bluuebunny/crossref_metadata_2025_split huggingface dataset:
O04.3 Correlates of IncidentTrichomonas VaginalisInfections Among African-American Adolescent Females
Authors: Swartzendruber A , DiClemente R J , Sales J M , Brown J L , Rose E S 
Published: July 2013

BackgroundTrichomonas vaginalisis associated with adverse reproductive health outcomes, including HIV. Despite marked racial disparities, few studies have reported factors related to incidentT. vaginalisinfection exclusively among young African-American women. The objective was to identify correlates of incidentT. vaginalisinfections among African-American adolescent females.MethodsData were collected via audio computer self-interviews at baseline and every 6 months for 18 months from 701 African-American females (14–20 years) enrolled in an HIV prevention trial. Vaginal swabs were self-collected at each assessment and assayed forT. vaginalis,Chlamydia trachomatisandNeisseria gonorrhoeaeusing DNA amplification. Generalized estimating equations assessed associations between incidentT. vaginalisinfection,defined as a positive test result subsequent to a negative result or documented treatment, and sociodemographic characteristics, partner-level factors, HIV/STI-associated behaviours and STIs. Factors significant at p < 0.1 in bivariate analyses were entered into a multivariable model, adjusting for age and trial condition. The final model was obtained using backward selection procedures.ResultsOf 606 (86.4%) participants who completed ≥ 1 follow-up assessment, an incidentT. vaginalisinfection was detected among 20.0% (n = 121). Trial condition was not independently associated with incident infection (p = 0.21). Significant correlates included: receipt of an increasing number of forms of government assistance (AOR: 1.20, 95% CI: 1.01, 1.42), cigarette smoking (AOR: 1.70, 95% CI: 1.08, 2.67), smoking marijuana an increasing number of days in the past 3 months (AOR: 1.02, 95% CI: 1.00, 1.04), concurrentC. trachomatis(AOR: 2.28, 95% CI: 1.43, 3.66) andN. gonorrhoeae(AOR: 5.99, 95% CI: 3.10, 11.57) infection and testing positive forT. vaginalisat the previous assessment (AOR: 4.56, 95% CI: 2.99, 6.96).ConclusionsIncidentT. vaginalisinfections were common. Strategies to reduce infection rates among this population may include improving partner notification and treatment services and addressing the role of substance use on sexual risk.
O04.4 Seroprevalence of Herpes Simplex Virus Types 1 and 2 United States, 1999–2010
Authors: Bradley H , Markowitz L E , Gibson T , McQuillan G M 
Published: July 2013

BackgroundHerpes simplex virus types 1 and 2 (HSV-1 and HSV-2) are common infections with serious sequelae. HSV-1 is an increasingly important cause of genital herpes in industrialised countries, potentially due to less acquisition of HSV-1 during childhood or to changes in sexual behaviour.MethodsUsing nationally representative data from the National Health and Nutrition Examination Surveys (NHANES), we examined change in seroprevalence of HSV-1 and HSV-2 among 14–49 year olds in the United States. We compared seroprevalence in 1999–2004 with 2005–2010, and examined seroprevalence among 14–19 and 20–29 year-olds stratified by socio-demographic characteristics and sexual behaviours. We also reviewed HSV-1 and HSV-2 seroprevalence from 1976–1980 to 2005–2010.ResultsIn 2005–2010, the seroprevalence of HSV-1 was 53.9%, and the seroprevalence of HSV-2 was 15.7%. From 1999–2004 to 2005–2010, HSV-1 seroprevalence declined by nearly 7% (P < 0.01), but HSV-2 seroprevalence did not change significantly. The largest decline in HSV-1 seroprevalence from 1999–2004 to 2005–2010 was observed among 14–19 year olds, among whom seroprevalence declined by nearly 23%, from 39.0% to 30.1% (P < 0.01). In this age group, HSV-1 seroprevalence declined among young men and women, non-Hispanic blacks and whites, and those living above and below the federal poverty level. Overall, HSV-1 seroprevalence declined more than 10% from 60.1% in 1976–1980 to 53.9% in 2005–2010 (P < 0.01). Among 14–19 year olds, HSV-1 seroprevalence declined more than 29%, from 42.6% to 30.1% (P < 0.01). Overall, HSV-2 seroprevalence increased slightly from 13.4% in 1976–1980 to 15.7% in 2005–2010 (P = 0.02).ConclusionsAn increasing number of adolescents lack HSV-1 antibodies at sexual debut and are susceptible to genital HSV-1 infection. In the absence of declines in HSV-2 infections, the prevalence of genital herpes may increase.
O04.5 Comparison of the Clinical and Demographic Characteristics of Neonatal Herpes Infections Caused by Herpes Simplex Virus Type 1 and Type 2; Findings from a Population-Based Surveillance System, 2006–2012
Authors: Schillinger J A , Washburn K , Klingler E , Blank S , Pathela P 
Published: July 2013

BackgroundThe epidemiology of neonatal herpes infection (nHSV) is changing as herpes simplex virus type 1 (HSV-1) is an increasingly common cause of genital herpes. Few sources of population-based data for nHSV exist; nHSV has been a notifiable disease in New York City (NYC) since 2006.MethodsTo compare the clinical and demographic characteristics of nHSV due to HSV-1 and herpes simplex virus type 2 (HSV-2), we used standard case investigation forms to abstract infant inpatient/outpatient medical records, and maternal labour and delivery records for babies ≤ 60 days of age diagnosed with laboratory-confirmed herpes infection and reported in NYC during 2006–2012. Disease syndromes were grouped as invasive (disseminated/central nervous system infection/death) versus localised (skin/eye/mucous membrane infection,). Cases lacking liver function test results, or lumbar puncture were excluded from analyses of disease syndrome. Bivariate analyses compared clinical and demographic characteristics by viral type.ResultsThere were 91 cases reported (HSV-1, 40; HSV-2, 36; untyped, 15). Among 76 cases with viral typing, the majority (53%; 40/76) were HSV-1. There were no statistically significant differences by viral type for any variables examined: age ≤ 7 days at presentation (HSV-1, 59% versus HSV-2, 41%), fever (HSV-1, 38% versus HSV-2, 46%), vesicles (HSV-1, 46% versus HSV-2, 53%), invasive disease (HSV-1, 53% versus HSV-2, 70%), case fatality rate (HSV-1, 18% versus HSV-2, 19%), maternal history of genital herpes (HSV-1, 20% versus HSV-2, 20%), maternal genital lesions at delivery (HSV-1, 8% versus HSV-2, 3%), vaginal delivery (HSV-1, 69% versus HSV-2, 61%), white non-Hispanic maternal race/ethnicity (HSV-1, 26% versus HSV-2, 12%), maternal age < 20 (HSV-1, 15% versus HSV-2, 27%).ConclusionsNeonatal herpes infections due to HSV-1 and HSV-2 have a similar presentation, and death rate. To prevent nHSV, candidate HSV vaccines will need to protect against HSV-1, as well as HSV-2 infection in women.
O04.6 Mycoplasma Genitalium- Is It a Pathogen in Acute Pelvic Inflammatory Disease (PID)?
Authors: Wiesenfeld H C , Hillier S L , Meyn L , Trucco G , Amortegui A , Macio I S , Rabe L , Cosentino L , Darville T 
Published: July 2013

BackgroundPID is a polymicrobial infectious condition of the female upper genital tract.Neisseria gonorrhoeae(GC) andChlamydia trachomatis(CT), long considered the predominant organisms involved in the pathogenesis of PID, are identified in fewer than half of U.S women diagnosed with acute PID.Mycoplasma genitalium(MG) is associated with male urethritis and some evidence suggests an association with other STD syndromes including cervicitis and PID. Our objective was to examine the association between MG and acute PID.MethodsThe ACE Trial is a randomised double-blind study evaluating the value of anaerobic therapy for acute PID. At enrollment, specimens were collected from the cervix and endometrium for testing for GC, CT and MG by transcription-mediated amplification. Histology was performed on endometrial tissue. Identification of cervical and endometrial organisms was correlated with endometritis.ResultsAmong the 125 women diagnosed with acute PID, twenty two percent (n = 27) tested positive forM. genitalium, while CT, GC and bacterial vaginosis were present in 14%, 7% and 54%, respectively. Forty six women (37%) had histologic endometritis. Histologic endometritis was more common among those having cervical infections with GC, CT or MG than uninfected women (66% vs. 24%, p < 0.001). Among women with endometritis, GC, CT and MG were present in 17%, 30% and 36%, respectively. Endometritis was present in 71% (20/28) of women with endometrial GC, CT or MG. Endometrial identification of GC (100% vs. 34%, p < 0.05), CT (77% vs. 32%, p < 0.01) and MG (64% vs. 33%, p < 0.05) were each independently associated with endometritis.ConclusionMycoplasma genitaliumis identified in 22% of women diagnosed with acute PID. Similar to CT and GC,the presence of MG in the endometrium is highly associated with endometritis among women diagnosed with PID. This study suggests thatM. genitaliummay play an important role in the pathogenesis of PID.
O05.2 Measuring Syphilis: Quantitative PCR Can Be Used to Monitor Treatment Response
Authors: Tipple C , Hodson L , Jones R , Rayment M , Nwokolo N , McClure M , Taylor G 
Published: July 2013

BackgroundThe humoral response toTreponema pallidum(T. pallidum), which causes syphilis, is divided into ‘non-specific’ anti-lipid and specific anti-treponemal protein antibodies. A four-fold reduction in anti-lipid antibodies is used to diagnose cure, which can take six or more months.Quantitative PCR (qPCR) can measureT. pallidumDNA copies in blood and ulcer samples. Bacteraemia is more common and of higher load in early disease.We present a pilot study monitoring the early treatment response in patients with infectious syphilis by qPCR.MethodsPatients with symptomatic primary or secondary disease were admitted to hospital and following baseline sampling were treated with 2.4 M units of benzathine penicillin. Whole blood was collected into EDTA and Tempus RNA preservation tubes and the ulcer sampled using a philtre paper strip every four hours forT. pallidumDNA (tpp047gene) and RNA (16S rRNA) quantification. Sampling ended when two consecutive PCRs were negative. Standard serological follow-up was performed.ResultsThree men were recruited (two secondary, one primary). All were homosexual and two were HIV-1 infected.Blood DNA quantification and clearance: A mean peak-level of 1611(range 1212)tpp047copies/ml was detected and mean half-life for clearance (t½ clearance) was 7.89 hours (range 5.34). Blood RNA: Mean peak-level 8829(range 20366)16SrRNAcopies/ml blood; (t½ clearance) 5.24 hours (range 0.78). Ulcer DNA 1.14 × 105copies/strip and RNA 4.35 × 107copies/strip with a t½ (clearance) of 1.67 and 3.76 hours, respectively.T. pallidumnucleic acids were undetectable in all samples after 56 hours.All patients had serology consistent with disease stage at baseline and cure at one month.ConclusionsT. pallidumqPCR presents a novel and quick way of monitoring early syphilis treatment efficacy. Both DNA and RNA may be suitable targets to measure bacterial clearance from blood and ulcer exudates.Ulcers may be non-infectious as soon as 56 hours post-treatment.
O05.4 Association Between Chlamydia Trachomatis Genital Infection and the Vaginal Microbiome
Authors: Ma B , Brotman R M , Gajer P , Fadrosh D , Mahurkar A , White O , Terplan M , Bavoil P , Forney L J , Ravel J 
Published: July 2013

BackgroundChlamydia trachomatis(CT) genital infection is one of the most widespread sexually transmitted infections (STIs). It is thought that certain types of vaginal microbiota are better able to prevent STIs, however, very little is known about the relationships between species and genomic composition of the vaginal microbiome and risk of infection. Information about these can be used to advance prevention strategies for STIs. We sought to characterise the vaginal microbiome at the time of diagnosis and after treatment of CT infection.Methods101 women with CT genital infection were recruited to a longitudinal study in Baltimore, MD. Participants were treated at diagnosis and returned for clinical visits every 3 months for 9 months, at which times the vaginal microbiota was determined using 16S rRNA analysis. We further applied high-throughput metagenomics to characterise the genomic makeup of the vaginal microbiome.ResultsThe average age of participants was 19.3 (range 14–28) and 92% were African-American. During CT infection, comprehensive surveys of the vaginal microbiota demonstrated two distinct community state types characterised by: (1) a complex assemblage of strict anaerobes with low proportions ofLactobacillusspp. (60% of samples) or (2) a high relative abundance ofLactobacillus iners-dominated communities (37% of samples).Metagenomic evaluation suggested unique characteristics of the genomes of the dominant species in these communities (i.e.,L. iners,Gardnerella vaginalis).L. inersappeared more genetically diverse than otherLactobacillusspecies.ConclusionsComplex communities of strict anaerobes with low proportions ofLactobacillusor specificL. inersgenome types represented a hallmark of the chlamydia-infected state in this population. SomeL. inersmay be better suited to adapt to diverse environments while others may be contributing factors to an at-risk microbiome. In the era of personalised medicine, future work will enhance our ability to intervene and establish a protective vaginal microbiome.
O05.5 A Longitudinal Study of the Vaginal Microbiota and HPV Detection
Authors: Brotman R M , Shardell M D , Gajer P , Tracy J K , Zenilman J M , Ravel J , Gravitt P E 
Published: July 2013

BackgroundThe vaginal microbiota can be clustered into six community state types (CSTs): 4 are dominated byLactobacillus iners, L. crispatus, L. gasseri, L. jensenni, and 2 lack significant numbers ofLactobacillusspp. (termed CST IV-A and IV-B). CST IV-A is characterised by a diverse assemblage of strict anaerobes, while CST IV-B has higher proportions of the generaAtopobium, Gardnerella,among others. We sought to describe the relationship between vaginal microbiota and human papillomavirus (HPV) detection.MethodsThirty-two reproductive-age women self-collected mid-vaginal swabs twice-weekly for 16 weeks (n = 937 samples). Participants reported behaviours on daily diaries. Vaginal bacterial communities were characterised by pyrosequencing of barcoded 16S rRNA genes (V1-V2 region). Each swab was tested for 37 types of HPV DNA using the Roche HPV Linear Array genotyping test. The effects of CSTs on the rate of transition between HPV-negative and HPV-positive states were assessed using continuous-time Markov models. Additive mixed effects logistic regression and additive mixed effects Poisson models were used to model high risk HPV (hrHPV) and count of HPV types, respectively, with normalised menstrual cycle time.ResultsParticipants had an average of 29 (range 25–33) samples tested for HPV, with point prevalence ranging from 58 to 77% and 16-week period prevalence of 84%. CST was significantly associated with changes in HPV status (p < 0.001).L. gasseri-dominated CSTs had the fastest HPV remission rate (HPV-positive to no detection) and CST IV-B had the slowest rate compared toL. crispatus-dominated CSTs (adjusted transition rate ratio (aTRR):7.58, 95% CI: 1.77–32.42 and aTRR:0.31, 95% CI: 0.09–1.05, respectively). Detection of hrHPV and count of different HPV types were highest in the middle of the menstrual cycle.ConclusionVaginal microbiota dominated byL. gasseriwere associated with increased clearance of detectable HPV. A mid-cycle increase in HPV detection suggests a role for sex hormones in modulating latent infection.
O05.6 EndometrialGardnerella VaginalisandAtopobium VagineaAre Associated with Histologic Endometritis Among Women with Clinically Diagnosed Pelvic Inflammatory Disease (PID)
Authors: Hillier S L , Rabe L K , Meyn L , Macio I , Trucco G , Amortegui A , Darville T , Wiesenfeld H C 
Published: July 2013

ObjectiveWhileNeisseria gonorrhoeae(GC) andChlamydia trachomatis(CT) are known to cause PID, many women with clinical signs and symptoms of PID and histologic evidence of endometritis have neither of these pathogens. Our objective was to describe microorganisms in the upper genital tract of women with PID, and to evaluate their association with histologic endometritis.MethodsWomen presenting with symptoms and meeting the CDC diagnosis of PID had an endometrial biopsy obtained by Pipelle, and the tissue was split for microbiological and histological assessment. Cultivated microorganisms were identified using phenotypic and genotypic characteristics. Fisher’s exact tests were used to assess the association between microorganisms and endometritis (plasma cells ± neutrophils).ResultsOf 136 women with clinical PID, 55 (40%) had histologic evidence of endometritis, and endometrial GC and/or CT was associated with endometritis (29% vs. 6%, P < 0.001). In addition to STIs, a broad range of bacteria representing 63 different species were recovered from 53 (39%) of the endometrial biopsy samples, including 8 novel species. The recovery of any non-GC/non-CT organisms from the endometrium was associated with histologic endometritis (53% vs. 30%, P = 0.008). BothG. vaginalis(35% vs. 16%, P = 0.01) andA. vaginae(22% vs. 3%, P < 0.001) were associated with histologic endometritis. Other anaerobic bacteria associated with bacterial vaginosis includingPrevotella timonensis, P. amniiandPeptoniphilus hareiwere also more frequent in the endometrium of women having endometritis (11% vs. 3%, P = 0.06) but this did not reach statistical significance. After excluding women having GC and/or CT,A. vaginaewas still independently associated with endometritis (17% vs. 3%, P = 0.03).ConclusionsThe recovery of non STIs from the endometrium is associated with histologic endometritis among women with clinically diagnosed PID.A. vaginaemay play an etiologic role in PID and merits further evaluation for its role in nongonococcal/nonchlamydial PID.
O06.1 Evaluation of 5 Different Tests For Trichomonas Vaginalis (TV) Infection and Cost Effective Planning For Clinical Implementation
Authors: Nathan B , Appiah J , Heron D , Saunders P , Brum R , Alexander S , Baraitser P , Ison C 
Published: July 2013

BackgroundTV is the most common non-viral STI in the world. Despite this, TV infection in UK Genitourinary clinics is mainly (and often exclusively) diagnosed by wet mount microscopy alone. Microscopy is known to have a low and variable sensitivity and therefore greatly underestimates the true prevalence of TV infection.ObjectivesA clinical trial was conducted to evaluate the performance of five methods for detecting TV: an in-house PCR; the Aptima TV kit; the OSOM Trichomonas Rapid Test (POCT); culture and microscopy to diagnose infection in symptomatic women. The results of the study were used to power a financial model for clinical implementation of a molecular test.MethodsSymptomatic women were recruited for testing. Results and resource costs from the study were extrapolated to calculate the cost of implementing POCT and in house PCR compared to wet mount microscopy in the clinic.ResultsA composite reference standard of 2 more or more positives was used. 246 women were recruited of which 24 had a positive test by 2 or more of the 5 methods. Aptima TV kit, POCT, Real-time PCR and culture (sensitivities 92, 92, 88 and 88%) all out performed wet-mount microscopy (sensitivity 38%). The prevalence based on two tests as reference standard was 9.75%.ConclusionsCost modelling showed although initial outlay costs for PCR and POCT were high, savings were made in labour costs. PCR and POCT would improve the rate of TV diagnosis in this group and therefore reduce repeat visits due to false positive results. PCR requires additional clinical time for recalling the patient for a further visit to give a positive result, treatment and contact tracing. Implementation of newer tests could potentially reduce clinical cost and improve patient outcomes in the long term.
O06.2 A Pilot Randomised Controlled Trial of High-Dose Vitamin D Supplementation to Prevent Recurrence of Bacterial Vaginosis
Authors: Turner A Norris , Reese P Carr , Anderson J , Fields K S , Ervin M , Klebanoff M , Jackson R 
Published: July 2013

BackgroundBacterial vaginosis (BV) is the most common cause of vaginal infection worldwide and is associated with myriad negative reproductive health outcomes. Several cross-sectional studies indicate that women with low vitamin D levels have increased BV prevalence.MethodsThis randomised, double-blinded, placebo-controlled trial started enrollment in September 2011 and concluded follow-up in January 2013. Women (n = 126) with symptomatic BV were enrolled from an urban STD clinic in the midwestern United States. All participants received standard metronidazole therapy. Intervention participants (n = 63) also received nine doses of 50,000 international units of cholecalciferol (vitamin D3) over 6 months; control arm women (n = 63) received matching placebo. BV status was assessed via Nugent scoring at three follow-up visits over six months. The primary analysis will be intention-to-treat using extended Cox proportional hazard models.ResultsParticipants’ median age was 26. Three-quarters (75%) of women were black and 25% were white. All reported a lifetime history of sex with men, and 29% also had a lifetime history of sex with women. At baseline, median serum vitamin D levels (measured as 25-hydroxy vitamin D) were the same for intervention and control women at 15.85 ng/mL (interquartile range (IQR): 12.1–21.4 ng/mL); levels < 20 ng/mL are considered insufficient. Eight-one percent of participants returned for one or more follow-up visits. At trial completion, median vitamin D level among intervention women was 30.5 ng/mL (IQR 24.4–37.7 ng/mL), vs. 17.8 ng/mL among control women (IQR: 11.7–27.1 ng/mL). Nugent scoring is ongoing with primary results available in early spring 2013.ConclusionImmunologic mechanisms regulated by vitamin D may play a role in BV recurrence, but no previous study has examined whether supplementing women with vitamin D will impact subsequent development of BV. If effective against BV, vitamin D supplementation can have worldwide impact as a safe, simple intervention.