bluuebunny/crossref_metadata_2025 huggingface dataset:
P3-S1.19 Evaluation of the cobas®4800 CT/NG test using clinician and self-collected vaginal swabs, cervical specimens in PreservCyt solution, and pharyngeal throat wash specimens
Authors: Krevolin M , Sunhachawee A , Hardy D , Pane J , Cervantes E , Kotadia R , Joshi S , Puckett R , Liesenfeld O
Published: July 2011

Objective

To evaluate the limit of detection (LOD), inclusivity, exclusivity, and interfering substances of the cobas® 4800 CT/NG Test using vaginal, PreservCyt, and pharyngeal specimens.

Methods

Chlamydia trachomatis(CT) andNeisseria gonorrhoeae(NG) cultures were diluted into pools of negative patient specimens at six concentrations to determine the LOD (lowest concentration giving a ≥95% hit rate). A panel of 15 serovars of CT, plus the Swedish variant (nvCT), and 45 strains of NG was diluted into each sample matrix to determine inclusivity. To ensure specificity, a panel of 184 non-CT and non-NG organisms that may be found in the oral or urogenital region was tested at Ġ≥10^5 CFU or copies/ml. The organisms were diluted into CT/NG positive and negative samples. Ten CT/NG positive and negative samples were spiked with blood (up to 5%), leukocytes (up to 10^7 cells/ml), cervical mucus, and saliva at concentrations up to 10% to check for interference. Ten (for pharyngeal) and 18 (for urogenital) over-the-counter products were also tested.

Results

LODs were as follows: Vaginal CT 10 IFU/ml, NG 100 CFU/ml; PreservCyt CT 0.6 IFU/ml, NG 3.5 CFU/ml, Pharyngeal CT 0.5 IFU/ml, NG 2.25 CFU/ml. All 15 serovars of CT, plus the Swedish variant (nvCT), and 45 strains of NG were detected at, or near the LOD. No cross reactivity was noted with 184 non-CT and non-NG organisms in any specimen type. Vaginal but not PreservCyt samples showed interference from leukocytes at >10^6 cells/ml. This interference was noted as clot detections and samples were not processed. Pharyngeal samples showed false negative results in the presence of blood at >0.25%, and saliva at >2.5%. No interference was noted with any over-the-counter products in any specimen type.

Conclusions

Vaginal, PreservCyt, and pharyngeal specimens are suitable sample types for the cobas® 4800 CT/NG Test.
P1-S1.42 Russian gonococcal antimicrobial susceptibility programme (RU-GASP) - resistance levels in 2010 and trends during 2005–2010
Authors: Frigo N , Unemo M , Kubanova A , Kubanov A , Solomka V , Polevshikova S , Lesnaya I
Published: July 2011

Background

Antimicrobial resistance (AMR) inNeisseria gonorrhoeaeis a major concern worldwide. AMR surveillance globally is crucial for guiding effective treatment and accordingly for public health purposes. In the former Soviet countries, the knowledge regarding AMR has been limited. However, in 2004 the Russian gonococcal antimicrobial susceptibility programme (RU-GASP), which now acts also under WHO protocols, was initiated. The aims of the present study were to examine and describe the prevalence ofN gonorrhoeaeAMR in 2010 in Russia, and reveal trends during 2005–2010.

Methods

In 2010,N gonorrhoeaeisolates (one isolate per patient; n=407) collected from 46 surveillance sites distributed in all eight Federal Districts of Russia were examined regarding their susceptibility to ceftriaxone, spectinomycin, azithromycin, penicillin G, ciprofloxacin, and tetracycline using agar dilution method, according to CLSI and WHO protocols. β-Lactamase production was identified using nitrocefin discs.

Results

In 2010, the AMR (intermediate susceptibility) levels were as follows - ceftriaxone 0% (0%), spectinomycin 4.4% (12.3%), azithromycin 4.9% (10.4%), penicillin G 32.5% (39.9%), ciprofloxacin 53.2% (3.0%), and tetracycline 41.9% (26.6%). Three isolates (0.7%) were resistant to all antimicrobials except ceftriaxone. During 2005–2010, the AMR has remained high to penicillin G, tetracycline, and ciprofloxacin. The proportion of resistant isolates to spectinomycin and azithromycin has ranged from 0% (2005) to 7.2% (2008), and 0.4% (2008) to 4.9% (2010), respectively. All isolates in 2005–2010 were susceptible to ceftriaxone. Nevertheless, the minimum inhibitory concentration (MIC) distribution of ceftriaxone has rapidly shifted to higher MICs, and isolates at the breakpoint for intermediate susceptibility/resistance (0.25 mg/l; n=8 [2%] in 2010) have rapidly increased over the years.

Conclusions

The AMR ofN gonorrhoeaein Russia is high and ceftriaxone (3250 mg) should be first-line for empirical treatment. If there are no access to ceftriaxone or in the presence of severe β-lactam antimicrobial allergy, spectinomycin is recommended for use. However, despite exceedingly rare in most countries spectinomycin resistance is annually identified in Russia, and accordingly the level of this resistance is crucial to monitor. Continuous, quality assured and quality controlled gonococcal AMR surveillance in Russia is crucial. RU-GASP now also works under WHO protocols.
P3-S1.20 Aetiology of urethral discharge syndrome and its association with sexual practices among males attending STI clinics in India
Authors: Kumar R , Parimi P , Narayanan P , Das A , Gurung A , Rao G , Risbud A
Published: July 2011

Background

Studies to validate the aetiology of urethral discharge (UD) syndrome are limited in India. The objectives of the study were to determine etiological agents of UD syndrome among males attending STI clinics and associated risk factors.

Methods

We conducted a cross-sectional study among males presenting with complaints of dysuria and/or urethral discharge at eight government and non-governmental organization STI clinics in four Indian states from 2008 to 2009. A behavioural questionnaire was administered, clinical examination performed and urine was collected to test forNeisseria gonorrhoeae(GC) andChlamydia trachomatis(CT) by Gen-Probe-APTIMA Combo II. In cases where a urethral discharge was elicited, urethral swabs were collected and tested forMycoplasma genitalium(MG),Ureaplasma urealyticum(UU) andTrichomonas vaginalis(TV) by using PCR method. Data were analysed using STATA V10.

Results

246 clients diagnosed with UD syndrome as per the national algorithm were enrolled in the study. 29% of the participants had at least one of the infections. The overall prevalence of GC was 14% and CT was 4%. Among the 86 participants from whom urethral swabs were collected, prevalence of MG and UU was 33% and 34% respectively while TV was not detected. In this sub-group of 86 participants, the prevalence of GC and CT was higher at 24% and 7% respectively while 64% individuals had at least one infection. Factors such as younger age (<25 years), illiteracy, paid sex in last 2 weeks and penetrative anal sex in last 3 months were found to be significantly associated with having any infection (see Abstract P3-S1.20 table 1).

Abstract P3-S1.20 Table 1

Correlates of infections (gonococcal and/or non-gonococcal)

S. No.CharacteristicOR (95% CI)p Value1Age up to 25 years1.7 (0.9 to 3.1)0.062Inability to read or write2.2 (0.9 to 5.1)0.053Paid sex in last 2 weeks2.1 (1.1 to 4.2)0.024Penetrative anal sex in past 3 months2.1 (0.9 to 4.8)0.055Vaginal sex in past 3 months2.8 (0.6 to 26.4)0.166No condom use at last sexual act1.4 (0.7 to 2.7)0.32

Conclusion

The current practice of diagnosing UD syndrome based on the history of dysuria and/or discharge is leading to over-diagnosis. A detailed sexual history for determining risk factors and demonstration of urethral discharge on clinical examination will help to improve the diagnosis.
P3-S1.21 Non-culture basedNeisseria gonorrhoeaeantimicrobial resistance surveillance
Authors: Goire N , Freeman K , Tapsall J , Lambert S , Nissen M , Sloots T , Whiley D
Published: July 2011

Background

Increased reliance on nucleic acid amplification tests for the diagnosis of gonorrhoea, and issues with transporting viableNeisseria gonorrhoeae(NG) isolates, particularly from remote regions, undermines bacterial-culture-based NG antimicrobial resistance (AMR) surveillance. In this study, we explored non-culture based NG AMR surveillance by developing and validating a real-time PCR assay for direct detection of penicillinase-producing NG (PPNG) in clinical samples.

Methods

The PPNG-PCR assay was designed as an indirect marker of penicillinase activity, by targeting a region of sequence conserved across all NG plasmid types harbouring the β-lactamse gene, while not targeting the actual β-lactamase encoding sequence. The assay was evaluated using 118 characterised NG clinical isolates, and then applied to samples collected from the Australia's Northern Territory (years 2008–2009) where penicillin is still used for treatment. These comprised 214 NG-positive clinical samples from whichN gonorrhoeaewere isolated and phenotypic penicillinase results were available and an additional 209 samples that were positive by NG-PCR only.

Results

The PPNG-PCR2 assay provided 100% sensitivity and 98.5% specificity compared to bacterial culture results for the detection of PPNG in clinical specimens. PPNG-PCR false-positive results, presumably due to cross reaction with unrelated bacterial species, were observed in four clinical samples but were distinguished on the basis of late cycle threshold values. A total of 15/423 (3.6%) samples were positive by PPNG-PCR. These data vary from phenotypic surveillance rates for this region (2.5%–2.9%).

Conclusion

In tandem with phenotypic surveillance, the PPNG-PCR assay provides enhanced epidemiological surveillance ofN gonorrhoeaepenicillin resistance and is of particular relevance to regions where penicillin is still used to treat gonorrhoea. We are currently evaluating assays targeting NG chromosomally-mediated resistance mechanism to β-lactam antibiotics.
P3-S1.22 Evaluation of performance of six commercial assays for detection of characterised isolates ofNeisseria gonorrhoeaeand otherNeisseria spp.
Authors: Tabrizi S , Unemo M , Limnios A , Hjelmevoll S O , Garland S , Tapsall J
Published: July 2011

Background

Molecular detection ofNeisseria gonorrhoeaein urogenital samples is now routinely conducted in many diagnostic laboratories with the demand also expanding to testing of extragenital samples. Testing of extragenital samples poses a challenge as it may result in false positive results due to cross-reaction with commensalNeisseria spp.andN meningitidis. Adequate evaluation of molecular assays is essential prior to expanding utilisation of the assays to such specimens.

Method

This study aimed to examine 450 characterised clinical isolates comprising of 216N gonorrhoeaeand 234 otherNeisseria spp.and closely related bacteria from various geographical regions worldwide with six commercial assays including GenProbe APTIMA Combo 2 and APTIMA GC; Roche COBAS Amplicor CT/NG and COBAS 4800 CT/NG; BD ProbeTec GC Qx Amplified DNA Assay and Abbott RealTime CT/NG.

Results

Among 216N gonorrhoeaeisolates included in the study, all assays except COBAS Amplicor where four (1.9%) gonococcus isolates were not detected, showed a positive result with allN gonorrhoeaeisolates. Among 234Neisseria spp.evaluated, initial results showed all assays evaluated to display cross reaction with non-gonococcal Neisseria isolates. COBAS Amplicor and ProbeTec showed highest number of false positives, detecting 33 (14.1%) and 26 (11%) non-gonococcal Neisseria isolates respectively. Abbott RealTime, APTIMA Combo and APTIMA GC, and Roche COBAS 4800 showed initially low level of cross reaction, that is, detected 2 (1%), 5 (2.1%), 4 (1.7%) and 2 (1%) of the isolates respectively. When retested by the company using a fresh culture, none of these nine isolates showed cross reaction with the respective assays.

Conclusion

COBAS Amplicor and ProbeTec displayed highest number of false positives among assays evaluated, with the remaining assays only showing sporadic low level false positivity. Especially when examining extragenital specimens, supplementary testing for all assays and platforms remains recommended.
P3-S1.27 Is antimicrobial resistance inChlamydia trachomatisa reality?
Authors: Pitt R , Alexander S , Horner P , Ison C
Published: July 2011

Introduction

The use of single dose therapy and the emergence of a stable tetracycline resistant strain of Chlamydia suis has raised concerns regarding potential development of antimicrobial resistance (AMR) inC trachomatis(CT). Specimens sourced from patients with persistently confirmed CT infections after treatment with first line recommended therapies were examined for the presence of AMR determinants identified in other organisms.

Methods

CT DNA positive specimens were examined for viable bacteria by tissue culture. Sequencing for mutations in three genes known to be involved in azithromycin (AZM) AMR; rplV, rplD and 23S rRNA (two alleles) and for the presence of six tetracycline AMR determinants; tet(A), tet(B), tet(C), tet(D), tet(E) and tet(M) was done. Susceptibility testing was performed using isolates grown in duplicate serial dilutions of AZM followed by quantitative RT-PCR. Isolates with a log or more increase in plasmid copy number were deemed resistant and those with a static or decreased copy number were deemed sensitive. Isolates were also screened for contaminating bacteria.

Results

Nine isolates were retrieved from twenty CT NAAT positive patients. When examined by AZM MIC assays, all isolates were sensitive. An identical non-silent single nucleotide polymorphism (SNP) was identified in three clinical specimens and one isolate from three patients in the rplD gene. A non-silent SNP was also identified in the rplV gene in one of these patients. The pre and post treatment specimen from a further patient showed a non-silent SNP in the rplD gene and identical point mutations in both alleles of the 23S rRNA gene. The tet(M) resistance determinant was identified in ten specimens and five isolates from eleven different patients. All screens for contaminating bacteria were negative.

Conclusions

Previously unreported mutations in genes responsible for AZM AMR in other organisms have been identified however all isolates were found to be AZM sensitive. Whilst the SNPs identified may not be significant, detection of them demonstrates that CT has undergone mutation in these key genes. A fragment of the tetracycline AMR determinant, tet(M) (responsible for high level tetracycline AMR inNeisseria gonorrhoeae), was identified in several clinical specimens and in five isolates. The function of the tet(M) fragment in CT is currently unknown and the establishment of tetracycline MIC assays are a priority.
P3-S1.29 Effectiveness of gentamicin for gonorrhoea treatment: a systematic review
Authors: Kirkcaldy R , Dowell D
Published: July 2011

Background

The development of resistance to multiple antimicrobials has limited treatment options for gonorrhoea. Potential emergence of cephalosporin resistance inNeisseria gonorrhoeaeand cephalosporin allergy in some patients make it necessary to evaluate the effectiveness of other available antimicrobials. Gentamicin is widely available in the USA and is used for gonorrhoea treatment in several countries.

Methods

We conducted a systematic review of the medical literature to assess the effectiveness of gentamicin for treatment of uncomplicated urogenital gonococcal infections. Two reviewers assessed relevant articles and independently selected studies that met pre-specified selection criteria (including systematic enrolment and assignment to treatment and culture-confirmed diagnosis and outcome). Summary measures for selected studies were pooled using inverse variance-weighted averages with fixed effects. Heterogeneity was assessed using I-squared, which estimates proportion (from 0% to 100%) of variability attributable to heterogeneity between studies. Pooled percentage with negative follow-up culture was compared with CDC criteria for selection of recommended therapy (>95% efficacy with lower 95% CI >95%).

Results

18 potentially relevant English-language studies were identified; three met inclusion criteria. Reviewer agreement for initial judgement on meeting selection criteria was substantial (κ 0.68). Two studies used 240 mg, and one study used 280 mg IM gentamicin. Percentages with negative culture after single-dose treatment were 90.7% (n=86), 91.4% (n=220), and 95.0% (n=40). Pooled percentage with negative culture after single-dose treatment was 91.5% (95% CI 88.1% to 94.0%, I-squared = 0%).

Conclusions

Gentamicin does not meet current CDC criteria for recommended treatment of gonorrhoea. However, if cephalosporin resistance emerges, gentamicin may be a useful alternative agent. Evaluation of additional regimens, including combination therapy, is warranted.
P3-S1.31 Comparison of Copan UriSwab with BD ProbeTec urine preservative transport kit for preservation and detection of CT and NG in the ProbeTec assay
Authors: Castriciano S , Montrucchio G , Moglia R , Concialdi E , Oddone L , Bolla C , Biglino A
Published: July 2011

Background

Urine specimen collection is better accepted by the patients than invasive collection techniques for detection ofChlamydia trachomatis(CT) andNeisseria gonorrhoeae(NG). Self-collection is useful for Sexually Transmitted Infection (STI) screening programs. Dedicated urine collection devices for molecular assay are unsuitable for other molecular assays and for bacteria culture investigation. Urine collection devices that are easy to collect and transport and are leak proof, that can be used for STD screening by culture and molecular assays are essential. Copan has introduced the UriSwab (US), that consists of a leak proof tube with a screw cap containing a plastic stick with sponges attached that absorb and retain the urine sample during transport while preventing bacterial overgrowth. The objective of this study was to compare the Copan UriSwab for collection, transportation and preservation of first catch urine (FCU) specimens to the BD ProbeTec Urine Preservative Transport Kit (UPT) for the detection of CT and NG with the BD ProbeTec assay.

Method

FCU specimens were self-collected from 134 male patients attending an STD clinic or who were residents of a detenction center in the Italian city of Asti. Duplicate FCU specimens were collected, one with the US and the other with the UPT. The US specimens were centrifuged and the urine pellets were eluted with ProbeTec lysis buffer. US and UPT urine specimens were processed according to the manufacturer's recommended procedure with the BD ProbeTec ET assay (Becton Dickinson).

Results

Out of 134 males from the detention center and the STD clinic, 115 were negative and 19 positive for either CT or NG in both US and UPT collection devices. Five patients were positive for both CT and GC. The CT prevalence was 8.2 %. The NG prevalence was 10.44%.

Conclusions

Good results agreement was found between the Copan UriSwab and the BD urine collection devices for the detection of CT and GC with the BD ProbeTec ET assay. The UriSwab is easy to transport and process in the laboratory for the detection of CT, GC and other STI infectious agents with molecular assays and can also be used for culturing all urogenital bacteria. The UriSwab can facilitate self-collection for STI screening.
P3-S2.01 Non sexually transmitted genital ulcers; patients referred to a STD clinic
Authors: Palit A
Published: July 2011

Introduction

Non-sexually transmitted genital ulcers are a cause of significant morbidity among sexually active young men and women. Establishing the underlying cause of the genital ulcer and differentiation from sexually transmitted infections may be challenging for the treating physician.

Case reports

Patient data were collected from a STD clinic in a tertiary care hospital in south India from 2008 to 2010. All the patients were routinely screened for syphilis and HIV infection. Smears from the ulcers were taken and stained with Gram stain and/or Giemsa stain. Biopsy from the ulcer edge was taken whenever indicated. Following causes for non-sexually transmitted genital ulcers were recorded: Behcet's disease was seen in two male patients. Infectious ulcers; One pregnant woman presented with multiple painful genital ulcers caused byKlebsiellaspp. An HIV infected man on antiretroviral therapy presented with ecthyma gangrenosum of scrotum with unilateral lymphadenopathy caused byPseudomonas sp.Chancroid-like ulcers; a monogamous, HIV-negative office worker and an HIV positive widow, sexually inactive since 5 years, presented with multiple, small shallow genital ulcers with excruciating pain simulating herpes genitalis. The ulcers did not respond to adequate therapy with acyclovir and organism could not be demonstrated on gram stain or bacterial culture. In both the cases, the ulcers healed completely with azithromycin. Factitious ulcer; seen over the shaft of penis in an unmarried man. Genital apthae due to chikungunya fever; during an epidemic of chikungunya fever in the region, 25 patients with acute disease presented with multiple aphthous ulcers involving scrotum, penoscrotal junction and adjacent crural region. Skin biopsy from the ulcers reveals lymphocytic vasculitis.

Conclusion

Causes of genital ulcers in patients referred to STD clinic may be varied. Atypical cases must be examined with care to identify the cause. Counselling plays an important role in the management of patients with non-sexually transmitted genital ulcer.
P3-S2.03 Clinical evaluation of the BD HSV1 Qx assay for the direct qualitative testing of HSV1 as compared to viral culture and a laboratory-based PCR assay using male and female external anogenital lesions
Authors: Pantone A , Van Der Pol B , Williams J , Corey L , Hook E , Body B , Taylor S , Fine P , Ginde S , Lebed J
Published: July 2011

Background

To compare the performance characteristics of the BD ProbeTecTM HSV1 Qx Assay* on the BD ViperTM System in Extracted Mode to viral culture and a well-characterised molecular assay for the detection of HSV1. External anogenital lesions were sampled with two different collection devices: a universal viral transport (UVT) kit and a BD Qx swab (QS) kit*.

Methods

Eleven geographically diverse clinical centers participated in the study, with nine of the sites enrolling participants. The UVT was collected first followed by the QS specimen. A portion of each UVT specimen was transferred to a Qx Diluent tube (diluted UVT) and a cryovial. The remainder of the UVT in the original tube was frozen at −70°C and sent to one of two sites for HSV viral culture using the ELVIS®HSV ID and D3 Typing Test System (Diagnostic Hybrids, Inc). The diluted UVT and QS specimens were shipped to one of three sites for HSV testing on the BD Viper. The UVT aliquot in the cryovial was stored at −70°C and shipped to the University of Washington for PCR testing for HSV.

Results

Subjects (n=508) were enrolled from February to August of 2010 with 312 UVT and 308 QS samples available for comparison to ELVIS culture, and 506 and 502 samples, respectively, for comparison to the PCR assay. Samples positive for HSV2 by viral culture did not have results for HSV1 per the ELVIS package insert and were excluded from further analysis. The sensitivity and specificity of the BD HSV1 Qx Assay as compared to ELVIS culture and the positive (PPA) and negative per cent agreement (NPA) of the assay compared to the HSV PCR assays were determined for both specimen types see Abstract P3-S2.03 table 1.

Abstract P3-S2.03 Table 1

HSV1

Specimen typeHSV1 Qxassay performanceCompared to ELVIS HSV1 cultureCompared to HSV1 PCR assaySensitivitySpecificityPPANPADiluted UVT96.8% (60/62)97.6% (244/250)98.6% (71/72)100% (434/434)QxSwab (QS)96.7% (59/61)95.1% (235/247)100% (71/71)98.8% (426/431)

Conclusions

The BD HSV1 Qx Assay on the BD Viper System had excellent agreement with viral culture and the lab developed PCR assay, which is currently recognised as one of the best available tests for the detection of HSV1. A commercially available molecular-based assay for the detection of HSV would not only improve detection and reduce turn-around time on results, but may also obviate the need for stringent transport conditions required for HSV culture. *Product not for sale, for investigational use only in the US.
P3-S3.01 Anal Pap smear screening among drug users living with HIV in Miami, Florida
Authors: Rosa-Cunha I , Hooton T , Cardenas G , Metsch L
Published: July 2011

Background

Human papillomavirus (HPV) is associated with anal cancer. Human immunodeficiency virus (HIV) infection and cocaine use are associated with increased risk for HPV infection and associated diseases, but little is known about anal dysplasia among HIV-infected drug users. The objective of our study was to assess the rate of abnormal anal Pap smears among drug users living with HIV in Miami, Florida.

Methods

Project HOPE (Hospital is an Opportunity for Prevention and Engagement) is a two-site study conducted in Miami and Atlanta to evaluate the efficacy of a brief prevention intervention for HIV-positive crack cocaine users recruited from two inner-city hospitals during their inpatient stays. At the Miami site, anal Pap smears from women and men (n=46) were collected.

Results

The study population was 95% Black, the mean age was 47, 63% were female (29/46), 35% heterosexual males (16/46) and 2% men who have sex with men (MSM) (1/46). Approximately half of the participants did not complete high school, 50% were on antiretroviral therapy and 50% had been diagnosed with HIV for more than 14 years. The median CD4 cell count was 198. Overall 69.5% (32/46) of anal Pap smears were abnormal; 69% of women (20/29) and 70.5% of men (12/17) had abnormal Pap smear.

Conclusions

These preliminary data suggest that abnormal anal Pap smears are common in drug users living with HIV in Miami and highlight the need for further studies on prevention and screening of anal dysplasia and cancer in this population.
P3-S3.02 Reiter's syndrome in association with HIV infection: report of three cases
Authors: Inamadar A
Published: July 2011

Introduction

Reiter's syndrome is a relatively rare, non-suppurative, sero-negative arthropathy seen among young adults with HLAB27. Epidemic (post-enteric) and endemic (sexually acquired) variants of the disease may occur. Reiter's disease is difficult to manage because of its chronic recurring course. The prevalence of Reiter's syndrome in HIV-infected patients varies between 1.7% and 11.2%. The course of the disease is more severe and progressive in these patients and often refractory to treatment. Here, clinical features and management of three HIV infected patients with Reiter's syndrome have been described.

Case reports

Three heterosexual men, age ranging from 20 to 40 years presented with psoriasiform skin lesions, dystrophic nail changes and incapacitating arthritis involving bilateral knees, ankles and toes of 3–6 months duration. Two of the patients had asymptomatic balanitis. Skin lesions, keratoderma blenorrhagica, were generalised and severe in one patient and were restricted to extremities in two others. There was no history of preceding gastro-intestinal infection or urethritis in any of them. All the three patients had history of unprotected sex with commercial sex workers in the past. They were tested HIV positive (Western blot method) and CD4 T cell count was 550, 489 and 450 respectively. The patients were treated with a combination of indomethacin, sulfasalazine for the arthritis and systemic isotretinoin. Arthritis responded to sulfasalazine and indomethacin. Cutaneous and nail changes responded to systemic isotretinoin. Long term treatment was required for all patients and one had recurrent flare-up of symptoms.

Conclusion

Reiter's syndrome is one of the causes of rheumatic disorders in HIV-infected patients. Direct etiological role of HIV infection in the development of Reiter's syndrome is not established. Reiter's syndrome as a manifestation of immune reconstitution syndrome in a HIV-infected patient has been reported. Clinical severity of the disease may be increased because of underlying immunosuppression. These patients present with therapeutic challenge because of the restricted opportunity to use conventional immunosuppressive therapeutic agents.
P3-S3.03 Clinical profile of Buschke-Lowenstein tumour in HIV infected patients
Authors: Shivanna R
Published: July 2011

Introduction

Buschke Löwenstein tumour (BLT) is a rare Human Pappiloma Virus (HPV)- triggered indolent lesion involving perineal and/or perianal skin. The lesions are locally invasive and difficult to manage because of the voluminous tissue bulk and recurrence potential. Underlying immune defect in the background of HIV infection may enhance tumour-aggressiveness in these lesions. Three HIV-infected patients with BLT have been reported.

Case reports

Patient 1: A 46-year-old woman presented with a cauliflower-like pink, fleshy mass of 18 months duration, protruding through the anal orifice, causing discomfort and disturbance in defecation. She was HIV-infected, acquired through conjugal relation. In addition to the above lesion, she had multiple genital molluscum contagiosum and bowenoid papulosis. Her CD4 T cell count was 350 and she was not on antiretroviral therapy (ART). Histopathology of the lesion was suggestive of BLT. The patient was treated with cryotherapy followed by surgical debulking of the lesion. ART was advised. Patient 2: A 35-year-old commercial sex worker presented with a large, variegated growth involving labia minora, extending to perineum, perianal region and lower part of gluteal folds, since last 5 years. There was sudden increase in extent and ulceration of the lesion since last 6 months. In the pubic region she had a conglomerated lesion of multiple condyloma acuminata and multiple bowenoid papulosis. She was HIV-infected with CD4 T cell count of 660. The lesion was biopsied from multiple sites and histopathological examination was consistent with BLT with grade II squamous cell carcinoma in some specimens. The patient was treated with surgical debulking followed by radiotherapy. Patient 3: A 40-year-old man with history of high risk sexual practices and intravenous drug abuse presented with multiple, fleshy masses over penis, scrotum and peno-scrotal junction, giving rise to deformed appearance of the genitalia. The lesions were present since several years with slow growth. He was HIV positive with a CD4 T cell count of 300. He was on ART since last 6 months. Histopathology of the lesion was suggestive of BLT. The patient was treated with cryotherapy followed by surgery.

Conclusion

HIV-infected patients with Buschke Löwenstein tumour are at a higher risk of developing invasive squamous cell carcinoma because of higher incidence of abnormal anal and genital cytology, presence of HPV-DNA in these cells and a low CD4 T cell count.
P3-S3.06 Quantifying lactobacillae species with real time PCR methods for HIV prevention trials
Authors: Crucitti T , Jespers V , Menten J , Smet H , Buvé A , Poradosú S
Published: July 2011

Background

The vaginal flora plays an important role in the defence against HIV infection. It is thus important to assess the impact on the vaginal milieu of products that are developed to protect women against HIV acquisition.

Objectives

Using Real Time PCR, describe and quantifyLactobacillae spp.in healthy European women who enter microbicide phase I studies.

Methods

Thirty healthy women who don't use hormones and have a regular menstrual cycle, were sampled with a COPAN flocked vaginal swab on days 7 and 21 of the cycle for a total of 5 visits. Real Time PCR was used to quantify bacterial cells for fourLactobacillus spp.at all visits.

Results

L crispatus, L iners, L jensenii, andL gasseriwere present at least once in 93%, 77%, 73% and 70% of women, respectively. High counts (≥8 log forL crispatus, ≥6 log for other species) were consistently present in 60%, 67%, 53%, and 53% of women. We labelled these latter women “L species-positive”. Using logistic regression we modelled the probability of belonging to this group. The temporal variation of the log counts within this group was modelled using random effects linear regression. No predictors of being “L. species-positive” for any of the studied Lactobacillae were identified. Longitudinal analysis showed thatL crispatuscounts were 0.22 log higher (p<0.001) andL inerscounts were 0.83 log lower (p<0.001) at the end of the menstrual cycle. Furthermore,L crispatuscounts decreased by 0.40 log after intercourse (PSA present) (p=0.002), whileL iners(+0.73 log, p=0.033) andL gasseri(+0.58 log, p=0.052) increased see Abstract P3-S3.06 figure 1.

Abstract P3-S3.06 Figure 1

Log counts of bacterial cells per ml by day in the menstrual cycle: Note: Lines connect consecutive counts for individual women. Bold line is overall trend in “L. species-positive” women.

Conclusion

The menstrual cycle and sexual activity have a significant effect onLactobacillus sp.counts. This should be taken into account when assessing safety of products in HIV prevention trials.
P3-S3.07 Analysis of patients who do not keep or cancel appointments at a university based HIV/AIDS clinic
Authors: Edwards J , Parrish R C , Frieson K , Crawford T , Thornton A
Published: July 2011

Background

The Bluegrass Care Clinic (BCC), a university based HIV/AIDS clinic, has an annual average patient no show rate of 13.6% to medical appointments. Treatment adherence greater than 95% is needed to obtain maximum benefits of therapy and minimal disease progression requiring attendance to regularly scheduled medical appointments throughout the patient's lifespan. Missed appointments are not only known to interfere with appropriate care but to misspend medical and administrative resources. The BCC sought to identify demographic trends, interpret perception and identify barriers unique to those individuals who frequently do not attend appointments.

Methods

Quantitative and qualitative data were collected through focus groups, phone surveys and data from Resource Scheduling Software. Descriptive statistics (frequencies and means) were derived.

Results

During a 29 month period the BCC expended roughly $3864 per month due to patients who did not show for appointments. 68 individual patients did not show for more than eight appointments. These 68 patients accounted for 21% of missed appointments, while 1053 patients accounted for the other 79% of missed appointments see Abstract P3-S3.07 figure 1. 13 patient focus groups were held where members cited transportation/coping/stress as potential barriers to attendance. During a phone survey of the 68 individuals only one individual correctly estimated the average number of appointments they missed per year. Female clients seem to disproportionately become frequent non-attenders as compared to their male counterparts. Female clients make up only 20% of the general BCC population, while they make up 34% of the clients who frequently miss appointments. There is a disproportionate effect in black clients. These individuals make up 21% of the BCC's total client population, while they make up 29% of the clients that frequently do not attend appointments.

Abstract P3-S3.07 Figure 1

Bluegrass care clinic: gender.

Conclusions

Surprisingly, a disproportionate percentage of individuals account for 1/5 of patients who do not attend or cancel appointments. Individuals surveyed by phone the majority had no actual perception of the average number of appointments they miss without cancelling. Interestingly, although the BCC serves 63 counties, 78% of those who frequently miss appointments live in the immediate area (within 30 miles of the BCC)- so transportation barriers that were identified during focus group sessions may not have a significant impact on those who frequently miss appointments.
P3-S3.10 An assessment of the effects of ancillary services on CD4 counts and viral loads of people living with HIV/AIDS
Authors: Ball K , Parrish R , Thornton A
Published: July 2011

Background

The Ryan White Modernisation Care Act 2006 integrated medical case management with supportive social services to ensure that Persons Living with HIV/AIDS (PLWHA) from lower socioeconomic, marginalised groups, and those with mental health/substance use issues are sustained in medical care. This study sought to establish the relationship between the CD4 and viral load of PLWHA and the receipt of ancillary services.

Methods

A random sample of N=222 subjects were drawn from the Bluegrass Care Clinic (BCC) database. The cohort was 67% white, 21.6% black, and 8.6% Hispanic with the majority of the subjects between 100 and 149% of the poverty level. Self-reported HIV risk factors for the sample were 59.9% MSM, 28.4% heterosexual, and 8.1% IDU. This sample adequately represents the population of the BCC as ethnicity, socioeconomic status and risk factors were similar for the clinic population as a whole. One way ANOVA tests were used to determine if the receipt of ancillary services by PLWHA in the BCC affects their viral loads and CD4 counts by using a multivariable analysis.

Results

There was a statistically significant difference in mean CD4 counts when comparing between ethnicities. The ANOVA test showed a statistically significant relationship (p=0.002) between Hispanic ethnicity and mean CD4 count, as subjects in the study that were of Hispanic origin had lower mean CD4 counts (305) than non-Hispanic whites (550) and non-Hispanic African Americans (500). There was also a statistically significant difference (p=0.021) between the mean viral load of PLWHA having one to three mental health visits and PLWHA with no mental health visits at all.

Conclusion

At the BCC, patients with adherence issues appear to be referred for mental health services, confirming the essential role of social workers on a multi-disciplinary HIV team. The BCC also has a Hispanic population with disproportionately lower CD4 counts. Implications for program improvement are to continue to target Hispanic patients with lower CD4 counts to retain them in medical care and improve adherence to ART medications. This study was limited by the fact that ancillary social services were lumped in with medical case management in the data set rather than delineated into individual service categories. Future research should use data sets that more accurately capture the various ancillary services provided to the sample subjects.
P3-S4.03 Impact of comprehensive management including counselling on health related quality of life index in Indian patients with anogenital warts
Authors: Gupta S
Published: July 2011

Background

Health related Quality of life (HRQOL) can be conceptualised as the absence of pain and an ability to function in day-today life. Our earlier study has shown that anogenital warts have an adverse effect on HRQOL because of its impact on physical, psychological and sexual health, even though the lesions are often asymptomatic.1To our knowledge, there are no studies available to show the impact of comprehensive management on HRQOL of these patients.

Methods

Thirty-five apparently healthy controls (meanage ±SD 34.8±11.2) and twenty patients with anogenital warts (mean age ±SD 32.7±11.8 years) were included in the study. HRQOL of patients was evaluated using the WHOQOL-BREF instrument at the time of presentation and again after 4 months. During this period, all patients were comprehensively counselled by a trained counsellor and received regular treatment for anogenital warts. The questionnaire was available in local language (Hindi) and was self-administered.

Results

All except two patients showed reduction in the size in response to treatment, however complete clearance was seen only in 10 patients (50%). At the baseline, the HRQOL scores of patients were significantly lower than controls in all domains. The HRQOL scores of patients after 16 weeks of comprehensive management were significantly higher than those at the baseline and comparable to those of controls (Abstract P3-S4.03 table 1).

Abstract P3-S4.03 Table 1

 HRQOL Scores in different domains of WHOQOLBREF of patients before and 16 weeks after comprehensive management and those of apparently healthy controls

HRQOL domainsPatients with ano-genital wartsp ValueHealthy controls mean (CI)Before comprehensive management mean (CI)After comprehensive management (at 4 months) Mean (C.I.)Physical40.8 (32.3 to 49.3)82.1 (77.9 to 86.3)<0.00172.0 (63.70 to 80.30)Psychological47.55 (37.8 to 57.3)78 (71.6 to 84.4)<0.00168.9 (60.5 to 77.3)Social45.05 (35.3 to 54.8)77.2 (70.8 to 83.6)<0.00174.6 (68 to 81.2)Environmental51.35 (44.9 to 57.8)73.55 (16.4 to 130.7)<0.00164.7 (58.5 to 71)Total184.75 (157.2 to 212.3)310.85 (294.7 to 327)<0.001280.2 (253 to 307.5)Overall QOL2.65 (2.2 to 3.1)4 (3.4 to 4.6)<0.0013.5 (3 to 4)Overall Health2.7 (2.3 to 3.1)4.35 (4 to 4.7)<0.0013.9 (3.5 to 4.4)Sexual health2.95 (2.5 to 3.4)4.15 (3.9 to 4.4)<0.0014.2 (3.8 to 4.5)

Conclusion

Comprehensive management of anogenital warts including counselling has resulted in the significant improvement in HRQOL scores. As anogenital warts are often asymptomatic, the effect on HRQOL appears to be due to its impact on psyche and fear of cancer and interventions including counselling can improve HRQOL more efficiently than in patients with other sexually transmitted diseases.
P3-S4.06 Men with genital warts do consult later than women
Authors: Dolcé P , Séguin V , Bernatchez H
Published: July 2011

Background

CSSSRN is a regional hospital of 240 acute-care beds with a STD clinic which works mainly with clinical nurses, under the supervision of Infectious Diseases physicians (ID). This study aimed to review the clinical data of patients with genital warts.

Methods

All files from patients with genital warts evaluated in our STD clinic between 2005 and 2010 were reviewed for clinical data including the delays before consultation. All data were analysed with Epi Info 3.5.2.

Results

From 2005 to 2010, an average of 5950 patients per year attended our STD clinic, and 70% were women. A total of 656 cases of genital warts were diagnosed by visual inspection from the attending ID physician. The specific types of lesions were warts associated with Human Papilloma Virus in 76%, molluscum contagiosum 20%, both 4%. The median age was 24 years (range 16–76) and 57% of patients were men. The patients did not notice any lesion prior to consultation in 61 cases (9.3%). For the others, the delays before consultation were: 0–7 days (16.2%); 8–14 days (8.9%); 15–27 days (12%); 1–2 months (30%); 3–5 months (11.5%); 6–12 months (11.9%); >1 year (8.7%). Significant longer delays before consultation were observed for men in comparison to women. The delays were: ≤7 days (men 42/349 [12%], women 54/244 [22.1%], p<.001); =14 days (men 70/349 [20.1%], women 79/244 [32.4%], p<.001); =27 days (men 113/349 [32.3%], women 107/244 [43.8%], p=0.006); ≥6 months (men 90/349 [25.7%], women 33/244 [13.5%], p<0.001); more than 1 year (men 41/349 [11.7%], women 11/244 [4.1%], p=0.002).

Conclusions

In our population, the median delay before consultation for genital warts was 1–2 months. However, men with genital warts do consult significantly later than women. Specific public health approach should be considered for men with visible genital lesions, in order to promote earlier consultation and limit transmission. More behavioural studies are needed to further investigate this observation.
P3-S5.02 Is urethral smear microscopy In asymptomatic men effective in reducing MajorM genitaliuminfection sequelae in women?
Authors: White P , Birger R , Saunders J , Estcourt C , Hallett T , Caffrey O , Mercer C , Roberts T
Published: July 2011

Background

Non-Chlamydial Non-Gonococcal Urethritis (NCNGU) is as prevalent as Chlamydial urethritis in UK men.Mycoplasma genitaliumlikely explains 10–46% of cases but there is no UK-licensed molecular test. In women,M genitaliumis associated with pelvic inflammatory disease (PID), infertility and ectopic pregnancy. New UK guidelines do not recommend urethral smear microscopy in asymptomatic men, so asymptomatic NCNGU cannot be diagnosed, whereas previously affected men and their sexual partners were treated with antibiotics. The impact of this policy on reproductive health sequelae in women is unknown.

Methods

We used a compartmental mathematical model to synthesise evidence on the natural history ofM genitalium, diagnosis and treatment levels. Uncertainty was accounted-for using Latin hypercube sampling, with rejection sampling to fit to data. The model was stratified by sex, incorporates heterogeneous sexual behaviour, and was parameterised by behaviour data from key UK surveys (NATSAL2, PATSI, MSTIC); STI surveillance data; and natural history data from the literature. It incorporates symptomatic and asymptomatic infection; PID; care-seeking due to symptoms, partner notification, and routine screening; and treatment failure. We fitted to national STI surveillance (KC60) data, (allowing for uncertainty in the amount of NCNGU caused byM genitalium), representing current practice, and examined (i) increasing microscopy in asymptomatic men by making it routine in all genito-urinary medicine clinics and (ii) decreasing rates by discontinuing it in the 20% of clinics currently still using it.

Results

Microscopy in asymptomatic men reduces the burden of infection in women by reducing prevalence in men thus reducing transmission to women; and treating women via partner notification from diagnosed men. The magnitude of these effects depends upon natural history in men and women, about which there is uncertainty. We determine ranges of parameter values in which routine microscopy would be effective in reducing M genitalium-related sequelae in women.

Conclusions

Further empirical work is required to determine if natural history parameters fall in the ranges that would make routine microscopy in asymptomatic men effective. Particularly important are the prevalence ofM genitalium; proportion of infections that are symptomatic in men and women; duration of untreated infection; and incidence of PID, infertility and ectopic pregnancy attributable toM genitalium.