bluuebunny/crossref_metadata_2025_split huggingface dataset:
S06.1 Treating Contacts to Gonorrhoea and Chlamydia Without a Clinic Visit; The Efficacy and Effectiveness of Different Models
Authors: Schillinger J A 
Published: July 2013

The sex partners of persons with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infection must be treated to prevent repeat infection of the index patient and to interrupt forward transmission of disease. Asking patients to refer sex partner(s) for evaluation and treatment (‘patient referral’) is an inadequate strategy, as many sex partners will not seek care, and the large burden of CT and GC infections makes it impractical and cost prohibitive to rely upon health care providers or public health field investigators to assure partner treatment. Although no single sex partner treatment approach will be a panacea, innovative strategies are clearly needed.This session will focus on strategies that do not require sex partners to attend a clinic to obtain treatment for CT or GC. The presenter will describe two models: (1) Expedited Partner Therapy (EPT), used in many parts of the US, includes patient delivered partner therapy, wherein a patient is asked to deliver medication or a prescription to their sex partner; (2) Accelerated Partner Therapy (APT), studied in the UK, uses clinician-staffed hotlines or pharmacists to assess the health status of sex partners before arranging for treatment. APT is being evaluated in a community-based randomised controlled trial, and efficacy data are not yet available, however, EPT has been shown to reduce risk for repeat GC infection by 68% and repeat CT by 20%. In practise, uptake and effectiveness of EPT has been limited by a variety of implementation challenges. The session will describe and - where possible - quantify obstacles to EPT, including: legal issues (perceived and real), lack of provider and pharmacist knowledge, patient preference and acceptability (for example, as few as 50% of eligible patients accept EPT for CT), medication costs, use of prescriptions rather than dispensing medication, and the emergence of cephalosporin resistance among GC.
S06.3 MSM Partner Services: What Works?
Authors: Steben M , Taylor D , Cheuk E 
Published: July 2013

BackgroundPartner notification (PN) is an important public health activity in STI control to stop onwward transmission. Various forms of PN services have been developed but not all have been evaluated to the same extent. In the era of evidence-based resource allocation, it is of utmost importance to focus limited resources on services shown to be the most efficient and effective.MethodsA review of the current literature and of the National Collaborating Centre for Infectious Diseases (NCCID) STBBI partner notification (PN) project productions was conducted. The impact of these various forms of PN services on disease incidence, re-infection, relationship status and healthcare costs will serve as efficiency and effectiveness markers.ResultsOutcomes of MSM PN services has been measured and found to be associated withreduced index case GC and CT reinfection rates through patient delivered therapy,higher adoption of safer sexual practises in both index case and their partners,reduced incidence of STIs,higher rates of notification to long term partners and significant partners,high acceptability of face-to-face patient delivered partner notification in significant or long term relationships compared to higher acceptability of physician or electronic notification for casual or anonymous partnershipslower cost per case reached by patient referral compared to provider referral,lower levels of stress in relationships. Emotional and physical abuse after PN services can occur. The fears accompanying PN services can affect sexual spontaneity.Caution should be used before discarding PN services when efficiency or effectiveness is low because epidemiologic insight can still be gathered to help redirect screening activities.ConclusionsA Review of the evidence indicates that MSM PN services works!
S06.4 New Directions in HIV Partner Services: An Evolving Model of Global, Integrated Field Services
Authors: Golden M 
Published: July 2013

Partner services are a longstanding component of public health efforts to control sexually transmitted infections (STI). However, they have not been a consistent part of HIV prevention efforts either in high-or lower-income nations. In many areas, partner services for HIV and other STIs have been administratively separated, and the goals of partner services have usually been narrowly conceived to concentrate exclusively on the diagnosis and treatment of sex partners. This is now beginning to change. New evidence suggests that HIV PS in high income nations may be less effective at finding new cases of HIV than previously believed, but could play an important role in linkage to care. In sub-Saharan Africa, HIV PS appears to be highly acceptable and effective.This session will focus on new opportunities in the area of HIV PS. The speaker will review the following issues: (1) data supporting the efficacy of HIV partner services as an HIV case-finding tool in both in high and low-income nations; (2) cost and cost-effectiveness data on HIV PS; (3) evidence that PS for bacterial STIs can been used to promote HIV case-finding and engagement in care among persons with previously diagnosed HIV infection; and (4) outstanding research questions related to HIV PS.
S08.1 Treatment of Gonorrhoea in an Era of Emerging Cephalosporin Resistance and Results of a Randomised Trial of New Potential Treatment Options
Authors: Kirkcaldy R D 
Published: July 2013

BackgroundCephalosporins are the mainstay of recommended gonorrhoea treatment, and there is an urgent need for treatment options for cephalosporin-allergic patients or infections with suspected cephalosporin resistance. We evaluated the efficacy and tolerability of two novel combinations of existing antimicrobials for treatment of uncomplicated urogenital gonorrhoea.MethodsWe conducted a non-comparative trial, randomising patients with urogenital gonorrhoea to one of two regimens: gentamicin 240 mg intramuscularly plus azithromycin 2 g orally (GENT/AZI), or gemifloxacin 320 mg orally plus azithromycin 2 g orally (GEMI/AZI). The primary outcome was microbiologic cure of urogenital infections (negative follow-up culture) at 10–17 days post-treatment. All participants who returned for follow-up and had evaluable follow-up cultures were included in this per protocol analysis.ResultsFor 401 evaluable participants (GENT/AZI-202; GEMI/AZI-199), the mean age of both groups was 30 years. Most participants were heterosexual men (GENT/AZI, 57%; GEMI/AZI, 51%), followed by men who have sex with men (GENT/AZI, 33%; GEMI/AZI, 39%), and women (GENT/AZI, 9%; GEMI/AZI, 11%). Microbiological cure was achieved by 100% (lower one-sided 95% confidence interval, 98.5%) of GENT/AZI participants, and 99.5% (lower one-sided 95% confidence interval, 97.6%) of GEMI/AZI participants. GENT/AZI cured 10/10 pharyngeal and 1/1 rectal infections; GEMI/AZI cured 15/15 pharyngeal and 5/5 rectal infections. In the GENT/AZI arm, the most common adverse events (AEs) were mild-moderate nausea (27% of participants), diarrhoea (19%), abdominal discomfort/pain and vomiting (both 7%). In the GEMI/AZI arm, the most common AEs were nausea (37% [8% moderate-severe]), diarrhoea (23%), and abdominal discomfort/pain (11%).ConclusionsBoth study regimens were highly effective. Gastrointestinal AEs, especially nausea and diarrhoea, were common. These results provide alternative gonorrhoea treatment options for patients who cannot be treated with cephalosporins.
S08.2 Is Azithromycin the Best Treatment For Chlamydia?
Authors: Radcliffe K 
Published: July 2013

Azithromycin has been widely used for many years as first-line therapy for chlamydial infection (or as equal first-line with doxycycline). However, there are now several reasons to reconsider its position.Firstly, although earlier trials showed azithromycin to have cure rates which were high and equivalent to those of doxycycline, more recent studies have found it to have lower, and inadequate, levels of success in women with cervical infection, men with urethral infection, and for rectal infection in both men and women.Secondly, the increasing recognition of the importance ofMycoplasma genitaliumas a pathogen, especially as an important cause of urethritis in men. In the absence of a readily available test forM. genitalium, men with non-gonococcal urethritis are often treated with a single dose of azithromycin, which is known to be a less effective treatment forM. genitaliumthan is doxycycline. As a result many such men have persistent symptoms following such treatment, requiring repeat visits and further antibiotic therapy. Their sexual partners may also require further treatment. Additionally, there is evidence that single-dose azithromycin therapy (as against longer courses) can induce resistance inM. genitalium.Thirdly, the widespread use of azithromycin is probably leading to increasing resistance to this agent in other infections where it has a place; especially in gonorrhoea where it is now widely recommended as an adjunct to ceftriaxone in the belief that this will reduce the likelihood of resistance to ceftriaxone developing, but also in the treatment of syphilis where azithromycin has a role as a second-line agent e.g. in cases of allergy to penicillins.
S08.3 Mycoplasma Genitalium and Chlamydia Trachomatis in Laparoscopically Diagnosed Pelvic Inflammatory Disease
Authors: Bjartling C , Osser S , Persson K 
Published: July 2013

IntroductionPelvic inflammatory disease (PID) is a well known complication of infection withChlamydia trachomatis(C.trachomatis). The knowledge ofMycoplasma genitalium(M.genitalium) and its role in PID is relatively limited. In this study we report on the proportions ofC.trachomatisandM.genitaliumattributable to PID from an ongoing study of laparoscopically diagnosed cases of PID.MethodWomen seeking care at the emergency service at the Department of Obstetrics and Gynaecology at Malmo University Hospital in Sweden from 2004 through the mid of 2012 with clinically suspected PID, who underwent diagnostic laparoscopy, were eligible. Specimens from the cervix/and or vagina together with abdominal fluid were collected and analysed for pathogens such asC.trachomatisandM.genitalium.ResultsIn all, 208 women were included and 123 (59.1%) were diagnosed with PID at laparoscopy.C.trachomatiswas present in cervix and/or abdominal fluid in 29/123 (23.6%) of these cases.M.genitaliumwas present in cervix and/or abdominal fluid in 5/123 (4.1%) cases of PID. In three of these casesM.genitaliumwas positive only in cervix and there was a dual infection withC.trachomatispositive in the abdominal fluid. Two PID cases wereM.genitaliumpositive only, (2/123, 1.6%). A significantly declining trend forC.trachomatisPID was observed (42.8% - 11.5% p = < 0.001). The prevalence ofC.trachomatisandM.genitaliumwas 2.8% and 2.1% respectively in 5519 women tested from 2003 to 2008 in the same clinic.ConclusionThe over all proportion of PID attributable toC.trachomatiswas 23.6% but over the study period a significantly declining trend was seen. The proportion of PID attributable toM.genitalium(1.6%) was significantly lower considering the prevalence to be in the same range as forC.trachomatis, suggesting thatM.genitaliumwas a less aggressive pathogen in terms of clinical manifestations of PID.
S08.4 Mycoplasma Genitalium: Implications For Disease, Treatment and the Public Health
Authors: Jensen J S 
Published: July 2013

M. genitaliumis an established cause of sexually transmitted urethritis and cervicitis, and may cause upper tract disease in women. Detection by nucleic acid amplification tests is currently the only diagnostic method available, but no FDA approved assays are currently available, and the CE marked tests suffer from limited clinical evaluation.In most settings,M. genitaliuminfections explain 15–25% of symptomatic non-gonococcal urethritis, but as diagnosis of the infection is not routinely carried out, treatment will usually be syndromic. However, only a few randomised trials have evaluated treatment ofM. genitalium, and compared only doxycycline 200 mg daily for 7 days with a 1 g single dose of azithromycin. Together with results from open trials, it is obvious that doxycycline is inefficient in eradicatingM. genitaliumshowing eradication rates around 35%. The eradication rate after azithromycin 1 g single dose is significantly better, but differs greatly between studies. Thus, older studies appear to have higher eradication rates than recent ones and a lower eradication rate is reported in studies from centres where azithromycin has been used as the primary treatment for chlamydial and idiopathic urethritis and cervicitis.At present, the only second line antibiotic that has been shown to have a high activity against macrolide resistantM. genitaliumis moxifloxacin. However, this drug is significantly more expensive and has a less favourable safety profile than macrolides, and multidrug resistant infections have emerged, primarily in patients with contact to South East Asia. Consequently, there is an urgent need for clinical trials with possible alternative drugs. Such trials should preferably also address the treatment efficacy in chlamydial and idiopathic urethritis and cervicitis as a single treatment covering these conditions would be advantageous.
S09.2 Neisseria Gonorrhoeae: Are We Exerting the Selective Pressure?
Authors: Ison C A 
Published: July 2013

Treatment of gonorrhoea has historically been delivered by a single dose of a highly effective antimicrobial agent, to which resistance is not documented, to aid compliance and break transmission. Resistance inNeisseria gonorrhoeaecompromises this approach and occurs both by acquisition of plasmids or chromosomal DNA from other bacteria orNeisseriaspp or by selection of mutants resulting from misuse or overuse of antimicrobial agents, such as long term use of a single agent.Resistance to ciprofloxacin, a fluoroquinolone, illustrates the effect of both misuse of earlier generations of quinolones and of suboptimal doses, as well as overuse. Quinolones target the DNA gyrase and topoisomerase enzymes that are responsible for DNA supercoiling and any interference with this process is bactericidal. Ciprofloxacin was widely used, often at low doses because of its high efficacy, but resistance emerged quickly resulting from selection of mutants, altering the target site and giving increasing drifts to resistance. Azithromycin, a macrolide which binds to 23S rRNA component of the 50S ribosome and interferes with protein synthesis, is effective against multiple STIs and therefore the selective pressure for resistance has been considerable. Although low-level resistance emerged quickly, high-level resistance inN. gonorrhoeae, resulting from a single point mutation in the peptidyltransferase loop of domain V of the 23S rRNA gene, was only reported in recent years and threatens to compromise its use. Sporadic use of spectinomycin selected for high-level resistance in a single step, which appears clonal and has not spread widely. Limited use of the aminoglycoside, gentamicin, for which the efficacy data is weak, appears to remain clinically active.In this era of multi-drug resistant gonorrhoea it is imperative that the selective pressure exerted by continual use of a single agent is understood and clinical practise modified, where necessary, to prevent gonorrhoea becoming untreatable.
S09.4 Mycoplasma Genitalium
Authors: Jensen J S 
Published: July 2013

M. genitaliuminfections explain 15–25% of symptomatic male NGU and causes sexually transmitted urethritis, cervicitis, and PID in women. The bacterium is extremely difficult to isolate by culture, and consequently, the knowledge about antimicrobial resistance and its underlying molecular mechanisms has been slow to accumulate.In the few randomised trials ofM. genitaliumconducted to date, doxycycline has been compared with a 1 g single dose of azithromycin, and together with results from open trials, it is evident that doxycycline is inefficient in eradicatingM. genitaliumwith eradication rates around 35%. The eradication rate after azithromycin 1 g single dose has most often been significantly higher, but differs greatly between studies. Remarkably, older studies appear to have higher eradication rates than the more recent ones, and in the latest study from the US, no significant difference between doxycycline and azithromycin efficacy could be detected.Although several mutations have been associated with increased macrolide MIC in strains selected by passage in the presence of macrolides, only mutations in the 23S rRNA gene at position 2058 and 2059 (E. colinumbering) have been detected in patients failing azithromycin treatment.A number of rapid methods for detection of such mutations directly from clinical samples have been developed and have proved to be clinically useful in directing treatment. Pre-treatment mutations have been found in between 10–15% of contemporary samples where doxycycline is used as the primary NGU treatment and is most commonly around 40% in settings where azithromycin is the primary drug. However, in Greenland where chlamydial infections are extremely common and azithromycin is used liberally, mutations have been found in nearly 100% of the specimens tested.At present, moxifloxacin is the only second line antibiotic that has a proven high efficacy against macrolide resistantM. genitalium. However, price and safety profile as well as the emergence of multidrug resistant strains emphasises the urgent need for clinical trials with alternative drugs.
S10.1 Predicting the Social and Behavioural Consequences
Authors: Hogben M S , Ford J V 
Published: July 2013

Recent data from HIV prevention trials conducted with sero-discordant couples suggest that HIV transmission drops when the infected individual is taking anti-retroviral medications (ARV). However, there is potential for unintended social and behavioural consequences of this and other interventions. Using the HIV treatment cascade as a lens, the review will cover individual and population-level data in HIV and STD prevention research with a view to identifying such consequences of intervention. Although the focus will be upon risk compensation as a potential consequence of HIV treatment, the review will also attend to potential positive social and behavioural consequences.With respect to data from which to predict social and behavioural consequences, the majority of HIV and STD prevention interventions are conducted through small groups or on a one-to-one basis (e.g., in clinical settings), rather than at the population level. Most are concerned explicitly with risk reduction behaviours or address the behaviours essential to successful biomedical intervention. Population-level interventions are rarer, but do include communication campaigns and efforts to affect HIV or STD through social determinants. With respect to risk compensation, some studies explicitly address risk compensation, while others have sufficient behavioural follow-up data from which to measure it - the unintended measurement of unintended consequences. Fewer studies permit one to attribute effects to different potentialcausesof risk compensation, including risk homeostasis, overestimation of protection, or the intentional resumption of previous behaviour patterns.The final part of the review is devoted to approaches that seek to minimise negative consequences or to maximise positive consequences, the latter arising when an intervention gives people hope where they once had little or none, and leading to further individual efforts to protect themselves and others (including changes in risk homeostasis). Positively-framed communication campaigns in particular may accelerate efforts and further population-level protective action and health promotion.
S10.3 Modeling the Effect of TAP on the HIV/AIDS Epidemic
Authors: Garnett G P 
Published: July 2013

BackgroundThe efficacy of ARV treatment that achieves viral suppression in dramatically reducing HIV infectiousness is proven. What is less clear is the implications for the best use of treatment in programmes, how treatment should and could be scaled up and wheat the effectiveness of treatment use in programmes will be across populations.MethodsReview of observational data on the impact of treatment programmes on HIV incidence and deaths and mathematical models exploring the impact of existing and proposed programmes.ResultsMathematical models show that HIV treatment can reduce HIV incidence, but this reduction depends upon who is treated, the success of the programme maintaining viral suppression in those treated and on patterns of risk behaviour. Observations of the impact of treatment programmes on the spread of HV at a population level show mixed impacts with competing interpretations and implications for future programmatic development. Treatment guidelines emphasise the treatment of those who probably contribute least to onward transmission of HIV and more work is required to understand local epidemiology and design treatment programmes accordingly.ConclusionsFuture, studies of the impact of treatment as prevention should concentrate on how to implement at scale treatment programmes and maximise reductions in incidence. Using HIV treatment as an HIV prevention intervention promises a major step forward in responding to the HIV pandemic, but taking success for granted could generate unsustainable programmes with perverse outcomes.
S11.1 Sexual Behaviour in Britain in the New Millennium: A New Era?
Authors: Mercer C H 
Published: July 2013

BackgroundIn 2001, Britain’s second National Survey of Sexual Attitudes and Lifestyles (Natsal-2) demonstrated increased sexual risk behaviour in contrast to Natsal-1, undertaken a decade earlier. STI diagnoses also increased between the mid-1990s and the mid-2000s, but since then, increases have been more modest. These trends coincided with changes in sexual health policy and practise in Britain, resulting in greater STI testing and the use of more sensitive diagnostic tests, making STI surveillance data less indicative of risk behaviour. This paper reviews a range of evidence to examine whether, and if so how, sexual behaviour has changed in Britain since the start of the millennium.MethodsAnalyses of routine data (including STI surveillance data, census data), general population surveys (including Natsal, Health Survey for England 2010 (HSE-2010), British Social Attitudes surveys), and community surveys of men-who-have-sex-with-men (MSM, including London’s Gay Men’s Sexual Health Surveys).ResultsDemographic trends support the limited sexual behaviour data collected experimentally by HSE-2010 suggesting that increases in heterosexual risk behaviour observed between 1990 and 2000 have not been sustained since 2000. At the same time, there has been increasing tolerance in Britain of more diverse sexual lifestyles, with public attitudes towards homosexuality increasingly liberal. While the population prevalence of recent same-sex behaviour in 2010 remains around 2–3%, among MSM, the proportion reporting high-risk sexual practises continues to rise, especially among HIV-positive MSM, as evident from increasing HIV incidence and STI outbreaks among this core-group.ConclusionsIncreases in sexual risk behaviour among MSM in Britain have clearly been observed since 2000, however, definitive conclusions regarding changes in heterosexual behaviour are limited until methodologically-comparable data are available from Natsal-3. These new data will enable us to better examine hypotheses regarding changes in the British population’s sexual behaviour across time and across the life-course.