bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3-S4.05 Missed opportunities for early detection of cervical cancer in an STD clinic
Authors: Arno J , Graffis R , Ferries-Rowe E , Hess L 
Published: July 2011

BackgroundIn 2009, more than 11 000 women were diagnosed with invasive cervical cancer and approximately 4000 died. Many of these women were never screened or not screened in the 5 years before their diagnosis. Because vaccine uptake has been low, it is critical to continue efforts at early detection. We examined how many women diagnosed with cervical cancer at a public hospital were seen at the public STD clinic up to 5 years before diagnosis to detect missed opportunities for early detection.MethodsAll cases with a diagnosis of cervical cancer from 1 January 1999 to 18 October 2010 were extracted from the electronic database of Wishard Hospital (Marion County Indiana's public hospital) using ICD-9 codes for severe squamous dysplasia (CIN3), adenocarcinoma in situ of the cervix and malignant neoplasm of cervix uteri. Results were validated using cytology and pathology records and women verified to have CIN3 or higher grade abnormalities were included. These were matched to patients in the electronic medical database of the Bell Flower Clinic (Marion County's public STD clinic) on the basis of first name, last name, date of birth, race and social security number when present. Missed opportunities were defined as those visits to Bell Flower within 5 years of a diagnosis of cervical cancer and no history of a PAP smear or HPV screening within 2 years at Wishard Hospital.ResultsWe identified 1309 women with cervical cancer diagnosed or treated at Wishard Hospital during the study period. Of these, 202 women were found to have visited Bell Flower at some time during the study period whereas 73 were found to have made 147 visits to Bell Flower Clinic <5 years prior to their diagnosis of CIN3 or higher. Because a substantial number of these women had normal or low grade abnormal PAPs at Wishard <2 years prior to their diagnosis, only 48 patients (97 visits) had visits that qualified as missed opportunities.ConclusionsMost women who developed cervical cancer diagnosed or treated at the public hospital had no record of a visit to the STD clinic. Of the 38 813 visits by women to Bell Flower during the study period, only 147 visits qualified as missed opportunities for detecting cervical cancer in 48 individuals. The number of women affected by missed opportunities was low, in part, because of accessible strong PAP smears at the public hospital.
P3-S5.01 Microbial diversity of genital ulcer disease in men enrolled in a randomised trial of male circumcision in Kisumu, Kenya
Authors: Mehta S , Maclain I , Baiely R , Moses S , Gillevet P , Spear G 
Published: July 2011

BackgroundMedical male circumcision (MMC) reduces the risk of HIV acquisition by ∼60%, in part by reducing genital ulcer disease (GUD) and HSV-2. In the Ugandan and Kenyan trials, PCR did not find a sexually transmissible agent in 50–60% of GUD specimens, and MMC did not protect against HSV-2 in the Kenyan trial. We sought to better define the aetiology of GUD in the Kenyan trial and examine how MMC affects GUD aetiology.MethodsWe defined GUD of unknown aetiology as negative for HSV type 1 and type 2,T pallidum, andH ducreyiby PCR, and negative for HSV-2 andT pallidumby serology. In 59 GUD specimens from 59 men, 23 (39%) had unknown aetiology. We identified bacterial microbiota in all 59 specimens using multitag pyrosequencing of the 16S rRNA gene, and compared results by unknown vs STI aetiology. Statistical analysis employed exact methods.ResultsOverall, 83 distinct genera were detected. Prevotella spp. was most abundant, accounting for 18% of microbiota on average, and present in 75% of specimens. Bacterial diversity was greater in GUD of unknown aetiology than STI associated GUD (median number of genera 13 [range 7–20] vs 11 [range 3–20], p=0.06).Fusobacterium spp., Sneathia spp. and Anaerococcus spp.were more abundant in GUD of unknown aetiology (7.7%, 7.6%, and 7.3%, respectively) than in GUD of STI aetiology (4.6%, 5.0%, and 5.4%). Fusobacteriales (Fusobacterium spp.orSneathia spp.) [OR=4.7; 95% CI: 1.3 to 19.9] andAnaerococcus spp.[OR=4.6; 95% CI: 1.2 to 22.5] were more likely to be recovered in GUD of unknown aetiology than STI associated GUD. Fusobacteriales were more often recovered from uncircumcised men than circumcised men (62% vs 22%, p=0.04), and Anaerococcus spp. was present in 22% of circumcised vs 70% of uncircumcised men (p=0.010). Reported penile coital injuries were more common among men withAnaerococcus spp.(85% vs 57%, p=0.01), and condom use was less common (50% vs 71%, p=0.11). There was no difference in these bacteria by ulcer location.ConclusionsFusobacteriales andAnaerococcus spp.may colonise genital ulcers that develop from a mechanism related to circumcision status. Many such “ulcers” may be epithelial disruptions that are traumatic in origin. These bacteria have cytotoxic properties that may ulcerate or exacerbate pre-existing minor epithelial disruptions. MMC may reduce GUD through a reduction in these anaerobic bacteria.
P3-S5.03 Conflict of interest and point of care tests: an exploration of accuracy in Hepatitis C infection
Authors: Shivkumar S , Jafari Y , Lambert G , Claessens C , Klein M , Martinez-Cajas J , Peeling R , Joseph L , Pai N P 
Published: July 2011

BackgroundThe WHO estimates that 170 million people worldwide are infected with Hepatitis C. In the context of HIV co-infection, rapid point-of-care tests gain importance in both the developing and developed countries. Moreover, in the light of the Food and Drug Administration's approval of the Oraquick point-of-care test for Hepatitis C for use in the USA, the accuracy of these tests is relevant.ObjectiveWe conducted a systematic review and meta-analysis of the literature examining the sensitivity and specificity of all rapid point-of-care tests used to diagnose incident or prevalent Hepatitis C, with an attention to involvement of industry in reporting of results.MethodsTwo reviewers conducted independent searches of five databases between the years of 1995 and 2010. Bayesian meta-analysis was conducted accounting for the use of imperfect reference standards (sensitivity and specificity ranges of 90%–100% were assumed) in the assessment of index tests. The quality of all included full-text studies was assessed using the QUADAS and STARD checklists, with a focus on reporting of conflict of interest with industry.ResultsA total of seven studies were identified from the database searches, of which five were conducted in developing settings. Eight index tests were examined including Oraquick, HCV Tri-Dot, HCV Bidot, Therma Ricerca, SM-HCV, Onecheck, Goldspot and Accurate. Sensitivity of all index tests ranged from 45% to 100%, while specificity ranged from 93% to 100%. Oraquick reportedly had the highest accuracy, with sensitivity ranging from 99% to 100% and a specificity of 100%. However, the authors of the study reported a financial relationship with Orasure Technologies Inc., the makers of Oraquick. Although pooled sensitivity of all tests was high at 92.72% (95% CI 72.11% to 99.93%), when the Oraquick study was removed from analysis, the pooled sensitivity of all other tests dropped to 77.11% (95% CI 45.49% to 99.61%) see Abstract P3-S5.03 table 1. Pooled specificity remained high at almost 100% regardless of whether the Oraquick study was included or not.Abstract P3-S5.03 Table 1Results of bayesian meta-analysis: diagnostic accuracy of index tests used to detect Hepatitis CPooled resultsSensitivity (95% CI)Specificity (95% CI)Including oraquick study92.72% (72.11% to 99.93%)99.88% (99.56% to 100%)Excluding oraquick study77.11% (45.49% to 99.61%)99.99% (99.82% to 100%)ConclusionAlthough Oraquick appears to be the most promising test, authors' ties with industry make these results less credible. More independent testing is required to be able to make policy recommendations for the most accurate index test to detect Hepatitis C infection.
P3-S5.05 Rapid point of care testing for ten sexually transmitted diseases
Authors: Kriesel J , Bhatia A , Vaughn M , Gardner J , Barrus C , Crisp R 
Published: July 2011

BackgroundDelays in the reporting of STD testing sometimes result in inappropriate patient care where a patient must be called back in for treatment. Some STDs may be missed because not all specimens are tested in a comprehensive manner. We are developing a multiplex point of care test to fill this clinical need. This fully automated system is capable of detecting ten PCR targets from a single specimen in <1 h.MethodsA Sexually Transmitted Disease (STD) Panel was designed for the FilmArray device to detect the following organisms:Chlamydia trachomatis(CT),Neisseria gonorrhoeae(GC),Treponema pallidum,Trichomonas vaginalis, Mycoplasma genitalium, Ureaplasma urealyticum, Ureaplasma parvum, Haemophilus ducreyi, and herpes simplex viruses (HSV-1 and 2). Multiple PCR primers for each of these organisms were multiplexed and validated with the appropriate laboratory strains or plasmids.ResultsThree hundred twenty-four subjects have been enrolled from the Salt Lake Valley Health Department STD clinic patient population, providing 600+ specimens for analysis. Ninety-nine clinical specimens have been tested so far. The STD panel test results were compared to the standard CDC recommended clinical tests run in parallel on duplicate specimens. Standard testing included gram staining, CT/GC amplification, wet mount examination, viral culture, and serum syphilis IgG. Sample types included urine (44), vaginal/cervical swabs (7), urethral swabs (5), ulcer swabs (7), oral swabs (20), and rectal swabs (16). Concordance between the new STD panel and standard testing was:C trachomatis(79/81, 98%),N gonorrhoeae(81/81, 100%), HSV1 (6/6, 100%), HSV-2 (6/6, 100%), andT vaginalis(5/6, 83%). The STD Panel detectedT pallidumin four samples from patients who were subsequently diagnosed with syphilis by serology.Ureaplasma spp. were detected in 28 of 99 (28%) andM genitaliumin three of 99 (3%) specimens. In patients with chronic dysuria where standard clinical testing failed to reveal a cause, we were able to detect infectious agent in 8 of 14 specimens (two HSV-1, fiveUreaplasma spp., oneM genitalium) see Abstract P3-S5.05 table 1.Abstract P3-S5.05 Table 1Positive tests among the 99 specimens subjected to point of care multiplex PCR using the filmarray deviceSpecimen typeDetected organismUrine N=44Urethral N=5Cervical N=7Rectal N=16Oral N=20Ulcer N=7TotalNeisseria gonorrhoeae422210Chlamydia trachomatis72312Treponema pallidum11114Trichomonas vaginalis123HSV-122HSV-20Mycoplasma genitalium33Ureaplasma spp.171342128Haemophilus ducreyi0ConclusionsPoint of care STD testing based on the FilmArray platform is a robust clinical diagnostic tool that has the potential to improve public health by providing sensitive and rapid results. This may improve clinical care for persons suspected of infections with STD organisms.
P3-S5.06 Surgery in the treatment of severe dyspareunia caused by vulvar vestibulitis syndrome-a long-term follow-up study
Authors: Paavonen J , Päivi T , Unkila-Kallio L 
Published: July 2011

BackgroundVulvar vestibulitis syndrome (VVS) causes severe dyspareunia in young women, but is poorly recognised and managed. We wanted to evaluate safety and effectiveness of posterior vestibulec-tomy in the treatment of VVS.MethodsA cohort study of consecutive patients with refractory VVS treated at the University Hospital Vulva Clinic. The study population consisted of 70 women treated by posterior vestibulectomy during 1995–2007. All operated women were invited to participate in a long-term follow-up study. Patient characteristics, baseline visual analogue scale (VAS) for dyspareunia, and data of the postoperative pe-riod were collected. Of the 70 women invited, 57 attended the follow-up, including face-to-face inter-view, gynaecologicalgynaecological examination with swab-touch test for vestibular tenderness, current VAS score for dyspareunia, and McCoy questionnaire for sexual problems. Main outcome measures were short-term and long term complication rates, dyspareunia by VAS score, vestibular tenderness on examination, sexual problem index, and overall patient satisfaction.ResultsNinety-one per cent of the patients were satisfied with the outcome. VAS for dyspareunia de-creased from a median of 9 to a median of 3 (66.7% decrease) (p <0.001). Posterior vestibular tender-ness was absent in 34 patients (64.2%). Six (8.6%) patients developed postoperative bleeding and 11 (15.7%) patients developed mild wound infection, and 4 (5.7%) patients developed Bartholin's cysts.ConclusionPosterior vestibulectomy is effective in the treatment of severe VVS and provides long-term patient satisfaction.
P3-S5.07 Multidisciplinary clinic for the treatment of Hepatitis C: an useful tool for the management of the patients; review of the experience of a regional hospital
Authors: Dolcé P , Brin-Clément S , Bernatchez H , Jutras P , Tourangeau F 
Published: July 2011

BackgroundCSSSRN is a regional hospital with 240 acute-care beds, with a multidisciplinary clinic for the treatment of hepatitis C. This study aimed to review the clinical data from treated cases of hepatitis C, including the evaluation of the multidisciplinary support needed.MethodsAll files from patients evaluated for hepatitis C at CSSSRN between January 2000 and March 2009 were reviewed for clinical and microbiological data. Also, the numbers of visits to the different clinics were recorded. The data were analysed with Epi Info 3.5.1.ResultsA total of 165 cases of hepatitis C were evaluated at our facility and 46 treatments were initiated in 42 patients (four patients had two treatments). The average age was 41 years old (range 22–58) and 78% were men. All, except one, were native from the province of Quebec. The acquisition of hepatitis C was: injection or inhalation drug use (74%), blood transfusion (19%) and other causes (7%). The majority of treated individuals were heterosexual (93%), 55% had a history of alcohol abuse, 30% have been in detention, 19% had attempted suicide and 5% had done prostitution. HIV coinfection was present in three patients and none had HBV coinfection. The genotypes observed were 1 (55%), 3 (29%), 2 (9%) and 4 (7%). Liver biopsy was performed in 26 patients, eight had cirrhosis and one developed liver carcinoma. The treatments received were standard interferon alfa-2b/ribavirine (seven cases, 2000–2002), peginterferon alfa-2b/ribavirine (22 cases, 2003–2006), and peginterferon alfa-2a/ribavirine (17 cases, 2005–2008). Treatment was completed in 78% of patients. Sustained virological response (SVR) was achieved in 53% of genotypes 1 and 4; and in 69% of genotypes 2 and 3. During treatment, an average of 30 visits per patient was recorded. The frequency and mean number of visits were: clinical nurses from the ambulatory care unit (100%, 14), infectious diseases (100%, 10), gastroenterology (100%, 5), psychiatry (35%) and dietetic (16%).ConclusionA SVR was achieved in 53% (genotypes 1 and 4) and 69% (genotypes 2 and 3) of patients. The treatment of hepatitis C involved an average of 30 visits, with many actors, which is eased by a multidisciplinary clinic.
P3-S6.01 Validation of a treponemic antibodies quimioluminiscence automated test for syphilis detection among inmates of Mexico City
Authors: Juárez-Figueroa L , Iracheta P , Conde-Glez C , Bautista-Arredondo S , González-Rodriguez A 
Published: July 2011

BackgroundWhen surveying large groups at risk for STI, the search of antiT pallidumAb is a valuable tool both for assessing risks associated with syphilis acquisition and, if followed by VDRL test, also for syphilis cases detection. By the other hand testing first with VDRL a large number of samples followed by confirmation with anti TP specific test would be laborious and prone to errors while the data of past cured syphilis would be lost. On 2010 the HIV/AIDS Program of Mexico City and the National Institute of Public Health, Mexico initiated a health survey of around 40 000 inmates of the city for assessing syphilis and other STIs. Presently more than 18 000 inmates have been surveyed for HIV, HBV HVC and syphilis using the automated immunoquimioluminiscence analysis system Abbott Architect i2000. The accuracy of Abbott Architect Syphilis TP (ASTP) for detecting treated and untreated syphilis was reported before thus our study focused in validate ASTP as compared with an accepted treponemic test.MethodsFor evaluatig the sensitivity and specificity of ASTP in the context of our HIV clinic we compared ASTP with a test extensively used for syphilis confirmation, Treponema pallidum haemagglutination assay (TPHA). Samples were assayed with ASTP in pools of four sera and each positive pool developed and re-assayed with ASTP to find one or more individual positive samples which were further assayed with tittered VDRL. ASTP− pools were not re-assayed and individual samples were scored as negative for syphilis. We selected 218 ASTP+ and 1920 ASTP− individual consecutive samples to be tested with BioRad Syphilis TPHA.ResultsFrom 218 ASTP+ samples 212 were TPHA+ and all 1920 ASTP− were also TPHA−. ASTP and TPHA detected all 77 VDRL+ samples thus considered diagnostic of latent or active syphilis. Six ASTP+/TPHA− samples and 135 ASTP−/TPHA− were also VDRL− and considered as evidence of treated/cured syphilis. Using TPHA as gold standard ASTP Sensitivity was 100% and Specificity was 99.7%. In two ASTP- pools that showed more than 0.6 but <1 S/CO reading, a sample weakly positive by ASTP and TPHA but VDRL− was found when assayed individually.ConclusionsReverting the traditional algorithm of syphilis diagnosis by first determining TP specific antibodies with ASTP followed by tittered VDRL of positive samples is highly accurate even if done in pools of four sera. This approach allows also the identification of epidemiologically valuable data of cured syphilis.
P1-S1.48 Prevalence of syphilis in antenatal clinic attenders and associated risk factors
Authors: Adu-Sarkodie Y , Mensah P , Opoku B K , Mayaud P , Peeling R 
Published: July 2011

BackgroundMaternal syphilis can adversely affect pregnancy outcomes. This can be averted if women are tested and treated adequately during pregnancy. As part of a programme towards the introduction of routine syphilis testing and treatment in pregnancy in Ghana, the prevalence of syphilis in pregnant women attending a tertiary facility (also used as primary facility by pregnant women) was carried out. Associated risk factors for syphilis seropositivity was also determined.Methods841 pregnant women were tested for syphilis using a Rapid Plasma Reagin kit (Immutrep Carbon Antigen, Omega Diagnostics, UK). All sero-reactive samples were confirmed with a TPHA assay (Immutrep TPHA, Omega Diagnostic, UK). A questionnaire seeking socio-demographic information, history of previous pregnancy outcomes, and history sexually transmitted infections was administered to the enrolled women.Results6 out of the 841 (0.71%) women were seropositive for syphilis (RPR reactive, TPHA positive), out of which one had a high RPR titre (1:8), one a RPR titre of 1:4 and four had low RPR titres of 1:2. None of the risk factors studied were associated with syphilitic infection.ConclusionA low prevalence of maternal syphilis was found in this urban population. This is low in comparison with a national prevalence of 6.5% among pregnant women, and high prevalences in rural settings in Ghana. This may be due to a low prevalence of syphilis in this urban area or better access to STI testing and treatment in this area which the women take advantage of due to the National Health Insurance Policy. Even with this low prevalence, studies indicate that testing and treatment is still cost -effective.
P3-S6.06 Does the concept of early and late latent syphilis hold well in today's scenario?
Authors: De D , Kanwar A 
Published: July 2011

BackgroundLatent syphilis refers to the asymptomatic stage in the natural evolution of syphilis in a patient not treated or inadequately/inappropriately treated for syphilis. Latent syphilis has been categorised as early latent and late latent for therapeutic purposes. Indiscriminate and inadequate over the counter use of antibiotics (happenstance) and HIV co-infection in present day scenario tends to change natural evolution of syphilis. Even though some patients remain asymptomatic without any historical evidence of clinical manifestation of syphilis, serologically they continue to reflect the ongoing infection process; the so called syphilis of unknown duration.ObjectiveTo determine the sero-epidemiological characteristics of patients with syphilis of unknown duration registered to a sexually transmitted disease (STD) clinic in an Institute setting.Patients and MethodsClinic records of patients registered to the STD clinic between 2006 and 2010 were retrieved. For study purposes, syphilis of unknown duration was defined as positivity withTreponema PallidumHaemagglutination assay (TPHA) irrespective of Venereal Disease Research Laboratory (VDRL) titre in patients who did not have any clinical sign of syphilis including neurological and cardiac, during clinic entry; had no features to suggest syphilis in the past and had not been treated with parenteral penicillin.ResultsOf the 76 patients registered during the study period, 52 (68%) satisfied the diagnosis of syphilis of unknown duration. Age of patients was between 20 and 56 years (mean 29.76, standard deviation 8.32). Males outnumbered females by a ratio of 2.25:1. Majority (33, 63.4%) of the patients were direct walk-in with positive serology results done in private laboratories, mostly in patients who are habituated to unprotected extramarital sexual intercourse. Others were referred from obstetric clinics (15.4%), private practitioners (15.4%), HIV clinic (1.9%), transfusion medicine (1.9%) and urology clinic (1.9%). Majority patients (31, 59.61%) showed low titre VDRL (upto 1:8) positivity while 5 (9.6%) were VDRL non-reactive.ConclusionIn majority of syphilis patients, duration of latency could not be determined due to lack of history of clinical lesions of early syphilis or reliable history of time of acquisition of infection. Consequently, the categorisation of latent syphilis to early and late phases in present day scenario appears redundant.
P3-S7.04 Candida susceptibility to antifungals in Gomel region (Belarus)
Authors: Khaikova A 
Published: July 2011

Candidiasis is a fungal infection that often affects urogenital tract. About 75% of women had at least one episode of vulvovaginal candidiasis. Recent times chronic cause of candidiasis is prevalent in the clinical picture of the disease in Belarus. Along withCandida albicansother yasts (Candida crusei,Candida tropicans,Candida glabrata, Candida parapsilosis, etc) play a role in pathogenesis of the disease. Wide use of fluconazole in Belarus as well as prophylactic treatment during prolonged antibiotic use caused the grow of the resistance to the drug. Aim of our study was to reveal the incidence of urogenital candidiasis in patients who where checked up for STI in Gomel dermatovenereal hospital (Belarus), to study the resistance ofCandida spp.to nystatin, clotrimazole, and fluconazole in vitro.Materials and MethodsWe observed 4397 patients using clinical examination, microscopy, and cultural examination. Susceptibility to antifungal was studied by cultured method in vitro in 187 samples from the patients.ResultsUrogenital candidiasis clinically and was diagnosed in 473 patients (10.8%) and confirmed by laboratory tests. Susceptibility to nystatin was founded in 183 cases (97.8%), to clotrimazole—in 125 cases (66.8%). Susceptibility to fluconazole was much lower and was registered only in 37 cases (19.8%).ConclusionsCandidiasis is a current problem for gynaecologists and venreologists in Belarus. Its rate reaches 10% among all patients coming for follow-up for STI. Effective treatment for candidiasis should be developed. Wide use of fluconazole should be reevaluated because of its low susceptibility.