bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1-S2.21 Integrating public health into the sex worker community in Indianapolis
Authors: Roth A M , Rosenberger J G , Waters J , Arno J , Van Der Pol B 
Published: July 2011

BackgroundSyphilis is a significant disease from a public health perspective both historically and as a result of the serious consequences of infection. While studies have explored the epidemiology of syphilis among at-risk populations, limited information exists regarding women's preferences for STD testing and treatment services. The purpose of this study was to explore sex workers preferences for receiving sexual health services.MethodsA total of six groups of 4–7 sex workers each were recruited from local community-based organisations. The semi-structured interview guide included questions based on the Health Belief Model such as—1) cues to action—“Think back to the last time you received a female wellness exam or got tested for STD. What prompted you to schedule that appointment?” 2) Perceived susceptibility—“Describe what worries you most when you think about your health and how it's affected by being on the streets.” and 3) perceived barriers—“What are some of the reasons why women who are working the streets don't get tested for STD?” Focus groups lasted 1 h, were audio recorded, and transcribed. Preliminary codes were selected, applied to the transcripts, and key concepts that spanned groups were identified.ResultsIn general, most women used utilised health protective behaviours to mitigate health risks associated with sex work. However, these behaviours were context and partner specific. Participants were interested in having increased access to sexual health services. Primary themes regarding program development included—experiences with healthcare providers, types of services that would encourage uptake, mechanisms for service delivery and the importance of collaborating with law enforcement and other service providers. The participant's recommendations were organised into a model program with specific service delivery mechanisms for each key concept.ConclusionsThese data suggest potential pathways STD control programs to intervene with hard-to-reach populations, like commercial sex workers. In this project, a participant-informed approach was utilised that should result in increased uptake and utilisation of sexual health services because participants provided key insights into the programmatic considerations necessary for STD prevention efforts to be most effective.
P1-S1.08 Prevalence ofNeisseria gonorrhoeaeandChlamydia trachomatisinfection in men attending STD clinics in Brazil
Authors: Barbosa M , Pinto V M , Moherdaui F , Ribeiro D , Espinosa A 
Published: July 2011

IntroductionThe study aimed to assess the prevalence ofNeisseria gonorrhoeaeandChlamydia trachomatisinfections and identify demographic, behavioural and clinical factors correlated with such infections in men attending six sexually transmitted disease clinics in Brazil.MethodsMulticentric, cross-sectional study performed among men attending STD clinics in Brazil. The study included STD clinics in six cities distributed throughout the five geographic regions of Brazil in 2005. Patients provided 20 ml of first catch urine for testing forN gonorrhoeaeandC trachomatisby DNA-PCR.ResultsA total of 767 (92.9%) men were included in the study. The mean age was 26.5 (SD 8.3) years old. Prevalence of Chlamydia infection was 13.1% (95% CI 10.7% to 15.5%) and gonorrhoea was 18.4% (95% CI 15.7% to 21.1%). Coinfection prevalence was 4.4% (95% CI 2.95% to 5.85%) in men who sought attendance in STI clinics. Factors identified as associated withC trachomatiswere younger age (15–24) (OR=1.4 (95% CI 1.01 to 1.91)), present urethral discharge (OR=4.8 (95% CI 1.52 to 15.05)), genital warts (OR=3.0 (95% CI 1.49 to 5.92)) and previous history of urethral discharge (OR=2.4 (95% CI 1.11-5.18)]. Variables associated with gonorrhoea were younger age (15 to 24) [OR=1.5 (95% CI 1.09-2.05)], presence of urethral discharge [OR=9.9 (95% CI 5.53-17.79)], genital warts [OR=18.3 (95% CI 8.03-41.60)] and ulcer present upon clinical examination [OR=4.9 (95% CI 1.06-22.73)]. Conclusions—These findings have important implications for education and prevention actions directed towards men at risk of HIV/STD. A venue-based approach to offer routine screening for young men in STD clinics should be stimulated.
P1-S2.29 Risky sexual practices among youth in Quebec Care Centers
Authors: Lambert Gilles , Haley Nancy , Jean Sandrine , Tremblay Claude , Frappier Jean-Yves , Otis Joanne , Roy Elise 
Published: July 2011

BackgroundAdolescents in Youth Protection facilities are a vulnerable population, with difficult life trajectories; many of their behaviours are health compromising.MethodYouth aged 14–17, living in semi-urban and urban youth centers in Quebec were recruited on a volunteer basis to participate in the study. Socio-demographic, drug use, sexual behaviours and health service utilisation data were obtained using a structured, face-to-face interview. A urine sample was collected to test for chlamydia and gonorrhoea.ResultsBetween July 2008 and May 2009, 578 youth were interviewed—(♂—58 %); median age—♂—16; ♀—15. The majority of youth were sexually active (89%); two thirds experienced voluntary coitarche before 14 years of age. Median number of lifetime partners was 6 (♂—8, ♀—5). Over a third (41%) reported group sexual activities. A large proportion of youth experienced 50% or more of their sexual activities under the influence of alcohol—18%, cannabis—37%, other drugs—18%. Lifetime history of “never or rarely” using condoms was 24.7% for vaginal relations and 42.1% for anal relations (♂—33%, ♀—55%). Protection used during last vaginal activity was—double protection (condom and another contraceptive method)—25%; condom only—32%; contraceptive method without condom—20%; no protection—24%. A quarter of girls (28%) and boys (27%) reported an unplanned pregnancy (lifetime). Prevalence of chlamydia was—girls 9%, boys 1.9%. No cases of gonorrhoea were documented.ConclusionsYouth in Quebec care centers report many risky sexual behaviours, often associated with drug and alcohol use. Only a quarter of youth used protection to prevention both STIs and pregnancy during their last sexual activity. Their sejour in residential care is an opportune moment to screen these youth for risk behaviours that may compromise their future health and to provide them with personalised prevention education and health services adapted to their reality.
P1-S2.39 Characteristics of Lymphogranuloma Venereum (LGV) infection among homosexual men in Melbourne.
Authors: Bissessor M 
Published: July 2011

BackgroundLymphogranuloma venereum (LGV) has re-emerged among men who have sex with men (MSM) internationally. Previous cases among MSM in Australia have been reported. We aimed to characterise a series of LGV cases seen at the Melbourne Sexual Health Centre.MethodsWe reviewed all cases of LGV seen at the Melbourne Sexual Health Centre between 2005 and 2010. During this period MSM who were diagnosed with rectal chlamydia using strand displacement assay were routinely questioned about symptoms of proctitis using a symptom check list. Those with symptoms of proctitis had specimens forwarded forChlamydia trachomatisomp1 genotyping. Genotyping of chlamydia-positive first void urine and penile ulcers in MSM was undertaken on selected MSM based on clinical presentation.ResultsDuring the study period, of 292 chlamydia positive ano-rectal specimens that were genotyped, 21 (7.2%) tested positive for LGV. Of the eight chlamydia positive urine or penile specimens genotyped, four were positive for LGV. There was also one case of an inguinal bubo that tested LGV positive from aspirated pus. In all cases L2 or L2b type was isolated. Of the 25 cases of LGV, 18 (72%) were in HIV positive men. Of the 21 men who had ano-rectal LGV, all had ano-rectal symptoms, namely—ano-rectal pain (71%), anal discharge (62%) and/or rectal bleeding (52%). All but one of the LGV infected men received at least a 3-week course of doxycycline 100 mg twice daily. Two men with ano-rectal LGV remained LGV positive on follow-up when tested 3 months later. Both these patients were noted to have had unprotected sex following initial treatment, hence, it is unclear whether this was due to treatment failure or reinfection.ConclusionsLGV continues to be seen among MSM in Melbourne presenting with proctitis. Genotyping of anal chlamydia infections has been useful in distinguishing LGV from the more common non-LGV chlamydial infections, therefore ensuring appropriate antibiotic therapy and follow-up are instigated.
O3-S1.01 British Ocular Syphilis Study (BOSS): National Surveillance Study of intraocular inflammation secondary to infectious syphilis
Authors: Goh B , Matthew R , Simms I , Westcott M 
Published: July 2011

BackgroundSyphilis poses a significant public health problem. There has been a 1032% increase in the incidence of syphilis between 1999 and 2008 in the UK. There are currently no epidemiological studies looking at the incidence of ocular syphilis in the light of the outbreak. Ocular syphilis is a rare, but treatable if recognised early. The purpose of this study is to ascertain the incidence of intraocular syphilis in the UK and to characterise the clinical presentation patterns of ocular syphilis.MethodsA prospective study was conducted in the UK and Republic of Ireland, where cases of ocular syphilis were reported through the national reporting system (British Ocular Surveillance Unit) over an 18-month period from May 2009. Case definition was any adult patient who presented with intraocular inflammation and early infectious syphilis as evidenced by positive syphilis serology with (1) high titre RPR of >1:8 or (2) signs of secondary syphilis.Results35 new cases of ocular syphilis were reported (annual incidence 0.46 per million) with a mean age of 51.5 years (range 22–75 years). 86% were males; 88% were caucasians and 12% were Afro-Caribbean. The mean duration of symptoms was 1.0 month prior to presentation (range 2 days to 4 months). 46% of patients had bilateral involvement and the mean presenting logMAR visual acuity was 0.48 (20/60 Snellen; range −0.1–1.86). 54% had visual acuities of 20/40 Snellen or better at initial consultation. Presenting acuity was not influenced by duration of visual symptoms. Intraocular pressure on presentation was elevated in only one patient (27 mm Hg). Although 68.4% had an anterior uveitis (AU), isolated AU was rare (1 case). 63% had vitritis; 61% had a form of posterior uveitis, (60% retinitis, 56% vasculitis, 50% macular oedema, 28% choroiditis). 32% of cases had optic nerve involvement. Of males whose sexual orientation was ascertained 85% were MSM. Of patients whose HIV status was known, 71% were HIV positive.ConclusionsThis study is the largest prospective series of ocular syphilis in the post-penicillin era providing up to date Western European incidence, demographic and clinical data. Syphilitic uveitis affects mainly adult males of all ages; majority were MSM or HIV positive. The uveitis is normotensive, posterior uveitis is common, and AU rarely presents in isolation. Clinician and public health awareness of ocular syphilis remains important.
O3-S2.01 Long-term efficacy of human papillomavirus vaccination against CIN3 and invasive cervical carcinoma: a registry based Passive follow-up of the phase III trial (PATRICIA)
Authors: Paavonen J , Lehtinen M , Rana M , Apter D , Luostarinen T , Pukkala E 
Published: July 2011

BackgroundWhile phase 3 trials have shown that vaccination against human papillomavirus (HPV) types 16 and 18 prevents persistent HPV type 16 and 18 infections and most high-risk HPV type positive cervical intraepithelial neoplasia (CIN) grade 2+ lesions, long-term follow-up of the phase 3 cohorts is needed to demonstrate that HPV16/18 vaccination prevents CIN3 and invasive cervical carcinoma (CIN3+).MethodsWe used data from the Finnish Cancer Registry for passive follow-up of cluster (age-cohort) and individually randomised cohorts of women born in 1984–1989 to assess incidence rates of CIN3+ in HPV16/18 vaccinated Finnish cohort of the bivalent HPV 16/18 vaccine PATRICIA trial participants (N=2404) and a reference cohort (N=7049) enrolled from the same communities. Six months after the Phase III trial was closed in 2009 the cohorts were linked with the Finnish Cancer Registry.Results and ConclusionsA pilot study in 2009 showed that the baseline incidence of CIN3+ was 41 per 100 000 women years in the reference cohort. Knowing that CIN3+ incidence rapidly increases as the cohorts age, the baseline incidence yields 80% power to show 70% vaccine efficacy against CIN3+ in just 5 years. The phase 3 trial included intensive clinical follow-up and thorough health education and counselling which may have modified subsequent risk of cervical neoplasia in all study participants, the incidence rates of CIN3+ need to be validated in a cohort not exposed to any clinical intervention. Preliminary data from such comparison of the incidence rates during passive follow-up the PATRICIA study participants (comprising 50 000 women years) and the reference cohort will be reported.
O3-S4.04 Time to cure chlamydia: prospective study on detection of anorectal and cervicovaginal chlamydia after directly observed treatment with azithromycin
Authors: Dukers-Muijrers N , Werner M , Brouwers E , Speksnijder A , Spauwen L , Bruisten S , van den Broek I , van der Sande M , Morré S , Hoebe C 
Published: July 2011

BackgroundWhen a person, diagnosed withChlamydia trachomatis(Ct), is being treated for Ct, STI Centres generally advise a short period of sexual abstinence; in most cases no test of cure is performed. These are considered best practices to cure Ct and prevent further spread, assuming high antibiotic efficacy. However, in about 5% of treated patients symptoms persist and among those retested 6–12 months later, 10% is Ct positive (again). Moreover, the efficacy of Azithromycin treatment for anorectal Ct is debated. The current study aims to increase understanding Ct treatment efficacy and to estimate time to cure cervicovaginal and anorectal Ct, using repeated measurements of laboratory, medical, and exposure parameters.MethodsProspective study among 49 persons with cervicovaginal Ct (45 women) and/or anorectal Ct (four men, three women). After directly observed treatment with 1000 mg Azithromycin, each participant provided during 2 months 18 time-sequential self-taken samples for testing for rRNA (TMA), Ct bacterial load (quantitative PCR; Ct plasmid DNA), and type Ct (serovar), and three time-sequential questionnaires on potential exposure (behaviour) and symptoms. Steady partners were treated as well. Here, we report on the 905 rRNA tests in 49 patients.ResultsOf all women with cervicovaginal Ct, the proportion rRNA positive was 100% at treatment, 54% at day 7, 11% at day 12 and 17% 2 months after treatment. For anorectal Ct, these rates were 100%, 57%, 29%, and 50%. In total 45% of persons with cervicovaginal Ct and 57% with anorectal Ct had at least one positive rRNA sample in the period between 2 weeks and 2 months after treatment. Three cases of anorectal Ct (negative Lymfogranuloma venerum (LGV) PCR) remained rRNA positive during 2 months and tested Ct negative after administration of doxycycline (testing 2 months later).ConclusionsThe proportion of Ct rRNA positivity during follow-up was much higher than expected in the light of assumed high effectiveness of Azithromycin treatment. Time to cure depends on the extent rRNA indicates clinically relevant or persistent Ct infection; this will be determined considering other markers (eg, Ct DNA) and symptoms as well (research ongoing). The persistent anorectal Ct cases that resolved after doxycycline treatment, contribute to the notion that this might be better treatment in anorectal Ct, after exclusion of LGV. Current study contributes to evidence based patient management and Ct transmission reduction.
O1-S03.02 Cephalosporin susceptibility ofNeisseria gonorrhoeaeisolates in the USA, 2000–2010
Authors: Kirkcaldy R , Murray E , Del Rio C , Hall G , Hook E , Whittington W , Papp J , Weinstock H 
Published: July 2011

BackgroundCephalosporins are recommended by CDC for first-line gonorrhoea treatment. Declining cephalosporin susceptibility and clinical cefixime treatment failure have been reported from Asia, Europe and other regions. We report cephalosporin susceptibility trends among USN gonorrhoeaeisolates.MethodsThe Gonococcal Isolate Surveillance Project (GISP) is a sentinel surveillance system that monitors antimicrobial susceptibility among isolates collected from men with urethritis. Minimum inhibitory concentrations (MICs) are determined by agar dilution. The proportion of isolates with elevated MICs to cefixime (≥0.25 μg/ml) and ceftriaxone (≥0.125 μg/ml) from 2000 through the first half of 2010 were tested for trends using the Cochran-Armitage trend test. Susceptibility tests for cefixime were not performed during 2007–2008.Results61 559 isolates were tested during 2000–June 2010 (annual mean=5845). Overall, 37% of isolates were from men in the northeastern or southern regions of the US, 25% were from the Midwest, and 38% were from the West; 21% were from men who have sex with men (MSM). The proportion of isolates with elevated MICs remained stable for cefixime (CFX) from 2000 to 2006 (0.2% to 0.1%; CFX susceptibility not tested 2007 and 2008) and for ceftriaxone (CRO) from 2000 to 2008 (0.1% to 0.1%); the proportions increased in 2009 and 2010 (CFX: 0.8% and 1.9% [n=53], p<0.001; CRO: 0.3% and 0.4% [n=11], p<0.001). In 2010, most isolates with elevated MICs to cephalosporins were from the West (CFX: n=48 [91%]; CRO: n=7 [64%]) and from MSM (CFX: n=46 [87%]; CRO; n=9 [82%]).ConclusionsThe proportion of gonococcal isolates with elevated MICs to cefixime and ceftriaxone recently increased in the US. Most of the isolates with elevated MICs were from men in the West and MSM. This is worrisome given trends elsewhere in the world and the history of fluoroquinolone-resistance in the US, which, early in the epidemic, was most often detected in the western US and among MSM. Cephalosporins remain effective for gonorrhoea treatment in the US, yet increasing MICs suggest that resistance may emerge. If cephalosporin resistance does emerge, alternative antibiotic treatment options will be needed.
O1-S03.03 Clonally relatedNeisseria gonorrhoeaeisolates with decreased susceptibility to extended-spectrum cephalosporins in Amsterdam, the Netherlands
Authors: Heymans R , Bruisten S , Golparian D , Unemo M , de Vries H , van Dam A 
Published: July 2011

BackgroundBetween 2006 and 2008, the prevalence ofNeisseria gonorrhoeae(NG) isolates with decreased susceptibility (0.125<MIC<0.5 μg/ml) to the extended-spectrum cephalosporin (ESC) cefotaxime (CTX) among visitors of the STI clinic in Amsterdam, the Netherlands increased from 4.8 to 12.1%. The transmission patterns, clonality, phenotypic and genotypic characteristics of the NG isolates transmitted within this high-risk group were examined.MethodsFrom 2006 to 2008, 74 NG isolates with a CTX MIC of >0.125 μg/ml (group A), 54 with a CTX MIC of 0.125 μg/ml (group B), and a control group of 74 with a CTX MIC of <0.125 μg/ml (group C), were included. All isolates were characterised using antibiograms, conventional penA mosaic gene PCR, and genotyping by NG-multi-locus variable-number tandem repeat analysis (MLVA). PenA mosaic positive isolates and a strict selection of the remaining isolates were further characterised by NG-multilocus sequence typing (MAST) and sequencing of ESC resistance determinants (penA, mtrR, and porB1b).ResultsThe majority of the isolates in group A (n=47; 64%) but only 11% (n=6) of the isolates in group B contained a penA mosaic allele. No penA mosaic-containing isolate was identified in group C (see Abstract O1-S03.03 figure 1). All the 53 penA mosaic isolates had an identical penA sequence (type XXXIV) and were assigned to the same MLVA cluster, which additionally included three isolates that were susceptible to CTX (MIC<0.125 μg/ml). Within this MLVA cluster, 46 (87%) of the penA mosaic isolates were assigned NG-MAST ST1407, and the remaining 7 isolates had closely related STs. All these penA mosaic isolates contained a mtrR promoter deletion and in 52/53 isolates the porB1b alterations G101K and A102N were found. Decreased susceptibility to cefixime and ceftriaxone (MIC≥0.016 μg/ml) was found in 50/53 and 44/53 isolates, respectively. The mosaic penA MLVA cluster, containing ST1407 (87%) and closely related STs (13%), represented Dutch homosexual men (66%), patients with frequent chlamydia co-infection (32%), and commercial sex workers (7%).Abstract O1-S03.03 Figure 1GGD.ConclusionsA strong correlation was found between the decreased ESC susceptibility and a NG penA mosaic strain (ST1407) that was highly prevalent among visitors of the STI clinic Amsterdam. This strain was identified in many other countries. The rapid spread of this NG strain might be facilitated by high-risk sexual behaviour and should be monitored closely to identify potential treatment failure.
O1-S03.05 Community-acquired methicillin-resistant and susceptibleStaphylococcus aureusamong men who have sex with men
Authors: De Vries H , Joore I , van Rooijen M , Schim van der Loeff M , van Dam A , De Vries H 
Published: July 2011

BackgroundCommunity Acquired Methicillin Resistant Staphylococcus aureus (CA-MRSA) has been found more often among men who have sex with men (MSM) in some studies (USA). This study assesses the prevalence and sexual risk factors for CA-MRSA and methicillin susceptibleStaphylococcus aureus(MSSA) colonisation and infection among MSM in Amsterdam, the Netherlands.MethodsMSM attending the sexually transmitted infections outpatient clinic in Amsterdam were invited to participate in this study and divided in two groups: (1) MSM with clinical signs of a skin/soft tissue infection (symptomatic group) and (2) MSM without clinical signs of such infections (asymptomatic group). Demographic characteristics, medical history, sexual behaviour, history of sexual contacts and known risk factors for colonisation withS aureuswere collected through a self-completed questionnaire. Swabs were collected from the anterior nasal cavity, throat, perineum, penile glans and, if present, from infected skin lesions. Culture forS aureuswas done on blood agar plates and for MRSA broth on selective chromagar plates after enrichment in broth. If MRSA was found, the sex partners of the index patient were invited for screening for MRSA.ResultsBetween October 2008 and April 2010 a total of 214 MSM were included in the study: 76 into the symptomatic group and 138 MSM into the asymptomatic group. The prevalence of MSSA in the nose was 36% (78/214) and in skin lesions 36% (27/76). The prevalence of MRSA was 0.9% (2/214). Both MRSA cases, one asymptomatic and one symptomatic, were HIV positive. The asymptomatic MRSA carrier had been hospitalised the previous year. None of the four sexual contacts that could be traced were colonised by MRSA. The symptomatic MRSA case had a soft tissue infection in the genital area; in this case also the nasal cavity, perineum and glans penis were positive for MRSA. No sexual contacts could be traced. There were no significant differences in age, sexual risk behaviour, drug use, history or diagnoses of sexual transmitted diseases, circumcision status or hygiene behaviour between those with and without a genitalS aureusinfection, but those infected withS aureuswere significantly more often HIV infected (55% vs 34%; p<0.01).ConclusionCA-MRSA among MSM STI outpatient clinic visitors in Amsterdam is rare. There were no indications for sexual transmission of MRSA or MSSA in this population.