Results call for the need to come up with an adjusted BMI index for female adolescents who are immuno-compromised to use as a standard measure for optimal health. BMI however has it's shortcomings since it does not measure the actual body fat. In resource poor settings, a simple tool like weight lost or gained over time might be a good indicator of clinical progression of HIV as opposed to validated tools like the BMI.
P4-S3.02 Subtyping of Treponema pallidum strains by sequence analysis of tp0279 and tp0548
Authors: Pillay A , Chen C Y , Morshed M G , Philip S , Ballard R C
Published: July 2011

Background

The goal of the study was to evaluate two sequence-based subtyping methods for their ability to further differentiate Treponema pallidum strains characterised by the CDC typing system.

Methods

12 clinical specimens with the 14d strain type obtained from patients with GUD in Cape Town in 2000; 14 specimens with the 14d strain type from patients with primary or secondary syphilis in San Francisco collected between 2004 and 2007; and 12 clinical specimens with the 14d strain type collected between 2000 and 2002 from a syphilis outbreak in Vancouver were included in the study. Specimens were previously characterised using the CDC typing method which involves analysis of the sequence variability with tprE, G, and J and, the variable number of 60-bp tandem repeats within the arp gene. Subtyping was performed by PCR amplification of a homonucleotide G" tandem repeat within tp0279 and a variable region within tp0548. PCR amplicons were purified and directly sequenced using the BigDye® Terminator v3.1 cycle sequencing kit and an ABI 3130 sequencer.

Results

Of the 12 samples from South Africa, sequence analysis of tp0279 revealed three subtypes (9G, 10G, 11G) and combining this data with the CDC typing method produced strain subtypes 14d9, 14d10, and 14d11. Sequence analysis of the variable region within tp0548 resulted in five subtypes designated a, c, f, k, and l among these samples and, combination with strain type using the CDC method produced subtypes 14d/a, 14d/c, 14d/f, 14d/k, 14d/l. All 14 samples from San Francisco had 9G tandem repeats within tp0279 resulting in subtype 14d9. Sequence analysis of the variable region within tp0548 resulted in 3 subtypes designated f, g and j among these 14 samples and incorporation of the CDC typing method produced subtypes 14d/f, 14d/g, and 14d/j. Of the 12 samples from Vancouver, sequence analysis of tp0279 produced two subtypes (8G, 9G) resulting in strain subtypes 14d8 (1/12) and14d9 (11/12). Sequencing of tp0548 also produced two subtypes (e, f) resulting in strain subtypes 14d/e (1/12) and14d/f (11/12).

Conclusions

The tp0279 subtyping method further differentiated 14d strains into four subtypes while the tp0548 method differentiated 14d strains into eight subtypes. Subtyping of strains from the initial syphilis outbreak in Vancouver suggests clonal spread ofT pallidum. Both subtyping methods enhanced the original CDC typing method and appear to be promising tools for molecular epidemiological studies on syphilis.
P4-S3.03 Characterisation ofUreaplasma parvumfrom symptomatic and asymptomatic men attending a family practice in Pretoria, South Africa
Authors: Kock M , Maningi N , Adam A , Hoosen A
Published: July 2011

Background

The genus Ureaplasma colonises human mucosal surfaces such as urogenital tract of men and women. In men it has been implicated in the aetiology of non-gonococcal urethritis and infertility. Although its pathogenesis is not yet fully understood, it has been suggested that certain serotypes are associated with disease. This study undertook to detect genitalUreaplasma spp.and to characteriseUreaplasma parvumin men with and without urogenital symptoms.

Methods

Two hundred first void urine specimens were collected from symptomatic (100) and asymptomatic (100) men attending a private clinic. All specimens were cultured in U9 broth and subcultured on A2 agar medium for confirmation. All isolates were tested for susceptibility using the Mycofast Evolution 3 kit. DNA was extracted from all specimens and amplified using a multiplex TaqMan polymerase chain reaction assay targeting the multiple-banded antigen gene for the detection and serotyping ofU parvum.Ureaplasma urealyticumwas detected by a commercial real-time PCR kit.

Results

Cultures were positive in 16/100 symptomatic and 12/100 asymptomatic men (p=NS). All isolates were susceptible to doxycycline, pristimycin, roxycycline and azithromycin. OneUreaplasma spp.from an asymptomatic male was resistant to ciprofloxacin and josamycin and intermediately resistant to ofloxacin and another was resistant to ofloxacin. An isolate from a symptomatic man was resistant to ciprofloxacin. There was no significant difference (p=0.16) between theU parvumisolated from symptomatic (11/100) and asymptomatic (18/100) men as well as forU urealyticumfrom symptomatic 16/100 and asymptomatic 15/100 men (p=0.86). Four men (two from each group) were colonised by bothUreaplasma spp.. The predominant serotype was six, followed by types 1, 14 and 3 with no significant difference between symptomatic and asymptomatic men (p=0.309).

Conclusions

There is no data of circulatingU parvumserotypes from South Africa. The prevalence rate was low and no significant differences were found between symptomatic and asymptomatic men for bothUreaplasma spp.. Serotype 6 was the most common type compared to reports from developed countries which suggests type 3 as being the most common. Macrolides and tetracyclines remain effective drugs for treatment of the Ureaplasma infections. Molecular techniques are valuable identification and characterisation of this fastidious group of bacteria.
P4-S3.04 Treponema pallidum molecular typing in China
Authors: Peng R R , Yin Y P , Wei W H , Wang H C , Chen X S
Published: July 2011

Background

Syphilis is resurgent in China, but there have been limited data on molecular epidemiology. A novelTreponema Pallidum(T pallidum) typing method that uses tp0548 gene in addition to arp and tpr E, G, J genes with greater discriminatory power has recently been developed. This study aimed to analyseT pallidumstrain types across geographical areas in China using this novel method.

Methods

From 2008 to 2010, genital specimens, including those from chancres, condyloma lata and mucosal patches, were collected from patients with clinically suspected primary or secondary syphilis in STI clinics in East China (Nanjing), South China (Guangzhou, Jiangmen and Fuzhou), Southwest China (Nanning and Chengdu), North China (Tianjin), and Northeast China (Harbin). All specimens were first amplified by PCR of polA gene to screen for positive DNA, followed by analysis of arp, tpr E,G, J and tp0548 genes for complete strain type. A χ2test was used to compare the distribution of strain types across the 5 geographical areas.

Results

TypeableT pallidumDNA was detected in 184 of 401 specimens, and 27 strain types were identified. Overall, 3 to 20 repeats (except 4, 11, and 19 repeats) and 25 repeats were found for the 60-bp arp gene. This was the first time 9 and 25 repeats for the arp gene have been detected. For the RFLP pattern of the tpr E, G, J genes, a, d, h, j and l were identified. For the sequence pattern of the tp0548 gene, c, e and f were identified. The distribution of strain types was significantly different across the geographical areas of China (χ2=29.2, p=0.008), but type 14d/f was most predominant within each geographical area (approximately 40% constituent ratio in each area). Taking all geographical areas into account, types 15d/f, 13d/f, 16d/f, and 14a/f were the next most common in descending order see Abstract P4-S3.04 figure 1.

Abstract P4-S3.04 Figure 1

Strain types ofT pallidumidentified in clinical specimens from five geographical areas in China.

Conclusions

There is substantial genetic diversity ofT pallidumin China. However, the overall predominance of a single 14d/f strain type may imply a potential link in sexual transmission of syphilis across geographical areas.