bluuebunny/crossref_metadata_2025 huggingface dataset:
P1-S1.51 Prevalence of anogenital Warts among STD clinic patients-STD surveillance network, USA, January 2010–September 2010
Authors: Llata E , Pugsley R , Tabidze I , Asbel L , Bernstein K , Kerani R , Schwebke J , Longfellow L , Mettenbrink C , Guerry S , Zenilman J , Klingler E , Weinstock H
Published: July 2011

Background

STD clinics routinely provide diagnostic and treatment services for anogenital warts. With the availability and increasing use of a highly effective quadrivalent vaccine against the HPV types associated with 90% of anogenital warts, the impact on patients presenting with anogenital warts to STD clinics may be significant. To be positioned to estimate the population-level impact of HPV vaccine on STD clinics, we conducted a baseline cross sectional analysis of patients with anogenital wart-related visits.

Methods

We reviewed STD clinic data collected on patients seen by a clinician from 1 January 2010 to 30 September 2010 in 11 sites (38 clinics) participating in the STD Surveillance Network (SSuN)—Seattle, WA (1 clinic); San Francisco, CA (1); Los Angeles, CA (12); Denver, CO (1); Chicago, IL (5); New Orleans, LA (1); Birmingham, AL (1); Richmond, VA (3); Baltimore, MD (2); Philadelphia, PA (2); New York City, NY (9). SSuN uses a collaboratively developed protocol to collect demographic, risk behaviour, and clinical data on all patients with anogenital warts at participating STD clinics. The unit of analysis was unique patients; patients were considered to have anogenital warts if warts were identified at any visit.

Results

Among SSuN sites, 3–13% (median 4%) of STD clinic patients had anogenital wart-related visits, with 5063 patients presenting for 6989 visits. Among patients with anogenital warts, 20% of the patients had multiple anogenital warts-related visits (range 2–26 visits). Overall, the median prevalence rate was 2% (range 1–5%) for women and 6% (range 4–22%) for men. By age and sex, median prevalence rates were highest among women aged 20–24 at 3% (range 1–7%) and among men aged 25–29 at 8% (range 5–25%). Among men who have sex with men (MSM), the median prevalence was 7% (range 4–18%) and among men who have sex with women only (MSW) it was 6% (range 3–23%). Of patients with anogenital warts, 40% were African American, 32% were white, 21% were Hispanic compared to all clinic patients who were 58% African American, 18% white, and 18% Hispanic. 59% received treatment and most treatment (97%) was provider applied.

Conclusions

The prevalence of anogenital warts among women is low in STD clinics. It may thus be difficult to monitor the impact of the HPV vaccine in women in these settings. However, the higher prevalence in MSM and MSW suggest that these clinics may provide settings in which to monitor anogenital warts in men.
P4-S1.08 Performance comparison ofNeisseria gonorrhoeae(NG) sequence typing methods NG-MAST and NG-MLVA on a defined panel of isolates
Authors: Heymans R , Golparian D , Bruisten S , Unemo M
Published: July 2011

Background

The increase inN gonorrhoeae(NG) prevalence since the mid-1990s, increasing antibiotic resistance, and the absence of an effective vaccine, demand more efficient national and international surveillance of the NG epidemiology. Accordingly, objective, robust and discriminatory genotyping is a crucial tool. The performance characteristics of the internationally frequently used NG multiantigen sequence typing (NG-MAST) and the recently developed multi-locus variable-number tandem repeat analysis (NG-MLVA), were compared.

Methods

From 2002 to 2003, NG isolates (n=330) were obtained from multiple anatomical locations from the same patient (n=118) and from self reported sexual contacts (54 couples). These isolates, were genotyped using NG-MAST, by sequencing of more polymorphic segments of porB and tbpB, and by NG-MLVA, which examines polymorphisms in five different tandem repeat loci.

Results

From the 118 patients with multiple isolates per visit, 97 (82.2%) had identical NG-MAST STs. Of these 97, 68 patients (57.6%) had isolates with identical MLVA types, 22 patients (18.6%) had single-locus variants (SLVs), six patients (5.1%) had double-locus variants (DLVs), and one patient (0.8%) had a multilocus variant. Of the isolates of 13 patients (11.0%) with non-identical NG-MAST STs, nine patients had identical MLVA types, three patients had SLVs, and one patient had a DLV. For the isolates of the remaining eight patients (6.8%), both typing methods identified divergent genotypes. So for 76 patients (64%) fully concordant clustering was obtained. Considering a SLV as an identical MLVA type the concordance between the two techniques increased to 83%. From 44 of the 54 couples (81.5%), the isolates of the patient and the contact had identical NG-MAST STs, while there were 34 MLVA couples (63.0%) with identical MLVA types, seven couples (13.0%) with SLVs, and three couples (5.6%) with DLVs. The isolates of 6 couples (11.1%) had identical MLVA types with different NG-MAST STs. In the isolates of four couples (7.4%) both typing methods identified divergent genotypes. So for 45 couples (83%) the two typing techniques were concordant.

Conclusions

For efficient international surveillance of gonorrhoea transmission, objective, highly discriminatory, but stable genotyping is essential. Both NG-MAST and NG-MLVA displayed a high resolution and are sequence-based portable genotyping methods. They can either be used singly or in combination, depending on epidemiological questions.
P4-S3.01 Macrolide-resistance testing and molecular subtyping of Treponema pallidum strains from South Africa
Authors: Muller E , Paz-Bailey G , Lewis D
Published: July 2011

Objectives

To determine whether the main 23S rRNA mutation (A2058G) that confers macrolide resistance inTreponema pallidumis present among DNA obtained from syphilitic ulcers in South Africa and to determine the strain subtype distribution using molecular methods.

Methods

DNA was re-extracted from sixty ulcer swabs, previously shown to containT pallidumDNA by in-house real-time multiplex PCR assay, using a MagNA Pure Compact DNA extraction system (Roche, Germany). The genital ulcer specimens were collected in South Africa between 2005 and 2009 during either national microbiological surveillance activities or as part of large episodic acyclovir treatment trial (HSV4294). The re-extracted DNA was screened for the A2058G point mutation in the peptidyltransferase region of the 23S rRNA subunit using a rapid PCR-based restriction digest assay. Subtyping ofT pallidum, using a previously-published technique, was based on the molecular characterisation of two variable treponemal repeat genes, arp and tpr.

Results

Macrolide resistance profiles and the subtype distribution for all 60 DNA samples were obtained. The mean age of all participants was 27.4 years (range 18–43; SD 5.24) of which 55 (92%) were male and 5 (8%) were female. None of the samples analysed contained the 23S rRNA gene point mutation that confers macrolide resistance. A total of eight arp repeat sizes, 8 RFLP patterns and a combined total of 17 subtypes were identified in this study population. The most common subtypes were 14d (43%), followed by 17d (13%), 14b (7%), 22b (5%) and 23b (5%).

Conclusions

This is the first South African study to examine both macrolide-resistance profiles and the subtype distribution of syphilis strains using molecular techniques. Macrolide-resistantT pallidumstrains appear to be uncommon in South Africa compared to more developed countries. Our results indicated subtype 14d to be the predominant circulatingT pallidumstrain in South Africa and there seem to be a high degree of genetic heterogeneity within this population.
P4-S3.05 Clinical titres and stability ofTrichomonas vaginalisRNA in urine specimens
Authors: Catania M , Bennett C , Pae A , Weinbaum B , Getman D
Published: July 2011

Background

This study estimated the range of concentrations ofTrichomonas vaginalis(TV) present in naturally infected female urine specimens and evaluated the ability of the APTIMATrichomonas vaginalis(ATV, Gen-Probe Incorporated) Assay to detect a clinically-relevant amount of TV cells spiked into TV-negative male and female urine samples and stored at various temperatures.

Methods

Female urine samples collected as part of a prospective, multicenter US clinical trial were tested with the ATV Assay, a nucleic acid amplification test for the diagnosis of TV infection in asymptomatic and symptomatic women. To determine TV cell titres, serial dilutions of TV-positive urine samples were tested and results were compared to results from serial dilutions of a laboratory culture of TV with a known cell titre. To assess the stability of TV cells in urine samples, 10 male and 10 female urine samples from non-infected volunteer donors were spiked with a cultured strain of TV, stored at 4°C, 20°C and 30°C, and tested daily for up to 14 days with the ATV assay.

Results

Of 39 randomly selected TV-positive female urine samples, the median titre in unprocessed samples was 311 cells/ml (mean=2040 cells/ml; SD=4765 cells/ml), with a range of 2–28 430 cells/ml. Of these 39, 87.2% (34/39) had a TV cell titre of ≥20 cells/ml in neat urine see Abstract P4-S3.05 figure 1. To assess stability of TV cells in urine, freshly collected male and female urine samples from volunteer donors were spiked with TV to 20 cells/ml (4 cells/reaction in the ATV assay), stored at various temperatures, and then tested with the ATV assay. For samples stored at 4°C, the ATV assay was 100% reactive for both male and female samples after 14 days of storage. For samples stored at 20°C, male samples were 100% reactive after 7 days storage, while female samples were 100% reactive after 6 days of storage. For samples stored at 30°C, 100% reactivity was obtained at 2 days storage for male samples and 4 days storage for female samples.

Abstract P4-S3.05 Figure 1

Two-phylotype population structure of globalTrichomonas vaginalisisolates.

Conclusions

This study shows urine samples from women infected with TV have a wide range of cell titres, with an average of ∼2000 TV cells/ml. TV can be detected for 14 days when stored refrigerated or for about 1 week at 20°C. The use of sensitive, automated molecular tests such as the ATV assay for testing urine samples should facilitate screening for TV.
P4-S3.06 Study on early infection of the low genital tract of female mice by different serotypesUreaplasma urealyticum
Authors: Yang B
Published: July 2011

Objective

To observe the early inflammatory response by animal model with low genital tract Uu infection for investigating the relationship between the serovars and their pathogenicity.

Methods

Fifty 8–10-week-old, female BALB/c mice were randomly divided into five groups, namely, control group, serovar 1 group, serovar 3 group, serovar 4 group, and serovar 8 group, and then treated respectively with vaginal inoculation of liquid medium and Uu inoculae of serovars 1, 3, 4 and 8 after subcutaneous injection of oestradiol benzoate. The vulval symptoms and vaginal and cervical swabs were observed weekly after Uu inoculation. Four weeks later, all mice were sacrificed and their cervixes and vaginae were removed for histopathology.

Results

There was a significant difference in the inflammation severity of cervical mucosa (p<0.001–0.05) except vaginal mucosa among all groups. The inflammation severity of cervical mucosa in serovar 4 and 8 infection was superior to that in serovar 1 infection (p<0.01–0.05), but there was no statistical difference among other groups (p>0.05).

Conclusions

The results suggest that Uu could colonise and infect the cervical columnar epithelium other than vaginal squamous epithelium. Uu-induced inflammation response is different among its serovars. Serovars 4 and 8 are more virulent compared with biovar 1 such as serovar 1.
P4-S3.07 Population genomics ofTrichomonas vaginalisreveals a globally distributed two-phylotype population structure
Authors: Conrad M , Gorman A , Schilinger J , Sullivan S , Upcroft J , Gonzalez J , Fiori P L , Arroyo R , Ravel J , Secor W E , Carlton J
Published: July 2011

Objective

Trichomonas vaginalis, the causative agent of human trichomoniasis, is the most prevalent non-viral sexually transmitted infection and has been associated with increased risk of HIV transmission, making detection and treatment a global health priority. In this study, we evaluate the population genomics of globally distributed clinical isolates to characterise genetic diversity and identify population structure.

Methods

We use a panel of 21 microsatellite and three single copy gene markers to evaluate the population genomics of 18 clinical isolates collected from female patients attending New York City STD clinics in 2008, as well as 177 extant isolates collected from the USA, Mexico, Chile, Italy, Southern Africa, Papua New Guinea, and Australia. We use a panel of population genetic tools including Arlequin 3.11 and FSTAT to calculate expected heterozygosity (HE) and population differentiation (FST) statistics. To infer population structure, we use STRUCTURE 2.2, Network 4.516, and SeaView 4.2.4. We test for significance in clinical and demographic variables (χ2and t-tests) using JMP Genomics 5.0.

Results

We detect significant genetic diversity within the species (HE=0.66) that is observed across global regions (range 0.52–0.67), and find that a two-phylotype population structure is maintained globally with few instances in population differentiation defined by geographical origin. This two-phylotype structure is further supported by minimum spanning networks, hierarchical clustering and phylogenies inferred from three single copy genes. These two phylotypes appear at nearly equal frequencies globally. Defining characteristics of the phylotypes include significantly different prevalence ofT vaginalisvirus infection (3% in phylotype 1 and 73% of phylotype 2 (p<0.0001, χ2)) see Abstract P4-S3.07 figure 1 and a significantly higher minimum inhibitory concentration of metronidazole in phylotype 1 (p=0.0024, χ2Wilcoxon Rank Sums).

Abstract P4-S3.07 Figure 1

TVV infection status by phylotype.

Conclusions

We detect clear population structure and high levels of genetic diversity from globalT vaginalisisolates. This preliminary data suggests that phylotypes differ phenotypically. An accurate survey of genetic diversity and population structure will facilitate responsible selection of drug and/or vaccine targets for future treatments, and will enable better understanding of virulence factors contributing to the wide range of severity of symptoms associated with trichomoniasis.
P4-S3.10 ATrichomonas vaginalishuman vaccine candidate: Freund's adjuvant vs aluminium hydroxide adjuvant in a BALB/c mouse vaginal infection model
Authors: Smith J , Garber G
Published: July 2011

Background

Trichomonas vaginalisis an underreported STD known to increase HIV transmission. Development of a vaccine againstT vaginaliscould greatly affect transmission ofT vaginalisand HIV as well as reducing their global prevalence. Herein, we aim to investigate the feasibility of developing aT vaginalisvaccine using the human-safe adjuvant Alhydrogel compared against an already established Freund's adjuvanted vaccine in a BALB/c vaginal infection mouse model.

Methods

A prime-boost vaccination schedule was employed with live, whole cellT vaginalis(1×107 Tv/ml) is injected in 2–200 ul aliquots 4 weeks apart and prior to vaginal infection challenge. Either Freund's, 0.5 mg Al/ml Alyhydrogel, or 0.75 mg Al/ml Alhydrogel were applied as adjuvants. Additionally, 0.75 mg Al/ml Alhydrogel sham and non-vaccinated groups serve as controls. The BALB/c vaginal environment was modified to mimic humans by adjustment of vaginal flora and estrogenisation prior to vaginal infection. The total IgG, IgG1 and IgG2a levels in serum were tested 3 weeks post each vaccine injection, then 2 and 4 weeks post-vaginal infection by ELISA. Groups were compared using Tukey's MCT (Post-Hoc one-way ANOVA; α<0.05).

Results

Alhydrogel adjuvanted groups showed comparable total IgG and IgG1 levels to Freund's adjuvanted group. These levels for all adjuvanted groups were significantly different from control groups at all time points following boost-vaccination. IgG2a levels were not as consistent with large SD seen within Freund's adjuvanted mice. Alhydrogel adjuvanted groups were not significantly different from control groups at any time point for IgG2a levels suggesting no induction of IgG2. Controls and sham vaccines showed no Ig response.

Conclusions

Our data suggest that in line with expected Th2 skewed response from Alhydrogel adjuvant and Th1 skewed response from Freund's adjuvant there was a difference in IgG2a antibody production. Additionally, the Alhydrogel adjuvanted vaccines are otherwise similar to Freund's adjuvant in terms of total IgG and IgG1 levels suggesting the feasibility to pursue Alhydrogel as a vaccine candidate. Alhydrogel induces a significantly elevated immune response compared to natural infection antibody production (non-vaccinated control) and does not induce a nonspecific immune response.
P4-S4.02 A 22-Organism microarray approach for detecting microbiological associations with symptomatic urethritis in males
Authors: Patel S , Pond M
Published: July 2011

Background

In addition to its known microbiological aetiology, urethritis in men may be linked with other genital tract organisms, as yet unidentified in its pathogenesis. We used a microarray, with capacity to detect 22 genital tract organisms, in order to determine the association of symptomatic urethritis with infection or carriage of these organisms.

Methods

129 patients were asked to provide an extra first void urine specimen or give permission for their residual urine specimen submitted forChlamydia trachomatisNAAT testing to be utilised. Patients were categorised into three self-reported symptom groups: definite symptoms of urethritis (discharge and/or dysuria), category 1(C1) n=80; non-specific symptoms of urethritis (eg, minimal urethral discomfort), category 2 (C2) n=26; and asymptomatic category 3 (C3) n=23. Total urine nucleic acid was extracted and subsequently used for PCR coupled microarray analysis. Organisms were defined as present or absent using an online data analysis method. In a pre-planned analysis, the following categories were compared for prevalence of organisms: C1 vs C2 and C3 combined; C1 and C2 combined vs C3 using Fisher's exact test.

Results

One or more organisms were detected in 74% (n=95) of patients and two or more organisms in 33% (n=42). The prevalence of organisms known to cause urethritis in this largely symptomatic cohort was: 16% (n=21), 9% (n=12) and 5% (n=6) forC trachomatis,Mycoplasma genitaliumand forNeisseria gonorrhoeaerespectively.Escherichia coliwas the most prevalent organism detected with a prevalence of 18% (n=23). The presence ofM genitaliumwas statistically associated with C1 and C1 and C2 combined (p=0.03 and 0.01 respectively). In symptomatic patients,C trachomatis,Ureaplasma urealyticum, andGardnerella vaginalisappeared to be more prevalent than in asymptomatics although not statistically significantly. Lactobacilli where detected in 1.3% and 4% of patients with C1 and C2 symptoms respectively, compared with 17% of asymptomatic patients. The absence of lactobacilli was associated with urethritis symptoms, either C1 alone or C1 and C2 combined (p=0.03 and p=0.01) respectively.

Conclusions

Using a polymicrobial microarray approach we have demonstrated that symptomatic urethritis is associated with depletion of lactobacilli. This confirms early work using urethral swabs. The temporal nature of Lactobacilli depletion in relation to the onset of symptomatic urethritis needs to be investigated further.
P4-S4.03 A low-cost microfluidics-based diagnostic test for STDs
Authors: Sia S
Published: July 2011

Background

Undiagnosed and untreated STIs cause large morbidity and mortality, including birth defects and stillborn babies. Since most STI's have known treatments, the largest barriers for treating patients include high cost of transporting specimens to central labs and lack of access to diagnostic testing. We present data on a portable and low-cost microfluidics device for point-of-care diagnosis of multiple STDs (such as HIV and syphilis) in combination. In order to reduce the cost and size of the assay while maintaining high performance, we incorporated microfluidic designs such as single-use plastic microfluidic cassettes, a passive method for delivering reagents, and an amplification chemistry using gold nanoparticles.

Methods

Our overall device is named mChip (mobile microfluidic chip for immunoassay on protein markers). We demonstrated an ability of mChip to simultaneously detect antibodies against HIV and syphilis in needle-pricked sample volumes. Both commercial specimens and archived specimens from Sub-Saharan Africa were used.

Results

The test sensitivities and specificities for detection of HIV-specific antibodies and treponemal-specific antibodies matched the performances from lab-based ELISA. Compared to ELISA, our test can be performed anywhere, uses a very small volume of blood, and is about 10 times faster. Some of these results are in press inNature Medicine, 2010.

Conclusion

The mChip provided excellent performance in the diagnosis of HIV using only 1 μl of unprocessed whole-blood and <15 min assay-time, and an ability to simultaneously diagnose HIV and syphilis with sensitivities and specificities equal to lab-based assays. Overall, we demonstrate an integrated strategy for miniaturising complex laboratory assays using microfluidics and nanoparticles to enable POC diagnostics and early detection of infectious diseases in remote settings.
P1-S1.53 Assessing HPV genotype prevalence in Australian women by Indigenous ethnicity pre-vaccination
Authors: Garland S M , Brotherton J M L , Stevens M I , Tabrizi S N I , Condon J , McIntyre P , Smith D
Published: July 2011

Background

A government funded HPV vaccination program was implemented across Australia from April 2007. The aim of this study was to ascertain whether HPV genotype prevalence, prior to vaccination, differed significantly by Indigenous status, age group, Pap cytology status or area of residence.

Methods

We used women attending for routine Pap smear, (April 2005–February 2008), as the sampling frame with 34 sites across Australia selected to include adequate numbers of Indigenous and remote-dwelling women. The final recruitment of 2620 (mean 33, range 15–66 years) included 26% (684) indigenous. DNA extracts from Thin-Prep specimens were screened by HPV AMPLICOR (Roche) and in-house HPV PCR/ELISA, with positives genotyped by LINEAR ARRAY HPV genotyping test (Roche).

Results

The overall prevalence of HPV infection was 39% (95% CI—36.8 to 40.6), with high risk (HR) HPV detected in 26% (95% CI—24.8 to 28.2). Single infections were detected in 17% (95% CI—15.8 to 18.7). While multiple infections were common overall at 22%, there was no difference in proportion of multiple HPV carriage between indigenous and non-indigenous (58% of HPV positive non-Indigenous women and 56% of HPV positive Indigenous women had multiple types detected). As with single infections, multiple type infections were less prevalent with increasing age. The six most common genotypes were—HPV 16 (8.3%), 51 (5.1%), 53 (4.7%), 62 (4.3%), 89 (3.9%) and 52 (3.8%). Age-specific HPV prevalence rates were similar for Indigenous and non-Indigenous women aged ≤30, but higher for Indigenous women aged 31–40, particularly for non-vaccine targeted HR-HPV genotypes. By HPV clades for this age group, indigenous women were significantly more likely to have α 7 HPV ((45, 39, 59, 68 or 70 without 18) OR 1.9 (1.1 to 3.3) p=0.03) or α 5 group (HPV51, 26, 69, 82) with OR 2.1 (1.1 to 4.3) p=0.02). There was no significant association between Indigenous status and detection of HPV from the α 9 clade (31, 33, 35, 52, 58, 67), with or without HPV 16. Overall, HR-HPV prevalence increased from 21% in women with normal cytology, to 81% in those with high-grade lesions/cancer.

Conclusions

Cross-sectional prevalence of HR-HPV was high in Australian women, with vaccine preventable genotypes observed in 13% of all women (25% in <25 year olds). Vaccination should significantly reduce vaccine related HPV infection and disease in Australian women, irrespective of indigenous status or area of residence.
P5-S1.04 The impact of pelvic inflammatory disease on sexual, reproductive and psychological health
Authors: Hocking J , Newton D , Bayly C , Fairley C , Chen M , Williams H , Keogh L , Temple-Smith M , McNamee K , Fisher J , Hsueh A , Hocking J
Published: July 2011

Background and Aim

Pelvic inflammatory disease (PID) is a condition commonly attributable to chlamydia infection. This qualitative study sought to explore the sexual, reproductive and psychological impact of this condition.

Methods

In depth, semi-structured interviews were conducted with 23 women diagnosed with PID. Both symptomatic and asymptomatic women were recruited from primary and tertiary healthcare services. Interviews were conducted with women from 2 to 12 months post-diagnosis in order to explore short and longer term psychological responses and experiences. A brief, self-report questionnaire containing demographic items was also completed by all women. Interview analysis was conducted using an inductive, thematic approach.

Results

Nearly all women experienced some form of distress when they received their diagnosis, and the emotional impact of their diagnosis was generally prolonged. Women typically experienced emotions such as shock, sadness or anger. At the time of diagnosis, women frequently had little or no knowledge of PID and continued to experience confusion about their condition post-diagnosis. Some women reported that PID had created conflict in their intimate relationships or had impacted on the level of intimacy they shared with their partner. Almost all women reported that their sexual behaviour had changed dramatically post- diagnosis. The possibility of being infertile stood out for women as their greatest health concern and nearly all women reported changes to their health behaviours since their diagnosis.

Conclusion

The findings of this study indicate that a diagnosis of PID can have significant psychosocial implications for the diagnosed individual. Recommendations for healthcare professionals are proposed.
P5-S2.03 Phase 1 implementation of male circumcision as a comprehensive package of HIV prevention in Rwanda
Authors: Mbabazi J
Published: July 2011

Background

Rwanda adopted Male Circumcision (MC) as part of a comprehensive package of HIV prevention strategies since 2007. In order to facilitate national roll out of MC, a Phase 1 campaign involving training of healthcare providers in Nyanza and Ruhengeri District Hospitals and their affiliated health centers targeting adolescents and adults was held from 30 August to 24 September 2010. The Center for Treatment and Research on AIDS, Malaria, Tuberculosis and Other Epidemics (TRAC Plus) provided MC kits and financial support (training, cost of MC procedure) to two selected districts hospitals (Nyanza and Ruhengeri) to implement phase 1. The aim of this training was to accelerate the implementation of safe, affordable and accessible male circumcision as an HIV prevention strategy while contributing in strengthening the existing programs. The quality of the MC services provided through routine data collection and formative supervision was ensured.

Methods

The training provided covered both theoretical and practical aspects of MC as an HIV prevention strategy considering the WHO training modules. The training was conducted by a team of five National trainers (three doctors, two counsellors) and the selection criteria of participants (doctors and nurses) considered those with minimum surgical skills.

Results

The training was for 10 days and 25 trainees (Medical doctors and nurses) from each District Hospital and health centers were trained in both theory and practical courses on Male Circumcision as an HIV prevention strategy and also provision of counselling on MC to the client before surgery. A 1-day training of community health workers on community sensitisation was done. Following the 2-week practical session in the two DH, 120 male circumcisions were performed and acceptability for HIV testing was 100%. Communication messages on male circumcision as an HIV prevention strategy and the other benefits of MC were provided to the communities. The follow-up visit of all people circumcised was done, and no adverse events were reported.

Conclusion

The MC phase 1 was successfully implemented in two district hospitals of Nyanza and Ruhengeri and the evaluation will be done. Among the lessons learnt were mainly on the coordination of MC activities as it requires a focal point to facilitate the activity on a continuous basis.
P5-S2.04 Assessing comprehension of key informed consent concepts among clients undergoing male circumcision during scale up of services in Zambia and Swaziland
Authors: Friedland B , Apicella L , Sheehy M , Schenk K D , Munjile K , Adams A , Hewett P C
Published: July 2011

Background

We evaluated the informed consent (IC) process for male circumcision (MC) as services were being scaled up in Swaziland and Zambia. A primary objective was to assess male clients' comprehension of key concepts in the informed consent process to improve, standardise and streamline consent procedures as service delivery was expanded.

Methods

In a post-test study design, we asked adult (18 years and older) and adolescent (13–17 years) clients who had completed counselling, but had not yet undergone MC, to respond to a 10-question, interviewer-administered, true-false comprehension test. We also collected data on demographics, recruitment for MC, and type of counselling received (group, one-on-one, VCT), and administered literacy and numeracy tests. Participants represented a convenience sample recruited from selected sites in urban Lusaka, and urban and rural sites in Swaziland. We used T-tests to test the null hypothesis that 90% of clients could pass the test (could score ≥80%), χ2tests to compare scores between sub-groups (eg, adults vs adolescents), and multivariate logistic regression models to explore factors associated with passing the comprehension test.

Results

Between November 2009 and August 2010, 228 MC clients in Lusaka (n=159 adults, 69 adolescents) and 953 MC clients in Swaziland (n=756 adults, 197 adolescents) participated in the comprehension assessment. Most clients (90%, Swaziland; 89%, Zambia) passed the comprehension test; however, the pass rate in Swaziland was significantly higher among adults than adolescents (96% and 85%, respectively; p<0.001). The question that posed the greatest difficulty to clients was about surgical risks; 67% of Zambian clients (71% adults; 56% adolescents) and 87% of Swazi clients (adults and adolescents) incorrectly responded that MC surgery has no risks. Factors significantly (p<0.05) associated with passing the test included: literacy (both countries); advanced education (Zambia); counselling language (Zambia); and age (Swaziland). In addition, not passing the test was significantly associated with hearing about MC from a friend (vs any other source) in Swaziland.

Conclusions

Service providers must place greater emphasis on potential risks of MC surgery to ensure that clients are fully informed before they consent to the procedure. Counselling messages should be tailored for adolescent clients, who may have lower levels of education and less sexual experience than adults undergoing male circumcision.
P5-S3.02 Implementing widespread antenatal syphilis screening in poor regions of Guangdong, China: a health services investigation of implementation barriers
Authors: Yang L G
Published: July 2011

Background

Decreasing the congenital syphilis burden across China is a national public health priority mandated by a newly issued National Syphilis Control Plan. But prenatal clinics in some less developed regions of China may have less capacity to implement a routine prenatal syphilis screening. This study examined the local capacity and coverage of syphilis prenatal screening in less developed regions of Guangdong Province, South China.

Methods

11 of the 14 less developed municipalities in Guangdong Province agreed to participate in this study and have a data collection survey under the auspices of the provincial health bureau. Health systems data about availability of syphilis testing, types of syphilis testing, and syphilis test screening among pregnant women were collected from all public medical settings in the study municipalities.

Results

Among the 109 clinics where a newborn delivery services were provided, only 40 clinics had syphilis testing. Prenatal clinics that were not hygiene stations, at the municipal or county level, or had greater number of deliveries per year were more likely to have syphilis testing capacity. Overall syphilis screening rates in the 109 medical settings were slightly >50% with higher screening rates at women and children's hospitals, general hospitals, medical setting at higher administrative levels or with greater number of deliveries. Only one women and children hospital had the capacity to conduct both non-treponemal and treponemal tests which are necessary to have for diagnosis of syphilis according to national guidelines.

Discussion

Syphilis screening is available at a limited number of township-level and other smaller prenatal clinics in Guangdong Province. With limited laboratory capacity at clinics at lower levels of the healthcare system and increasing prevalence of syphilis in the province, development and implementation of innovative testing strategies, including a rapid syphilis testing that can be easily performed in any healthcare setting is an urgent priority. These findings have important implications not only for successfully achieving the national plan targets of syphilis control but also for syphilis surveillance and monitoring.
P1-S1.54 High-risk Human Papilloma Virus (HPV) types prevalence in 20–64-years-old Women; Slovenian National HPV Prevalence Study, 2010
Authors: Klavs I , Ucakar V , Poljak M
Published: July 2011

Background

To estimate prevalence of 14 high-risk human papilloma virus (HPV) types among Slovenian women screened for cervical cancer.

Methods

In 2010, we conducted a cross-sectional study in a convenience sample of 4469 women 20–64 years old, who were eligible for a preventive cytological examination of the cervical smear according to the criteria of the Slovenian National Cervical Cancer Screening Program, presented during the study period within a network of 16 outpatient gynaecology services with a nationally wide geographical coverage and consented to participate. We used three-step HPV genotyping strategy on cervical smear specimens positive with Digene Hybrid Capture 2 HPV DNA Test and/or Abbot Real Time High Risk HPV Test. Infection with high-risk HPV types was defined as the presence of one or more of the following 14 HPV types—HPV16, HPV18, HPV31, HPV33, HPV35, HPV39, HPV45, HPV51, HPV52, HPV56, HPV58, HPV59, HPV66 and HPV68. The owerall prevalence of high-risk HPV types as well as individual high-risk HPV types was estimated with 95% CIs Statistical analyses were performed using the STATA package version 10.0.

Results

Prevalence of cervical infection with any high-risk HPV type examined was 13.1% (CI—12.1 to 14.0), prevalence of infection with HPV16 only was 3.5% (CI—3.0 to 4.1) and prevalence of infection with HPV18 was 1.0 (CI—0.7 to 1.3). The corresponding age specific prevalence estimates decreased with age and were the highest among 20–24 years old women—26.0% (CI 22.4 to 29.5), 9.2% (CI 6.8 to 11.5) and 1.9% (CI 0.8 to 3.0), respectively. Overall prevalence of infection with any high-risk HPV type examined was the lowest among participants without evidence of cervical disease 10.8% (CI 9.9 to 11.8) and increased with the severity of cervical disease to 72.5% (CI 61.7 to 83.3) in women with low grade squamous intraepithelial lesion (LSIL) and 83.7% (CI 72.2 to 95.2) in women with high grade squamous intraepithelial lesion (HSIL). Corresponding HPV16 prevalence estimates were 2.5% (CI 2.0 to 3.0), 26.1 (CI 15.5 to 36.7) and 41.9% (CI 26.5 to 57.2), and corresponding HPV18 prevalence estimates were 0.9% (CI 0.6 to 1.2), 7.3% (CI 1.0 to 13.5) and 7.0% (CI 0.0 to 14.9).

Conclusions

Our results provide baseline high-risk HPV types prevalence estimates and will inform future monitoring of the impact of HPV vaccination program, including possible replacement of non-vaccine HPV types and design of effective cervical cancer screening strategies.
P5-S4.02 Routine HIV testing of family members of hospitalised patients: a novel approach to HIV testing in Nigeria, sub Sahara Africa
Authors: Busari O , Adeyemi A , Nakayima M
Published: July 2011

Background

In traditional African setting, family members are closely knitted and provide effective social and supportive care for their loved ones during admission in hospitals. HIV testing for family members of HIV positive (HIV+) patients may enhance disclosure of status of spouses, encourage family social support and improve access to HIV services. The objective was to evaluate the approach of HIV testing of family members of both HIV+ and HIV− patients on admission in a large national HIV-treatment centre in Nigeria, West Africa.

Methods

This was a prospective study in which HIV testing was offered to consented family members of HIV+ and HIV− patients on admission between January 2009 and June 2010.The family members included spouses, children of patients, parents of paediatric patients and other family members. Analysis was done in frequencies and percentages.

Results

2829 family members of 3284 patients were tested. The details are: spouses, 339 (12%); fathers, 255 (9%); mothers, 1442 (51%); and others family members, 792 (28%). 2630 (93%) of testers were first timers. Most of the testers (97%) had post-test counselling. Overall HIV prevalence was 14%: 7% among spouses; 11% and 7% among mothers and fathers respectively; and 4% among other family members. Discordant status occurred in 19% of couples tested.

Conclusion

The results indicate that routine HIV testing of family members of patients on admission is a strategy for identification of large number of HIV infected persons. This method is not only innovative, but also a novel approach effective for scaling up of access to HIV prevention, care and treatment services in sub-Sahara Africa.
P5-S4.03 Systematic selection of screening participants by risk score in chlamydia screening programme is feasible and effective
Authors: Hoebe C J P A , Brouwers E E H G , van Bergen J E A M , Fennema J S A , Gotz H M , Koekenbier R H , Op de Coul E L M , Pars L , van Ravensteijn S M , van den Broek I V F
Published: July 2011

Background

Systematic screening forChlamydia trachomatis(Ct) by individual invites ensures general reach, but is less (cost) effective, as it includes people at no or low risk. Selective systematic screening can overcome this. In a large-scale Chlamydia Screening programme in the Netherlands selection by risk score was applied in one region where relatively low prevalence was expected. Here we show the effect of selection on participation, positivity and acceptability in three srceening rounds.

Methods

Invitees were alerted by personal letter to login tohttp://www.chlamydiatest.nl/and fill in an 8-item questionnaire before a test could be requested. Questions, based on a prediction rule assessed in a pilot, addressed age, place of residence, education, ethnicity, symptoms, condom use and sex partners. Answers yielded different points accumulating in a risk score. Only invitees with sufficient score of 6 or more could proceed and receive a testkit. Mailed samples were tested at a regional laboratory with NAAT. A sample of excluded participants received an acceptability questionnaire.

Results

The selection led to exclusion of 36% of potential participants and a positivity rate of 4.8% among participants (see Abstract P5-S4.03 table 1 Women scored on average higher than men (6.6 with 95% CI 6.5 to 6.7 vs 5.8 with 95% CI 5.7 to 5.9, p<0.001). Higher scores were clearly related to higher positivity rates. Persons who were excluded from participation in the first year because of a low risk score had a significantly lower response to the invitation the second round (21% vs 29%, p<0.01). The acceptability questionnaire among excluded participants (n=67, response 34%) revealed disappointment about exclusion in 30% of them but most approved of the screening set-up; 8% still went to a GP or STI centre for a Ct test.

Abstract P5-S4.03 Table 1

Participation and selection in three screening rounds

Round 1Round 2Round 3OverallInvited13 26925 18938 39576 853Filled in questionnaire (% of invited)2973 (22%)3825 (15%)4381 (11%)11 179 (15%)Average score* (95% CI)6.16 (6.07 to 6.25)6.41 (6.33 to 6.48)6.31 (6.23 to 6.38)6.30 (6.26 to 6.35)Sufficient score (% respondents)1851 (62%)2480 (65%)2777 (63%)7108 (64%)Package returned (% package requests)1477 (80%)1927 (78%)2149 (77%)5553 (78%)Positive test (% of tested)74 (5.0%)103 (5.3%)90 (4.2%)267 (4.8%)*

Average score of all persons who filled in the questionnaire.

Conclusions

Systematic selection of screening participants by risk score in Chlamydia screening is feasible and successful in realising higher positivity rates than without selection. A previous study showed a population prevalence of 2% in the same population. Acceptability of selection is high but could still be improved by better communication on expectations.
P5-S4.04 The interface between HPV vaccine implementation and STI prevention: HPV vaccine discussions as an opportunity to provide messages about sexual health
Authors: Gottlieb S , McRee A L , Reiter P , Dittus P , Halpern C , Brewer N
Published: July 2011

Background

Early parent–child communication about sex is associated with healthier behaviour during adolescence. Understanding parents' cues to initiating these conversations may provide new opportunities for public health intervention. Human papillomavirus (HPV) vaccine is recommended for all 11–12-year-old girls and is highly acceptable to parents. We sought to characterise mothers' communication with their daughters about HPV vaccine and the potential for HPV vaccine discussions to provide an opportunity for discussions about sex.

Methods

During December 2009, we conducted an online survey with a nationally representative sample (n=900) of US mothers of adolescent females aged 11–14 years (response rate=66%). We compared the proportion of all mothers using HPV vaccine discussions as a cue to talking about sex vs other potential cues using McNemar's χ2. We also assessed whether communication about HPV vaccine was independently associated with communication about sex using multivariate logistic regression. Estimates are weighted.

Results

Sixty-five per cent of mothers reported talking with their daughters about HPV vaccine, of whom 41% said that doing so led to a conversation about sex. Thus, 27% of all mothers talked about sex as a result of HPV vaccine conversations, similar to the proportion talking about sex as a result of some more widely recognised cues, such as their daughter starting menses (21%) or talking about alcohol or drugs (29%), but less than some others, such as their daughters showing an interest in boys (36%; p<0.05) or having sex education at school (46%; p<0.05). Mothers who had talked with their daughters about HPV vaccine were more likely than those who had not to have ever talked with their daughters about sex (92% vs 74%, p<0.001), even after controlling for other cues and factors associated with communication about sex (OR=3.1, 95% CI 1.4 to 6.5). Among mothers who talked about sex when talking about HPV vaccine, many felt HPV vaccine provided a good reason to do so (64%) or that it made it easier to start a conversation (33%).

Conclusions

HPV vaccine discussions provide an acceptable opportunity for mothers to talk with their daughters about sex at an age when such communication is most influential. It may be possible to capitalise on HPV vaccine discussions to promote parent–child communication about sex and provide messages about sexual health and STI prevention to early adolescents.
P5-S4.08 Integration of syphilis point-of-care test into outreach intervention services at commercial sex venues in Southern China
Authors: Yin Y P , Li J , Wei W H , Wang H C , Peeling R W , Chen X S
Published: July 2011

Background

Introduction of the point-of-care tests (rapid tests) for sexually transmitted infections (STIs) presents an opportunity to expand screening and treatment services in non-clinical settings, such as commercial sex venues where individuals who do not access standard healthcare services can be reached. A free syphilis screening with the rapid test was implemented in two southern Chinese cities (LZ and JM) to assess the feasibility of integrating rapid syphilis testing into existing outreach services for female sex workers (FSWs).

Methods

Commercial sex venues in the study sites were systematically mapped, and free rapid syphilis testing using whole blood from fingerstick was provided to the target population as a component of routine outreach services at those venues.

Results

From April 2009 to February 2010, a total of 2821 FSWs were approached by outreach workers and offered invitation to accept an onsite rapid syphilis testing, 95.1% of which accepted the test. Test acceptance rate varied a bit across different types of commercial sex venues, ranging from 91.5% among FSWs working at nightclubs to 97.6% among those on streets. Most (99.5%) preferred immediate onsite results notification or through cellphone rather than receiving it at a designated referral clinic. 182 (6.8%) respondents had a positive result, among whom 63.7% visited designated referral clinics for confirmatory test and treatment. Test uptake was positively correlated with JM (AOR 2.4, 95% CI 1.4 to 4.2), age 30–44 years old (AOR 1.9, 95% CI 1.1 to 3.3), no prior syphilis infection (AOR 2.7, 95% CI 1.3 to 5.5), or unknown history of syphilis infection (AOR 4.5, 95% CI 1.5 to 13.3), and negatively associated with working in roadside restaurants (AOR 0.3, 95% CI 0.1 to 0.9) or sauna/bathing centers (AOR 0.5, 95% CI 0.3 to 0.9) compared to FSWs working on streets.

Conclusions

It concludes that integration of a rapid and onsite syphilis testing into routine outreach services at sex work venues is feasible and well received at the study areas. However, linkage between onsite testing and referral services should be improved with further efforts to maximise the impact of onsite testing.