bluuebunny/crossref_metadata_2025_split huggingface dataset:
O06.3 Macrolide Resistance of Mycoplasma Genitalium in France Directly Detected in Clinical Specimens by Real-Time PCR and Melting Curve Analysis
Authors: Touati A , Peuchant O , Skov-Jensen J , Bébéar C , Pereyre S 
Published: July 2013

ObjectivesMycoplasma genitalium(MG) is a sexually transmitted organism associated with non-gonococcal urethritis in men and several inflammatory reproductive tract syndromes in women. These infections are commonly treated with azithromycin. However macrolide resistance has been reported and is associated with point mutations in domain V of the 23S rRNA gene. In order to evaluate the prevalence of macrolide resistance in MG in French clinical specimens, we first used a recently published High Resolution Melting (HRM) assay. Because wild-type and mutated MG were hardly discriminated in MG-positive clinical specimens, we developed a new molecular assay for the rapid detection of macrolide resistance.MethodsBetween January 2011 and September 2012, 207 urogenital MG-positive clinical specimens were collected from 185 patients. For the detection of macrolide resistance-associated mutations, we designed a real-time PCR based on fluorescence resonance energy transfer (FRET) coupled with melting curve analysis. The assay was first validated on macrolide-resistant MG isolates with characterised A2058G/C and A2059G mutations (Escherichia colinumbering), then optimised to be applied directly on clinical specimens. Resistant genotypes were confirmed by 23S rRNA gene sequencing.ResultsAmong 207 MG-positive clinical specimens, 136 from 119 patients were amplified with our assay, showing a sensitivity of 65.7% (136/207). A substitution in the 23S rRNA gene was found in 14.2% (17/119) of the patients, with a rate of 14.5% in 2011 and 14% in 2012. Nine and eight clinical specimens harboured the A2059G and A2058G mutations, respectively. In four cases, a mixed population of wild-type and mutated MG was observed.ConclusionMacrolide resistance prevalence of MG is 14.2% in France. Our FRET PCR assay is able to discriminate wild-type from resistant genotype in one reaction directly in clinical specimen. It will allow clinicians to shorten the time to initiate effective treatment and contribute to reduce transmission of resistant strains.
O06.5 An Exploratory Evaluation of Universal Opt-Out Chlamydia Testing During Clinical Encounters For Young Women in the United States
Authors: Owusu-Edusei K , Hoover K W , Hart-Cooper G D , Gift T L 
Published: July 2013

BackgroundChlamydia testing rates are low, with only about a third of sexually active young women tested at clinical encounters. Even fewer sexually active female adolescents are tested. Interventions to increase testing coverage have been moderately successful. In this study, we assessed the relative health and economic outcomes of patient-directed, universal, opt-out testing for women aged 15–24 years in the United States who have at least one clinical encounter each year when compared with current testing (30% coverage).MethodsWe used a basic dynamic compartmental model that included two groups based on their self-reported sexual activity in the past 12 months, with 72% being sexually active and 28% inactive. For our base case analysis, we assumed a 75% uptake of the intervention by sexually active women and 5% by sexually inactive women. All model parameters were obtained from the literature. The model was calibrated to produce a pre-intervention prevalence close to the national burden for those aged 15–24 years in the United States (≈2.5%). Health outcomes were measured in quality-adjusted life years (QALYs).ResultsBased on our model (including health insurance coverage and utilisation rates), the estimated effective annual testing rate increased to approximately 52%, and overall chlamydia prevalence decreased by 60% to ≈1% over a three-year period. The estimated cost per QALY gained was $1372. When we assumed an uptake rate ≥ 85%, the overall prevalence decreased to zero.ConclusionThe universal, opt-out testing intervention was cost-effective because it did not require additional costs over and above testing and treatment. Our exploratory analyses suggest that implementation of opt-out testing of young women during clinical encounters might substantially increase testing coverage of sexually active young women. However, even with a higher uptake, testing gaps would remain because many women might not have health insurance coverage, or not utilise healthcare.
O06.6 A Randomised, Double-Blind, Controlled Study to Assess the Efficacy and Safety of Nifuratel in the Treatment of Trichomoniasis
Authors: Mendling W , Caserini M , Palmieri R 
Published: July 2013

BackgroundTrichomoniasis is the most prevalent non-viral sexually transmitted disease and there is a clear need for identifying oral therapies that are effective against 5-nitroimidazole-resistantT. vaginalis(TV) infections. A randomised, double-blind, double-dummy, parallel group pivotal study was carried out to assess the efficacy and safety of a 7-day oral treatment course with nifuratel in comparison with metronidazole in women with trichomoniasis infection.MethodsFour-hundred-thirty-one patients, aged ≥ 18 years, were enrolled after providing their written informed consent. Women with a positive TV wet-mount microscopy were randomised and the diagnosis was confirmed by the InPouchTMTV culture method 3 days after. They received one tablet of nifuratel 200mg or metronidazole 250mg and one tablet of the corresponding placebo of the comparator three times daily after meals for 7 days. The TV eradication rate was assessed on day 21 ± 3 after the first drug intake. The concomitant infection by candidosis and the vulvovaginal signs and symptoms were also evaluated.The non-inferiority of nifuratel compared to metronidazole at the pre-specified margin of Δ-10% was defined as the clinically acceptable difference between the two active treatments.ResultsThe TV eradication was achieved by the 95.9% of patients in the per protocol data set: 95.2% and 96.5% in the nifuratel and metronidazole group, respectively (p = 0.0062). The eradication rate of vulvovaginal candidosis after treatment with nifuratel or metronidazole was 53.6% vs. 45.8%. A similar decrease in vaginal signs and symptoms, such as edoema, erythema, colpitis, cervicitis, itching, burning and dysuria, was detected in both groups. The treatments were also well tolerated with a comparable safety profile.ConclusionThe trial proved that nifuratel 600 mg/day, minimum recommended daily dosage, is effective as metronidazole 750mg/day, average dosage recommended, in the treatment of trichomoniasis infection and suggests that nifuratel could still be an efficient alternative to metronidazole as first-line treatment.
O07.2 The Changing Relationship Between Migration and HIV Over the Life Course of Affected Households in North India
Authors: Rai T , Lambert H S , Piot P , Agarwal K S , Ward H 
Published: July 2013

BackgroundMuch research explores the relationship between migration and HIV risk; elsewhere the focus is on how HIV affects household structure and viability. In India, rural-to-urban, circular migrants are targeted with prevention campaigns but little is known about the impact of HIV on livelihoods.AimTo explore the structural and contextual influences on the life course of HIV-affected circular migrant families, focussing on long-term prognosis, and consider implications for programmes.MethodsIn-depth interviews with HIV-positive patients at an antiretroviral therapy (ART) centre in northern India. Data were analysed using framework and thematic analysis.Results20 men and 13 women were interviewed. Short-term migration to urban areas secured an improved economic livelihood, but HIV diagnosis was often late following a prolonged period of privately-obtained symptomatic treatments. At eventual HIV diagnosis, most participants faced serious debt and physical degradation. They felt conflicted about future migration – their economic liabilities pushed them towards migrant work, but their poor health and strict treatment regime made them reluctant to leave home. Insecure job markets and discriminatory policies attenuated their employment choices while the opportunity costs of monthly ART centre visits and related medical care mounted up. The role reversal from primary earners and carers to needing care and financial support changed household organisation. Temporary care arrangements gave way to shifts in household composition, with gendered effects. Long term adherence to daily antiretroviral medication and the recommended healthy, regular meals could be compromised by the social and economic consequences of becoming positive.DiscussionMigration may increase HIV risk but following infection, HIV regulates future migration. It often increased the need to migrate again and forced some people to make choices that compromised their long-term health. Targeting migrants with prevention, testing and treatment programmes may fail to achieve desired outcomes without the simultaneous implementation of structural interventions.
O07.3 A Psychological Experiment to Examine the Global Impact of Stigma on Individuals Diagnosed with Type 1 Herpes Simplex Virus (HSV-1)
Authors: Whale J , Clarke E , Patel N , Graham C , Ingham R , Patel R 
Published: July 2013

BackgroundHSV-1 causes at least 50% of primary genital herpes infections in Europe, Canada, Australia and the USA. In the UK, rates may be even higher, as the level 3 STI clinic in Southampton observes approximately 80% of primary genital herpes infections in young women are due to HSV-1. Regardless of location, individuals disclosing genital herpes infection may experience enacted stigma associated with negative stereotypes of sexual immorality. Patients may often fear rejection and conceal their HSV status, deleteriously affecting social relationships and self-identity. Our study aimed to assess whether a relationship could be established between female HSV-1 infected status and sexual attractiveness to males, and whether a significant difference existed between male responses to HSV-1 orolabial and genital herpes infection disclosures by females.MethodsThe study was a randomised controlled trial of 111 male participants, recruited from university undergraduate students. Participants were randomly allocated to 1 of 3 groups and shown discrete video scenarios of a female actress disclosing HSV-1 infection. Group-specific questionnaires yielded quantitative data from visual analogue scales measuring attractiveness and truthfulness regarding disclosure.ResultsPilot data showed that there may be a significant reduction in female attractiveness to males, associated with HSV-1 genital herpes disclosure, but not following HSV-1 orolabial herpes disclosure. Pilot data showed there may be a significant reduction in male’s perceived truthfulness of HSV-1 orolabial herpes disclosure by females, in place of HSV-1 genital herpes. A full complement of results will be available by the ISSTDR/IUSTI conference.ConclusionFemale patients diagnosed with HSV-1 genital herpes are often advised by clinicians that strategic disclosure of orolabial herpes will maintain role relationships with male partners. However, our findings show that orolabial herpes disclosure may negatively affect relationships, as male partners may perceive such disclosure to be significantly less truthful than genital herpes disclosure.
O07.4 The Price of Sex: Insights into the Determinants of the Price of Commercial Sex Among Female Sex Workers in Rural Zimbabwe
Authors: Elmes J , Nhongo K , Hallett T , White P , Ward H , Garnett G , Nyamukapa C , Gregson S 
Published: July 2013

BackgroundAmid overall reduced demand for paid sex it is unclear how the economic organisation of sex work is affected. We explore factors associated with the price of paid sex in rural Eastern Zimbabwe.MethodsWe collected and analysed cross-sectional data on 161 women who reported receiving either cash or commodities at their most recent commercial sexual encounter and who were recruited using snowball and location-based methods in October-December 2010. We used linear modelling to assess the impact of social and behavioural variables on payments for sex.ResultsEighty percent of sex workers (SW) were paid in cash; the mean payment was US$11 (95% CI:$9-$13) and amount did not vary by payment type (p > 0.2). All acts were penile-vaginal. When clients requested condoms, consistent condom use was more prevalent than in encounters where they did not (82% vs. 38%,p < 0.01). Mean payment in 100% protected encounters was $3 lower than when condom use was inconsistent (at least one unprotected act) (p = 0.03). Mean payment was higher when encounters were initiated in private locations (SW or client’s house) than in bars and public places (e.g. markets): $13, $11 and $8, respectively (trend: p = 0.003). Independent factors positively associated with payment were secondary education (vs. no or primary education, p = 0.013), a night-long encounter (vs. one act, p = 0.03), higher numbers of acts (p < 0.01), clients not requesting condoms (vs. requesting condoms, p < 0.05); encounters initiated in public (vs. private locations p < 0.01) were negatively associated with payment.ConclusionClients who did not request protected sex paid more than clients who did, and more educated SW were able to negotiate higher prices. Under extreme macroeconomic pressures SW may be less financially able to refuse unprotected sex. We need to understand better the importance of economics of sex work for HIV/STI epidemics.
O07.5 Unprotected Sex Among High-Risk Partners: Associations Between Relational Characteristics of Last Sexual Partner and Unprotected Anal Intercourse (UAI) Among Men Who Have Sex with Men (MSM) and Transgender Women (TGW) in Lima, Peru
Authors: Cambou M C , Perez-Brumer A , Segura E R , Salvatierra J , Peinado J , Lama J R , Sanchez J , Clark J L 
Published: July 2013

BackgroundFactors influencing condom use among MSM/TW may include partner type and recent STI diagnosis. We examined the association of partner type with UAI among MSM/TW in urban Lima, Peru, recently diagnosed with HIV or STI.MethodsWe surveyed MSM/TW in Lima diagnosed with HIV/STI within the last month regarding their sexual practises with the most recent partner according to partner type (stable, casual, anonymous, commercial sex client or sex worker). We used a multivariate regression analysis to estimate prevalence ratios (PR) with UAI as the main outcome.ResultsAmong 340 participants (mean age: 30.9, range: 18 – 60), 62.5% self-identified as homosexual, 5.7% heterosexual, 17.6% bisexual, and 14.3% TW. Participants classified their last partners as 44.5% stable, 34.0% casual, 10.2% anonymous, 9.9% commercial sex client and 1.5% sex worker. Overall, 72.3% of participants reported UAI with their last partner. Using stable partners as the reference category, UAI was positively associated with all other partner types: PR: 1.5 (95% CI: 1.1 – 1.9, p < 0.05) for casual partners, PR: 1.5 (95% CI: 1.0 – 2.0, p < 0.05) for anonymous partners, PR: 1.6 (95% CI: 1.2 – 2.0, p < 0.05) for commercial sex clients and PR: 2.3 (95% CI: 1.7 – 3.0, p < 0.05) for sex workers.ConclusionUAI with the last partner was more commonly reported for non-stable partners. These unexpected results warrant further investigation into the influence of partner type on high-risk sexual behaviour among HIV/STI infected MSM/TGW. A better understanding of relational partner-level factors is critical for improving HIV/STI prevention and partner notification efforts for Peruvian MSM/TGW.
O07.6 Age Related Differences in Contraceptive Prevalence and Preference Among Harder-To-Reach Women on Antiretroviral Therapy (ART) Living with HIV in British Columbia (BC), Canada
Authors: Patterson S , Salters K , Zhang W , Chen Y , Hogg B , Ogilvie G , Kaida A 
Published: July 2013

BackgroundContraceptive use among HIV-positive women prevents unwanted pregnancy and reduces STI and HIV transmission. Recent studies link the use of hormonal contraceptive methods to increased risk of HIV transmission, consequently WHO guidelines recommend dual protection for HIV-positive women. Little is known about the uptake of dual contraceptive methods among women living with HIV. This study sought to measure differences in contraceptive prevalence and preference among HIV-positive women of different ages.MethodsThe Longitudinal Investigation into Supportive and Ancillary health services (LISA) cohort is a prospective study of harder-to-reach HIV-positive individuals accessing ART in BC. Interviewer-administered surveys collected information on socio-demographic, behavioural and structural factors while clinical variables were linked through the Drug Treatment Program at BC Centre for Excellence in HIV/AIDS. This analysis included non-pregnant women aged 18–49 years. The outcome variable of interest was self-reported current contraceptive use.ResultsOf the 166 women in this analysis, the median age was 38 years (IQR 33–43. In the six months before interview, 57% demonstrated viral suppression (VL < 50 copies) and median CD4 count was 280 (IQR 170–490). Contraceptive use was reported by 109 women (66%). Of the 104 women reporting vaginal sexual intercourse ≤ 6 months before interview, contraceptive methods included: barrier methods (condoms) (30%); dual methods (barrier method plus hormonal/permanent method) (27%); no method (24%), permanent methods (tubal ligation/hysterectomy) (10%); and hormonal methods (nuvaring/intrauterine device/oral/injectable) (9%). A significant difference was observed in contraceptive preference between sexually active women aged ≤ 35 years (n = 42) and > 35 years (n = 62), with older women choosing permanent or dual methods and younger women selecting hormonal, barrier or no contraceptive method (p = < 0.001).ConclusionYounger women demonstrate poor uptake of dual contraceptives, electing to use individual hormonal or barrier methods, or engage in unprotected intercourse. This demographic are at most risk of HIV transmission, potentially exacerbated by hormonal contraceptives.
O08.2 Use and Effectiveness of an Online Partner Notification Tool For STI, Called Suggest-A-Test
Authors: Gõtz H M , Rooijen M S van , Vriens P , Coul E Op de , Hamers M , Heijman T , Heuvel F van den , Koekenbier R , Leeuwen P van , Voeten H 
Published: July 2013

BackgroundPartner notification (PN) is crucial for STI control. We developed SuggestATest.nl (SAT), an internet-based notification system for verified diagnoses of STI/HIV, that uses an index-chosen method per partner (email, text messaging, postal letter or a gay dating site; anonymous or non-anonymous). SAT was piloted at the Public Health STI clinics in Amsterdam and Rotterdam, the Netherlands. It was offered additional to counselling by the nurse.MethodWe evaluated SAT use and effectiveness from March-July 2012. Numbers/method of sent SAT notifications were extracted from the SAT database, and epidemiological data from electronic patient records. Determinants for SAT use (age, sex, ethnicity, partners, STI) were assessed using logistic regression analysis.ResultsOf 1184 index-clients receiving a SAT code, 160 (14%) notified through SAT. They sent 588 notifications (median 2), 82% by text messaging and 16% by email; 86% was non-anonymous. Univariate analysis of SAT use in heterosexuals showed that people with only 1 partner used SAT less often than others; this was the only significant predictor. In MSM, the STI diagnosed was the only significant univariate factor, with MSM with syphilis using SAT more often than MSM having other STI. Among all 67 SAT users in Rotterdam, 56% (225/402) of their eligible partners were notifiable, and 95% (213/225) of those were notified using SAT. In 17 MSM, 36% (87/239) of eligible partners were notifiable, and 97 (111% of 87) were notified in SAT. Of all notified partners, 56% entered SAT to see the STI they were notified for, and 20% visited the STI clinic in Amsterdam/Rotterdam. STI positivity in partners was lower in those notified by SAT (28%, n = 116) than in those with contact cards (45%, n = 152; p < 0.001).ConclusionSAT is a valuable addition for supporting partner notification and management, although challenges as non-notifiable partners are not solved by SAT.
O08.3 Barriers to Bacterial STI Screening of HIV+ Men Who Have Sex with Men (MSM) in HIV Primary Care Settings
Authors: Barbee L A , Dhanireddy S , Tat S , Radford A , Marrazzo J M 
Published: July 2013

BackgroundIn the U.S., bacterial STI disproportionately affect HIV+ MSM. Screening for STI in HIV care settings remains suboptimal, but barriers have not been fully elucidated.MethodsAs part of a CDC initiative to increase STI screening among HIV+ MSM in care, we sought to (1) define current screening coverage, and (2) identify patient and provider related barriers to screening at the largest HIV clinic in the Pacific Northwest. We extracted aggregated testing data from electronic medical records, and created separate anonymous surveys for patients (written) and providers (electronic). All male clinic attendees seen during a 3-week period in 2012 were invited to participate; 110 MSM contributed. Of 33 clinic providers invited, 28 (85%) responded; 82% (23/28) were attending physicians.ResultsFrom March 2011-September 2012, among 1,379 HIV+ MSM engaged in care, 38% had extragenital testing, 40% urine testing, and 80% syphilis serology at least once. Of patients surveyed, 71% reported having sex in the last 2 months. 31% described seeking STI screening outside of the HIV clinic; of those, reported reasons included: being “easier” (42%), preferring “anonymity” (21%), wanting “more frequent screening” (16%). Providers reported being unfamiliar with current CDC screening guidelines (32%) and uncomfortable with discussing sexual practises and performing a genital exam (21%). Many (68%) stated time was a major barrier. Eleven (40%) providers cited patients’ reluctance as a barrier, reporting common patient excuses including: being unprepared (55%), testing elsewhere (82%) and preferring same-gender provider (27%). Asked about potential solutions, providers chose easier access to electronic-tracking of testing results (82%), access to results from other clinics (71%) and self-collection of specimens (57%).ConclusionAt a large academic HIV primary care clinic, STI screening was substandard, with providers reporting numerous barriers. Interventions to address these obstacles include implementation of an STI self-testing programme, and enhanced education for providers.