bluuebunny/crossref_metadata_2025_split huggingface dataset:
S16.5 Management of Syphilis in Pregnancy
Authors: Wilson J 
Published: July 2013

There are a number of clinical challenges that are specific to managing syphilis in pregnancy: Which women have the highest risk of adverse pregnancy outcome and is there anything extra we should do for them? What effect does the timing of treatment have on the pregnancy? What is the best treatment and should this be modified in the presence of HIV? What effect does the Jarisch-Herxheimer reaction have on pregnancy? What rate of adverse pregnancy outcome can be expected following successful treatment? Should all babies be treated at birth and how should the baby be monitored?Early stage maternal infection and higher RPR increase the risk of adverse pregnancy outcome. Treatment in the third trimester is also associated with poorer outcomes. Parenteral penicillin G is the only recommended therapy for treatment of syphilis during pregnancy, and the lack of effective alternatives is why desensitisation is recommended in those who report a penicillin allergy. However, a meta-analysis concluded there is insufficient evidence to determine an optimal penicillin regimen. Adequate treatment in pregnancy significantly reduces adverse pregnancy outcomes (APOs) and congenital syphilis but APOs are still reported probably due to placental damage and effects of the fetal immune response. Some guidelines recommend treating all infants born to positive women whether or not the mother was adequately treated in pregnancy whereas others suggest this is probably not necessary. All recommend examination and serological testing of the babies every 3 months until the test/s become nonreactive.This presentation will look at the evidence base, and the recommendations in different national guidelines, to try to provide answers to these questions.
YI.1 Condom Use & Pleasure in a Sample of YMSM: A Conceptual Framework
Authors: Arrington-Sanders R , Harper G W , Fortenberry J D , Bauermeister J A 
Published: July 2013

PurposeLittle research addresses sexual pleasure in young men who have sex with men (YMSM). In this qualitative study, we developed a sexual health focused conceptual framework to explore relationships that emerged between condom use and sexual pleasure in sexual relationships among a sample of gay, bisexual, and transgender males.Methods30 YMSM (ages 18–24 years) were recruited (through advertisements on social networking sites, participant referrals, and flyers posted at local venues frequented by YMSM) to complete a 90-minute, semi-structured interview seeking to better understand partner-seeking behaviours of YMSM. Interviews were transcribed verbatim. Analysis used inductive open coding such that emergent concepts were connected across interviews and major themes identified.ResultsMedian age was 22 years old (M = 21.96; SD = 1.75). Most (N = 18, 60%) of participants self-identified as White, and gay (N = 22, 73%). Over 90% (N = 28) reported having had sex with someone met on a dating website in the past 3 months. Five (17%) participants reported being HIV-positive and 12 (40%) reported a prior history of a sexually transmitted infection. Emotional effects (such as connectedness with others) and physical effects (loss of sensation and erectile difficulties) mediated the relationship between pleasure and condom use during insertive penile-anal intercourse. Specific characteristics of sexual events (e.g., use of lubricant), relationship with the partner, and of the specific sex act (including sexual position) moderated the relationship, with pleasure and satisfaction greater during receptive anal sex without a condom with emotionally intimate or regular partners.Conclusions Our findings suggest that relationship between sexual pleasure and condom use may be mediated by both emotional and sexual factors. Prevention work with YMSM need to acknowledge the centrality of pleasure in sexual health and focus on modifiable factors that may impact pleasure among YMSM.
YI.2 Teens, the Internet, and STD Risk: Findings and Lessons Learned from the Communication, Health, and Teens (CH@T) Study
Authors: Buhi E R , Powers E , Hughes S , Klinkenberger N , Wheldon C W , Rietmeijer C 
Published: July 2013

BackgroundFew studies have examined the association between sexual health risks and online sex seeking among teenagers. The purpose of this study was to assess the associations between meeting sex partners online and a range of sexual risk behaviours and outcomes among adolescents.MethodsParticipants aged 13–19 years were recruited from a publicly funded teen clinic in Florida. After obtaining informed consent/assent, 273 participants completed an audio computer-assisted self-interview (ACASI) that included questions on demographics, sexual behaviour, STD history, and online sex-seeking behaviours and experiences. Participants also provided urine samples for chlamydia and gonorrhoea testing. Data were analysed using logistic regression to identify the association between having an online sex partner and sexual behaviours/outcomes.ResultsAfter adjusting for significant bivariate correlates, teens reporting online sex partners were more likely to be male, be multiracial, have a history of same-sex sexual activity, report a higher number of vaginal sex partners, and report a lower age at first vaginal sex. However, teens with online sex partners were no more likely to have ever had an STD or a current biological STD.ConclusionThis study is one of the first to link biological STD results to online sex-seeking data in a youth population. While meeting a sex partner online was not associated with past or current STDs, it was associated with other sexual risk behaviours. Future research is needed to examine the complex nature of online sexual partnering among adolescents and to develop intervention approaches. In-depth qualitative interviews, currently being conducted with teens, are exploring the process and context of meeting partners online. These interview data will also be discussed in light of the ACASI and biological STD data findings.
YI.3 Sexually Transmitted Infections (STIs) Vary Among African American Women Who Have Sex with Women Based on Exposure to Male Sexual Partners
Authors: Muzny C A , Harbison H S , Whittington A M , Whidden R L , Richter S S , Jones M G , Austin E L , Hook E W 
Published: July 2013

IntroductionLittle is known about partner characteristics or rates of STIs among African American women who have sex with women (AAWSW).MethodsAfrican American women aged ≥ 16 years attending a Health Department STD clinic were enrolled in this ongoing study if they reported sexual activity with a female partner during the preceding year. Participants completed a study questionnaire and were tested for curable (trichomoniasis, Chlamydia, gonorrhoea, and syphilis) and non-curable (HSV-2, HIV) STIs.ResultsOf 128 participants reporting female partners during the preceding year, 52% (67/128) also reported sex with men during the same interval (WSWM). WSW and WSWM did not differ with regards to age, lifetime number of female partners, or number of female partners during the preceding year. WSWM reported increased numbers of lifetime male partners compared to WSW (p= 0.01). During the 30 days preceding enrollment, WSWM reported a median of 2 sexual partners (interquartile (IQR) range 0–4) while WSW reported a median of 1 sexual partner (IQR 0–2). WSWM were significantly more likely than WSW to report new or casual female partners within 30 days preceding enrollment (46% vs. 28%;p= 0.03) while WSW were more likely to report regular female partners (75% vs. 34%;p= 0.01). Additionally, 39% (26/67) of WSWM reported new or casual male partners within 30 days preceding enrollment. Although not statistically significant, diagnosis of all curable STIs (trichomoniasis, Chlamydia, gonorrhoea, and syphilis) was more common among WSWM than WSW (30% vs. 16%;p= 0.07). Similarly, seropositivity for HIV and HSV-2 was more than twice as common among WSWM as WSW.ConclusionsAAWSW in this study were at high risk for STIs. AAWSWM, as a subgroup, may demonstrate heightened STI rates compared to exclusive AAWSW, perhaps influenced by partnership characteristics. Sexual health services for AAWSW should take into account partner gender heterogeneity when screening for STIs.
YI.4 Gonococcal Genomics Shows Impact of Recombination on Obscuring Phylogenetic Signal and Disseminating Resistance Loci
Authors: Grad Y , Kirkcaldy R , Dordel J , Goldstein E , Trees D , Weinstock H , Parkhill J , Hanage W P , Bentley S , Lipsitch M 
Published: July 2013

BackgroundRecombination plays a significant role in the plasticity of theNeisseria gonorrhoeaegenome by generating antigenic diversity and as a mechanism of spread of antibiotic resistance elements. Extensive recombination in a population can also limit inferences about phylogenetic history. Here, we investigate the impact of recombination in the study of isolates with reduced susceptibility to cefixime (cefRS; cefixime MICs ≥ 0.25 µg/ml) in the United States.MethodsWe generated draught genome sequences for 242 gonococcal isolates collected by CDC’s Gonococcal Isolate Surveillance Program (GISP). These isolates comprise all 141 cefRSisolates from GISP in 2009–10 and 141 susceptible isolates matched by location, collection date, and sexual orientation of the infected individual. We predicted recombinant regions and generated a maximum likelihood phylogenetic tree from core SNPs. We performedin silicoMLST and NG-MAST typing, and compared phylogenies of antibiotic resistance loci to whole genome-based phylogenies.ResultsPer siter/mratios (relative likelihood that a polymorphism was introduced through recombination rather than mutation) of recent branches in the phylogenetic tree are higher and fraction of homoplasic sites much lower than for the overall tree, suggesting that extensive recombination reduces confidence in the phylogeny’s deep branches. Comparison within silicoMLST and NG-MAST reveals that traditional typing-based phylogenetic inferences, even for recent events, are confounded by recombination. Of the 21 penA alleles in this dataset, mosaic PBP2 pattern XXXIV was the most common (present in 116/121 cefRSisolates). We find several recombination events introducing this allele into distinct lineages, and an event within thedcwgene cluster, which includes the penA allele, associated with reversion from cefRSto cefixime susceptibility.ConclusionsGenomic methods reveal the impact of recombination on phylogenetic history, spread of resistance elements, and genome evolution, and offer a superior approach to traditional typing schemes in understanding population structure and dynamics.
YI.5 Sexual Risk Factors Amongst Women Who Have Sex with Men and Women: The Women in Indiana Sexual Health and Experience Study (WISHES)
Authors: Schick V R , Pol B Van Der , Dodge B , Bell A , Neal C 
Published: July 2013

BackgroundPrevious research suggests that women who have sex with women and men (WSWM) may be at a higher risk for STI than women with exclusively male (WSM) or female (WSW) partners. In contrast to previous research which has compared WSWM to WSW/WSM, the present study explored risk factors which may be unique to WSWM.MethodsLocal women aged 18 or older who reported genital contact with a male and female partner within the past year were invited to participate in the study. Upon completion of an internet-based baseline survey about their sexual and STI history, participants were invited to participate in an in-person interview. During the meeting, participants engaged in a semi-structured interview followed by completion of a sexual event history calendar (SEHC). Participants were then asked to self-collect oral, vaginal and anal samples to screen for Chlamydia, Gonorrhea and Trichomoniasis.ResultsEighty participants with a mean age of 26.74 (SD = 7.97) completed the survey. The majority of the participants reported genital contact at an earlier age with a male partner (M = 16.02, SD = 3.31) than with a female partner (M = 18.93, N = 5.13).The most common type of genital contact was external genital rubbing with a male (97.5%, N = 78) and/or female (93.5%, N = 74) partner. Most participants reported a wide variety of sexual behaviours. Over half of the participants (57.5%, N = 44) reported engaging in a threesome/orgy within the past year. Data on the sequence of sexual acts was captured using the SEHC. Most participants self-collected a sample for STI screening. Approximately 30% (N = 25) of the participants reported an STI diagnosis within their lifetime and close to 10% of the participants tested positive for Chlamydia.DiscussionThe study was successful in recruiting a sizable number of participants with a range of sexual experiences. The majority of participants opted to participate in all phases of the study.
O01.1 Association of Genetic Variants withChlamydia TrachomatisReinfection
Authors: Kapil R , Tang J , Press C G , Geisler W M 
Published: July 2013

BackgroundUp to 20% ofChlamydia trachomatis(CT)-infected patients are reinfected within months after treatment, suggesting some fail to develop protective immunity. Genetic determinants influencing CT reinfection risk have not been fully elucidated. Our primary research objective is to identify genetic determinants of CT reinfection. Based on previously reported associations of HLA class II alleles with CT complications, our initial investigations focus on HLA class II genes.MethodsIn an ongoing prospective natural history study, CT-infected subjects are enrolled, treated with azithromycin 1 g single dose, and return for a 6-month follow-up visit for repeat CT testing using the Gen-Probe APTIMA Combo 2 assay (Gen-Probe, Inc., San Diego, CA). HLA class II alleles are resolved by a combination of PCR-based techniques. Genomic DNA is stored for further genotyping.ResultsA total of 199 African American subjects have been studied to date: 90% women and median age 23. CT reinfection at follow-up was noted in 18%. Subjects withHLA-DQB1*05more often had reinfection (20 [26%] vs. 16 [13%], P = 0.018), which remained significant after controlling for age and gender (OR 2.6, 95% CI 1.2–5.6, P = 0.012). OtherHLA-DQB1alleles were not significantly associated with reinfection (P ≥ 0.1).ConclusionHLA-DQB1*05was associated with CT reinfection, suggesting it could influence protective immunity. More comprehensive genotyping from larger prospectively studied cohorts should help confirm or refine this observation. Analysis of additional HLA class II genes and genes beyond the human MHC is in progress.
O01.2 Innate Immunity Modulation by Trichomonas Vaginalis Galectin-Binding Glycolipid Domains
Authors: Fichorova R N , Yamamoto H S , Fashemi T , Buck O R , Foley E , Hayes G R , Sato S , Singh B N 
Published: July 2013

BackgroundTrichomonas vaginalisis a protozoan extracellular parasite causing long-lasting and recurrent vaginitis with a wide range of symptoms and increased risk of HIV and other viral STIs. The protozoan virulence factors that subvert the mucosal immune response are poorly understood. Here we investigate the role of the ceramide-phosphatidyl-inositol glycolipid core (CPI-GC) of the protozoan lipophosphoglycan (LPG), which is the major glycoconjugate on the trichomonad surface (2–3 million copies/parasite). We have previously determined that CPI-GC lacks mannose but contains polylactosamine repeats representing potential ligands for animal lectins called galectins, implicated in HIV pathogenesis.MethodsCPI-GC was isolated fromT. vaginalisLPG by mild acid hydrolysis and C18-SepPak separation. Binding to galectin-1 and –3 (Gal-1 and –3) was determined by Biolayer Interferometry. Inflammation-related proteins and Gal-1 and 3 were measured by a multiplex immunoassay in supernatants from human cervical and vaginal epithelial cells infected withT. vaginalis orexposed to CPI-GC from different clinical isolates.ResultsCPI-GC activated NF-κB and upregulated cFos, COX-2, IL-8, MIP-3α, IL-6, IL-1β and VEGF in a MEK1/2 dependent manner. In addition, IL-6, ICAM-1 and VEGF up-regulation was mediated by p38 while IL-8 and MIP-3α were ERK 1/2 mediated. CPI-GC from different clinical isolates varied in their ability to bind Gal-1 and Gal-3, which were constitutively expressed by vaginal and cervical epithelial cells and released at higher levels in the extracellular space during exposure to live trichomonas and CPI-GC. CPI-GC from all isolates invariably reduced levels of the natural microbicide SLPI. Mutant trichomonads that failed to bind Gal-1 and Gal-3 showed higher proinflammatory activity suggesting a role for the CPI-GC –galectin binding in suppressing innate immune responses.ConclusionInterventions targeting CPI-GC or restoring the balance of natural immune defences represent a promising strategy for preventing adverse outcomes fromT. vaginalisinfection.
O01.3 Regulatory T Cells in Peripheral Blood and Cerebrospinal Fluid of Syphilis Patients with and Without Neurological Involvement: A Comprehensive and Comparative Study
Authors: Wang C , Lu H , Gu X , Guan Z , Zhou P 
Published: July 2013

BackgroundSyphilis, a sexually transmitted disease caused by spirochetal bacterium Treponema pallidum, can progress to affect central nervous system, causing neurosyphilis. While many neurosyphilis patients may be asymptomatic, some patients can develop severe neurological and psychiatric symptoms. Accumulating evidence suggest that skin lesions and clinical symptoms of early syphilis patients result from host immune and inflammatory responses. However, very little is known about the immune components in neurosyphilis.Methodology/Principal FindingsIn the present study, we perform a comprehensive and comparative analysis of regulatory T cells (Tregs) between 102 neurosyphilis patients and 431 syphilis patients without neurological involvement. We found secondary and serofast patients had increased Treg percentage, suppressive function and TGF-β levels in peripheral blood compared to healthy donors and serum Rapid Plasma Reagin (RPR) titers were positively correlated with Treg numbers in these patients. Neurosyphilis patients had higher Treg frequency in peripheral blood than those of syphilis patients without neurological involvement. Importantly, CD4+ T cells were increased and predominated in cerebrospinal fluid (CSF) of both asymptomatic and symptomatic neurosyphilis patients. Interestingly, a significant decrease in CSF CD4+ CD25 high Treg percentage was observed in symptomatic neurosyphilis patients compared to those of asymptomatic neurosyphilis patients, which may be associated with low CSF TGF-β levels.ConclusionsOur findings suggest that neurological progression in syphilis patients may be associated with an enhanced systemic Treg response and an increased local CD4+ T cell infiltration. A decrease in Treg frequency in CSF of symptomatic neurosyphilis patients indicates that immune-mediate tissue damage might be involved in the development of neurological symptoms.
O01.4 Blood Transcriptional Profiling of Women with Chlamydia Trachomatis Identifies a Pelvic Inflammatory Disease (PID) Signature
Authors: Darville T , Zheng X , O’Connell C , Nagarajan U , Macio I , Wiesenfeld H , Rabe L , Hillier S 
Published: July 2013

ObjectiveMost women with Chlamydia trachomatis (CT) infection are asymptomatic, while ∼3% progress to pelvic inflammatory disease (PID) within two weeks of untreated infection. The identification of biomarkers that predict development of PID would aid in identification of women at risk for complications of infertility and ectopic pregnancy. The specific aim of this study was to identify a whole blood transcript signature for acute PID due to chlamydial infection.MethodsWe performed gene expression microarrays using whole blood from 79 women who had a gynecologic exam, and cervical and endometrial microbiologic testing. Samples were divided into five groups: Group 1, women with acute PID who were CT+ at endometrium (PID+, CT+, and E+); Group 2, asymptomatic women who were CT+ at endometrium (PID-, CT+, E+); Group 3, asymptomatic women who were CT+ at cervix (PID-, CT+, E-); Group 4, asymptomatic women who were CT- at cervix and endometrium (PID-, CT-, E-); Group 5, women with symptoms of PID who were negative for CT or other sexually transmitted pathogens (PID+, STI-, E-).ResultsWe identified a transcript signature that discriminated women with chlamydial PID from all other groups. Pathway analysis revealed that the chlamydial PID signature contained genes from interferon response pathways. Gene transcription in a subset of women with chlamydial endometrial infection clustered with women with chlamydial PID.ConclusionsOur study raises the possibility that transcriptional biomarkers with potential as diagnostic and prognostic tools can be identified to combat chlamydial reproductive tract disease in women.
O01.6 Persistent SIV-Seronegative Macaque Monkeys Generate Multi-Cytokine Anti- SIV Mucosal Immune Responses Following Serial Low-Dose SIV Mucosal Challenge
Authors: MacDonald K S , Haq K , Chan J , Iwajomo O , Janes M , Perciani C , Pilon R , Caldwell D , Sandstrom P , Willer D O 
Published: July 2013

BackgroundThere are no systematic prospective human or simian studies on the effects of repeated sub-infectious doses of HIV/SIV on mucosal and systemic immunity. The capacity and mechanism of how these responses may impact acquisition and subsequent disease course are also unknown.MethodsTo address this, we examined cynolmolgus macaques as part of a vaccine trial, for their ability to generate mucosal and systemic immune responses following repeated ultra low-dose mucosal SIVmac239 challenge. Animals were challenged intra-rectally weekly according to a 24-week dose-escalation. Blood was obtained weekly, and rectal biopsies were obtained 18 to 24w post SIV challenge and analysed by flow cytometry for anti-SIV T-cell responses. Intracellular cytokine responses (IFN-γ, IL-2, TNFα and CD107a) were measured.ResultsTotal CD4+ responses against two distinct antigenic targets correlated with apparent resistance to infection as measured by the number of challenges, total dose and infecting dose. Moreover, CD8+ responses were also predictive of susceptibility to infection. Both CD4 and CD8 T cell effectors were observed secreting IFN γ, TNF α, IL2 and CD107a in response to SIV gene products not present in the SIV vaccine that the animals received. Placebo-vaccinated animals did not have significantly fewer mucosal immune responses than vaccinees but they did have fewer blood responses suggesting that mucosal responses were generated by the SIV exposure while systemic responses were generated by the vaccine. Multiple sub-infectious SIV challenges did not induce humoral responses in the blood, as determined by western blot assay.ConclusionsTogether, this data suggests that these mucosal immune responses are the predominantly the result of priming by repeated low dose SIV challenge. Such an effect alters subsequent susceptibility to infection which has implications for vaccine studies and for understanding the biology of transmission since it increases the resistance to infection of both vaccinees and placebo recipients unpredictably.