bluuebunny/crossref_metadata_2025 huggingface dataset:
S12.4 Chlamydia Trachomatis
Authors: Johnson R M
Published: July 2013

In vaccine enterprises there are two goals that must be achieved to be successful. Priority is usually given to the vaccine components, which antigen(s) and adjuvants. However an equally important goal is to understand the parameters of protective immunity, or the immunologic goal of vaccination.Chlamydiatrachomatisinfections pose a unique challenge for host immunity. In the majority of infected individuals the invading bacteria replicate only in the epithelial monolayer lining the reproductive tract. The business end (mechanism) of an effective vaccine is likely to be T cells functioning at the epithelial interface. During natural infections individuals’ immune responses range from asymptomatic clearance, to asymptomatic infertility, to hospitalisation for PID. EarlyChlamydiavaccine attempts were associated with enhanced immunopathology. It is possible thatChlamydiavaccine candidates will cause enhanced immunopathology, with or without enhanced protection from bacterial replication in the reproductive tract. Evaluation ofChlamydiavaccines will need to include their ability to limit bacterial replication and immunopathology. There are some after-the-fact correlates for bad outcomes in women infected withC. trachomatisincluding circulating peripheral mononuclear cells that make too little IFN-γ, too much IL-10 or TNFα when activated byC. trachomatisantigens. TheChlamydia muridarummouse model provides an opportunity to define the parameters of protective immunity in the genital tract, and then evaluate/validate them in humans. The mouse model has shown the CD4 T cells are critical to protection and CD8 T cells likely responsible for immunopathology. More recently it was demonstrated that there are redundant mechanisms for clearingC. muridarumfrom the genital tract. This presentation will cover the newest mouse model data, correlating it with what is known in humans. The practicable human correlates of protective immunity and immunopathology are likely to be novel CD4 and CD8 T cell subsets, with antibody possibly falling into disfavour.
S13.1 Current and Future Challenges in Gay Men’s Health
Authors: Hart G J
Published: July 2013

Epidemics of HIV in men who have sex with men (MSM) were first recognised in the early 1980s. Since the introduction of antiretroviral treatment (ART) in the mid-1990s incidence of HIV has not, despite expectations, reduced significantly in many countries. Indeed, the numbers of new diagnoses has increased in some European countries, the USA and Australia. In the UK, for example, over 3000 MSM were diagnosed with HIV in 2010, the highest number since the beginning of the epidemic. As a consequence, the prevalence of HIV is increasing and, for gay communities, a growing number of men are now living with HIV.

Although incidence of sexually transmitted infections (STIs) in MSM fell dramatically in the early years of AIDS, post-ART we have seen a return in some jurisdictions to pre-AIDS incident STIs, and the emergence of new sexually transmitted pathogens.

This paper will focus on behavioural and epidemiological research in the era of ART, with particular reference to the continuing transmission of HIV. It will review current risk factors for HIV infection in negative MSM, sexual risk behaviour and risk reduction interventions among HIV positive MSM, and the emergence and re-emergence of new and established STIs. It will conclude with current challenges to the prevention of HIV and STIs in MSM, and prospects for the future.
S13.2 Evidence-Based Targeted Review of HIV and STI Prevention Interventions Among MSM
Authors: Thorson A , Strömdahl S , Sabido M , Pharris A
Published: July 2013

Background

In Europe, men who have sex with men (MSM) are disproportionately affected by STI/HIV. Sex between men is the predominant mode of HIV and syphilis transmission and contributes to a third of gonorrhoea cases in 2011. The main goal of this evidence-based review was to gather and critically appraise the scientific evidence for and to inform European guidance on a comprehensive approach for HIV, STI and hepatitis prevention among MSM.

Methods

Relevant data bases were searched for publications related to disease prevention and health promotion among MSM. All kinds of reviews were included but gave presence to systematic reviews, when no reviews were found individual studies were included. A critical appraisal of the quality of each study was performed before inclusion in the targeted review. The Highest Attainable Standard of Evidence (HASTE) was used for grading as the basis for recommendations as HASTE was specifically developed to evaluate evidence regarding HIV/STI interventions among key populations. HASTE takes into account three categories with equal weight: efficacy data; implementation science data; biological and public health plausibility.

Results

Seven interventions were identified to be strongly recommended for prevention of HIV, STI and/or hepatitis, and 15 interventions for probable or possible recommendation. Consistent condom use, HIV treatment as prevention, peer outreach and support groups for men testing HIV negative as well as for HIV positive men, together with HSV-2 suppression therapy with acyclovir to prevent genital ulcer disease and hepatitis B vaccination, were all strongly recommended according to the HASTE grading.

Conclusions

In general, studies of acceptable quality from the European context were few and made the assessment of context-specific effectiveness difficult. Additionally, effectiveness studies looking into real-life effectiveness of biomedical interventions were very few. Future research would be able to contribute with more information from the specific European settings including (cost-) effectiveness studies.
S13.3 The Status of HIV Prevention Among MSM: An Overview of the European Response
Authors: Sfetcu O , Noori T , Spiteri G , Pharris A , Laar M van de
Published: July 2013

Introduction

MSM in the European Union and European Economic Area (EU/EEA) are disproportionately affected by STI: 39% of all HIV diagnoses, 33% of gonorrhoea and 55% of syphilis cases were reported among MSM in 2011.

Methods

Analyses of surveillance data and information from countries responses for Dublin Declaration monitoring were combined with a review of existing national prevention intervention programmes targeted at MSM. Characteristics of 118 prevention interventions studies were included in the repository.

Results

Outbreaks of syphilis, hepatitis C and lymphogranuloma venereum and increasing trends of gonorrhoea and HIV among MSM, observed between 1995–2011, were reported to be associated with high levels of risk behaviour, sexual networking and socio-economic and cultural factors. The national responses included: strenghtening of surveillance, prevention and care; enhanced partner notification; and development of a range of prevention intervention programmes. The majority of prevention interventions used media campaigns, education and counselling followed by harm reduction strategies like condom distribution and HIV/STI testing alone or combined with other activities. Nearly half of the behavioural interventions studies reported proper outcome evaluation.

In 2012, HIV/STI prevention programmes targeted to MSM were implemented in 22/30 EU/EEA countries, with non-governmental organisations playing a key role in programme implementation through campaigns, outreach work, information provision and condom distribution. Reported coverage of HIV prevention programmes for MSM ranged from 43% to 76% across countries. Rates of HIV testing among MSM during the last 12 month ranged from 12% to 74% and rates of condom use at last anal intercourse from 42% to 64%.

Conclusion

Diversity across EU/EEA in the design and implementation of prevention intervention strategies reflects various characteristics of MSM populations and the changing epidemiology of STI/HIV. A common need exists for improving the effectiveness of prevention intervention programmes, for targeting young, migrant and ethnic-minority MSM and for ensuring adequate funding.
S13.4 What Do Gay Men Need? - Challenges Regarding Comprehensive Approaches in HIV-Prevention Interventions from a National Perspective
Authors: Sander D
Published: July 2013

Regarding empirical evidence gay men are facing several health problems which can arise from the mastering of living in homo-negative environment. We can e.g. find high levels of substance use, mental health problems, and risky behaviour.

The presentation will raise the question on how these different and interacting health matters work together and how they can be tackled in campaigns focused on gay men and other MSM. What is the experience of the national German campaign “I KNOW WHAT I'M DOING”; what can be done in future work from the MSM community perspective; who are the necessary co-operative partners, what has to be requested from different policy sectors?
S14.2 The CISNE Project: Implementation of POCT For Syphilis and HIV in Antenatal Care and Reproductive Health Services in Peru
Authors: Garcia P , Peeling R , Mabey D , Holmes K , team C
Published: July 2013

Background

Congenital syphilis and syphilis in pregnancy in Peru persist as important public health issues, and improvement of screening/treatment for pregnant women remains challenging. Rapid syphilis testing (RST) allows simple and immediate diagnosis and treatment at a single clinic visit and could increase screening and treatment coverage reducing the incidence of stillbirth and congenital syphilis and generate in the long term a sustainable cost effective intervention.

Methods

We tested the feasibility, performance, impact and cost-effectiveness of implementing RST in an underserved urban area at a biggest maternity hospital in Peru and a network of 16 peripheral health centres offering prenatal care in a periurban poor area in Callao-Ventanilla, Peru. RST (integrated with HIV rapid test: the “two for one”) were offered at the first prenatal visit (ANC), at delivery and within miscarriage/abortion services.

Results

Data from the baseline pre-implementation evaluation revealed limited coverage of screening and treatment services for maternal syphilis and a complex and inefficient system for ANC. RST was started in January 2010. Overall success of implementation was measured by rates of maternal syphilis screening and treatment coverage, partner treatment, and acceptability of RST among providers and patients. We also performed a cost-effectiveness analysis of RST against the Rapid Plasma Reagin (RPR). Attention was paid to the process of dissemination and transfer activities to the Ministry of Health of Peru, through the involvement of both the National Program of STIs and HIV and the Reproductive Health Program. National guidelines have been modified, and recommend the use of both tests, RST and rapid HIV testing in the screening of pregnant women.

Conclusions

RST implementation was feasible, successful, acceptable and cost effective. Its introduction catalysed improvements in the quality of care, and by the end of the project it has been introduced in the country as a National policy.
S14.3 Explaining Inaction: The Politics of Congenital Syphilis and the Global Health Agenda
Authors: Bump J , Salisbury N
Published: July 2013

Background

If disease burden were directly correlated with priority on the global health agenda, then congenital syphilis would have a high position. But even though congenital syphilis adversely affects around 650,000 pregnancies and newborns annually and is relatively simple to diagnose and treat, it is largely absent from high-level discussions of reproductive and child health and is not a major programmatic focus at prominent global health organisations. We sought to examine explanations for the low prioritisation of congenital syphilis and use our findings to inform framing strategies to improve the placement of congenital syphilis on the global health agenda.

Methods

First, we reviewed published literature on congenital syphilis to construct a basic narrative, identify trends, and identify important stakeholders. Second, we conducted semi-structured interviews with stakeholders involved with or important to congenital syphilis control to understand the prioritisation of congenital syphilis and attempts to promote it. Third, we surveyed influential representatives of global health institutions to assess their perspectives on the position of congenital syphilis on the global health agenda. Finally, we analysed the data to track changes in priority given to congenital syphilis over time. We then developed political strategies based on these data.

Results

Based on our literature review and key informant interviews, we develop framing strategies, identify potential political allies, and suggest pathways advocates can use to increase the prominence of congenital syphilis on the global health agenda.

Conclusions

Although it is an important cause of stillbirth and neonatal death, congenital syphilis is largely invisible on the global health agenda. Past efforts to raise awareness have had limited impact. Future efforts toward elimination of congenital syphilis could benefit greatly from increased attention to framing strategies and alliances with related issues in global health.
S14.4 Monitoring the Finish-Line: Integrated Global Criteria and Processes For Validation of EMTCT of Syphilis and HIV
Authors: Newman L , Hayashi C
Published: July 2013

Background

The global community is committed to elimination of mother-to-child transmission (EMTCT) of HIV and syphilis as public health problems. International and regional goals have been set, and countries are scaling up programmes towards EMTCT. Regional initiatives in the Americas, Asia-Pacific, and Africa have approached control of MTCT of HIV and syphilis as an integrated process. Prior to this work, there were no internationally standardised processes and criteria to validate EMTCT of HIV or syphilis.

Methods

As the global community prepares to assess progress towards global health goals in 2015 and beyond, standardised processes and criteria are needed to assess and validate EMTCT of HIV and syphilis across widely varying epidemiologic and programmatic contexts. This presentation will review the process for development of minimum global processes and criteria, provide a description of global validation targets and indicators, explain validation procedures, including maintenance of validation status, and describe next steps at the global, regional, and national levels.

Results

These guidelines are intended for use by national, regional, and global validation committees; national AIDS, sexually transmitted infection, maternal, and child health programme managers; monitoring and evaluation (M&E) officers; policy-makers; and international partners. Currently there are at least 4 regions moving forward with establishment of regional processes for validation, and several countries have expressed interest in applying for validation of EMTCT of HIV and/or syphilis.

Conclusions

As experience is gained through establishment of global and regional validation processes, additional guidance and tools will be developed to complement these initial minimum global standards. Although it is recognised that not all countries are able to meet these criteria at this time, these criteria can also serve as aspirational targets for countries for 2015 and beyond and an opportunity to improve programmes and monitoring systems, reduce disparities within countries, and highlight models of success.
S14.5 Piloting Methods For Validation of Elimination of MTCT of HIV and Syphilis in St. Lucia and Chile
Authors: Hoover K W , Caffe S , Alonso M , Kamb M
Published: July 2013

Introduction

In 2010, the Pan American Health Organization (PAHO) member countries approved the Strategy and Plan of Action for Elimination of Mother-to-Child Transmission (MTCT) of HIV and Congenital Syphilis, with the goal of elimination by 2015. Elimination targets are MTCT of syphilis of ≤ 0.5 cases per 1,000 live births; MTCT of HIV of ≤ 0.3 cases per 1,000 live births; and transmission of HIV from HV-infected mothers to their infants of ≤ 2%. PAHO has supported Latin American and Caribbean countries to achieve these goals, by developing several technical resources, a system for reporting indicators of elimination, and methodology for validating elimination.

Methods

In 2012, we piloted validation methodology in St. Lucia and Chile, countries with robust elimination programmes. Teams of external experts travelled to each country to assess the national surveillance system and verify reported data; the national laboratory system; and programmatic aspects important for achieving and sustaining elimination. The assessment included review of databases and reports, triangulation and re-calculation of data, mapping of health services delivery, interviews with national and regional stakeholders, and visits to service delivery sites.

Results

The validation methodology was able to identify national strengths and challenges in surveillance, health services, laboratory, and programme. It also was able to demonstrate sub-national variances and inequities in achieving and maintaining elimination targets, and barriers to health services access in underserved populations. Data verification and triangulation led to re-calculation of some indicators, but others could not be calculated due to data gaps.

Conclusion

The validation methodology is useful for assessing progress in elimination of MTCT of HIV and syphilis, but also as a tool for countries to review their programmatic actitivies to identify opportunities for accelerating achievement of elimination. Challenges in re-calculation of indicators emphasise the importance of comprehensive information systems that collect data necessary to verify elimination.
S16.1 Recurrent and Persistent Urethritis in Men - a Structured Evidence Based Approach to Management
Authors: Horner P
Published: July 2013

This occurs in 10–20% of men treated for acute NGU. Its aetiology is multifactorial, an infectious agent being identified in < 50% cases.Mycoplasma genitaliumhas been identified in 20–40% andChlamydia trachomatisin up to 20%.Ureaplasma urealyticummay also play a role.Trichomonas vaginalisis identified in up to 10% in populations where it is endemic.

Until recently azithromycin 1grm and doxycycline 100 mgs bd 7days were considered equally effective in treating men with acute NGU. However this is not the case. The microbiological failure rate of azithromycin 1 grm is 13 – 30% forM. genitaliumand associated with 23S rRNA gene macrolide antimicrobial resistance mutations, which it can induce. This has also been demonstrated to occur women. A prolonged course of azithromycin for 5 days appears to be effective but not always, possibly because of prior macrolide resistance. Up to 20% of men with Chlamydia will also fail azithromycin 1grm but do not develop antimicrobial resistance mutations. Doxycycline 100 mgs bd 7 days has a failure rate > 50% withM. genitaliumbut probably < 5% with Chlamydia. It does not induce antimicrobial resistance mutations. Ofloxacin is probably effective against Chlamydia but has a high failure rate (∼50%) againstM. genitaliumand may result in quinolone antimicrobial resistance mutations. Moxifloxacin is effective against both micro-organisms.

Any treatment of recurrent/persistent NGU should coverM. genitaliumandT. vaginalis.As there is a significant risk of macrolide and quinolone resistance developing inM. genitalium, an infection for which there is no commercial test, the most sensible strategy would be to use doxyccline 100mgs bd 7dys as first line treatment and when using azithromycin to restrict prescribing to a five day course for both index cases and partners. The use of quinolones should be limited to moxifloxacin in those who fail azithromycin 5dys treatment.
S16.2 Recurrent BV
Authors: Marrazzo J
Published: July 2013

Bacterial vaginosis (BV) is a common cause of vaginitis and increases women’s risk of pelvic inflammatory disease, adverse pregnancy outcomes, and risk of STD/HIV acquisition. The aetiology of BV is unclear, though it is believed to involve loss of vaginal hydrogen peroxide-producing lactobacilli and acquisition of complex bacterial communities that include many fastidious BV-associated bacteria (BVAB) that have recently been detected using PCR methods. Treatment failure (persistence) is common, and may be facilitated by unprotected sex. Potential contributions to BV and BV persistence include (1) sexual partners as a reservoir for BVAB; (2) specific sexual practises, including male partners’ condom use; and (3) the composition of the vaginal microbiota involved in BV. Specific BVAB in the Clostridiales Order may predict BV persistence when detected pre-treatment, and have been detected in men whose female partners have BV. BVAB may be associated with unprotected sexual behaviour and failure of BV to resolve in women, supporting the hypothesis that BVAB colonisation of male genitalia may serve as a reservoir for re-infection of female partners. Moreover, specific sexual practises may favour vaginal colonisation with certain BVAB that have been associated with persistence. This session will provide background on BV, and discuss the epidemiologic and microbiologic data to support a role for acquisition of BVAB and how this process might differ among subsets of women.
S16.4 Lymphogranuloma Venereum in Men Who Have Sex with Men. An Ongoing Epidemic Since 10 Years, But Still Not Tackled
Authors: Vries H J C De
Published: July 2013

LGV is endemic in large parts of the tropics. Since 2003 anorectal LGV is also endemic among Men who have Sex with Men (MSM) throughout the industrialised world. Currently we see an increase in de incidence of LGV cases among MSM in Amsterdam. Occasional cases of heterosexual LGV are usually imported from endemic countries.

LGV is caused by Chlamydia trachomatis (Ct) biovar L. Compared to non-L biovar infections, LGV has a completely different clinical picture characterised by an invasive, lymph destructive and fibrosing inflammatory reaction. The majority of MSM with LGV are HIV co-infected (up to to 85%), and a considerable portion is hepatitis C co-infected.

LGV requires extensive treatment in contrast to non-L Ct infections, thus correct biovar identification is clinically relevant. Routinely LGV is excluded in Ct positive anal, ulcer, and bubo samples. Urethral LGV is not screened routinely. The vast majority of reported LGV cases comprise anorectal infections. Infections residing at other locations than the rectum could form an undiagnosed and undertreated reservoir contributing to ongoing LGV transmission. We recently found concurrent urethral LGV infections in 2.1% of MSM with anorectal LGV. Moreover, 6.8% of the partners of anorectal LGV cases had a urethral LGV infection. This shows that urethral LGV is common, probably key in transmission, and missed in current routine LGV screening algorithms.

In European MSM the majority of LGV infections is caused by biovar L2b (Amsterdam variant). Based on clonal relatedness of prevalent LGV strains, there is evidence that the LGV epidemic among MSM prevailed already in the United States in the 1980s and was introduced into Europe by the end of the last century via the highly internationalised network of sexual contacts among MSM. A new LGV variant was unveiled and designated L2c.
S16.5 Management of Syphilis in Pregnancy
Authors: Wilson J
Published: July 2013

There are a number of clinical challenges that are specific to managing syphilis in pregnancy: Which women have the highest risk of adverse pregnancy outcome and is there anything extra we should do for them? What effect does the timing of treatment have on the pregnancy? What is the best treatment and should this be modified in the presence of HIV? What effect does the Jarisch-Herxheimer reaction have on pregnancy? What rate of adverse pregnancy outcome can be expected following successful treatment? Should all babies be treated at birth and how should the baby be monitored?

Early stage maternal infection and higher RPR increase the risk of adverse pregnancy outcome. Treatment in the third trimester is also associated with poorer outcomes. Parenteral penicillin G is the only recommended therapy for treatment of syphilis during pregnancy, and the lack of effective alternatives is why desensitisation is recommended in those who report a penicillin allergy. However, a meta-analysis concluded there is insufficient evidence to determine an optimal penicillin regimen. Adequate treatment in pregnancy significantly reduces adverse pregnancy outcomes (APOs) and congenital syphilis but APOs are still reported probably due to placental damage and effects of the fetal immune response. Some guidelines recommend treating all infants born to positive women whether or not the mother was adequately treated in pregnancy whereas others suggest this is probably not necessary. All recommend examination and serological testing of the babies every 3 months until the test/s become nonreactive.

This presentation will look at the evidence base, and the recommendations in different national guidelines, to try to provide answers to these questions.
YI.1 Condom Use & Pleasure in a Sample of YMSM: A Conceptual Framework
Authors: Arrington-Sanders R , Harper G W , Fortenberry J D , Bauermeister J A
Published: July 2013

Purpose

Little research addresses sexual pleasure in young men who have sex with men (YMSM). In this qualitative study, we developed a sexual health focused conceptual framework to explore relationships that emerged between condom use and sexual pleasure in sexual relationships among a sample of gay, bisexual, and transgender males.

Methods

30 YMSM (ages 18–24 years) were recruited (through advertisements on social networking sites, participant referrals, and flyers posted at local venues frequented by YMSM) to complete a 90-minute, semi-structured interview seeking to better understand partner-seeking behaviours of YMSM. Interviews were transcribed verbatim. Analysis used inductive open coding such that emergent concepts were connected across interviews and major themes identified.

Results

Median age was 22 years old (M = 21.96; SD = 1.75). Most (N = 18, 60%) of participants self-identified as White, and gay (N = 22, 73%). Over 90% (N = 28) reported having had sex with someone met on a dating website in the past 3 months. Five (17%) participants reported being HIV-positive and 12 (40%) reported a prior history of a sexually transmitted infection. Emotional effects (such as connectedness with others) and physical effects (loss of sensation and erectile difficulties) mediated the relationship between pleasure and condom use during insertive penile-anal intercourse. Specific characteristics of sexual events (e.g., use of lubricant), relationship with the partner, and of the specific sex act (including sexual position) moderated the relationship, with pleasure and satisfaction greater during receptive anal sex without a condom with emotionally intimate or regular partners.

Conclusion

s Our findings suggest that relationship between sexual pleasure and condom use may be mediated by both emotional and sexual factors. Prevention work with YMSM need to acknowledge the centrality of pleasure in sexual health and focus on modifiable factors that may impact pleasure among YMSM.
YI.2 Teens, the Internet, and STD Risk: Findings and Lessons Learned from the Communication, Health, and Teens (CH@T) Study
Authors: Buhi E R , Powers E , Hughes S , Klinkenberger N , Wheldon C W , Rietmeijer C
Published: July 2013

Background

Few studies have examined the association between sexual health risks and online sex seeking among teenagers. The purpose of this study was to assess the associations between meeting sex partners online and a range of sexual risk behaviours and outcomes among adolescents.

Methods

Participants aged 13–19 years were recruited from a publicly funded teen clinic in Florida. After obtaining informed consent/assent, 273 participants completed an audio computer-assisted self-interview (ACASI) that included questions on demographics, sexual behaviour, STD history, and online sex-seeking behaviours and experiences. Participants also provided urine samples for chlamydia and gonorrhoea testing. Data were analysed using logistic regression to identify the association between having an online sex partner and sexual behaviours/outcomes.

Results

After adjusting for significant bivariate correlates, teens reporting online sex partners were more likely to be male, be multiracial, have a history of same-sex sexual activity, report a higher number of vaginal sex partners, and report a lower age at first vaginal sex. However, teens with online sex partners were no more likely to have ever had an STD or a current biological STD.

Conclusion

This study is one of the first to link biological STD results to online sex-seeking data in a youth population. While meeting a sex partner online was not associated with past or current STDs, it was associated with other sexual risk behaviours. Future research is needed to examine the complex nature of online sexual partnering among adolescents and to develop intervention approaches. In-depth qualitative interviews, currently being conducted with teens, are exploring the process and context of meeting partners online. These interview data will also be discussed in light of the ACASI and biological STD data findings.
YI.3 Sexually Transmitted Infections (STIs) Vary Among African American Women Who Have Sex with Women Based on Exposure to Male Sexual Partners
Authors: Muzny C A , Harbison H S , Whittington A M , Whidden R L , Richter S S , Jones M G , Austin E L , Hook E W
Published: July 2013

Introduction

Little is known about partner characteristics or rates of STIs among African American women who have sex with women (AAWSW).

Methods

African American women aged ≥ 16 years attending a Health Department STD clinic were enrolled in this ongoing study if they reported sexual activity with a female partner during the preceding year. Participants completed a study questionnaire and were tested for curable (trichomoniasis, Chlamydia, gonorrhoea, and syphilis) and non-curable (HSV-2, HIV) STIs.

Results

Of 128 participants reporting female partners during the preceding year, 52% (67/128) also reported sex with men during the same interval (WSWM). WSW and WSWM did not differ with regards to age, lifetime number of female partners, or number of female partners during the preceding year. WSWM reported increased numbers of lifetime male partners compared to WSW (p= 0.01). During the 30 days preceding enrollment, WSWM reported a median of 2 sexual partners (interquartile (IQR) range 0–4) while WSW reported a median of 1 sexual partner (IQR 0–2). WSWM were significantly more likely than WSW to report new or casual female partners within 30 days preceding enrollment (46% vs. 28%;p= 0.03) while WSW were more likely to report regular female partners (75% vs. 34%;p= 0.01). Additionally, 39% (26/67) of WSWM reported new or casual male partners within 30 days preceding enrollment. Although not statistically significant, diagnosis of all curable STIs (trichomoniasis, Chlamydia, gonorrhoea, and syphilis) was more common among WSWM than WSW (30% vs. 16%;p= 0.07). Similarly, seropositivity for HIV and HSV-2 was more than twice as common among WSWM as WSW.

Conclusions

AAWSW in this study were at high risk for STIs. AAWSWM, as a subgroup, may demonstrate heightened STI rates compared to exclusive AAWSW, perhaps influenced by partnership characteristics. Sexual health services for AAWSW should take into account partner gender heterogeneity when screening for STIs.
YI.4 Gonococcal Genomics Shows Impact of Recombination on Obscuring Phylogenetic Signal and Disseminating Resistance Loci
Authors: Grad Y , Kirkcaldy R , Dordel J , Goldstein E , Trees D , Weinstock H , Parkhill J , Hanage W P , Bentley S , Lipsitch M
Published: July 2013

Background

Recombination plays a significant role in the plasticity of theNeisseria gonorrhoeaegenome by generating antigenic diversity and as a mechanism of spread of antibiotic resistance elements. Extensive recombination in a population can also limit inferences about phylogenetic history. Here, we investigate the impact of recombination in the study of isolates with reduced susceptibility to cefixime (cefRS; cefixime MICs ≥ 0.25 µg/ml) in the United States.

Methods

We generated draught genome sequences for 242 gonococcal isolates collected by CDC’s Gonococcal Isolate Surveillance Program (GISP). These isolates comprise all 141 cefRSisolates from GISP in 2009–10 and 141 susceptible isolates matched by location, collection date, and sexual orientation of the infected individual. We predicted recombinant regions and generated a maximum likelihood phylogenetic tree from core SNPs. We performedin silicoMLST and NG-MAST typing, and compared phylogenies of antibiotic resistance loci to whole genome-based phylogenies.

Results

Per siter/mratios (relative likelihood that a polymorphism was introduced through recombination rather than mutation) of recent branches in the phylogenetic tree are higher and fraction of homoplasic sites much lower than for the overall tree, suggesting that extensive recombination reduces confidence in the phylogeny’s deep branches. Comparison within silicoMLST and NG-MAST reveals that traditional typing-based phylogenetic inferences, even for recent events, are confounded by recombination. Of the 21 penA alleles in this dataset, mosaic PBP2 pattern XXXIV was the most common (present in 116/121 cefRSisolates). We find several recombination events introducing this allele into distinct lineages, and an event within thedcwgene cluster, which includes the penA allele, associated with reversion from cefRSto cefixime susceptibility.

Conclusions

Genomic methods reveal the impact of recombination on phylogenetic history, spread of resistance elements, and genome evolution, and offer a superior approach to traditional typing schemes in understanding population structure and dynamics.
YI.5 Sexual Risk Factors Amongst Women Who Have Sex with Men and Women: The Women in Indiana Sexual Health and Experience Study (WISHES)
Authors: Schick V R , Pol B Van Der , Dodge B , Bell A , Neal C
Published: July 2013

Background

Previous research suggests that women who have sex with women and men (WSWM) may be at a higher risk for STI than women with exclusively male (WSM) or female (WSW) partners. In contrast to previous research which has compared WSWM to WSW/WSM, the present study explored risk factors which may be unique to WSWM.

Methods

Local women aged 18 or older who reported genital contact with a male and female partner within the past year were invited to participate in the study. Upon completion of an internet-based baseline survey about their sexual and STI history, participants were invited to participate in an in-person interview. During the meeting, participants engaged in a semi-structured interview followed by completion of a sexual event history calendar (SEHC). Participants were then asked to self-collect oral, vaginal and anal samples to screen for Chlamydia, Gonorrhea and Trichomoniasis.

Results

Eighty participants with a mean age of 26.74 (SD = 7.97) completed the survey. The majority of the participants reported genital contact at an earlier age with a male partner (M = 16.02, SD = 3.31) than with a female partner (M = 18.93, N = 5.13).The most common type of genital contact was external genital rubbing with a male (97.5%, N = 78) and/or female (93.5%, N = 74) partner. Most participants reported a wide variety of sexual behaviours. Over half of the participants (57.5%, N = 44) reported engaging in a threesome/orgy within the past year. Data on the sequence of sexual acts was captured using the SEHC. Most participants self-collected a sample for STI screening. Approximately 30% (N = 25) of the participants reported an STI diagnosis within their lifetime and close to 10% of the participants tested positive for Chlamydia.

Discussion

The study was successful in recruiting a sizable number of participants with a range of sexual experiences. The majority of participants opted to participate in all phases of the study.
O01.1 Association of Genetic Variants withChlamydia TrachomatisReinfection
Authors: Kapil R , Tang J , Press C G , Geisler W M
Published: July 2013

Background

Up to 20% ofChlamydia trachomatis(CT)-infected patients are reinfected within months after treatment, suggesting some fail to develop protective immunity. Genetic determinants influencing CT reinfection risk have not been fully elucidated. Our primary research objective is to identify genetic determinants of CT reinfection. Based on previously reported associations of HLA class II alleles with CT complications, our initial investigations focus on HLA class II genes.

Methods

In an ongoing prospective natural history study, CT-infected subjects are enrolled, treated with azithromycin 1 g single dose, and return for a 6-month follow-up visit for repeat CT testing using the Gen-Probe APTIMA Combo 2 assay (Gen-Probe, Inc., San Diego, CA). HLA class II alleles are resolved by a combination of PCR-based techniques. Genomic DNA is stored for further genotyping.

Results

A total of 199 African American subjects have been studied to date: 90% women and median age 23. CT reinfection at follow-up was noted in 18%. Subjects withHLA-DQB1*05more often had reinfection (20 [26%] vs. 16 [13%], P = 0.018), which remained significant after controlling for age and gender (OR 2.6, 95% CI 1.2–5.6, P = 0.012). OtherHLA-DQB1alleles were not significantly associated with reinfection (P ≥ 0.1).

Conclusion

HLA-DQB1*05was associated with CT reinfection, suggesting it could influence protective immunity. More comprehensive genotyping from larger prospectively studied cohorts should help confirm or refine this observation. Analysis of additional HLA class II genes and genes beyond the human MHC is in progress.
O01.2 Innate Immunity Modulation by Trichomonas Vaginalis Galectin-Binding Glycolipid Domains
Authors: Fichorova R N , Yamamoto H S , Fashemi T , Buck O R , Foley E , Hayes G R , Sato S , Singh B N
Published: July 2013

Background

Trichomonas vaginalisis a protozoan extracellular parasite causing long-lasting and recurrent vaginitis with a wide range of symptoms and increased risk of HIV and other viral STIs. The protozoan virulence factors that subvert the mucosal immune response are poorly understood. Here we investigate the role of the ceramide-phosphatidyl-inositol glycolipid core (CPI-GC) of the protozoan lipophosphoglycan (LPG), which is the major glycoconjugate on the trichomonad surface (2–3 million copies/parasite). We have previously determined that CPI-GC lacks mannose but contains polylactosamine repeats representing potential ligands for animal lectins called galectins, implicated in HIV pathogenesis.

Methods

CPI-GC was isolated fromT. vaginalisLPG by mild acid hydrolysis and C18-SepPak separation. Binding to galectin-1 and –3 (Gal-1 and –3) was determined by Biolayer Interferometry. Inflammation-related proteins and Gal-1 and 3 were measured by a multiplex immunoassay in supernatants from human cervical and vaginal epithelial cells infected withT. vaginalis orexposed to CPI-GC from different clinical isolates.

Results

CPI-GC activated NF-κB and upregulated cFos, COX-2, IL-8, MIP-3α, IL-6, IL-1β and VEGF in a MEK1/2 dependent manner. In addition, IL-6, ICAM-1 and VEGF up-regulation was mediated by p38 while IL-8 and MIP-3α were ERK 1/2 mediated. CPI-GC from different clinical isolates varied in their ability to bind Gal-1 and Gal-3, which were constitutively expressed by vaginal and cervical epithelial cells and released at higher levels in the extracellular space during exposure to live trichomonas and CPI-GC. CPI-GC from all isolates invariably reduced levels of the natural microbicide SLPI. Mutant trichomonads that failed to bind Gal-1 and Gal-3 showed higher proinflammatory activity suggesting a role for the CPI-GC –galectin binding in suppressing innate immune responses.

Conclusion

Interventions targeting CPI-GC or restoring the balance of natural immune defences represent a promising strategy for preventing adverse outcomes fromT. vaginalisinfection.
O01.3 Regulatory T Cells in Peripheral Blood and Cerebrospinal Fluid of Syphilis Patients with and Without Neurological Involvement: A Comprehensive and Comparative Study
Authors: Wang C , Lu H , Gu X , Guan Z , Zhou P
Published: July 2013

Background

Syphilis, a sexually transmitted disease caused by spirochetal bacterium Treponema pallidum, can progress to affect central nervous system, causing neurosyphilis. While many neurosyphilis patients may be asymptomatic, some patients can develop severe neurological and psychiatric symptoms. Accumulating evidence suggest that skin lesions and clinical symptoms of early syphilis patients result from host immune and inflammatory responses. However, very little is known about the immune components in neurosyphilis.

Methodology/Principal Findings

In the present study, we perform a comprehensive and comparative analysis of regulatory T cells (Tregs) between 102 neurosyphilis patients and 431 syphilis patients without neurological involvement. We found secondary and serofast patients had increased Treg percentage, suppressive function and TGF-β levels in peripheral blood compared to healthy donors and serum Rapid Plasma Reagin (RPR) titers were positively correlated with Treg numbers in these patients. Neurosyphilis patients had higher Treg frequency in peripheral blood than those of syphilis patients without neurological involvement. Importantly, CD4+ T cells were increased and predominated in cerebrospinal fluid (CSF) of both asymptomatic and symptomatic neurosyphilis patients. Interestingly, a significant decrease in CSF CD4+ CD25 high Treg percentage was observed in symptomatic neurosyphilis patients compared to those of asymptomatic neurosyphilis patients, which may be associated with low CSF TGF-β levels.

Conclusions

Our findings suggest that neurological progression in syphilis patients may be associated with an enhanced systemic Treg response and an increased local CD4+ T cell infiltration. A decrease in Treg frequency in CSF of symptomatic neurosyphilis patients indicates that immune-mediate tissue damage might be involved in the development of neurological symptoms.
O01.4 Blood Transcriptional Profiling of Women with Chlamydia Trachomatis Identifies a Pelvic Inflammatory Disease (PID) Signature
Authors: Darville T , Zheng X , O’Connell C , Nagarajan U , Macio I , Wiesenfeld H , Rabe L , Hillier S
Published: July 2013

Objective

Most women with Chlamydia trachomatis (CT) infection are asymptomatic, while ∼3% progress to pelvic inflammatory disease (PID) within two weeks of untreated infection. The identification of biomarkers that predict development of PID would aid in identification of women at risk for complications of infertility and ectopic pregnancy. The specific aim of this study was to identify a whole blood transcript signature for acute PID due to chlamydial infection.

Methods

We performed gene expression microarrays using whole blood from 79 women who had a gynecologic exam, and cervical and endometrial microbiologic testing. Samples were divided into five groups: Group 1, women with acute PID who were CT+ at endometrium (PID+, CT+, and E+); Group 2, asymptomatic women who were CT+ at endometrium (PID-, CT+, E+); Group 3, asymptomatic women who were CT+ at cervix (PID-, CT+, E-); Group 4, asymptomatic women who were CT- at cervix and endometrium (PID-, CT-, E-); Group 5, women with symptoms of PID who were negative for CT or other sexually transmitted pathogens (PID+, STI-, E-).

Results

We identified a transcript signature that discriminated women with chlamydial PID from all other groups. Pathway analysis revealed that the chlamydial PID signature contained genes from interferon response pathways. Gene transcription in a subset of women with chlamydial endometrial infection clustered with women with chlamydial PID.

Conclusions

Our study raises the possibility that transcriptional biomarkers with potential as diagnostic and prognostic tools can be identified to combat chlamydial reproductive tract disease in women.
O01.6 Persistent SIV-Seronegative Macaque Monkeys Generate Multi-Cytokine Anti- SIV Mucosal Immune Responses Following Serial Low-Dose SIV Mucosal Challenge
Authors: MacDonald K S , Haq K , Chan J , Iwajomo O , Janes M , Perciani C , Pilon R , Caldwell D , Sandstrom P , Willer D O
Published: July 2013

Background

There are no systematic prospective human or simian studies on the effects of repeated sub-infectious doses of HIV/SIV on mucosal and systemic immunity. The capacity and mechanism of how these responses may impact acquisition and subsequent disease course are also unknown.

Methods

To address this, we examined cynolmolgus macaques as part of a vaccine trial, for their ability to generate mucosal and systemic immune responses following repeated ultra low-dose mucosal SIVmac239 challenge. Animals were challenged intra-rectally weekly according to a 24-week dose-escalation. Blood was obtained weekly, and rectal biopsies were obtained 18 to 24w post SIV challenge and analysed by flow cytometry for anti-SIV T-cell responses. Intracellular cytokine responses (IFN-γ, IL-2, TNFα and CD107a) were measured.

Results

Total CD4+ responses against two distinct antigenic targets correlated with apparent resistance to infection as measured by the number of challenges, total dose and infecting dose. Moreover, CD8+ responses were also predictive of susceptibility to infection. Both CD4 and CD8 T cell effectors were observed secreting IFN γ, TNF α, IL2 and CD107a in response to SIV gene products not present in the SIV vaccine that the animals received. Placebo-vaccinated animals did not have significantly fewer mucosal immune responses than vaccinees but they did have fewer blood responses suggesting that mucosal responses were generated by the SIV exposure while systemic responses were generated by the vaccine. Multiple sub-infectious SIV challenges did not induce humoral responses in the blood, as determined by western blot assay.

Conclusions

Together, this data suggests that these mucosal immune responses are the predominantly the result of priming by repeated low dose SIV challenge. Such an effect alters subsequent susceptibility to infection which has implications for vaccine studies and for understanding the biology of transmission since it increases the resistance to infection of both vaccinees and placebo recipients unpredictably.