bluuebunny/crossref_metadata_2025 huggingface dataset:
P1-S2.20 Factors influencing cervical infection among female sex workers in Benin
Authors: Diabaté S , Chamberland A , Géraldo N , Zannou M , Massinga-Loembé M , Anagonou S , CLabbé A , Tremblay C , Alary M
Published: July 2011

Background

As female sex workers (FSW) continue to play a key role in HIV-1 epidemic in sub-Saharan Africa, programs aiming at reducing sexually transmitted infections (STI) involved in HIV acquisition and transmission are still needed. The objective of this study was to determine factors influencing STI acquisition among FSW in Cotonou, Benin.

Methods

Three hundred and eighty seven (387) FSW were recruited in a medical center dedicated to STI treatment among female sex workers and their clients. Cervical infections byNeisseria gonorrhoeae(NG) andChlamydia trachomatis(CT; SDA, BD Probe Tec®) were investigated at enrolment into the study. All infected FSW received adequate treatment for free. We used a multivariate logistic regression model to assess variables independently associated with cervical infection at enrolment (p value<0.05).

Results

The FSW were essentially from Benin (39.5%) and neighbouring countries such as Nigeria (22.1%), Togo (21.8%) and Ghana (15.1%). One hundred and forty three subjects (143; 37.0%) were HIV-1 positive (52 were treated with antiretroviral therapy and 91 remained untreated because not yet meeting eligibility for treatment). Median age (IQR) and median duration (IQR) in the work were 33 (27—40) and 3 (1.2—5) years. Cervical infections by NG and CT were diagnosed in 4.4% and 3.9% cases, respectively. Only two women (0.5%) had both infections. Seventy seven per cent (77.1%) and 86.8% of the FSW reported, respectively, consistent condom use during the last 7 days of work and condom use at last sexual intercourse with a client. After adjustment for age and condom use, being HIV-1 infected [RR 3.04; 95% CI 1.25—to 7.40], not working in a brothel (RR 3.28; 95% CI 1.64—to 9.27), and being working for less than 12 months (RR 3.55; 95% CI 1.53—to 8.23) were independently associated with cervical infection in our study population.

Conclusion

Our results suggest that HIV-1 infection and cervical infection by NG and CT alter each other. Antiretroviral therapy in association with preventive programmes aiming at controlling STI should be encouraged among new FSW and also among those working outside brothels.
P1-S2.24 HIV and hepatitis C risk factors, infection status awareness and access to care among people who inject drugs - results from a national surveillance system, I-Track Phase 2 (2005–2008)
Authors: Tarasuk J , Frescura A M , Ogunnaike-Cooke S , Archibald C
Published: July 2011

Background

HIV and hepatitis C (HCV) risk factors, infection status awareness and access to care among people who inject drugs (IDU) were compared across infection groups in a national enhanced surveillance sample.

Methods

Phase 2 data collection for I-Track (Enhanced surveillance of HIV and HCV risk behaviours among IDU) was conducted from 2005 to 2008 in 10 Canada sites. Confidential face-to-face interviews collected data on demographics, drug-use and sexual risk behaviours, and HIV and HCV testing. Dried blood or oral fluid samples were collected for HIV and HCV antibody testing. Descriptive statistics for demographics, risk behaviours and access to care and treatment were compared across four exclusive infection groups—HIV-seropositive-only, HCV-seropositive-only, HIV-HCV seropositive and HIV-HCV seronegative individuals.

Results

Of 2969 IDU, 1.7% were HIV-seropositive-only, 57.5% were HCV-seropositive-only, 11.6% were HIV–HCV seropositive, and 29.2% were HIV–HCV seronegative. The proportion of IDU who were accurately aware of their negative or positive HIV infection status (based on concordance between self-report and laboratory result) was 85.7% among HIV-seropositive-only, 87.5% among HCV-seropositive-only, 78.7% among HIV–HCV seropositives and 77.5% among HIV–HCV seronegatives. The highest proportions reporting needle borrowing (past 6 months 24.2%) and high drug injecting frequency (69.4% > once or twice per week) were in the HCV-seropositive-only group. The highest proportions reporting multiple sex partners (past 6 months 44.9%) and no condom use at last sex (33.8%) were among HIV–HCV seronegative IDU; this group was also least likely to have been tested for HIV or HCV (85.1% and 80.6% respectively). Among those who were HIV-seropositive-only, 87.8% were under the recent care of a doctor and 74.2% were taking prescribed drugs for HIV. Among those HCV-seropositive-only, 45.5% were under the recent care of a doctor and 13.1% were taking prescribed drugs for HCV.

Conclusions

Injecting and sexual risk behaviours were prevalent particularly among HCV-seropositive-only and seronegative IDU, respectively. Awareness of correct HIV infection status and frequency of HIV testing were lowest among seronegative IDU. These findings underscore the importance of routine and integrated HIV and HCV testing for at-risk IDU which may lead to higher levels of awareness for both HIV and HCV infections.
P1-S2.27 Response of troubled youth and STIs
Authors: Bhutta A Iqbal
Published: July 2011

Description

Pakistan, the second most populous Muslim nation in the world, has started to finally experience and confront the HIV/AIDS epidemic. The country had been relatively safe from any indigenous HIV cases for around 2 decades, with most of the infections being attributable to deported HIV positive migrants from the Gulf States. However, the virus finally seems to have found a home-base, as evidenced by the recent HIV outbreaks among the injection drug user community. Extremely high-risk behaviour has also been documented among youth (school going and out of school). The weak government response coupled with the extremely distressing social demographics of this South-Asian republic also helps to compound the problem. The time is ripe now to prepare in advance, to take the appropriate measures to curtail further spread of the disease. If this opportunity is not utilised right now, little if at all could be done later. Islamic charities provide health, education and social services to millions of people in Pakistan. But in Pakistan still sexuality is a taboo topic. Strong hold of religious leaders on socio cultural pattern of community (attitude with extremism). Prevailing concepts to talk about sex considered as act of vulgarity and immoral activity. Word STIs and HIV/AIDS conceived as symbol of sexual delinquencies.

Method

Through a Questionnaire data on knowledge, attitude, behaviour and practices related to STIs/HIV/AIDS was collected from 1200 male religious students and religious scholars from randomly selected Islamic religious centers. Baseline knowledge, attitude, acceptability of the concept were assessed.

Results

According to KABP study 70% students have friends of opposite sex and due to strong religious values and restriction 30% have no friendship with opposite sex. Regarding nature of sex, 40% had kissing and only 18% had intercourse. During intercourse only 3% used condoms. 42% consider that condom is used only for family planning purpose. 56% answered that during intercourse use of condoms reduce sexual pleasure and enjoyment. 32% youth use drugs and 38% did not know about STIs and HIV/AIDS. General discussions were also started with four Maderssas students and their teachers. These meetings addressed the sensitisation of religious scholars to the issue of HIV/AIDS and highlight the role of Maderssas in STIs and HIV prevention.

Conclusions

Training of adolescent as peer educators is recommended. Ours being an Islamic society, such information should be given to youth in a way that does not challenge local norms and values. Problem-based learning and participatory education for improving knowledge and condom use and community-based interventions should be considered for STIs/HIV/AIDS prevention.
P1-S2.28 Sexually transmitted infections in sexually abused children and adolescents in Ibadan, Nigeria
Authors: Fayemiwo S A , Ayede I A , Olusanya O O , Akinbami O F , Bakare R A
Published: July 2011

Background

Sexual assault is a violent crime that affects men, women, and children of all ages. Sexually transmitted infections (STIs) may be transmitted during sexual assault. This study was aimed at finding the prevalence of sexually transmitted infections in potentially sexually abused children and adolescent in Ibadan.

Methods

This is a descriptive cross-sectional survey of Children and adolescents referred for possible evaluation of sexual abuse at Special Treatment Clinic, University College Hospital, Ibadan between January 2006 and December 2008. Urethral, Endocervical and high vaginal swabs were collected to establish diagnosis after clinical examination and informed consent.

Results

There were 18 children and adolescents with a mean age of 9.75 years (SD=5.78; range 2–18 years). About 66.7 % (12) had various STIs. The male to female ratio was 1:8. Five (27.8%) had physical evidence of sexual assault at presentation, 4 (22.2%) of which had hyperaemic labia and one had torn hymen. 12 (66.7%) presented with vaginal discharge syndrome. The most common STI diagnosed was genital warts (22.2.0%). Other STIs diagnosed were vaginal candidiasis (16.7%), bacterial vaginosis (11.1%) and HIV (5.6%). There was no statistical significance between HIV infection and other STIs (p>0.05).

Conclusion

Our study revealed high prevalence of sexually transmitted infections among the sexually abused children and adolescents. Screening for infection should be mandatory in presumed sexually abused girls with vaginal discharge and ideally should be undertaken in all children presenting at STI clinics for evaluation of sexual abuse.
P1-S2.30 STI among vulnerables youth attending free targeted HIV counselling and testing services including and STI diagnosis and management in Benin, West Africa
Authors: Marguerite B N , Amour B A
Published: July 2011

Background

In collaboration with two health facilities and a mobile clinic, Counselling and Testing (CT) services was implemented in two departments of Benin (Atacora and Donga) trough a project funded by the Kreditanstalt für Wiederaufbau (KfW) Germany. These interventions targeted vulnerable youth (15–24) and included STI prevention, screening and management, using clinical screening algorithms. 28 868 clients requesting HIV counselling and testing were registered from 2007 to 2009 trough a database.

Objectives

To assess rate and risks factors of STI among vulnerable youth attending counselling and testing facilities, including STI management.

Methods

Descriptive analysis and logistic regression was performed on the database with SPSS 17. The dependent variable is “having had an STI the last 3 months”. The independents variables are—“having multiple partners in the three past months”, “consistent use of condom” and socio-demographic characteristics.

Results

In all 5.1% of HIV counselled and tested clients approached for STI on-site screening had STI the last 3 month, while STI prevalence among this population is 1.9%. Multiple partners (OR=4.5; p=0.000), no consistent use of condom (0R=1.3; p=0.002) were significantly associate to IST infection. The level of instruction (OR=1.3; p=0.000) and sex (OR=0.6; p=0.000) were the significant socio-demographic characteristic associated with STI.

Conclusions

Data findings indicate that having had STI in the last 3 month may be a motivation for youth which are attending HIV counselling and testing facilities in Atacora/Donga in Benin, and “high numbers of partners” is the main risk factor for STI among them. Then, scaling up HIV counselling and testing services may be a right way for STI prevention, screening and management. Finding suggests that such intervention (counselling) focused on reducing number of partner, improved to promotion of condom use, may reduce STI incidence among vulnerable youth that need further investigation.
P1-S2.32 Do as I think, not as I do: the discordance between perception of risk for STBBIs and sexual risk behaviours among Canadian street-involved youth
Authors: Fang L , Klar S A , Friedman D , Gratrix J , Rossi M , Tawse C , Taylor D , Wright J , Wylie J , Wong T , Jayaraman G C ,   Team for the Enhanced Street Youth Surveillance
Published: July 2011

Background

Canadian street-involved youth are perceived to be at greater risk for sexually transmitted and bloodborne infections (STBBI) and may be more vulnerable to these infections because of their age, socioeconomic status, life course factors, and engagement in high risk behaviours. However, perception of their own risks and the behaviours that influence this perception are less understood and will be described using the Enhanced Surveillance of Canadian Street Youth (E-SYS) data.

Methods

E-SYS is a repeated cross-sectional surveillance study of street-involved youth (15–24 years). Preliminary data from Cycle 6 (2009-present) (n=705) were used to determine how these youth perceive their risk for STBBI and factors that contribute to perception. Participants completed an interviewer-administered questionnaire and provided sera and urine samples for STBBI testing. Chi-square tests and unadjusted ORs were performed to assess these relationships (α=0.05, 2-sided).

Results

Among interviewed street-involved youth, 65.8% reported that they felt they were at no or low risk of being infected with an STBBI. Age and gender did not influence perception of risk for STBBI. Factors that were significantly associated with medium or high perception of risk for STBBI included being bisexual (OR 1.6, 95% CI 1.1 to 2.3), having sex while under the influence of drugs or alcohol (OR 2.5, 95% CI 1.5 to 4.1), and not being aware of where to access health services (OR 1.7, 95% CI 1.1 to 2.6). Although engaging in anal sex affected their perception of risk for STBBI (p<0.05), having vaginal sex did not (p=0.75). Those who did not use a contraceptive barrier (eg, condom) when they last had vaginal sex felt they were at greater risk for an STBBI (OR 1.7, 95% CI 1.2 to 2.3), but barrier use during anal sex did not affect their perception of risk (p=0.3).

Conclusions

Although many street-involved youth acknowledge that certain behaviours may put them at greater risk for STBBI, they continue to engage in these behaviours. These youth may not be fully knowledgeable about the extent to which certain risks enhance STBBI transmission or options for altering behaviours may be limited. Of concern is our finding that some youth, who perceive themselves as being at medium or high risk for an STBBI, may not know where to access services for STBBI counselling, testing, and treatment. Concerted efforts continue to be needed to engage this population and to translate knowledge into action.
P1-S2.41 Sentinel survillance for pharyngeal chlamydia and gonorrhoea among men who have sex with men - San Francisco, 2010
Authors: Park J , Marcus J , Bernstein K , Pandori M , Snell A , Philip S
Published: July 2011

Background

Although a potentially important route for transmission, limited data exist on the burden of pharyngeal chlamydia (CT) and gonorrhoea (GC) among men who have sex with men (MSM). The San Francisco Department of Public Health has recommended nucleic acid amplification test (NAAT)-based pharyngeal screening for MSM since 2005. We examined pharyngeal CT and GC among MSM participating in the STD screening program in 2010.

Methods

MSM seeking services at a variety of clinical sites provided clinician-collected pharyngeal specimens for APTIMA Combo 2 testing. The prevalence of pharyngeal CT and GC was estimated at five sentinel sites—the municipal STD clinic, a gay men's health clinic, an HIV care clinic, an HIV testing site, and primary care clinics supported by the San Francisco Department of Public Health. Positivity for each infection was calculated as the number of positive tests divided by the number of testers with corresponding CIs. Additionally, we calculated positivity and OR to determine whether the prevalence of pharyngeal CT and GC differed by HIV status among patients tested at the municipal STD clinic.

Results

In 2010, over 12 000 pharyngeal specimens were tested for an overall CT positivity of 1.69% (95% CI 1.47 to 1.93) and GC positivity of 5.76% (95% CI 5.36 to 6.19). At the five sentinel sites, pharyngeal CT positivity ranged from 1.10% (HIV testing site) to 2.28% (STD clinic); pharyngeal GC positivity ranged from 3.4% (HIV testing site) to 7.01% (STD clinic). For tests conducted at the STD clinic among HIV-uninfected testers, pharyngeal CT positivity was 1.57% (95% CI 1.11 to 2.15) and pharyngeal GC positivity was 7.02% (95% CI 6.03 to 8.11). Among HIV-infected testers, the pharyngeal CT and GC positivity were 4.06% (95% CI 2.92 to 5.49) and 6.99% (95% CI 5.48 to 8.76), respectively. HIV-infected testers were more likely to have a positive pharyngeal CT test compared with HIV-uninfected testers (OR 2.65, 95% CI 1.65 to 4.27); there were no differences in pharyngeal GC positivity between HIV-infected and HIV-uninfected testers at the STD clinic.

Conclusion

Sentinel surveillance data indicates that there is a substantial burden of pharyngeal CT and GC infections among MSM in San Francisco. Identification and treatment of pharyngeal infections could prevent ongoing transmission of these bacteria. Increasing access to NAAT-based pharyngeal screening should be a public health priority.
O1-S02.04 Evidence of HPV vaccine effectiveness in reducing genital warts: an analysis of California Public Family Planning Administrative Claims Data, 2007–2009
Authors: Bauer H , Wright G , Chow J
Published: July 2011

Background

The quadrivalent HPV vaccine, available in the US since 2006, is recommended for females age 9–26. This vaccine prevents HPV types 6 and 11, which cause 90% of genital warts (GW). Because of the rapid development of GW after infection, monitoring GW trends may provide early evidence of population level vaccine effectiveness.

Methods

Trends in GW diagnoses were assessed using clinical encounter claims data from the California Family Planning Access Care and Treatment program which serves low-income females and males. Following implementation of diagnostic coding requirements, reliable data on International Classification of Diseases (ICD-9) codes were available 2007 through 2009. GW cases were defined as unduplicated clients with either an ICD-9 diagnostic code for viral warts (078.10) or condyloma (078.11) or a National Drug Code (NDC) for pharmacy-dispensed imiquimod or podofilox. Inclusion of procedure codes for destruction of genital lesions was unnecessary because these claims closely correlated (>95%) with appropriate ICD-9 codes. Denominators included unduplicated clients served. The proportions of clients with GW were stratified by age (<21, 21–25, 26–30, 31+), gender, and year. No data on vaccination status were available. Statistical significance of gender- and age-specific trends was assessed using the Cochran-Armitage test for linear trend.

Results

Between 2007 and 2009, an average of over 1 735 000 female and 248 000 male clients were served annually. Total clients served increased each year for both females and males across all age groups, with the greatest increases seen among older age groups. Overall, 0.7% of females and 3.4% of males were diagnosed with GW. Between 2007 and 2009, GW diagnoses declined 19.4% among females less than age 21 (p trend <0.0001), whereas GW diagnoses were stable or increasing among females in older age groups see Abstract O1-S02.04 table 1. No statistically significant declines in GW diagnoses were observed among males of any age group; however, significant increases were observed among older males.

Abstract O1-S02.04 Table 1

Per cent change between 2007 and 2009 in GW diagnoses by gender and age group

FemalesMalesAge group% Changeptrend% Changeptrend<21−19.4<0.0001−3.30.32821–25−2.80.137−4.10.06126–30+8.80.006+12.60.000431++10.90.002+11.40.004

Conclusions

This analysis provides preliminary evidence that the HPV vaccine may be preventing GW among young women. Although using existing administrative claims data to assess trends in HPV-related diseases was inexpensive and expeditious, trends are ecological and may be explained by factors other than vaccination.
O3-S1.02 Deciphering the code ofTreponema pallidumin the UK: implications for treatment and prevention
Authors: Tipple C , Taylor G
Published: July 2011

Background

The efficacy and convenience of single-dose oral azithromycin meant it became the preferred treatment for syphilis in many countries and a suitable alternative to penicillin in many more. However, two point mutations (A2058G and A2059G) in the 23srRNA gene ofTreponema pallidum(T pallidum) have separately been shown to confer high-level macrolide resistance. Furthermore, molecular analyses ofT pallidumwith an enhanced sub-typing method have revealed the existence of a number of strain types, which both persist over generations and may be associated with distinct clinical phenotypes.

Methods

Following informed consent, whole EDTA blood and ulcer exudate absorbed onto filter paper Snostrips were collected from patients with any stage of syphilis in a London genito-urinary medicine clinic between 2006 and 2008.T pallidumDNA was extracted and strain types and macrolide resistance-associated mutations sought by: (1) PCR amplification of the 23srRNA gene and restriction fragment length polymorphism (RFLP) analysis following Mbo-II and Bsa-I digestion; (2) determination of the number of 60-base repeats within the ARP gene by PCR and agarose gel electrophoresis; (3) PCR amplification of the TPR gene family and RFLP analysis following Mse-I digestion; (4) sequence analysis of a section of the tp548 gene.

Results

Forty-two of the 44 (95.5%) patients diagnosed with syphilis were male, of which 63.6% were MSM and 28/44 (63.6%) were HIV-1 infected.T pallidumDNA was present in sufficient quantity and quality for analysis in 18/44 (40.9%). 23srRNA gene analysis revealed 6/18 (33.3%) wild-type sequences, 11/18 (61.1%) A2058G mutants and 1 (5.6%) A2059G mutant. Full strain-typing was possible in 5 clinical samples (four were 14d/g and one was 14d/f), and partial typing in a further 7 (see Abstract O3-S1.02 table 1).

Abstract O3-S1.02 Table 1SampleNumber of ARP gene repeatsTPR gene Mse-1 RFLP analysisTp548 gene sequence analysisFinal enhanced strain type1––G–214dG14d/g314dG14d/g414dG14d/g5––G–6––F–714dF14d/f814–F–9––G–1014dG14d/g1114–F–12––F–Positive control (Nichols)14–A14a/a

Conclusions

The high frequency ofT pallidummacrolide resistance mutations described in the UK for the first time has clear implications for national treatment strategies. The majority of patients with syphilis were men, of which most were MSM and over half were HIV-1 positive. It is thought that transmission ofT pallidumwithin sexual networks has played a part in the resurgence of syphilis in the UK over the last decade and the predominance of the 14d/g subtype may reflect this. Alternative explanations are that this strain type is more virulent or has become endemic, as in the case of the Scottish data that revealed 77% of syphilis cases there to be type 14d.
O3-S1.03 Performance of reverse sequence syphilis screening in Jamaica
Authors: Hobbs M , Gordon F , Cooper C J , Eastman S , Hylton-Kong T , Watson-Grant S , Weir S , Figueroa J P
Published: July 2011

Background

Algorithms for syphilis serologic testing traditionally have relied on screening with a non-treponemal test, such as the rapid plasma reagin (RPR) test or the toluidine red unheated serum test (TRUST) followed by confirmation using a treponemal test, such as Treponema pallidum particle agglutination (TP-PA). To reduce time, material and labour costs, many laboratories, including at the Comprehensive Health Centre in Kingston, Jamaica, have reversed the sequence testing first with a rapid treponemal test followed by non-treponemal testing of reactive sera.

Methods

In a survey of STIs among men who have sex with men (MSM) in Jamaica, syphilis serologic testing is currently conducted using an initial rapid treponemal SD Bioline Syphilis 3.0 test followed by TRUST for reactive sera. Discordant sera that are Bioline-positive and TRUST-negative, or sera with TRUST titres < or =8 undergo supplemental testing by TP-PA. SD Bioline was previously validated in the field and reference laboratory in Jamaica and is 95.2% sensitive and 93.5% specific compared to TP-PA. Here we report the results from sera obtained from 135 MSM in Kingston between December 2010 and February 2011.

Results

Among 135 sera evaluated using the reverse syphilis screening sequence, 13 (9.6%) had a positive rapid treponemal test. Among these 13 reactive sera, 6 (46.2%) were nonreactive with TRUST. All discordant sera were also reactive by TP-PA, indicating that initial rapid testing did not produce false-positives in this setting. The proportion of discordant syphilis test results was similar among HIV+ and HIV- men. The prevalence of primary syphilis detected by concordant positive treponemal and non-treponemal tests in this survey was 5.2%, compared to 5.3% in a previous survey conducted in this population during 2007–2008 using the traditional screening sequence.

Conclusions

The prevalence of primary syphilis among MSM in Kingston has not changed since the previous survey. In the current survey using the reverse screening sequence, nearly half of sera that were reactive with the treponemal test produced discordant results with the non-treponemal test. Such results are consistent with previous syphilis infection, treated or untreated, or early primary syphilis in which non-treponemal antibodies have yet to develop. Distinguishing these possibilities requires detailed history and clinical assessment in addition to serologic test results.
O3-S1.05 Quality assurance of syphilis testing in a rural health facility using dried tube specimens (DTS)
Authors: Adu-Sarkodie Y , Dompreh A , Opoku B Kofi , Dzokoto A , Mabey D , Peeling R
Published: July 2011

Background

Assuring the quality of a diagnostic test is important in healthcare. For syphilis testing, this includes proficiency testing of previously well characterised serum samples by health workers blinded to the results of characterisation. As part of a study on the feasibility of using a Point of Care (POC) rapid test devise for syphilis testing in rural antenatal settings, proficiency testing material prepared in a referral laboratory using Dried Tube Specimens (DTS) was sent for testing by the nurses/midwifes in these rural settings.

Methods

Five well characterised DTS (one high RPR reactive, three low RPR reactives and one RPR non-reactive) were sent for on-site testing in eight rural antenatal facilities in Eastern Ghana. Training of nurses/midwifes in reconstituting the DTS and their testing and reporting was previously carried out. An instruction leaflet was enclosed in each batch of the DTS. Four rounds of the testing were carried out at monthly intervals.

Results

Seven out of the eight facilities correctly reported results of the DTS for all the rounds. One facility however reported all specimens as negative at the first round. On-site investigation showed that the nurse running the antenatal clinic who normally wore reading glasses had lost them. On replacing her glasses and going through an on-site re-training, she obtained 100% in subsequent rounds of testing.

Conclusion

Syphilis proficiency testing in rural facilities carried out by non-laboratory personnel using DTS is feasible. Initial training with on-site monitoring is important to detect any testing problems.
O3-S1.06 Diagnostic accuracy of rapid point-of-care tests to detect syphilis: a meta-analyses
Authors: Jafari Y , Peeling R , Shivkumar S , Lambert G , Claessens C , Cajas J , Klein M , Joseph L , Pai N
Published: July 2011

Background

The World Health Organization estimates that in 2006, there were 12 million new cases of syphilis. In developing countries, there is a lack of proper screening due to limited laboratory services and long distances from clinics. In developed countries, there is limited access to care among hard-to-reach populations. In this context of disconnect with the health care system, point of care (POC) tests have proven to be an invaluable resource, yet their accuracy needs to be established in order to justify their use.

Method

Electronic databases were searched from 1 January 1980 to 24 September 2010 for articles evaluating syphilis POC tests. Data were extracted and a second reviewer independently reviewed a subset of the articles. Subgroups were made according to the index test, the sample tested, and reference standard employed. Pooled sensitivity and specificity were calculated using Hierarchical Summary Receiver Operating Characteristic Curve. Adjustments were made to account for imperfect reference standards.

Results

30 (47%) from 64 full text articles assessed articles were included in the meta-analysis. The most common kits evaluated were Determine, Bioline, Syphicheck, and Visitect in whole blood and sera samples. Using a Treponema Pallidum (TP) specific reference standard, in sera, the Determine test was the most accurate with a pooled sensitivity of 98.43% (96.03, 99.94) and a specificity of 97.74% (96.38, 98.92). In whole blood, Bioline was the most accurate with a sensitivity of 87.70% (84.78, 90.58) and a specificity of 99.07% (98.50, 99.59). The sensitivity of Determine and Visitect were lower when using whole blood than when using serum. When we adjusted for imperfect reference standards, the pooled parameters of accuracy improved when compared to pooled accuracy under the assumption of a perfect reference standard.

Conclusions

Determine with high sensitivity and Bioline with high specificity appeared to perform the best of the tests studied. Higher accuracy in serum warrants the use of serum rather than whole blood wherever possible. Confirmation with non-TP specific reference standard are required to confirm whether the infection is active or treated.
O1-S02.05 Population based surveillance for cervical intraepithelial neoplasia grade 3 and adenocarcinoma in situ in three central cancer registries, USA 2009
Authors: Flagg E W , Datta S Deblina , Lyu C , Nagaraja J , Copeland G , Silva W , Peters E , Cole L , Tucker T , Byrne M J , Unger E R , Saraiya M , Weinstock H
Published: July 2011

Background

Human papillomavirus (HPV) vaccine has been recommended routinely to 11–12-year-old US girls for cervical cancer prevention since 2006, and evaluation of the population impact of HPV vaccine is a critical need. In addition to measuring the impact of HPV vaccines on cervical cancer incidence, surveillance should include endpoints more proximal in time to HPV infection such as cervical intraepithelial neoplasia grade 3 (CIN3) and adenocarcinoma in situ (AIS). These immediate precursors to invasive cervical cancer manifest only 5–10 years after HPV infection. Although CIN3/AIS are detected during cervical cancer screening, these lesions are not routinely reported to US central cancer registries (CCRs). Compared to other precursor lesions, CIN3/AIS show the most consistent inter-pathologist agreement in histopathology interpretation making them the most suitable precursor lesion surveillance endpoints.

Methods

The Centers for Disease Control and Prevention conducted a project in three statewide CCRs to assess the feasibility of collecting data on CIN3/AIS lesions using existing registry infrastructure, a standardised case definition, and well-defined coding rules. State-specific vintage 2009 bridged-race postcensal population estimates were used to calculate incidence rates.

Results

Statewide age-adjusted incidence rates of CIN3/AIS in 2009, using the 2000 US Standard Population, were 76.8 (Kentucky), 57.5 (Michigan), and 54.7 (Louisiana) per 100 000 women. Highest rates were observed in those aged 20 to 29; rates among these women were 272.8 in Kentucky, 196.7 in Louisiana, and 192.6 in Michigan. Race was missing for 16% of records. Among records for which race was reported, incidence rates in Kentucky were highest for whites, while rates in Michigan were highest for blacks; in Louisiana rates did not differ significantly between whites and blacks. In each state, overall rates of CIN3/AIS were over sixfold higher than invasive cervical cancer rates. Only 3.8% of cervical lesions were AIS.

Conclusions

These results are the first reports of statewide population based incidence of CIN3/AIS in the US, and demonstrate that routine collection of CIN3/AIS lesions by cancer registries is feasible and could provide an earlier endpoint than cervical cancer with which to evaluate the impact of HPV vaccination in the US. Sentinel registries should be established to collect ongoing data on CIN3/AIS to monitor the impact of HPV vaccine in the US.
O3-S2.02 Long-term efficacy of human papillomavirus vaccination against CIN3 and invasive carcinoma: registry based follow-up of a phase iii trial (FUTURE II)
Authors: Paavonen J , Rana M , Apter D , Luostarinen T , Pukkala E , Lehtinen M
Published: July 2011

Background

Human papilloma viruses (HPV) 16/18 are known to cause approximately 70% of cervical cancers. Phase III clinical trials of HPV vaccination have demonstrated >95% efficacy against persistent HPV type 16/18 infections and associated cervical intraepithelial neoplasia (CIN) grade 2+ lesions, and up to 90% efficacy against all CIN3+ lesions. A long-term follow-up is, however, needed to confirm the protective efficacy against cervical carcinoma.

Methods

Phase III clinical trial (FUTURE II) consisted of intensive clinical 4-year follow-up including health education and counselling. The intervention potentially affects the incidence of neoplasia also in the placebo group. To increase power of the long-term follow-up and to determine the impact of the clinical intervention as such, a population based reference cohort of similarly aged women not exposed to any intervention was enrolled at the same time from the same communities. The HPV vaccine cohort and placebo vaccine cohort of 16–17-year-old women from the Finnish FUTURE II trial (N=1749) and a reference cohort of 18–19-year-old women (N=15 744) were linked with the Finnish Cancer Registry to determine the incidence of CIN3 and cervical cancer (CIN3+) during the passive follow-up, starting 6 months after the clinical follow-up of the phase III trial was completed.

Results & Conclusions

Currently the incidence of CIN3+ at the age of 20–24 years is 95 per 100 000 person years in Finland (http://www.cancer.fi). The incidence doubles in 5 to 10 years as the cohorts age. Thus, in less than 10 years the cumulative incidence yields 80% power to demonstrate 90% vaccine efficacy against cervical CIN3+. During the first 2 years this passive registry-based follow-up identified no CIN3+ cases in the HPV vaccine cohort, two cases in the placebo vaccine cohort, and 21 cases in the unvaccinated reference cohort suggesting that the vaccine efficacy translates into efficacy against cervical cancer. The passive follow-up continues and new cases emerging in future will be monitored by redoing linkage with the population-based cancer register at specific time intervals in the future, which will effectively add up person years to our follow-up study. In conclusion, valid comparisons between the vaccine and placebo recipients (excluding cross-vaccinated placebo vaccine recipients) and the reference cohort not exposed to intervention are feasible, and will be critical to define more definitively the long-term protection provided by HPV vaccination against the hard endpoints.
O3-S2.06 The effect ofTrichomonas vaginalis(TV) infection on the vaginal microbiome
Authors: Martin D H , Zozaya-Hinchliffe M , Lillis R , Miller J , Ferris M
Published: July 2011

Background

Among pregnant women the prevalence of TV infection is highest in women who have intermediate Nugent scores (NS) compared to those with low and high scores reflective of normal and bacterial vaginosis (BV) types of vaginal flora. The goals of this study were to determine if this relationship held true for non pregnant women and to determine if TV infection was associated with changes in the vaginal microbiome.

Methods

The study subjects were 394 women enrolled in a cross-sectional study of the aetiology of cervicitis in the New Orleans STD clinic. TV was diagnosed using the InPouch culture method. NS was determined using standard criteria.C trachomatis(CT),N gonorrhoeae(NG), andM genitalium(MG) were diagnosed using NAATs. DNA was extracted from a vaginal swab and stored. Associations between NS and STIs and NS and sexual behaviour were analysed for all 394 women. 454 pyrosequencing analyses were performed on vaginal DNA from 30 TV positive and 30 TV negative samples evenly divided between those with normal, intermediate, and BV flora as determined by NS.

Results

95% of enrolled women were African American and the mean age of the population was 25.6 years. The prevalence of TV (y axis) by 5 NS categories (x axis) is shown in the Abstract O3-S2.06 figure 1. As opposed to TV, the prevalence rates for CT, GC, and MG were highest among women with NS of 7–10. Also there was no difference in high risk sexual behaviour between those with low and high NS. These data suggested that the striking decrease in TV prevalence observed among women with BV was the result of vaginal environmental factors, not decreased risk for STIs. A heat map based on pyrosequencing data showed that the vaginal flora of 18/30 of the women positive for TV had similar microbiomes which were distinctly different from those of the other 42 women. In the former group,Mycoplasma spp. andUreaplasma spp. were more abundant than in the latter group while the reverse was true ofMegasphaera spp. andGardnerella spp.

Abstract O3-S2.06 Figure 1

T. vaginalisPrevalence by Nugent Score.

Conclusions

Though published research shows that the incidence of TV is highest in women with BV, our data along with those from a previous study in pregnant women clearly establish that TV prevalence is highest in women with intermediate NS. These data in conjunction with our pyrosequencing results suggest that following infection TV modifies the vaginal microbiome by suppressing some of the BV associated organisms and enhancing the abundance of mycoplasmas.
O3-S3.02 Performance of the bio-rad Dx CT/NG/MG assay for simultaneous detection ofChlamydia trachomatis,Neisseria gonorrhoeaeandMycoplasma genitaliumin urogenital samples
Authors: Bébéar C , Le Roy Chloe , Le Hen Isabelle , Clerc M , Arfel V , Normandin F , de Barbeyrac B
Published: July 2011

Objectives

To investigate the performance of the Bio-Rad Dx CT/NG/MG Assay with an internal control for the detection ofChlamydia trachomatis(CT) andMycoplasma genitalium(MG) in urogenital samples in comparison with the Roche Cobas TaqMan CT test and an in-house TaqMan PCR test for MG. ForNeisseria gonorrhoeae(NG), only positive PCR results were controlled by culture.

Methods

In this prospective study, urogenital samples were obtained from symptomatic and asymptomatic patients attending the STI center of Bordeaux, France, from January to April 2010. For symptomatic women and men, two endocervical swabs and two urethral swabs were collected, respectively. All patients and women collected first-catch urines and two vaginal swabs, respectively. Two swabs per site were used, a flocked swab in the universal transport medium and the Bio-Rad flocked swab in its transport medium. For the Bio-Rad CT/NG/MG assay, the DNA was manually extracted and amplified according to the manufacturer's instructions. For the comparator PCR tests, DNA was extracted using the MagNa Pure LC instrument (Roche Diagnostics) and amplified with the Cobas TaqMan CT 48 assay (Roche Diagnostics) and with a MgPa-targeted PCR assay on an ABI Prism 7000 (Applied Biosystems) for MG. The patient was considered as infected if at least two of the 4 or 6 PCR tests performed according to the gender and characteristics of patients, were positive. For asymptomatic men, in case of discrepancy, the urine sample was retested by both methods and the patient was considered infected if at least two of the four PCR results were positive for the considered microorganism.

Results

A total of 658 clinical specimens (259 male and 180 female urines, 191 vaginal, 21 cervix and seven urethral swabs) from 453 patients were analysed. The prevalence of CT and MG infections was 7.7% (20/260) and 1.9% (5/260) in men and 10.3% (20/193) and 2% (4/193) in women, respectively. The Bio-Rad Dx CT/NG/MG test sensitivity was 100% for CT and MG in men and women. In male urines, the specificity was 99.6% for CT and 100% for MG. In women, the specificity was 99.5% for swabs and 100% for urines for CT and MG. All 7 NG-PCR positive samples were positive by culture. Patients were co-infected in 5/56 (9%) with CT/MG in three cases and CT/NG in two cases.

Conclusion

The Bio-Rad Dx CT/NG/MG Assay was found to be very effective for the simultaneous detection of CT, MG, and NG infections in urogenital specimens.
O3-S3.05 Chlamydia trachomatisdetection by nucleic acid amplification assay using rectal swabs
Authors: Williams J , Van Der Pol B , Pantone A
Published: July 2011

Background

Rectal infection withC trachomatis(CT) is increasing in many settings; however, there are currently no FDA approved NAAT for use with rectal specimens. Access to reliable diagnostics using rectal specimens is critical to both surveillance and disease management and control. This is important as CT culture has been shown to have lower sensitivity, 54.8 %, when compared to NAAT in our patient population. The objective of this study was to evaluate the performance of rectal swabs tested on the Abbott m2000 (m2000) as compared to the GenProbe APTIMA Combo 2 (AC2) for detection of CT.

Methods

Rectal samples were collected and placed into chlamydia transport medium (CTM) for testing by both m2000 and AC2 for CT. CTM was split as follows; 1 ml into an empty m2000 tube; 100 ul into m2000 multi-collect tube containing buffer; 100 ul into an AC2 swab collection tube. From this point forward, testing was performed according to the package insert for both platforms with two CT negative samples being tested for every positive one. ĸ scores were determined to measure agreement between the m2000 and AC2 collection tubes.

Results

A total of 59 samples were tested for CT by m2000 and AC2. AC2 was considered the reference standard for this study with 20 samples identified as positive and 39 as negative for CT. Neat CTM placed into an empty m2000 tube detected 95% (19/20) and had a single positive that was not detected by AC2 (38/39 agreed). The single neat CTM missed by m2000 was positive in the spiked multi-collect tube. CTM spiked into an m2000 multi-collect tubes also detected all but one of the infections identified by AC2 (19/20) and negatives agreed completely (39/39). The m2000 multi-collect miss was CT positive in the neat sample. Both collection methods on the m2000 generated results that had very good agreement with the reference test: ? scores were 0.924 for empty and 0.962 for multi-collect tubes.

Conclusion

The m2000 has excellent performance characteristics compared to AC2 for the detection of CT. NAATs offer an alternative to culture for the detection of CT in rectal samples, and are less susceptible to transport conditions and sterility that are often a concern with culture. The collection of rectal specimens in CTM offers the opportunity for routine testing using multiple collection devices and platforms with the data suggesting that the m2000 assay can be used to meet the revised CDC recommendations for rectal testing for CT.
O1-S02.06 Detection of cervical cancer precursors and associated HPV types in the USA: HPV-IMPACT preliminary results
Authors: Powell S E , Hariri S , Steinau M , Bauer H , Bennett N , Bloch K , Schafer S , Niccolai L , Unger E R , Markowitz L
Published: July 2011

Background

Cervical intraepithelial neoplasia (CIN) grade 2 or 3 and adenocarcinoma in situ (AIS) (CIN2+) can be used to monitor HPV vaccine impact. This spectrum of preinvasive cervical lesions are commonly associated with multiple HPV types and detected through screening. This abstract describes baseline CIN2+ data and associated HPV types among defined populations of US females.

Methods

As part of a vaccine impact monitoring project (HPV-IMPACT), CIN2+ cases in females 18–39 years were reported from pathology laboratories in five catchment areas (CA, CT, NY, OR, TN). One diagnostic block was selected and unstained serial sections were prepared for PCR. Extracts from samples with residual lesion on both H&Es were used in Roche Linear array to detect and type HPV. CIN2/3 diagnosis rates were determined in catchment areas (CA, CT and NY) with complete case reporting. HPV typing data were analysed from all five defined catchment areas.

Results

In 2008, rates per 1000 population in 18–39-year-old females were 2.8 in CA, 5.3 in CT and 4.9 in NY. In all five sites, CIN2 was most common (49%), followed by CIN3 (31%) and AIS (2%). The proportion of lesions not distinguished by grade (CIN2/3) varied across sites (from 12 to 27%). Median diagnosis age was 31 years in CA, 29 in CT, 27 in NY, 29 in OR, 28 in TN. Among 5035 18–39-year-old females, 1413 (28%) specimens were tested; 96% were HPV DNA positive. HPV16 was most prevalent (47%), followed by HPV31 (11%), HPV52 (9%) and HPV51 (8%). HPV18 prevalence was 5.4%. HPV16 prevalence varied by diagnosis: 38% in CIN2, 51% in CIN2/3, and 59% in CIN3.

Conclusions

CIN2+ rates varied by catchment area, possibly reflecting differences in screening or case ascertainment. HPV16 or 18 were present in ∼52% of lesions. Type-specific monitoring of CIN2+ can allow evaluation of vaccine impact on cervical disease, and may be useful in determining whether type replacement occurs.