bluuebunny/crossref_metadata_2025_split huggingface dataset:
O1-S03.04 Core groups, antimicrobial resistance and rebound in gonorrhoea
Authors: Chan C , Fisman D , McCabe C 
Published: July 2011

BackgroundNeisseria gonorrhoeae(NG) is a major cause of sexually transmitted infection worldwide. Surveillance data from North America suggest that incidence has increased in recent years, after initially falling in the face of intensified control efforts, as antimicrobial resistance in NG has increased. We evaluated the likely mechanisms behind such rebound using simple compartmental models, and explored the implications of such rebound for disease control practice.MethodsWe evaluated the impact of risk-focussed treatment strategies on long-term gonorrhoea trends using risk-structured susceptible-infectious-susceptible" (SIS) compartmental models that included and excluded the possibility of antibiotic resistance in gonorrhoea transmission and control. We also examined optimal treatment strategies to minimise gonorrhoea rates when more than one antibiotic is available.ResultsModel projections, consistent with previous work, showed that when antibiotic resistance is not possible, strategies that focus on treatment of highest risk individuals (the so-called “core group”), result in collapse of gonorrhoea transmission see Abstract O1-S03.04 figure 1. In contrast, in the presence of antimicrobial resistance, a focus on the core group causes rebound in incidence, with maximal dissemination of antibiotic resistance. When two antibiotics are available for treatment, we found that random assignment of treatment was most effective at delaying rebound in overall rates in the population, while the current strategy, which is to switch first-line treatment when a threshold level of resistance is reached, produced the quickest rebound.Abstract O1-S03.04 Figure 1Prevalence over time with risk group-focused treatment strategies.ConclusionsWhile previous models have shown that the targeted treatment of core-group individuals is the most effective at lowering rates of gonorrhoea, our model suggests that core group-focused treatment strategies efficiently disseminate antimicrobial resistant strains of NG, with rebound in gonorrhoea rates. This paradox poses a great dilemma to the control and prevention of gonorrhoea, especially when development of new antibiotic classes has lagged in recent years and vaccine development for gonorrhoea still faces many challenges. Our study highlighted the need for focus on non-antimicrobial strategies for the prevention and control of gonorrhoea.
O5-S4.01 Register-based chlamydia screening: does it make a difference if the invitation is sent by GP or by Municipal Health Service?
Authors: van Bergen J E A M , Koekenbier R H , Fennema J S A , Brouwers E E H G , Götz H M , Hoebe C J P A , Op de Coul E L M , Pars L L , van Ravensteijn S M , van den Broek I V F 
Published: July 2011

BackgroundIn cervical cancer screening, uptake of screening is approximately 10% higher if a woman is invited by her General Practitioner (GP) compared to invitation by Municipal Public Health Service (PHS). A large register-based selective Chlamydia Screening Programme is implemented in Amsterdam (Netherlands) since 2008 by the PHS. We wanted to evaluate whether response rates in Chlamydia screening where higher if invitational letters are sent by a persons' GP and not by PHS.MethodsBased on the municipal registers, annually all 140 000 persons in Amsterdam aged 16–29 yr are invited with a postal letter to participate. Further procedures are internet-based: requesting test-packages, obtaining results, even partner-referral, can be realised via the internet and the unique identifier provided in the personal letter. In one part of the city, the Southeast inner-city area, GP-registers of six health centre are matched with the list of invitees extracted from the municipal register. In the invitational letter these matched eligible's are personally addressed by their GP and not by the physician of the PHS. Participation rates from invitees of GP and PHS in the same geographical town area are compared in three screenings-rounds (r 3 not yet fully completed).ResultsIn these four town area's in each screening round annually 13 500 persons are invited, of which 35% by the GP and 65% by PHS. In screenings-round 1, the response to invitations by the GP was slightly higher than the response to invitations sent by the PHS in 3 out of 4 neighbourhoods where this was piloted (overall GPs: 16.2% [range: 15.3%–29.1%]; overall PHS: 14.9% [14.4%–21.6%], p=0.023). In round 2 and 3 the difference was not significant (GP vs MHS: r2 10.3%–10.2%; r3 9.5% vs 9.4%). (Abstract O5-S4.01 figure 1).Abstract O5-S4.01 Figure 1Participation rate comparing response among GP- and MHS-invitees in 4 town-areas of Amsterdam Southeast.ConclusionsIn the first screening-round uptake was slightly higher among GP-invited, but this effect was lost in subsequent screening-rounds. Inviting universally via the PHS is logistically easier and yields the same response rate.
O1-S04.02 Regional HIV surveillance of youth MSM through multilevel analysis of RDS studies in Latin America
Authors: Jacobson J O , Alonso-Gonzalez M , Ramachandran D , Paz-Bailey G , Balan I , Morales-Miranda S , Guardado M E , Salamanca-Kacic R , Nieto-Gomez A I , Maddaleno M 
Published: July 2011

BackgroundMen who have sex with men (MSM) are the population most affected by HIV in Latin America (LA). Youth MSM (YMSM) are of particular interest given potentially greater levels of risk behaviour and as a barometer of recent epidemic dynamics. Yet single MSM studies lack sufficient sample size to characterise YMSM so that HIV prevalence and variation among YMSM within LA is unknown.MethodsWe developed a multilevel statistical framework to borrow strength across recent (2006–2009) respondent-driven sampling (RDS) studies with similar survey methodologies to permit characterisation of HIV prevalence and risk factors among YMSM in LA and comparisons across cities. Data from participants aged 18–24 years tested for HIV in MSM studies in nine high-population cities in Argentina, Bolivia, Costa Rica, El Salvador and Honduras (N=1410) were pooled. Weights incorporating personal network and population sizes adjusted for selection probability. Logistic, multilevel models identified correlates of HIV infection, including city-level fixed effects and accounted for intraclass correlation within recruitment chains.ResultsHIV prevalence was 4.6% (95% CI: 3.2% to 6.5%) in the pooled sample and varied significantly across cities from 2.7% in Buenos Aires, Argentina to 9.3% in San Pedro Sula, Honduras. Samples varied (p value<0.05) in terms of completion of secondary education (69.6%–100.0%), gay (range 2.5%–77.5%) and bisexual self-identity (18.8%–97.6%), past-year drug use (5.9%–64.8%), condom use at last anal sex (26.6%–72.7%) and other risk behaviours, knowledge of HIV prevention and transmission (26.4%–71.9%) and lifetime HIV testing (28.7%–59.2%). In multivariate analysis, syphilis infection (adjusted OR [AOR]=2.5), aged 23–24 years (vs 18–22) (AOR=2.2), past-year crack/cocaine use (AOR=2.2) and bisexual self-identity (AOR=0.5) were associated with HIV infection. Significant city effects for Salvador, El Salvador and Santa Cruz, Bolivia persisted net of individual-level differences.ConclusionsFormal comparisons of HIV burden and risk differences among cities can be achieved through multilevel analysis. HIV prevalence, drug and sexual risk behaviours, and low HIV testing among YMSM in LA are considerable and vary substantially within the region. The need for prevention among YMSM in LA is urgent and must address substance abuse, STI and be tailored to local context. Prevention should target younger YMSM as probability of infection rises rapidly with age.
O1-S04.03 Co-infection with sexually transmitted infections among Canadian street-involved youth 2001–2006
Authors: Atwood C V , Fang L , Demers A , Gratrix J , Rossi M , Taylor D , Wright J , Wong T , jayaraman G ,   For the Enhanced Street Youth Surveillance Team
Published: July 2011

BackgroundCanadian street-involved youth are at greater risk for sexually transmitted infections (STIs), due to their increased vulnerabilities related to age, socioeconomic status, life course factors, and engagement in high risk behaviour such as sex trade. We present a risk factor analysis for those with single and multiple STIs, using the Enhanced Surveillance of Canadian Street Youth (E-SYS) data.MethodsE-SYS is a cross-sectional surveillance system of street-involved youth (15–24 years). Participants from seven urban centres completed an interviewer-administered questionnaire and were tested for multiple sexually transmitted and blood-borne infections. For this analysis, data were restricted to five infections (HIV, chlamydia, gonorrhoea, syphilis and HSV-2). Data from three cycles (2001–2006) were analysed to determine total number of infections per participant using an iterative tracker. Participants who indicated previous participation were excluded from the analysis to avoid double-representation.ResultsOf those who provided biological specimens (n=3823), 17.0% tested positive for one infection and 3.4% tested positive for two or more infections (Abstract O1-S04.03 table 1). Over half (15 of 28) of HIV-positive individuals were multiply-infected. Risk factors for multiple infections included older age (p=0.0449), being Aboriginal (p=0.0061; particularly females), being HIV infected (p=<0.0001), having a previous history of an STI (p=0.0144), pregnancy (p=0.0079), and reporting prostitution as the primary source of income (p=0.0028).Abstract O1-S04.03 Table 1Single and multiple STI in the enhanced street youth surveillance populationChlamydiaGonorrhoeaSyphilisHSV-2HIVChlamydia268(7.98%)Gonorrhoea42(1.26%)17(2.35%)Syphilis2(0.07%)2(0.07%)3(0.09%)HSV272(2.78%)19(0.74%)4(0.14%)348(12.20%)HIV4(0.15%)0(0.00%)1(0.03%)14(0.50%)13(0.44%)Tested overall33573339319028522951Total # of individuals infected375691044228Prevalence overall11.17%2.07%0.56%15.50%0.95%* Same-infection crosses represent single infections.%’s based on individuals tested for both infections.An individual may be counted more than once if they have more than two infections.ConclusionsThe prevalence of certain STI co-infections (eg, chlamydia and gonorrhoea) is high among street-involved youth and within this population, certain sub-groups may be more vulnerable to these co-infections. Continued efforts are required to promote comprehensive STI testing among street-involved youth and to raise awareness of the potential for multiple infections.
O1-S04.06 Pelvic inflammatory disease occurring between the time of testing and treatment for gonorrhoea and chlamydia
Authors: Risser W , Risser J 
Published: July 2011

BackgroundWe conducted a prospective study to confirm our impression that incarcerated adolescents sometimes developed pelvic inflammatory disease (PID) during the brief interval between testing and treatment for gonorrhoeal and chlamydial cervicitis.MethodsWe performed the study at the Harris County Juvenile Detention Center, Texas, where PID in females is relatively common and where the prevalence of gonorrhoea and chlamydia infections is high. At the time of their mandated medical assessment, all incarcerated adolescents submitted first-catch urine samples for chlamydia and gonorrhoea testing. We used Gen-Probe NAAT assays. If at the time of testing a patient had symptoms suggestive of PID, we performed a bimanual pelvic examination and treated those who met the criteria for PID. For the diagnosis of PID, we used the criteria of the US Centers for Disease Control and Prevention: the presence of adnexal or cervical motion or uterine tenderness. The pelvic examinations were performed by one of three experienced physicians. For the patients who did not have PID at the time of testing, we re-assessed them when we learnt that their urine test was positive. The tests were run in batches by the city health department, so that a variable length of time elapsed between the day of testing and the day that we received test results. At re-assessment, patients received a PID diagnosis if they had lower abdominal pain and met the PID diagnostic criteria on bimanual pelvic examination.ResultsWe evaluated 99 subjects between 29 March 2010 and 27 December 2010. Their mean age was 15.8 (SD 1.1) years. Their race/ethnicity was 43% black, 32% Hispanic, and 25% white; 74% had chlamydia, 14% gonorrhoea, and 12% both. The interval between testing and treatment ranged from 2 to 17 days; the mean (SD) was 7.5 (2.9) days. During this interval, 13 of 99 (13%) developed lower abdominal pain and had bimanual pelvic examination findings that supported the diagnosis of PID. Of these 13, 10 (77%) had chlamydia, 2 (15%) had gonorrhoea, and 1 (8%) had both infections. Time from initial urine testing to treatment for PID ranged from 7 to 15 days.ConclusionIn incarcerated adolescents infected with gonorrhoea and/or chlamydia, a surprisingly large proportion (13%) developed PID during the brief period between testing and treatment.
O1-S05.02 Biological evidence of semen exposure is associated with incidentBacterial vaginosis
Authors: Gallo M , Warner L , King C , Sobel J , Rompalo A , Cu-Uvin S , Klein R , Schoenbaum E , Jamieson D 
Published: July 2011

Objectives(1) To identify correlates of incidentBacterial vaginosis(BV) among high-risk women and (2) to identify predictors of discordance between self-reported lack of semen exposure in the past 6 months and the detection of spermatozoa on Gram stain, which provides biological evidence of recent exposure.MethodsAnalyses were based on among 871 HIV-infected and 439 HIV-uninfected women participating in HIV Epidemiology Research Study (HERS) which was conducted in 4 sites in the US Participants completed study visits conducted at baseline and at 6-month intervals thereafter. We conducted both cohort and case-crossover analyses, stratified by HIV infection status, to evaluate potential correlates of incident BV. We also used logistic regression to identify predictors of discordance between self-reported lack of exposure to semen and the detection of spermatozoa on Gram stain.ResultsBV incidence was 21% among HIV-infected women and 19% among HIV-uninfected women. We found fewer correlates of incident BV when assessed with a case-crossover design than with a cohort design. Reporting frequent coitus (regardless of consistency of condom use) was correlated with incident BV in the cohort analyses but not in the case-crossover analyses. The sole correlate that emerged in both the cohort and case-crossover analyses among HIV-infected and -uninfected women was the detection of spermatozoa on Gram stain. Seven factors were associated with discordance between self-reported semen exposure and spermatozoa detection in the multivariable analysis. Discordance differed by study site and race/ethnicity and was more common among younger women. The following infections or conditions also were predictive of discordance: HIV (adjusted OR [aOR], 2.8; 95% CI, 1.7% to 4.6%), BV (aOR, 1.9; 95% CI, 1.5% to 2.5%), and human papillomavirus (aOR, 1.3; 95% CI, 1.0% to 1.8%). Finally, reporting current injection drug use (aOR, 0.6; 95% CI, 0.4% to 0.9%) was inversely related to discordance.ConclusionsThe inconsistent association between condom use and BV found in prior studies could be the result of participant reporting bias. The present study found evidence of a relationship between semen exposure and incident BV. Also, given the number and range of correlates of discordance between self-reported and biological evidence of semen exposure, inaccuracies in the reporting of sexual behaviours cannot be assumed to be distributed randomly across a study population.
O1-S01.03 High yield in reinfections during a chlamydia screening programme when automatically sending testkits after 6 months to previously infected
Authors: Götz H M , Hoebe C J P A , van Bergen J E A M , Brouwers E E H G , Op de Coul E L M , Fennema J S A , Koekenbier R H , Pars L L , van Ravesteijn S M , van den Broek I V F 
Published: July 2011

BackgroundReinfections remain challenging in the control ofChlamydia trachomatis(Ct). In a systematic internet-based Ct Screening programme (CSI) in the Netherlands, all Ct-positive participants automatically received a test kit after 6 months to facilitate discovery of reinfections. Determinants for reinfection for two screening rounds, treatment and partner notification are discussed.MethodsCSI-home-based testkits can be requested online after register based postal invitation. Infected participants get a referral letter for their health provider to get treatment for themselves and their current partner; expartners can be alerted by the participant and request a test kit via the website. Participants fill in a questionnaire on sexual behaviour voluntarily. Ct-positives answer questions about treatment and partner notification 10 days after checking their results. Infected participants who do not check their result online receive it by postal letter. After 6 months retest kits are automatically sent to previously infected participants.ResultsOverall, 3185 participants (4.1%) tested positive; 7% of Ct-positives did not check their result online and received a postal letter. The majority (86%) of Ct-positive participants who answered the treatment questionnaire (response 43%) was treated within 2 weeks after checking their result online; 80% of those with a current relationship reported their partner had also been treated and 16% of those with past relationships notified ex-partners via the website. One third of the ex-partners participated, 28% of whom were Ct-positive. After 6 months, 3055 participants received a retest kit and 66% responded. The reinfection rate was 8.8%. Results of the questionnaire revealed 75% of retest-positives had been treated for the initial infection and 70% had had their partner treated, while these proportions were 87% and 80% among retest-negatives. At higher risk for reinfections were young people (<20 years 17%), specific ethnic minorities (Netherlands Antillean 16%, Turkish 17%, sub-Sahara African 18%), persons living in Rotterdam (11 vs 8% Amsterdam 4% Limburg), and in high-risk areas (14%).ConclusionsThe uptake of retesting was successful counting two third with automatically sent testkits 6 months after screening. Reinfection rates were high, especially among known risk-groups. Questionnaire results show that follow-up of (partner) treatment after Chlamydia infections could be improved.
O1-S06.06 Patterns and trends in concurrency and polygamy in rural Zimbabwe, 1998–2008
Authors: Takavarasha F , Gregson S , Eaton J , Schumacher C , Mushati P , Garnett G , Nyamukapa C 
Published: July 2011

BackgroundIt has been suggested that the decline in HIV prevalence in Zimbabwe from the late 1990s may be partly due to reductions in sexual concurrency but little is known about levels and trends in the different forms of concurrency or their association with HIV risk.MethodsWe use data from four rounds (1998–2000, 2001–03, 2003–05, 2006–08) of a large longitudinal population-based HIV survey to investigate patterns of non-spousal (two or more current sexual partners, at least one of whom is not a spouse) and spousal (multiple spouses but currently no extra-marital sexual partners) concurrency, and associations with prevalent HIV infection in rural east Zimbabwe.Results15.4% (95% CI 14.4% to 16.5%) of men (17–54 yrs, N=4327) and 1.9% (1.5% to 2.3%) of women (15–44 yrs, N=5148) reported concurrent sexual partners at baseline. 11.7% (10.8% to 12.7%) and 3.7% (3.2% to 4.3%) of men reported non-spousal and spousal concurrency, respectively. Non-spousal concurrency was most common in single (16%) and divorced/widowed (11%) men but was also reported by married men with single (6.5%) and multiple (4%) spouses (Abstract O1-S06.06 figure 1). HIV prevalence is similar in men with (19.2%) and without (19.5%) concurrent partners but is higher in those with concurrent partners after controlling for age (age-adj. OR (aOR), 1.37; p=0.02). However, after excluding non-sexually experienced men, this difference was not statistically significant (aOR, 1.27, p=0.08). Among all men, HIV prevalence was higher for those with non-spousal concurrency (aOR, 1.38; p=0.015) but not for those with spousal concurrency (aOR, 1.26; p=0.2). For women, concurrency (all non-spousal) was 1.9% (95% CI 1.2% to 2.7%) in single women, 0.4% (0.2% to 0.7%) in married women, and 5.4% (4.1% to 7.0%) in divorced/widowed women. HIV prevalence was higher in women with concurrent partners than in those without (55.7% vs 25.4%; aOR, 3.26, 2.08 to 5.11) even after excluding women who had not started sex (aOR, 2.83; p<0.001). For males, non-spousal concurrency fell from 11.7% (95% CI 10.8% to 12.7%) in 1998–2000 to 6.1% (5.3% to 7.0%) in 2001–2003 and 4.3% (3.7% to 5.0%) in 2006–2008; prevalence of spousal concurrency fell from 3.7% (3.2% to 4.3%) to 2.6% (2.0% to 3.2%) to 1.3% (1.0% to 1.7%) over the same period. For females, concurrency declined from 1.7% (1.4% to 2.1%) in 1998–2000 to 1.0% (0.7% to 1.3%) in 2001–2003 and 0.5% (0.3% to 0.7%) in 2006–2008.Abstract O1-S06.06 Figure 1Prevalence of non-spousal concurrency by marital status, Men, 17–54 years.ConclusionA 2/3rds reduction in (mainly non-spousal) concurrency may have contributed to HIV decline in east Zimbabwe.
O1-S07.03 Prevalence and correlates of rectal chlamydia and gonorrhoea among female STD clinic clients
Authors: Javanbakht M , Guerry S , Stirland A , Gorbach P , Kerndt P 
Published: July 2011

BackgroundThe prevalence and correlates of rectal sexually transmitted infections (STI) are well described among men who report receptive anal intercourse (AI). However, very little is known about the epidemiology of rectal STIs among women.MethodsWe conducted a cross-sectional study of women attending twelve public STD clinics in Los Angeles County, California. Women were eligible for inclusion in this study if they reported AI in the previous 90 days, were tested for rectal chlamydia (CT) and gonorrhoea (GC), and were seen between January 2008 and December 2009. Data collected included demographics, types of sexual contact, substance use, other risk behaviours, and STI results. Results Among the 716 females included in this analysis, the median age was 28 years (range 14–60), 40% were Hispanic, 37% African American, and 15% White. The prevalence of CT and GC by anatomic site was: 11.8% (n=83) urogenital CT, 14.2% (n=100) rectal CT, 2.7% (n=19) urogenital GC, and 3.0% (n=21) rectal GC. Among positives, 27% of CT cases and 27% of GC cases had rectal only infections. Among women =25 years the prevalence of rectal infections was higher among those incarcerated in the past year (39.4% vs 22.1%; p value=0.03) and those who reported sex with an injection drug user (50.0% vs 23.3%; p value=0.05). Among women >25 years the prevalence of rectal infections was higher among those with longer term sex partners (ie, >90 days; 12.6% vs 5.9%; p value=0.03), and those who reported substance use (14.8% vs 8.3%; p value=0.04). While the number of women with a rectal-only infections (ie, no urogenital infection; n=33) was small, similar trends were observed. After controlling for age and race/ethnicity, among women ≥25 years those incarcerated in the previous year were more likely to have a rectal infection (adjusted OR [AOR]=2.55; 95% CI 1.14% to 5.71%). Among women >25 years, after controlling for race/ethnicity and age, those who reported substance use were more likely to have a rectal infection (AOR=2.28; 95% CI 1.14% to 4.55%) while those reporting new sex partners were less likely to have a rectal infection (AOR=0.38; 95% CI 0.16% to 0.88%).ConclusionThese findings highlight that the prevalence of rectal Chlamydia and gonorrhoea among women is similar to that of urogenital infections and a relatively large number of infections would be missed in the absence of rectal testing. Factors associated with rectal infections may differ by age.