bluuebunny/crossref_metadata_2025_split huggingface dataset:
O15.3 Evaluation of an Immunochromatographic Point-Of-Care Test For the Simultaneous Detection of Nontreponemal and Treponemal Antibodies in Patients with Syphilis
Authors: Castro R , Lopes Â 
Published: July 2013

BackgroundWe described the evaluation of the DPP Syphilis Screen and Confirm Assay, a point-of-care test (POC) for the simultaneous detection of nontreponemal and treponemal antibodies for the serological diagnosis of patients with syphilis.MethodsA total of 248 samples from patients with active syphilis (173), past syphilis (15) and from individuals considered as no infected byTreponema pallidum(60) were studied with the DPP Syphilis Screen and Confirm, Rapid Plasma Reagin (RPR), and fluorescent treponemal antibody absorption (FTA-Abs) tests. In addition patients with active syphilis cases (36) primary, (39) secondary, and (98) latent, were evaluated. The DPP Syphilis Screen and Confirm device consists of a plastic cassette with a recombinantT. pallidumand a synthetic nontreponemal test line antigens and a procedural control line.ResultsThe sensitivity of the DPP Syphilis Screen and Confirm, nontreponemal and treponemal tests was 97.6% and 96.8% while the specificity was 94.7% and 93.1% respectively, when compared to the predicates RPR and FTA-abs tests. The treponemal and nontreponemal clinical sensitivity of primaries was 100% (36/36), for both and for secondary syphilis was also 100% (39/39), for both test and predicates. For patients with latent syphilis the sensitivity was 97.96% (96/98) for the treponemal test and 98.98% (97/98) for the nontreponemal test while for the predicates FTA-ABS and RPR was 100% (98/98) and 98.98% (97/98), respectively. With patients without syphilis the specificity of the DPP Syphilis Screen and Confirm test was 91.66% (55/60) for the treponemal line and 96.66% (58/60) for the nontreponemal line.ConclusionThese results indicates that the DPP Syphilis Screen and Confirm POC test could be a useful tool for the serological diagnosis of syphilis, including resource-poor settings where there is a need to provide counselling and treatment on site and thus prevent the further spread of the disease.
O15.4 Field Performance of the Alere Determine HIV Combo Assay in a Large Australian Multi-Centre Study in a Sexual Health Clinic Setting
Authors: Conway D P , Holt M , McNulty A , Couldwell D L , Smith D E , Davies S C , Cunningham P , Keen P , Guy R 
Published: July 2013

BackgroundRapid HIV testing has been available to gay and other men who have sex with men (MSM) overseas for many years. Alere’s Determine HIV Combo ‘fourth generation’ rapid test containing antibody and antigen components is now available in Australia, but field performance data for this assay are limited.MethodsFrom September 2011, MSM attending four Sydney public sexual health clinics were offered rapid HIV testing using the Determine HIV Combo and also had sexually transmissible infection screening and conventional HIV serology. Rapid test sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated by comparing results to reference tests (Abbott Architect HIV Ag/Ab Combo, Biorad Genscreen HIV antigen and HIV Western blot).ResultsIn 15 months, 1716 men had 2043 rapid tests performed with four invalid rapid tests (0.2%) excluded from analysis. Of 34 men confirmed as HIV-positive by national HIV case definitions, 29 had reactive rapid tests (sensitivity = 85.3%, 95% CI: 68.2–94.5). With 29 true reactive rapid tests from a total of 44 reactive tests, PPV overall was 65.9% (50.0–79.1). Of five men with false non-reactive tests, four were seroconvertors. Rapid tests were non-reactive in 1990 out of 2005 cases where laboratory HIV testing was negative; hence, overall specificity was 99.3% (95% CI: 98.7–99.6) and NPV was 99.8% (99.4–99.9). Of 15 men with false reactive rapid tests, four had non-specific reactivity on HIV Western blot. Specificity and NPV for the antibody component was 99.5% (99.0–99.7) and 99.9% (99.6–100.0) and for the antigen component was 99.8% (99.4–99.9) and 99.6% (99.1–99.8), respectively.ConclusionAntibody and antigen component specificity was consistent with the rapid test package insert; whereas sensitivity was lower, notably in those with recent infections. Hence, identifying patients at risk of recent infection is vital so that conventional laboratory serology is performed. A formal assessment of test performance in seroconvertors is warranted.
O15.5 Performance Characteristics of SD Bio Line Rapid HIV-Syphilis Duo Test Kit For Simultaneous Detection of HIV and Syphilis Infections
Authors: Ondondo R O , Odoyo J B , Bukusi E A 
Published: July 2013

BackgroundHuman immunodeficiency virus (HIV) andTreponema pallidumshare modes of transmission. Congenital syphilis is a significant cause of stillbirth, prenatal death and serious neonatal infections. We sought to evaluate rapid test kit for HIV-syphilis dual detection to improve diagnosis and enable accurate management towards achieving the renewed zeal of eradicating syphilis and congenital syphilis.MethodsSix hundred and eighty serum specimens from HIV discordant couples in a clinical trial, tested for syphilis infection by RPR with reactive specimens confirmed by TPHA, were used for this evaluation. HIV status was determined by Uni-Gold™ and Determine™ HIV rapid kits and all positive samples confirmed by two HIV Enzyme immunoassay test. These specimens were blindly retested using the HIV-Syphilis Duo kit.ResultsOf 698 samples evaluated 139 (20%) were RPR positive and 346 (50%) were HIV positive. Among the RPR positive, 85 (61%) were TPHA positive. None of 559 RPR negative samples tested syphilis positive on HIV-Syphilis Duo kits. Of the 85 RPR positive-TPHA positive samples, none tested syphilis negative on the HIV-Syphilis Duo kit. All RPR positive-TPHA negative samples tested syphilis negative on the HIV-Syphilis Duo kit. Sensitivity and specificity was: both 100% for syphilis detection and; 99.71% and 100% respectively for HIV detection. On this sample set the Sensitivity of Determine™ and Uni-Gold™ was 96.82% and 98.27% respectively while the Specificity was 93.75% and 99.43% respectively. HIV-Syphilis Duo kit detected 5 early HIV infections that were missed out by Determine™ and Uni-Gold™ at least one month prior to a seroconversion visit.ConclusionHIV-Syphilis DUO test kit performed better compared to RPR for syphilis and Determine™ for HIV detection. It was equivalent to TPHA for syphilis and Uni-Gold™ for HIV detection. Its implementation in antenatal clinics/VCTs will present an added opportunity for simultaneous diagnosis of HIV and syphilis.
O15.6 Molecular Surveillance ofNeisseria GonorrhoeaePenicillin Resistance: Informing Empiric Prescribing Policy in Western Australia
Authors: Speers D J , Goire N , Mak D , Fisk R 
Published: July 2013

Against the worldwide trend, there remain populations in the remote regions of Western Australia (WA) where the efficacy rates for penicillin may be above the World Health Organisation (WHO) 95% guideline forN. gonorrhoeadrug selection. Oral amoxicillin (3g) with probenecid (1g) is used empirically in these regions. The majority of gonorrhoea diagnoses in our laboratory are performed by PCR with culture-based antimicrobial resistance surveillance limited by the lack of a representative number of isolates. We therefore implemented a world-first comprehensive molecular gonococcal surveillance of penicillin resistance in our remote populations.We tested allN. gonorrhoeae-PCR positive cases from August 2011 to July 2012 (n = 1235) using a PCR assay targeting the penicillinase-producingN. gonorrhoeae(PPNG). This represented approximately 60% of the 2092 notified WA gonorrhoea cases but 91% of cases from the remote regions. Of these regions, the Kimberley PPNG rate was 0.7%, the Pilbara 4.0%, the Goldfields 10.3%, and the Mid West 0% compared to Perth, the state capital city with 12(8–16)%. When adjustments were made for chromosomal-mediated penicillin resistance (additional 3.4%), the Kimberley and Mid West regions remained below the 5% WHO resistance threshold for penicillin. In addition, a review of the Pilbara and Goldfields regions found PPNG only in the major regional centres.Based on this data, continuation of amoxicillin with probenecid in the Kimberley region with its reintroduction into the Mid West was recommended. In the Pilbara and Goldfields amoxycillin with probenecid could be continued in remote communities but empiric treatment in the regional centres and of non-locals should employ intramuscular ceftriaxone therapy, as for other parts of WA. Our study shows that molecular surveillance of gonococcal antimicrobial resistance directly from clinical specimens is feasible and could be extended to include other targets conferring resistance to other antibacterials such as ceftriaxone.
O16.2 Strain Typing to Resolve RepeatedChlamydia TrachomatisInfections in Young Heterosexual Dutch Populations
Authors: Götz H M , Bom R J M , Wolfers M , Fennema J S A , Broek I V F van den , Speksnijder A G C L , Bruisten S M 
Published: July 2013

Repeated infections ofChlamydia trachomatis(CT) occur frequently in young adults. These may be new infections, or persistent infections due to treatment failure or unresolved infections in sex partners. We compared CT multilocus sequence typing (CT-MLST) toompAgenotyping in discriminating new from persistent Chlamydia infections. Samples from young heterosexual persons were selected from Dutch screening implementation studies in Amsterdam and Rotterdam, the Netherlands, between 2009 and 2011. Paired CT positive samples at baseline (T0) and after 6 months (T1) were genotyped with 6 MLST loci which included:ompA,CT046,CT058,CT144,CT172andCT682. The uniqueness of Chlamydia strains was assessed by adding samples from 256 heterosexuals in Amsterdam.For 27 out of 34 persons with repeated infections, full MLST types were obtained for paired samples. In 17 of these 27 persons a multilocus (n = 13) or single locus variant (n = 4) was found, indicating new CT infections at T1. For 5 MLST discordant participants, theompAgenovar was identical. The 10 persons with concordant typing results were categorised as treatment failure (5 persons) or unresolved infections (5 persons). A minimum spanning tree, generated from all cases and 256 reference samples showed large and small clusters and singletons. Surprisingly, the persons with concordant samples had CT strains that were either unique (singleton) or found in small clusters. The median time between T0 and T1 did not differ between the persons with concordant and discordant samples. The number of sex partners before T0 however, was higher for the discordant group. High resolution sequence typing was superior compared toompAtyping in discriminating new from persisting Chlamydia infections. Many persons (37%) showed exactly the same Chlamydia strain after 6 months indicating possible treatment failure.
O16.3 Controlling Chlamydia: Population Modeling to Assess Promising Interventions
Authors: Glasser J W , Owusu-Edusei K , Glick S N , Aral S O , Gift T L 
Published: July 2013

BackgroundChlamydia is an important public health problem associated with neonatal sequelae, pelvic inflammatory disease, infertility, and ectopic pregnancy.MethodsUsing a population model with 2 genders and ages 15–44 years in 5-year groups, but only heterosexual contacts, we evaluated the impact of actual and hypothetical interventions on chlamydia in the U.S. Parameters were obtained from the literature or estimated from the National Health and Social Life Survey and Seattle Sex Survey. The model was calibrated by adjusting gender-specific probabilities of infection on contact. We calculated the basic reproduction number (R0), defined as the average number of secondary infections per infectious person in a wholly-susceptible population without interventions. We also calculated the age- and gender-specific equilibrium prevalence and contributions to R0. And we assessed the impact of interventions by comparing reproduction numbers with and without them. To assess the feasibility of opportunistic screening, we analysed Market Scan, a commercial health insurance database, to determine the proportion of people seeking medical care.ResultsTreating symptomatic men and women who seek care and screening 38% of women aged 15–24 years during annual examinations more than halve the reproduction number. The equilibrium age- and gender-specific prevalence of infection match those observed in the National Health and Nutrition Examination Survey. Men cause more secondary infections than women (contributing twice as much to R0in some age groups), and people aged 25–29 years cause as many as those aged 20–24. Analysis of the Market Scan database indicates that insured men seek care often enough for screening to have substantial impact. Screening women reduces the reproduction number by 3%; screening a similar proportion of young men would reduce it another 4%.ConclusionsOur modelling suggests that screening men as well as women and extending the upper age to 29 years may affect chlamydia transmission or sequelae.
O16.4 Human Papillomavirus in Very Young Men Who Have Sex with Men and the Potential Benefit from Vaccination
Authors: Zou H , Morrow A , Tabrizi S , Grulich A , Garland S , Hocking J , Bradshaw C , Prestage G , Fairley C , Chen M 
Published: July 2013

BackgroundHomosexually active men are at increased risk for human papillomavirus (HPV) infection and HPV associated anal cancer. Prophylactic HPV vaccines have maximum efficacy in people who have not already been infected with HPV. This study aims to determine the prevalence of HPV among teenage MSM.MethodsSame sex attracted males aged 16 to 20 were recruited in Melbourne via clinics, universities, community events, media, social networking and peer recruitment. At baseline, 3, 6, and 12 months anal and penile swabs and an oral rinse were obtained to test for 37 HPV genotypes.Results200 men were recruited. At baseline 39% had at least one type of HPV DNA detected from at least one site. High risk (HR), low risk (LR) and quadrivalent vaccine (QV) preventable types were detected in 31% (95% CI: 25–37%), 30% (95% CI: 24–37%) and 23% (95% CI: 17–29%) of men respectively. Multiple types of any, HR, LR and QV preventable HPV were detected in 27%, 13%, 11% and 8% of men respectively. The site specific prevalence of any HPV detected from the oral cavity, penis and anus were 2%, 9% and 31% respectively: the prevalence of QV preventable types at these 3 sites was 0.5%, 4% and 20% respectively. Anal HPV was absent in 27 of 30 men who reported never receiving anal sex. Additional results of serology for HPV 6/11/16 and 18 will also be presented.ConclusionIn this study, the first to focus on early HPV acquisition among teenage MSM, HPV was common but in the minority. HPV vaccination prior to the onset of sexual activity is ideal; however, short of universal vaccination of school aged males, selected vaccination of teenage same sex attracted young men could still prevent many infections.
O16.5 Concordance of Anal, Penile, and Oral Human Papillomavirus Hr-HPV Infections and HPV Seropositivity in HIV-Infected and HIV-Negative Men Who Have Sex with Men: The HIV & HPV in MSM (H2M) Study
Authors: Rijn V M van , Mollers M , Mooij S H , Speksnijder A C G L , King A J , Vries H J C de , Klis F R M van der , Melker H E de , Sande M A B van der , Loeff M F Schim van der 
Published: July 2013

BackgroundInfection with human papillomavirus (HPV) is not generally followed by seroconversion for reasons not yet fully understood. This cross-sectional study investigated concordance between high-risk (hr) HPV infections at three anatomical sites and concordant seropositivity, in both HIV-infected and HIV-negative men who have sex with men (MSM).MethodsMSM aged ≥ 18 years were recruited from the Amsterdam Cohort Studies, an STI clinic and an HIV treatment centre in Amsterdam, the Netherlands. The associations between anal, penile, and oral HPV infections and concordant seropositivity of 7 hr-HPV types (16, 18, 31, 33, 45, 52 and 58) were estimated using generalised estimating equations (GEE) regression analyses.ResultsAmong the 306 HIV-infected MSM 93% were hr-HPV seropositive (i.e. seropositive for at least one of the 7 hr-HPV types) and 69% were infected with at least one anal, penile, or oral hr-HPV infection. Of 441 HIV-negative MSM 74% were hr-HPV seropositive and 41% were infected with one or more hr-HPV infections. Type-specific hr-HPV seropositivity was not more likely for men with concordant infections at multiple anatomical sites (OR 1.58, 95% CI 1.06–1.86) compared to those with concordant infections at only one anatomical site (OR 1.45, 95% CI 1.22–1.73). In multivariable analysis, adjusting for key demographic and sexual behavioural factors, type-specific hr-HPV seropositivity was associated with concordant anal hr-HPV infections (OR 1.60, 95% CI 1.32–1.92), but not with concordant penile (OR 0.79, 95% CI 0.58–1.06) or oral (OR 1.36, 95% CI 0.85–2.17) hr-HPV infections; in stratified analyses, these associations were similar for HIV-infected and HIV-negative men.ConclusionsIn both HIV-infected and HIV-negative MSM, anal hr-HPV infections were associated with hr-HPV seropositivity, while penile and oral hr-HPV infections were not. Our findings support the hypothesis that seropositivity differs by the type of epithelium infected, implying that mucosal infection may provide a stronger signal to the immune system.
O16.6 Pre-Vaccination Seroprevalence of 15 Human Papillomavirus (HPV) Types Among Slovenian Women Screened For Cervical Cancer
Authors: Klavs I , Učakar V , Jelen M M , Faust H , Dillner J , Poljak M 
Published: July 2013

BackgroundOur objective was to estimate the seroprevalence of 11 high-risk (hr) HPV types (HPV 16, 18, 31, 33, 35, 39, 45, 52, 56, 58, 59) and four low-risk (lr) HPV types (HPV 6, 11, 68, 73) among Slovenian women screened for cervical cancer before the introduction of vaccination against HPV.Methods3259 serum specimens from the Slovenian HPV prevalence survey were tested for HPV type-specific antibodies with a multiplexed pseudovirion-based serological assay (PsV-Luminex).ResultsSeropositivity for any of the 15 HPV types was 65.7%, any of the 11 hr-HPV types 59.2%, and any of the four lr-HPV types 33.1%. Antibodies against multiple HPV types were more common (45.3%) than against single HPV types (20.4%). Antibodies against at least one of the four vaccine HPV types (HPV 6, 11, 16, and 18) were detected in 40.8% women. Among hr-HPV types seropositivity was the highest for HPV 16 (25.2%) and among lr-HPV types for HPV 6 (19.1%). Age-specific seropositivity for HPV 16 was the highest among 30–39 years old women (29.6%) and decreased with increasing age to 14.0% among 60–64 years old women (p = 0.014). Seropositivity for any of the hr-HPV among women with pathological cytology was 76.8% and those negative for intraepithelial lesion or malignancy 58.3% (p < 0.001).ConclusionOur results show a substantial burden of lifetime sexual exposure to these 15 HPV types before the introduction of vaccination and also a relatively high cumulative exposure to at least one of the four vaccine HPV types. Thus, vaccination of females before sexual debut with a quadrivalent HPV vaccine has a potential to contribute to a substantial reduction of the burden of cervical infections and cervical cancer as well as some other HPV related morbidity, including genital warts. Our data also present the baseline for monitoring HPV long-term vaccination impact.
O17.2 HIV Prevention at Scale: Has It Worked? Evaluation of the Impact of the Avahan Programme in South India
Authors: Pickles M , Boily M , Vickerman P , Lowndes C M , Moses S , Blanchard J F , Ramesh B M , Paranjape R S , Alary M 
Published: July 2013

BackgroundAvahan, the India AIDS initiative of the Bill & Melinda Gates Foundation, is the largest targeted HIV preventive intervention in the world. We examine evidence for its overall impact, and estimate HIV infections averted acrossAvahandistricts.MethodsA mathematical model of HIV transmission among high-risk groups and the general population was developed. It was parameterised using data from serial cross-sectional surveys (IBBAs) within a Bayesian framework, to reproduce HIV prevalence trends amongst female sex workers (FSWs), their clients, and men who have sex with men (MSM) in 24 South Indian districts. We test whether these prevalence trends are more consistent with self-reported increases in consistent condom use (CCU) followingAvahan,or a counterfactual assuming CCU increased at slower pre-Avahanrates. To assess this we used a Bayes factor, which also measures strength of evidence for the impact estimates. Using regression analysis, the prevention impact in the IBBA districts is extrapolated to allAvahandistricts.ResultsIn 13/24 districts, modelling suggests medium to strong evidence for the large self-reported increase in CCU sinceAvahanimplementation. Elsewhere evidence is weaker, with CCU generally already high pre-Avahan. Approximately 32,700 HIV infections (95% credibility interval 17,900–61,600) were averted over four years in IBBA districts with moderate/strong evidence. Adding districts with weaker evidence increases this to 62,800 (32,000–118,000), and extrapolation suggests that 202,000 (98,300–407,000) infections were averted across all 69Avahandistricts in South India, increasing to 606,000 (290,000–1,193,000) over ten years. Over four (ten) years, 42% (57%) of HIV infections were averted.ConclusionThis is the first evaluation ofAvahanto account for the causal pathway of the intervention, changing risk behaviour in FSWs and MSM to avert HIV infections in these groups and the general population. The findings suggest considerable impact can be achieved from targeted behavioural HIV prevention initiatives.
O17.3 Do We Need to Vaccinate Males Against HPV?
Authors: Ali H , Korostil I , Guy R J , Wand H , Grulich A E , Read T R H , Regan D G , Fairley C K , Donovan B 
Published: July 2013

BackgroundFrom mid-2007 Australia funded a universal HPV vaccination programme for young females, which achieved high coverage rates. In 2013, Australia has become the first country to extend the HPV vaccination programme to boys aged 12–13 years. A catch-up programme includes boys aged 14–15. The aim of this study was to look at the current and expected impact of the vaccination programme on genital warts in men.MethodsEight Australian sexual health services provided data on all new patients. We compared trends in proportion of patients diagnosed with genital warts in the pre-vaccination (2004 to mid-2007) and vaccination (mid-2007 to 2011) periods. Furthermore, we used a mathematical model of HPV transmission to predict the impact of male vaccination on the incidence of genital warts.ResultsIn the pre-vaccination period, there was no change in proportion of men diagnosed with genital warts. In the vaccination period, there were significant declines in proportions of < 21 (81.8%, compared to 92.6% decline in women) and 21–30 year old (51.1%, compared to 72.6% in women) heterosexual men diagnosed with genital warts; from 12.1% in 2007 to 2.2% in 2011 and from 18.2% in 2007 to 8.9% in 2011 respectively. There was no significant decline in diagnosis in men > 30 years of age, or in homosexual or bisexual men. Results of the model are in-line with this decline in men. With the introduction of male vaccination programme, the model predicts a much lower incidence, approaching elimination, in coming decades.ConclusionAlthough there has been a decline in the proportion of young heterosexual men diagnosed with genital warts suggesting herd immunity, the decline is slower than that of young females and no decline is observed in homosexual/bisexual men. The male vaccination programme will lead to near elimination of genital warts in both females and males in Australia.