bluuebunny/crossref_metadata_2025 huggingface dataset:
S1.4 Pharmacological assessment of medication adherence—oral PrEP and microbicides
Authors: Hendrix C
Published: July 2011

HIV chemoprevention trials (oral PrEP and topical microbicides) will benefit greatly from an accurate assessment of medication adherence during the trial to assist in the interpretation of prevention success or failure in the trial. HIV infection during the trial may be a result of failure to achieve preventive drug concentrations, which itself may result from either (1) a prescribed regimen, to which the subject fully adhered, that is still insufficient to prevent infection or (2) a result of poor adherence to the prescribed regimen also resulting in insufficient drug concentrations. In addition, an accurate adherence assessment in the midst of a trial could trigger adherence interventions. Objective evidence of adherence in several HIV chemoprevention trials suggests that subjective measures greatly overestimate adherence. Drug concentration has been proposed as a more objective adherence measure. Blood, hair, or other samples are sampled at specified times and the resultant “observed” drug concentration is compared to the “expected” drug concentration. The proportional difference between the expected and observed drug concentrations may be used as an estimate of the proportion of doses for which the subject was adherent to the prescribed regimen. This method attempts to provide more accurate and quantitative measures than those currently employed, but obstacles to their application and feasibility in estimating adherence remain to be demonstrated. Problems of white-coat effect, inter- and intra-individual variability, dose-proportionality, and backward looking temporal frame of reference all need to be addressed as part of the validation and interpretation of drug concentration as an adherence measure.
S11.2 Which algorithm performs better, screening with a non-treponemal or treponemal test?
Authors: Fortin C
Published: July 2011

Background

A growing number of diagnostic laboratories have recently adopted treponemal EIA tests that permits automation for syphilis screening thus reducing time and labor. This leads to a reverse sequence approach of screening in which an EIA is performed first, followed by testing of reactive sera with a non-treponemal test. The province of Quebec implemented two revised algorithms for syphilis testing on 1 February 2010. The first algorithm (Algo 1) is adapted for low throughput laboratories who initiate testing with a non-treponemal test while the second (Algo 2), which is adapted for high throughput settings, follows the reverse sequence approach. Using these recently implemented algorithms in Quebec, the performance the reverse sequence algorithm will be discussed.

Methods

The performance algorithms 1 and 2 has been evaluated with a retrospective analysis of all sera sent by diagnostic laboratories to our reference laboratory for treponemal confirmation between 1 February 2010 and 31 January 2011. Positive sera by both EIA and RPR were not submitted for confirmation.

Results

A total of 3662 sera were sent for confirmation during the study period. Only sera from patients not known to have a previous positive treponemal test were analysed. Among the 929 RPR positive or indeterminate sera screened by Algo 1, only 315 (34%) were positive by TP-PA. Among the 904 EIA positive/RPR negative sera screened by Algo 2, 525 (58%) were positive, 333 (37%) were negative and 46 (5%) were indeterminate by TP-PA. The TP-PA negative or indeterminate sera were further tested using a line immunoassay. Among these 379 sera, 35 (9%) were positive and 108 (28%) were indeterminate by line immunoassay. The overall proportion of false positive EIA when reflex RPR test is negative (Algo 2) was 38% compared to a proportion of 66% (614/929) of false positive results when RPR is used as the first screening assay (Algo 1).

Conclusion

The higher rate of false positive when sera are screened with Algo 1 can be explained by a low prevalence setting. The high rate of false positive EIA when RPR test is negative (Algo 2) confirms the need to reflexively test all such sera with at least a second treponemal test. Although most EIA positive/RPR negative/TP-PA negative sera truly are false positive EIA results, a second treponemal confirmatory test helps identifying more true-positive EIA positive/RPR negative sera, though more data are needed to generally recommend this approach.
S12.1 Transmission of human papillomavirus infections
Authors: Burchell A N , Coutlée F , Tellier P , Hanley J , Franco E L
Published: July 2011

Background

There have been few studies of the sexual transmission of human papillomavirus (HPV) between partners. Our objective was to estimate transmission rates among persons with documented sexual exposure to an infected partner and longitudinal follow-up.

Methods

We analysed data from the HITCH Cohort Study, a study of recently-formed couples. Women aged 18–24 attending a university or junior college in Montreal, Canada and their male partners were eligible. Self-collected vaginal swabs and clinician-obtained swabs of epithelial cells from the penis and scrotum were tested for DNA of 36 HPV types. We analysed follow-up data at visit 2 from 179 couples who were discordant for one or more HPV types at enrolment. We defined the index partner as that which was infected with a type(s) not found in the other partner, and a transmission event as subsequent detection of that HPV type in the non-index partner. Transmission rates are expressed as the number of transmissions per 100 person-months (PM), with 95% CI estimated using Poisson regression.

Results

Transmission was observed in 73 partnerships. There was little difference between the male-to-female (3.5 per 100PM, 95% CI 2.7 to 4.5) and the female-to-male transmission rate (4.0 per 100PM, 95% CI 3.0 to 5.5). These rates are consistent with a per-partnership transmission probability of 0.20 (95% CI 0.16 to 0.24) over 6 months. Transmission rates did not differ with the lifetime number of partners reported by the non-index partner at enrolment or with the circumcision status of the male partner. Rates were highest when the index partner was still positive for that type at follow-up; rates of male-to-female transmission quadrupled and female-to-male transmission tripled (5.2 and 6.2 per 100PM, respectively), compared to when the index partner was negative at follow-up (1.2 and 1.8 per 100PM, respectively, p<0.05).

Conclusions

Transmission rates based on follow-up of discordant partners are probably underestimates of the true rate due to clearance in index partner and the depletion of susceptibles. Our results contribute to a small but growing evidence base regarding the natural history of HPV transmission and the probability of transmission. These estimates may be of utility to improve forecasting estimates from mathematical modelling efforts to project the public health impact and cost-effectiveness of HPV vaccination.
S2.1 Introduction of rapid syphilis tests in antenatal care services in Tanzania: clients' and service providers' acceptability and uptake of testing
Authors: Changalucha J , Mosha J , Mngara J , Masesa C , Kabalila L , Makaranga E , Sollis K , Kapiga S , Mabey D , Peeling R
Published: July 2011

Background

Syphilis is still a major cause of morbidity and mortality in women and children. In Tanzania syphilis was shown to cause adverse pregnancy outcomes in 49% and stillbirth in 25% of pregnant women with high titre syphilis. Although syphilis screening and treatment is a national policy and is one of the most cost effective interventions, its implementation on a large scale is limited. Lack of a simple and rapid point of care diagnostic test for syphilis has been suggested as one of the major reasons for this limitation. We implemented a demonstration project in Geita district, Tanzania to assess the feasibility of introducing a rapid diagnostic test in antenatal care services. The objectives of the project were to determine (1) the feasibility of increasing access to antenatal syphilis screening using same day testing and treatment strategy, and (2) the acceptability of introducing rapid syphilis testing to service providers and clients.

Methods

A health facility based baseline survey was carried out using a structured questionnaire to determine syphilis uptake before rapid test introduction. A team of four district trainers and supervisors were trained on how to perform the test, on quality assurance and stock management. Health workers were also trained on how to perform the test, quality assurance and stock management. Then rapid tests were introduced in all health facilities and qualitative data were collected to assess acceptability of the test. The uptake of syphilis testing and treatment among pregnant women in 3 months before and after rapid test introduction were compared using χ2test.

Results

Numbers of pregnant women tested in the 3 months after rapid test introduction were significantly higher than those tested before its introduction in the same period (p<0.01). Similarly a significantly higher number of syphilis positive women were treated compared to those treated before test introduction (p<0.01) see Abstract S2.1 figure 1. The same day testing and treatment strategy enabled 95% of women testing positive to be treated at their first visit. The rapid test was acceptable to both service providers and clients.

Abstract S2.1 Figure 1

Number of pregnant women tested and treated at clinics before and after Rapid Test introduction in 3 months.

Conclusions

Introduction of rapid syphilis tests has made it possible to implement national policy for screening pregnant women in Tanzania. Increasing access to screening and treatment will prevent many perinatal deaths.
S14.2 A study of African American and Latina women and human papillomavirus: lessons learnt
Authors: Bonney L , Fost M , Wang Y F , Green V L , Wingood G , del Rio C , Rothenberg R
Published: July 2011

Background

African American and Latina women in the United States suffer from sexually transmitted infections at higher rates than white women. It is particularly important to prevent HPV in these groups as they also suffer disproportionately from cervical cancer. From 2006, a prophylactic HPV vaccine has been approved for use in girls and women aged 9–26 years. However, public health focus has been on young girls and teens. There are limited options for young women over 19 years of age who have aged out of the Vaccines for Children entitlement program. The objectives of this study were to assess a sample of minority women who attend neighbourhood health centers to determine predictors of vaccination, and to assess for the presence of HPV infection in these women. Those without evidence of prior HPV infection may benefit from a prophylactic vaccine.

Methods

Between April 2009 and April 2010, we enrolled a convenience sample of 100 African American and 100 Latina women who completed a computer-assisted personal interview. Participants were queried regarding: demographics, risk for sexually transmitted infections including drug or alcohol use, HPV vaccine willingness, knowledge, attitudes and beliefs, and vaccination status. Frequencies were calculated using SAS, version 9.2. Self-collected vaginal swab samples from 118 participants were tested for HPV using line probe assay.

Results

Participants were poor with 113 (57%) having a household income of <$20 000; and at risk for HPV infection. One hundred twenty-one (61%) did not use condom at last sex. However, only 17/118 (14%) were positive for any HPV. Predictors of vaccination could not be determined because there was not sufficient outcome response variation. A vast majority 161 (80%) of participants had not received HPV vaccination, though a most 136 (68%) reported willingness.

Conclusions

Three years after vaccine approval, the majority in a sample of vulnerable women had not been vaccinated despite their willingness. Public health campaigns have been successful at raising awareness and making vaccine acceptable, but may be less successful at providing the vaccine to vulnerable women. Strategies should focus on delivering vaccine to African American and Latina women in order to decrease cervical cancer disparities.
S14.4 Detecting chlamydial and gonococcal infections through social and sexual networks
Authors: Al-Tayyib A A , Rietmeijer C A
Published: July 2011

Background

The overall goal of this ASTDA award was to adapt and evaluate Respondent-Driven Sampling (RDS) to enhanceChlamydia trachomatis(Ct) andNeisseria gonorrhoeae(GC) screening activities. Specifically, the aims were to develop and evaluate a programmatic approach using RDS as a method to prospectively screen for Ct/GC in networks of infected persons, to compare the prevalence of Ct/GC infections detected via current venue-based screening activities to the prevalence of infection detected using RDS as a referral mechanism, and to determine and compare the cost per infection detected via current screening activities to the cost per infection using RDS.

Methods

Using two components of RDS, the systematic referral scheme and the dual incentive structure, we developed a program to refer social and sexual contacts for Ct/GC screening. Initial seed participants ages 15–24 were identified and asked to recruit their peers for screening, who in turn recruited their peers, and so on. Persons received incentive for their own participation ($10) in addition to incentive for participation of those they refer ($10). Participants could refer up to 5 social and sexual contacts. Participants provided a urine specimen for Ct/GC screening and completed a brief survey questionnaire.

Results

Between December 2008 and March 2010, 66 initial seeds were recruited. Of the 66 seeds, 17 (25%) were successful in recruiting referrals. A total of 439 referrals were recruited, resulting in 7 networks initiated from an infected seed and 10 networks from a non-infected seed. The majority of referrals, 372 (85%), belonged to a single network (Abstract S14.4 figure 1). The remaining 67 referrals belonged to 16 networks ranging in size from 2 to 18 members. Across all networks, 67% of referrals were male and 33% were female. The overall prevalence of infection was 5.7% for Ct and 6.9% for GC among the referrals. This is compared to a prevalence of 12.2% for Ct and 1.5% for GC detected through venue-based screening in the same age demographic.

Abstract S14.4 Figure 1

Conclusions

With the exception of one large network, RDS was not a particularly efficient way to screen for Ct/GC. Only one-fourth of those initially recruited by research staff in turn referred their social and sexual contacts. While social network testing has been adopted in the HIV testing realm, in the Ct/GC screening realm a focus on messages encouraging those who are tested to get their friends tested may have the greatest public health impact.
S14.5 Treponema pallidumσ24 regulon and envelope stress response
Authors: Giacani L , Denisenko O , Tompa M , Molini B , Centurion-Lara A
Published: July 2011

Background

During syphilis infection, the envelope ofTreponema pallidumis constantly exposed to the host environment and, therefore, the most likely target of the host defences against the invading spirochaete. The mechanisms that maintainT pallidumenvelope integrity and functionality, particularly in response to host-induced stresses, are however poorly understood, and their elucidation would likely help identify important pathogenesis-associated molecules, perhaps related toT pallidum'sability to persist in the host despite a robust immune response. We hypothesised that inT pallidum, similarly to other Gram-negative pathogens, the transcription factor σ24 (σ24, encoded by the rpoE gene, TP0092) might be a key element in maintainingT pallidumenvelope homeostasis. Putative σ24 binding motifs can be identified in silico upstream of severalT pallidumgenes that were experimentally shown to be involved in envelope stress response (ESR) inEscherichia coli. Furthermore, during early experimental syphilis σ24 is highly transcribed compared to other σ factors, and its expression increases even more as primary infection progresses. We therefore decided to investigate the possible role of σ24 inT pallidumESR by identifying the components of theT pallidumσ24 regulon.

Methods

T pallidumcells grown in rabbits were fixed after harvest to crosslink DNA-binding proteins to their target sequences in the chromosome. DNA sequences recognised by σ24 in vivo were isolated using chromatin immunoprecipitation in combination with high-throughput DNA sequencing (ChIP-seq) to identify bound DNA regions.

Results

Thirty-nine DNA fragments targeted by σ24 were identified in theT pallidumchromosome. Seven of these target genes (lon-1, greA, ftsZ, prfB, htrA, and rpoE) were previously reported to be induced in response to envelope stress inE coli, suggesting that theT pallidumσ24 regulon is likely to be similar to that of other bacteria. Other putative target genes encode transporters, cell division proteins and a subset of motility and chemotaxis proteins.

Conclusions

InT pallidum, σ24 seems to control genes involved in a variety of cellular processes, including maintenance of envelope homeostasis and barrier function. Additional putative σ24-dependent functions, apparently not directly involved in ESR, could as well be important in helpingT pallidumadapt to the host environment during the infection.
S15.1 Sexually transmitted infections in Europe: coordinating the European STI network
Authors: van de Laar M
Published: July 2011

Background

Since 2008, the European Centre for Disease Prevention and Control is coordinating the enhanced STI surveillance in 30 EU/EEA countries. Each country was requested to nominate experts for collaboration and data submission to the European Surveillance System. Five STI are under surveillance, syphilis, congenital syphilis, gonorrhoea, chlamydia and LGV, as per Decision 2119/98/EC of the European Commission.

Methods

Surveillance objectives and the set of variables for enhanced STI surveillance were agreed upon in the annual network meeting and training session to use the European Surveillance System for data submission. Data were collected for the period 1990–2009; two network meetings were organised for all 30 EU/EEA countries to discuss the preliminary results.

Results

Chlamydia is the most frequently reported STI in Europe, accounting for the majority of all STI reports with 343 958 cases in 2009 (185 per 100 000 population). Chlamydia was reported more in women than in men and 75% were reported in young people (15 and 24 years). Chlamydia is increasing continuously over time. In 2009, 29 202 gonorrhoea cases have been reported (9.7/100 000) and nearly a quarter of all gonorrhoea cases were reported in MSM. For syphilis, 18 317 cases have been reported (4.5 per 100 000) and half of syphilis cases were reported in MSM. The overall trend in gonorrhoea and syphilis across the EU/EEA showed a notable decreasing trend in countries which previously had reported very high rates. These declines are probably due to changes in healthcare systems, diagnostic capacity and reporting rather than true changes in the incidence. However, dramatic increases were noted in other countries and—based on the information from the male-to-female ratio—this is most likely due to recent increases of syphilis among MSM. The overall trend in chlamydia showed a continuously increasing trend, reflecting an increase in testing and screening practices across countries. These trends must be interpreted with caution due to the heterogeneity in reporting and healthcare systems. A further limitation to the interpretation is that many diagnoses are either not made or under-reported. Diagnoses from certain countries cannot be included in trend analyses as they do not have comprehensive surveillance for STI.

Conclusion

Enhanced surveillance of STI in Europe is essential to provide the information that is necessary to monitor the distribution of disease and to evaluate the public health response to control the transmission of infections. Collaborating within the European STI expert networks provides the platform for sharing best practices and expert knowledge across Europe.
S15.3 European MSM Internet Survey (EMIS): differences in sexually transmissible infection testing in European countries
Authors: Marcus U , Schmidt A J , Breveglieri M , Davila P F , Ferrer L , Folch C , Hickson F , Hospers H J , Mirandola M , Reid D , Weatherburn P ,   for the EMIS network
Published: July 2011

Background

Comparing rates of sexually transmissible infections (STIs) among men who have sex with men (MSM) in different European countries is challenging due to national differences in reporting systems, healthcare systems, infectious disease surveillance methods, quality of data, and/or levels of social acceptance of homosexual behaviours and openness about homosexuality.

Methods

From June through August 2010, the European MSM Internet Survey (EMIS) mobilised more than 180 000 respondents from 38 European countries to complete an online questionnaire in one of 25 languages. The questionnaire covered sexual happiness, HIV and STI-testing and diagnoses, unmet prevention needs, intervention performance, HIV-related stigma and gay-related discrimination. Recruitment was organised predominantly online, through gay social media, and links and banners on more than 100 websites for MSM all over Europe.

Results

Perceptions on access to free/affordable STI-testing differed across Europe (median: 80%; range: 40–95%); and was substantially correlated with reported recent STI-testing (R2=0.27). Quality of STI-testing was highly diverse: While blood-testing was common in all participating countries, only Ireland, Malta, and the UK seem to offer penile or particularly anal examinations as standard of care. In all participating countries HIV-positive respondents reported higher rates of both STI-testing and diagnosis. Self-reported STI-screening among men without HIV diagnosis ranged from 10% (Turkey) to 37% (Netherlands). Substantial correlations between rates of testing procedures appropriate for MSM (such as anal or genital swabs) and diagnosed gonorrhoea (R2HIV-pos=0.24) or Chlamydia infections were observed (R2HIV-pos=0.50; R2others=0.29).

Conclusion

Self-reported testing and diagnosis rates for bacterial STIs suggest high levels of under-diagnosis and unmet sexual healthcare needs in most European countries. In Europe, there is an urgent need to implement or improve sexual healthcare tailored to MSM-specific needs.
P1-S1.01 Trends in chlamydia and gonorrhoea positivity among heterosexual men and men who have sex with men (MSM) attending a large urban sexual health service in Australia, 2002–2009
Authors: Vodstrcil L , Fehler G , Leslie D , Walker J , Bradshaw C , Hocking J , Fairley C
Published: July 2011

Background

Notifications for Sexually transmitted infections cannot be used to measure changing incidence or prevalence of infection if a substantial proportion of infections are asymptomatic and screening rates are low. This analysis aimed to determine whether chlamydia positivity among heterosexual men and chlamydia and gonorrhoea positivity among men who have sex with men (MSM) have changed over time after adjusting for sexual risk.

Methods

Computerised records for men attending a large sexual health clinic between 2002 and 2009 were analysed. Urethral chlamydia positivity in all men, and anal chlamydia and anal and pharyngeal gonorrhoea positivity in MSM was calculated. Logistic regression was used to assess change in positivity over time adjusting for demographic, clinical, and sexual behavioural risk factors. Testing data from the Victorian Infectious Diseases Reference Laboratory (VIDRL) was also included to supplement the MSHC data.

Results

17769 heterosexual men and 8328 MSM tested for chlamydia and 7133 MSM tested for gonorrhoea between 2002 and 2009. In heterosexual men, 7.37% (95% CI 6.99 to 7.77) were chlamydia positive with positivity increasing by 4% per year (OR 1.04, 95% CI 1.01 to 1.07) in multivariate analysis. In MSM, 3.70% (95% CI 3.30 to 4.14) had a urethral chlamydia infection and 5.36% (95% CI 4.82 to 5.96) had an anal chlamydia infection, but positivity did not change over time. In MSM, 3.05% (95% CI 2.63 to 3.53) tested positive for anal gonorrhoea and 1.83% (95% CI 1.53 to 2.18) for pharyngeal gonorrhoea. Univariate analysis found anal gonorrhoea positivity had decreased (OR 0.93; 95% CI 0.87 to 1.00), but after multivariate analysis adjusting for sexual risk there was no change. Urethral gonorrhoea cases in MSM as a percentage of all MSM tested for gonorrhoea also fell (p<0.001). The gonorrhoea and chlamydia infection rates in MSM from VIDRL supported our clinic findings showing significant declines in anal and pharyngeal gonorrhoea infections over time and a less marked, but also significant, decline in anal chlamydia; however only univariate analysis was possible.

Conclusions

These data suggest that chlamydia prevalence in heterosexual men is rising and chlamydia and gonorrhoea prevalence among MSM is stable or declining. High STI testing rates among MSM in Australia may explain differences in STI trends between MSM and heterosexual men.
P1-S2.43 Behavioural and biological surveillance among man who have sex with man using respondent-driven sampling methodology in Manaus, Amazon, Brazil
Authors: Benzaken A S , Galban E G , Benzaken N S ,   C K, Pinho A , Mello M , Vasquez F , Barros C A , Sansigolo Kerr L R Franco
Published: July 2011

Background

There is a renewed interest in including men who have sex with men (MSM) in global HIV surveillance. A multicenter study of 10 Brazilian cities was designed to generate a national-level estimate the prevalence of HIV and syphilis among MSM. This abstracts presents the results of one of the participating cities.

Objectives

To establish a baseline among MSM in Manaus to continuously monitor the prevalence of HIV and syphilis infection, level of knowledge about STI/HIV/AIDS, prevailing sexual attitudes and practices, and frequency of acts of discrimination against MSM.

Methodology

A cross-sectional study of 824 MSM (>18 years old) was conducted from October to May 2008 using respondent-driven sampling (RDS)- a chain-link and snowball sampling method that generates probability-based samples and is systematic, so it can be used to develop comparable surveillance data.

Results

The weighted prevalence obtained with the use of Respondent-Driven Sampling Analysis Tool (RDSAT) software were 6.8% (CI 4.9 to 9.8) for HIV and 4.0% (CI 2.6 to 5.8) for syphilis. A number of participants reported sex with both men and women (47.8% of HIV positive and 56.1% of syphilis cases), while 20% of HIV positive and 30% of syphilis cases classified themselves as gay or homosexual. A previous infection of syphilis was the main predictive variables associated with HIV. The average age of first intercourse was 13.25 (with a range 5−23). This pattern of early sex suggests abuse. Fifty four point five per cent of participants had their first sexual intercourse with men, 42.6% with women, and 2.2% with transvestites. Participants also reported—41% (CI 37 to 47) used condoms in their first relationship, 73.1% (CI 69.7 to 77.2) had at least one casual sex partner during the previous 12  months, 31.6% (CI 27.7 to 35.9) used condoms consistently with casual relationships if they were with men and 15.5% (CI 11.9 to 18.9) with a woman. Nineteen per cent of MSM said they had been the target of direct physical aggression due to their sexual identity, 10% reported being forced to have sex against their will, and over 30% reported being humiliated or disrespected because of their sexual orientation.

Conclusions

The prevalence of HIV and syphilis infection in MSM in the city of Manaus is relatively high. There is substantial discrimination against MSM. The need of specific public policy and awareness campaigns for this vulnerable group is urgent.
P1-S2.44 Trends in STI in MSM visiting Dutch STI centres; does age matter?
Authors: Koedijk F , van Beek P , Koops K , van der Sande M A B ,   On behalf of the Dutch STI centres
Published: July 2011

Objectives

This study examined the distribution of selected sexually transmitted infections (STI) in men and men having sex with men (MSM) attending STI clinics in the Netherlands, separately for young (≥25 years) and older (>25 years) MSM.

Methods

Data from 2004 up to June 2010 from the Dutch national surveillance in the STI centres were used to characterise trends in positivity rate in STI (at least one of the following—chlamydia, gonorrhoea, syphilis or HIV). Logistic regression was used to identify factors associated with STI positivity in both groups.

Results

Older MSM tested more often positive for STI than younger MSM—21.5% vs 18.4%, respectively (p<0.05). However, in older MSM there was a significant decreasing time trend in STI positivity (from 23% in 2004 to 19% in 2010, p<0.05, abstract P1-S2.44 figure 1), while in young MSM the STI positivity rate remained stable over time. In multivariate analyses for young MSM, non-Dutch MSM tested significantly more often positive (OR 1.4, 95% CI 1.3 to 1.6), as did those with a previous STI (OR 1.9, 95% CI 1.6 to 2.1), known HIV positives (OR 3.1, 95% CI 2.3 to 4.2), sex workers (OR 1.2, 95% CI 1.1 to 1.6) and those with a low socio-economic status (OR 1.5, 95% CI 1.2 to 1.9). In older MSM, also non-Dutch MSM tested significantly more often positive (OR 1.2, 95% CI 1.1 to 1.2), as did those with a previous STI (OR 1.6, 95% CI 1.5 to 1.7), known HIV positives (OR 1.9, 95% CI 1.8 to 2.1) and those with a low socio-economic status (OR 1.2, 95% CI 1.1 to 1.3). In contrast with young MSM, older MSM working as sex workers were at significantly lower risk (OR 0.7, 95% CI 0.6 to 0.9) for testing positive for any STI.

Conclusions

Young MSM are a specific group within total group of MSM, with some risk factors differencing from older MSM. While trends in positivity are decreasing over time in older MSM, they remain stable and high in young MSM. Therefore special attention needs to be paid towards counselling and reaching (specific groups of) young MSM, since they are at high risk for STI acquisition and transmission.
P1-S2.47 Serosorting and sexual risk behaviour during casual sex among MSM - from one-night stands to sex buddies
Authors: Stolte I , Van den Boom W , Sandfort T , Davidovich U
Published: July 2011

Background

Among HIV-negative men who have sex with men (MSM), any incident of unprotected anal intercourse (UAI) between casual partners is usually regarded as risky for HIV. However, men are increasingly using knowledge of their casual partner's HIV-status to reduce the risk for HIV during UAI (serosorting). Since familiarity between casual partners may lead to higher levels of UAI and serosorting, we examined how often men have UAI and report serosorting with three casual partner types that differ in the degree of familiarity.

Methods

We included 240 HIV-negative men of the Amsterdam Cohort Study among MSM. We distinguished three casual partner types—one-night stand (“met by chance and had sex only once”); multiple-time casual partner (“met by chance and had sex several times”); and sex buddy (“contacted on a regular basis for sex but not considered a steady partner”). Serosorting was defined as UAI with an HIV-negative partner. GEE analyses were performed to examine the association between casual partner type and sexual risk behaviour.

Results

240 participants accounted for 362 reports of anal intercourse, of which 206 (57%) with one-night stands, 95 (26%) with multiple-time casual partners, and 61 (17%) with sex buddies. The proportion of UAI was 19% (39/206) with one-night stands, 20% (19/95) with multiple-time casual partners, and 34% (21/61) with sex buddies. When performing UAI, 21% (8/39) reported serosorting with one-night stands, 42% (8/19) with multiple-time casual partners, and 52% (11/21) with sex buddies. Analyses revealed that only men with a sex buddy were significantly more likely to have UAI (OR [95% CI] 2.39 [1.39 to 4.09]), but were also more likely to practice serosorting than men with a one-night stand (OR [95% CI] 5.20 [1.20 to 22.52]). No differences were found between the multiple-time casual partner and the other partner types.

Conclusions

Men with a sex buddy had more UAI but also reported more serosorting than men with a one-night stand. As a result, the proportion of UAI without serosorting is lower for men with a sex buddy, and therefore men might have less UAI at risk for HIV with this partner type. However, the quality of serosorting with casual partners and hence their protective value against HIV needs to be further established. At this time, we suggest that a distinction between the one-night stand and the sex buddy should be incorporated in future studies as risk behaviour of MSM is significantly different between these partner types.
P1-S2.48 Exponential growth of Lymphogranuloma venereum diagnoses in the UK: Investigation of the largest documented outbreak among men who have sex with men
Authors: Hughes G , Alexander S , Simms I , Conti S , Powers C , Ison C
Published: July 2011

Background

With over 1500 cases reported, the UK now has the largest documented outbreak of Lymphogranuloma venereum (LGV) among men who have sex with men (MSM). Of particular concern is the recent exponential rise in cases—a third of all cases have been reported since 2010. We investigated the characteristics of this outbreak and specifically whether any factors were associated with the sharp upsurge in cases in 2010.

Methods

The UK LGV Incident Group launched a diagnostic reference service and enhanced surveillance of LGV in the UK in October 2004. All symptomatic patients attending UK GUM clinics who were chlamydia-positive or contacts of positive cases were referred to STBRL in London and later also to the Scottish Bacterial Sexually Transmitted Infections Reference Laboratory in Edinburgh for confirmation. Enhanced LGV surveillance forms were completed by clinicians caring for cases and submitted to the HPA for analysis. An epidemic curve was plotted and the point of exponential growth estimated. The characteristics of cases prior to and during the exponential growth phase were compared.

Results

Since 2003, 1570 LGV cases have been reported in the UK, of which 1268 (81%) had enhanced surveillance forms available. All but 8 (99%) were in MSM and most (77%) were seen in London, Brighton and Manchester. The point of exponential growth was estimated as 1st October 2009. Compared to cases prior to this date, cases in the growth phase were more likely to be older (41% vs 38% aged over 40), to be HIV positive (84% vs 78%), to be HCV antibody positive (27% vs 22%), to report unprotected anal intercourse (UAI) (80% vs 77%) and fisting (19% vs 14%), to present outside London (32% vs 27%), and to have acquired LGV in the UK (91% vs 87%). Overall, median case age was 38, 84% were white and 11% reported they acquired the infection outside the UK, mostly in Western European countries associated with the epidemic. UAI was reported by 78% of cases and at least 50 were identified as re-infections.

Conclusions

LGV is becoming endemic in the UK and is characterised by HIV positive MSM involved in dense sexual networks. Although cases associated with the recent upsurge are more geographically widespread, there is no evidence of dispersal among lower risk or HIV negative MSM. LGV control will require intensified awareness raising and outreach among at risk populations. Regression modelling of key variables is underway to investigate and validate these findings.
P1-S2.50 Anal non-L Chlamydia trachomatis infection in men who have sex with men, at l'Actuel, Montreal, Quebec
Authors: Charest L , Thomas R , Trottier B , Boissonnault M , Legault D , Longpré D , Szabo J , Maziade P J , Machouf N
Published: July 2011

Few cases of sexually transmitted Hepatitis C infection (HCV) in men who have sex with men (MSM) had been reported in the literature.

Background

The incidence of genital infection from non-LChlamydia trachomatis(CT) is increasing in the province of Quebec. Traditionally it was more prevalent in young women. In the last few years, CT infection has emerged in men who have sex with men (MSM) group. The objective of this study was to describe anal non-L CT infection in MSM in an HIV-STI clinic in a large urban setting.

Methods

Retrospective study of anal non-L CT cases diagnosed at Clinique l'Actuel in 2010. We collected information on age at diagnosis, HIV status, CT serovars, symptoms, mode of transmission and concomitant presence of CT in urine. An anal swab specimen was collected with a TAAN test (BD Probe Tec TM).

Results

From 2006 to 2009, we diagnosed respectively 42, 58, 82 and 118 anal non-L CT infection in MSM. In 2010, we diagnosed 154 different anal non-L CT infections in 152 MSM. Patient's age at diagnosis was 33 years (IQR—25−38) from 18 to 70 years. 28% were HIV+ at time of diagnosis. Anal infection was primarily caused by serovars J (35%), G (31%), D (23%), E (10%), F (1%) and C (1%). Among HIV patients the serovars was predominantly J (46%), D (30%) and G (24%). But this difference was not statistically significant. Anal non-L CT infection was detected in asymptomatic patients while screening in 54% of case. 7% of MSM had no symptom but consulted because they were notified by a sexual partner. 39% had symptoms—proctitis (26%), urethritis (11%) or symptom of other STI including syphilis and HIV primary infection (2%). Mode of transmission for the anal infection was not specifically specified in the file of the patients, but 88% reported anal unprotected penetration in the past year, 12 % did not report anal penetration but had mouth to anus contact (rimming) or friction from penis to anus. One patient reports sharing anal toys. Urine CT was positive in 18% of MSM, so those MSM had two infected sites.

Conclusion

Given the high rate of positive results, MSM should be screen with a TAAN test for anal CT infection. This screening should be included in the regular follow-up of HIV patients. MSM community should be aware of this emerging infection. Public health authority should focus on developing and promoting new guidelines of screening, access to validated test with identification of serovars.
P1-S2.54 Repeat Gonococcal and chalymadial infections in a cohort of men who have sex with men in India
Authors: Deshpande G R , Risbud A R , Narayanan P , parimi P , Das A
Published: July 2011

Background

Men who have sex with men (MSM) are found to be at increased risk for many sexually transmitted infections (STI). Among the STIs, most common are bacterial STIs such asNeisseria gonorrhoea(NG) andChlamydia trachomatis(CT). In the present study we analysed determinants of repeat gonococcal and chlymadial infections among the cohort of high-risk MSM.

Methods

Between 2008 to 2009, 512 MSM attending STI clinics in four clinics of two cities (Mumbai and Hyderabad) of India were recruited and followed for 3 months. First catch urine, rectal swabs, Pharyngeal swabs were collected in all visits and tested for NG and CT by Gen-Probe APTIMA Combo II assay and Roche PCR (Pharyngeal swabs positive by Roche Amplicor and 16s RNA NG PCR were considered). Presumptive treatment for gonorrhoea and chlamydia at the baseline visit and syndromic STI management at all subsequent visits was provided during the study period. Re-infection was defined as a positive test result occurring after 30 days and above after an initial positive result until the last follow-up.

Results

Of 417 MSMs recruited during 2008−2009, 454 made at least on fallow-up visit. Three hundred and fifteen were NG infected and 138 were CT infected. 41 (9%) NG and 7 (1.5%) CT re-infections were observed during the follow-up visits see Abstract P1-S2.54 Table 1. Past history of STI (as reported by the participants) (OR=2.82, p=0.00) and diagnosis of any STI by Physician (OR=2.24, p=0.05) were significantly associated factors with re-infection.

Conclusions

Cumulative incidence of repeat gonococcal infections among MSMs highlight the need of a routine STI screening, prevention counselling, promoting use of consistent condom, laboratory screening and prompt treatment of patients at high risk. These efforts maximally help in avoiding recurrent NG/CT re-infection among high risk MSMs and there partners.

Abstract P1-S2.54 Table 1

Re-infection frequency among cohort of men having sex with men in India

VisitsVisit 1Visit 2Visit 3Visit 4TotalNG-Re-infection No re-infection/ Negatives5124353422321521 Re-infected (31 to 292 days)01913941 Total5124543552411562CT-Re-infection No re-infection/Negatives5124513522401555 Re-infected (31 to 291 days)03317 Total5124543552411562
P1-S2.59 Oropharyngeal human papillomavirus (HPV) prevalence and risk factors in men having sex with men (MSM)
Authors: Read T , Vodstrcil L , Tabrizi S , Garland S , Grulich A , Hocking J , Catriona B , Chen M , McCullough M , Fairley C
Published: July 2011

Background

HPV-associated oropharyngeal cancers are becoming more common. We sought to determine the prevalence of, and risk factors for oropharyngeal HPV infection in MSM, and to compare the sensitivity of throat swab, oral rinse and absorbed rinse specimens.

Methods

Cross-sectional study of 500 MSM (half with HIV infection) attending Melbourne Sexual Health Centre in 2010. Men completed a behavioural questionnaire, provided a self-administered throat swab and a gargled saline sample. Half the saline was absorbed in a tampon, to be suitable for postage. If HPV was present on type-common polymerase chain reaction, it was typed by linear array. ORs for risk factors were calculated by logistic regression.

Results

At least one type of HPV was found in 74 of 500 men, a prevalence of 14.8% (95% CI 11.7% to 17.9%) and HPV type 16 was found in 2.8% (95% CI 1.4% to 4.3%). Prevalence of any oropharyngeal HPV was 21.9% in HIV-infected men and and 8% in HIV-negative men—univariate OR 3.2 (95% CI 1.8% to 5.8%). The number of oral sex partners in the previous 2 weeks or previous year was not significant. After multivariate analysis, HIV status was no longer significant. But smoking, older age or higher numbers of reported lifetime oral sex partners all remained significant (Abstract P1-S2.59 table 1).

Abstract P1-S2.59 Table 1Adjusted OR95% CIpHIV+1.70.9 to 3.30.11smoker1.81.0 to 3.10.03Age <30Age 30–401.60.7 to 3.60.25Age >402.51.1 to 5.60.03Oral sex partners: <20 during lifetime20–1002.41.1 to 5.20.03>1003.51.6 to 7.50.002

Conclusions

Oropharyngeal HPV was more than twice as prevalent in HIV-infected MSM as in HIV-negative MSM, likely due to confounding by older age and higher numbers of lifetime sexual partners in this group.
P1-S2.61 High HIV rates among men who have sex with men in Jamaica despite increased prevention efforts
Authors: Figueroa J P , Weir S , Cooper C J , Byfield L , Eastman S , Hobbs M , Duncan J
Published: July 2011

Background

Adult HIV prevalence in Jamaica is 1.7% while rates among men who have sex with men (MSM) were 32% in a 2007 survey. Following this survey prevention interventions among MSM were increased. The objective of this study was to estimate HIV rates among MSM in 2011 and compare findings with the 2007 survey.

Methods

An experienced research nurse attended prevention workshops for MSM as well as their social activities and invited MSM to participate in a cross sectional survey. MSM were interviewed and tested for HIV and other STIs. Sensitive behavioural data was interviewer administered and self-completed. Confidential results were given to participants with treatment as indicated. Ethical approval and informed consent was obtained. The 2011 survey is ongoing so results are preliminary.

Results

33% of 157 MSM were HIV positive in 2011 compared with 32% of 201 MSM in 2007. In 2011, 8 of 157 (5.1%) MSM were positive for syphilis and 3.8% were indeterminate. 12 of 139 MSM (8.9%) were positive for Chlamydia and 2 (1.4%) had gonorrhoea. In 2007 HIV positive MSM were more likely to ever have a STI (37.5% vs 19.0%, p=0.004) and to be receptive (73.4% vs 59.1%, p=0.005). 33% of MSM reported sex with a woman in the past 4  weeks and 65% reported ever having sex with a woman. Nearly 60% of HIV positive MSM had not disclosed their status to their partner. MSM who were of low socio-economic status, ever homeless and victims of physical violence were significantly more likely to be HIV positive.

Conclusions

HIV prevalence among MSM remains unacceptably high. MSM are more socially vulnerable than the general population. Many MSM reported having sex with a woman and not disclosing their HIV status to their partners. MSM are likely to act as a bridge for HIV into the general population. Prevention efforts among MSM need to be scaled up urgently and measures taken to reduce their social vulnerability including stigma and discrimination.

Abstract P1-S2.61 Figure 1
P1-S1.12 Age-specific incidence of chlamydia, gonorrhoea, and trichomoniasis infection in adolescent women
Authors: Tu W , Batteiger B , Ofner S , Van Der Pol B , Fortenberry D
Published: July 2011

Background

Age-specific incidence rates of sexually transmitted infections (STI) withChlamydia trachomatis(CT),Neisseria gonorrhoeae(GC), andTrichomonas vaginalis(TV) are not well characterised in adolescents and young adult women. In this research, we described the CT, GC, and TV incidence rates in young women as functions of age.

Methods

Young women aged 14 and 17 were recruited from three adolescent medicine clinics in Indianapolis, Indiana. Study participants were followed longitudinally for up to 8.2 years. Participants were tested for CT, GC, and TV at the time of enrolment, and at subsequent quarterly visits. Infected individuals were treated at or shortly after each visit. We analysed the longitudinally measured incidence infections with CT, GC, and TV using generalised additive mixed effect models (GAMM) with a logit link for binary outcomes. The age effect on STI incidence was modelled as a smooth non-linear function in the GAMM analysis and a random subject effect was included to accommodate the correlations among repeated STI assessments within each individual. Estimated incidence rates (with 95% CIs, in colour) for each organism were reported as smooth functions of age.

Results

The cohort included 386 young women. The average age at enrolment of study participants was 15.3 years (SD=1.1 years). A majority (89.1%) of study participants were African-American. The average age at first sexual intercourse was 14.2 years (SD=2, median=14 years). The mean cumulative number of sexual partners measured at the time enrolment was 3 (SD=4, median=2). The average length of follow-up was 3.5 years (SD=2.2 years). Baseline prevalence rates were 10.9%, 4.4% and 6.0% for CT, GC, and TV, respectively. The age-specific incidence rates for the three organisms and any STI are seen in the Abstract P1-S1.12 figure 1.

Abstract P1-S1.12 Figure 1

WTU.

Conclusions

The estimated STI incidence rates clearly differ by organisms, not only in magnitude but also in peak age. While the prevalence rates of the respective organisms in the partner population may be a contributor to the differential risk of STI acquisition, the fact that such differences were observed from the same group of individuals with the same sexual partners and sexual behaviours raises questions about age-related differences in susceptibility to infection by the three organisms.