bluuebunny/crossref_metadata_2025_split huggingface dataset:
S10.4 Sexual health and public policy in Latin America and the Caribbean (LAC)
Authors: Mazin R 
Published: July 2011

BackgroundSexual health and its determinants are central to overall well-being and development. Thus, sexual health should be considered by public health as a critical element not only of the population's health, but also as an essential component of the health generated by the population. Regrettably, strict social norms and traditions in LAC have maintained the public discussions about sexuality in secretive and private domains. Moreover, rigid and stereotyped gender roles and social mores and values regarding sexuality have limited the incorporation of this area in the public health agendas, with the only exception of issues related to reproduction.MethodsWith the purpose to initiate a process aimed at incorporated the notion of sexual health into the public agenda, in May 2000, the Pan American Health Organization, in association with the World Association for Sexology/WAS (which has since changed its name to World Association for Sexual Health), held a consultation in Guatemala in which a definition of sexual health was coined: a state of physical, psychological, and socio-cultural well-being related to sexuality. The sexual health and the quality of sexual life of individuals, families and communities and the various factors that can affect them were also discussed and avenues for action were proposed.Since then PAHO has also been engaged in several processes to further advance the sexual health agenda in the Americas, among which the collaboration with WAS in their initiative “Sexual Health for the Millennium”, the explicit incorporation of indicators on sexual health in PAHO's Strategic Plan for the Region, active support to the Mexico City Declaration, and several others intended to improve the health of members of sexual minorities and to rekindling of STI programs in LAC.ResultsPreliminary empirical evidence seems to indicate that the use of a public health rationale contributes to create convergence in an open debate that would be impossible to hold if other approaches were to be used (eg, based on moral, tradition or assumptions and beliefs). The discussion should lead to the realisation of sexual health, which means adoption of healthy lifestyles and the creation of supportive environments conducive to well-being for all. It would also contribute to the reorientation of the health services to better respond to the sexual needs of individuals through the life cycle, families, and communities.
S11.1 Problems encountered with reverse sequence syphilis screening
Authors: Hoover K W 
Published: July 2011

CDC has long recommended screening for syphilis with a non-treponemal test such as the RPR test and, if reactive, confirming with a treponemal test. Non-treponemal antibody levels rise during active infection and tend to decline after treatment, so non-treponemal screening identifies persons with active disease who are likely infectious and require clinical and public health interventions. Although treponemal antibodies rise slightly earlier than non-treponemal antibodies, they tend to remain elevated after treatment so their presence does not always indicate active infection. Thus, treponemal tests have not been recommended for initial screening. Also, older treponemal tests that utilise native treponemal antigens, such as the TP-PA and FTA-ABS tests, were thought to have a high false positive rate due to binding of cross-reacting serum antibodies. Newer treponemal tests, enzyme immunoassays (EIAs) and chemiluminescence immunoassays (CIAs), utilise recombinant treponemal antigens which should result in tests with high sensitivity and specificity, capable of detecting small quantities of antibody without nonspecific binding of cross-reacting antibodies. Because EIA/CIA can be automated, U.S. laboratories have begun to screen for syphilis using a reverse sequence with EIA/CIA screening and confirmation of EIA+ sera with an RPR test to identify active infection.Using this reverse sequence for syphilis screening, discordant sera (EIA+/RPR−) would be expected in patients with previous infection or early primary infection. CDC studies have found that more than half of all EIA+ sera were discordant with EIA+/RPR− results. A recent CDC epidemiologic study found that 32% of discordant sera were due to false-positive EIA/CIAs (eg, EIA+/RPR−/TP-PA−), with rates that ranged from 12% in a high prevalence population to 60% in a low prevalence population.Discordant sera cause uncertainty about patient management, and the TP-PA test might be a useful confirmatory test with these sera. Recent studies suggest that the TP-PA test has equivalent sensitivity but higher specificity than EIA/CIAs, performance characteristics that are necessary for a confirmatory test. The FTA-ABS should not be used because it has low specificity, its interpretation is inherently subjective, and its performance requires trained personnel and a dedicated fluorescence microscope. Research is needed to better understand the variation in treponemal test performance.
S11.3 Performing a treponemal test to confirm a reactive EIA test: before or after the non-treponemal test?
Authors: Ison C 
Published: July 2011

Detection of the host's immune response to infection has been the mainstay of the diagnosis of syphilis for decades. Serological characterisation ofTreponema palliduminfection presents a number of challenges including the life-long antibody response to treponemal antigens following primary infection, absence of a test specific only toT pallidumand lack of a test detecting treponemal antibody that indicates newly acquired infection or response to treatment. Non-treponemal or reagin-based tests offer the best indication of infectious syphilis but themselves can show cross-reactivity to other infections and conditions. These challenges are coupled in much of the developed world with very low rates of infection.The choice for screening or testing individuals for syphilis can be difficult in that the treponemal tests such as the enzyme immunoassays and chemiluminescent assays, are highly sensitive, can be automated and allow screening of large numbers of sera, whereas the rapid plasma reagin (RPR) test is an agglutination test, cannot be automated and does not easily lend itself to large scale testing. In England & Wales, the National Standard Operating Procedure (VSOP 44) and the Antenatal Screening Committee Laboratory Standards both recommend screening using an enzyme immunoassays, or chemiluminescent assays, followed by confirmation by the Treponemal Passive Particle Assay, to eliminate any non-specific reactivity. Sera giving a positive reaction with both tests will then be immediately tested using the RPR.The advantages of this approach are that large numbers of sera can be screened in local laboratories, where most will give a negative result, allowing the small number of potentially infected individuals to be quickly identified for further testing. There may be a resulting delay in identifying an infectious case particularly in low prevalence populations, where the laboratory may not perform the confirmatory tests and refers to a regional centre and therefore standards for turnaround times and rapid referral to a specialist physician to ensure timely treatment, especially in maternal syphilis, are essential. In high prevalence areas the RPR is likely to be more cost-effective as a screening test, however, the approach taken should address the population to be tested, the laboratory resources for screening / testing and the prevalence of infection to identify and treat the maximum number of cases for the public health control of syphilis.
S11.4 Serological screening for syphilis: research needs
Authors: Lukehart S A 
Published: July 2011

Background and problemThe recent development and implementation of serological screening for syphilis using recombinant protein-based immunoassays has resulted in much confusion about the interpretation of positive results, particularly in low prevalence settings. Early experience suggests that a high proportion of positive tests are not confirmed by either non-treponemal or other treponemal tests. Many questions remain about the accuracy and relevance of these results.Research needsWe will discuss research questions related to the performance, utility, and effectiveness of these tests.Performance of the existing testsSensitivity, specificity, and positive predictive value in high- and low-prevalence populations. What gold standard should be used for evaluation of these tests?Can performance of the existing tests be improved by simple modifications?Reactivity in persons with past treated syphilis—how can this be determined?Effectiveness of using the current tests for screeningDoes screening with the EIA tests result in the need for more additional, unnecessary testing? Does the delay in receiving prompt complete serological results result in delayed treatment and increased transmission of syphilis? How much unnecessary treatment results from the use of these tests for screening? What is the impact of EIA screening on public health time and dollars spent on contact tracing? What is the real cost of EIA screening, including the need for additional testing, possibility of additional transmission, and required public health follow-up?Biological basis for the unconfirmed reactivity in the existing testsWhichTreponema pallidumantigens are recognised by patient sera that are reactive only in the EIA tests?Do such antisera have cross-reactivity with antigens of other treponemal species found in humans?Next generation recombinant protein-based antibody testsAre thereT pallidum-specific antigens? How can we identify them? Are there antigens for which antibody disappears or declines significantly following treatment?ConclusionsThe increasingly widespread use of recombinant protein-based immunoassays has contributed to much confusion in serological testing for syphilis. Research efforts to understand the source of the problems with these first-generation tests are needed to provide clinicians with appropriate algorithms and tools to accurately and rapidly diagnose untreated syphilis in their patients.
S12.3 What is the latest data from the 2 commercially available prophylactic cervical cancer vaccines?
Authors: Garland S 
Published: July 2011

Since 2007 two prophylactic HPV vaccines (a bivalent incorporating VLPs 16 and 18, plus a quadrivalent vaccine with VLPs 16, 18, 6, 11) have been licensed for use. This was based on excellent efficacy, immunogenicity and safety data from phase 3 clinical trials. In addition there is also some cross protection for disease for phylogenetically related genotypes. Where these vaccines have been incorporated into public health programs with high coverage, (particularly targeted school based programs), already reductions in those disease those with the shortest incubation periods, are being seen that is, genital warts for the quadrivalent vaccine.The greatest challenge today is to obtain wide vaccine coverage to those countries with the highest incidence of disease.
S13.4 Use of respondent-driven sampling for monitoring HIV behaviours among injecting drug users in the United States
Authors: Lansky A , DiNenno E A , Wejnert C 
Published: July 2011

BackgroundApproximately 1.1 million persons in the United States are living with HIV and for 18.5% their infections are attributable to injection drug use. In 2009 there were an estimated 5063 new HIV diagnoses attributed to injection drug use. In 2002, CDC developed the National HIV Behavioural Surveillance System (NHBS) to help state and local health departments in areas with high AIDS prevalence monitor behaviours and use of prevention services in groups at highest risk for HIV infection, including injection drug users (IDU). NHBS uses a sampling method most appropriate for each group; respondent-driven sampling (RDS) was chosen as the method for NHBS-IDU. We describe implementation and key monitoring indicators from the first two rounds of NHBS-IDU.MethodsNHBS-IDU is implemented in more than 20 cities every 3 years using a standardised protocol for conducting surveys and HIV testing among persons who had injected drugs within the 12 months prior to interview. Data are analysed for each city independently and then aggregated and weighted to form national estimates.ResultsDuring the first IDU cycle (NHBS-IDU1, conducted 2005–2006), a total of 13 519 persons in 23 cities were recruited to participate, which resulted in 11 471 persons included in the final dataset. A total of 10 901 persons received 34 038 coupons to recruit others; 13 115 (62%) coupons were returned (range by city: 52.2%–75.3%). Challenges to the underlying assumptions of RDS included a somewhat high (5%) proportion of participants who reported their recruiter was “a stranger” and limited geographic cross-recruitment, suggesting IDU networks were not linked. These issues were found for some cities and were addressed in the operational guidance for NHBS-IDU2, conducted during 2009. Data from NHBS are used to monitor national progress in HIV prevention for IDU; in NHBS-IDU1, an estimated 32.8% of IDU shared syringes, and 63.4% had unprotected vaginal sex; 66.3% had been tested for HIV, and 29.7% had participated in an HIV behavioural intervention.ConclusionsUse of RDS for NHBS-IDU has identified challenges in implementation and analysis that continue to further the development of this method for conducting behavioural surveillance among IDU in order to characterise the HIV epidemic in the USA.
S14.1 Genital and oral human papillomavirus in adolescent males
Authors: Weaver B A , Brown D , Fortenberry J D 
Published: July 2011

BackgroundHuman papillomavirus is a common STI which causes genital warts and cancers in males. Studies of HPV in adult males are underway, but the epidemiology and natural history of HPV in adolescent males has not been investigated. The purpose of this study is to describe genital and oral HPV infections in young men.MethodsA subset of young men was recruited from an ongoing study of the male adolescent penile and urethral microbiome and sexual behaviours. Participant consent and parental permission were obtained. This study was approved by the Institutional Review Board at Indiana University. Approximately every 3 months, genital swabs and an oral rinse sample were collected from each participant. Genital swabs were collected using saline wetted cotton swabs rubbed over the entire skin surface of the participant's glans penis, penile shaft, and scrotum. Participants provided oral samples by a swish and spit method using 15 ml of mouthwash. Samples were tested for HPV using the 37 HPV type Linear Array HPV Genotyping Test (Roche). Participants completed daily cell phone diary entries and quarterly surveys about their sexual behaviours. Descriptive statistical analysis was performed using SPSS.ResultsA total of 34 adolescent males were recruited, ages 14–18 at enrolment (mean 15.8; SD 1.18). The racial/ethnic identity of participants was: 19 (55.9%) black, 12 (35.3%) white, and 3(8.8%) other. At the time of their first HPV sample collection, 19 participants (55.9%) reported ever having vaginal sex, 8 participants (23.5%) reported ever giving oral sex, 16 participants (47.1%) reported ever receiving oral sex, and 5 (14.7%) reported ever having anal sex. In their enrolment genital samples, HPV (high risk (HR) plus low risk (LR)) was detected in 13 of 34 participants (38.2%); HR types were detected in nine participants and LR types were detected in eight participants. Seven participants had >1 HPV type. HPV was detected in both sexually active participants and those denying prior sexual contact. One participant had trichomonas at enrolment; no participants had gonorrhoea or chlamydia. In the enrolment oral samples, HPV was detected in one participant (HPV 6).ConclusionsThis study provides the first information about HPV genital and oral infections in adolescent males. Genital HPV can be detected in adolescent males, and is not predicted by prior vaginal or oral sex. Oral HPV was infrequently detected in this small sample.
S14.3 Evaluating the internet as an STD risk environment for teens: findings from the communication, health, and teens (CH@T) study
Authors: Buhi E R , Klinkenberger N , Blunt H , Daley E M , Baldwin J , Rietmeijer C 
Published: July 2011

BackgroundTheCH@Tstudy aims to identify/characterise a group of teens reporting meeting sex partners online and a group reporting meeting sex partners in-person (not online) and examine the differences between the 2 groups in sexual health risks.MethodsYouth aged 13–19 years (N=273) visiting a publicly-funded clinic completed a 20-min Audio-Computer Assisted Self-Interview. Included were global sexual behaviour questions (eg, oral/vaginal/anal sex experience, number of sex partners) and specific partnership history questions, including meeting partners online/offline. Participants were also tested for chlamydia/gonorrhea. Audio-Computer Assisted Self-Interview responses were anonymously linked to teens' biological STD results. A χ2test was performed to determine the association between meeting a sex partner online and current STD status.ResultsParticipants identified as female (89.4%) and heterosexual (80.7%). Nearly 9 in 10 (88.6%) reported oral, 97.8% vaginal, and 28.6% anal sex experience. Of those with biological STD data (n=267), 14.2% had a current STD infection. Of all teens, 15.4% (n=42) reported having sex with a partner originally met online (of these, > half [57.1%] met >1 partner). Compared with teens reporting only partners met in-person, teens reporting an online partner had significantly greater numbers of oral, vaginal, and anal sex partners. However, analyses indicated no association between having a current STD and reporting an online partner, χ2(1, N=267)=0.95, p=0.34.ConclusionsTheory-driven STD prevention and sexual health promotion interventions should be tailored to meet specific needs of young people seeking partners both online and offline. Sex-seeking, dating, and social networking websites may represent important intervention contexts.
S14.6 Prevalence and predictors of trichomonas infection in incarcerated women
Authors: Nijhawan A , Salloway R , Andrea S , Champion J , Seadale M , Chapin K , Clarke J G 
Published: July 2011

BackgroundTrichomonas vaginalisis the most prevalent curable sexually transmitted infection in the United States and may lead to preterm delivery, infertility and increased HIV transmission. Illicit drug use, HIV infection and Black race have been associated with high rates of infection. Incarcerated women may be at especially high risk for infection, though few studies have examined routine screening for trichomonas in this population.MethodsWomen >18-years-old entering the Rhode Island Department of Corrections between September 2009 and December 2010 were recruited to participate. All women submitted a self-collected vaginal swab for trichomonas culture and Transcription Mediated Amplification testing. Each participant completed a survey addressing demographics, symptoms, sexual behaviour, and substance use by audio computer-assisted self-interview. Data analysis was completed using multivariate logistic regression in STATA.Results288 women enrolled in the study, mean age was 28 years. 59% of participants were White, 17% Hispanic, 12% Black and 12% other races. Forty-three per cent reported vaginal symptoms and 54% reported illicit drug use in the 30 days prior to incarceration. Among all participants, the prevalence of trichomonas was 8.7% by culture and 12.5% by NAAT. The strongest predictors of infection included Black race (OR 4.1, 95% CI 1.4 to 12.0), cocaine use in the 30 days prior to incarceration (OR 2.5, 95% CI 1.1 to 5.7), and >3 year since last pap smear (OR 5.2, 95% CI 1.5 to 17.8). Vaginal symptoms and age were not significantly associated with trichomonas detection.ConclusionsTrichomonas infection is common in incarcerated women, especially among Blacks, recent cocaine users and those not receiving routine gynaecologic care. Infection was not predicted by symptoms or by age. Routine screening for trichomonas infection in high-risk populations may lead to increased detection and treatment.
S15.2 European gonococcal antimicrobial surveillance programme (Euro-GASP): towards timelier monitoring
Authors: Cole M J , Chisholm S A , Unemo M , Hoffmann S , van de Laar M J W , Ison C A 
Published: July 2011

BackgroundIt is imperative that antimicrobial resistance (AMR) surveillance systems work in a timely manner and outcomes are translated into treatment guidelines without delay. For the first time in 2010, the European gonococcal antimicrobial surveillance programme (Euro-GASP) introduced biannual testing to allow more frequent reporting of trends and developments inNeisseria gonorrhoeaeAMR across Europe.MethodsIn the first half of 2010, 18 out of the 30 EU/EEA Member States contributed up to 55 consecutive gonococcal isolates to Euro-GASP. Susceptibility testing was performed by Etest or agar dilution for therapeutically relevant antimicrobials: azithromycin, cefixime, ceftriaxone, ciprofloxacin, gentamicin and spectinomycin. Biannual testing continued into the second half of 2010. Additionally 10 laboratories performed decentralised testing with the submission of AMR data into Euro-GASP instead of gonococcal isolates.ResultsIn the first round of biannual testing 900N gonorrhoeaeisolates were tested. Eight per cent of the isolates displayed decreased susceptibility (>0.125 mg/l) to cefixime, which was an increase from 5% in 2009. No decreased susceptibility to ceftriaxone was detected. For ciprofloxacin, the overall incidence of resistant isolates decreased from 63% in 2009 to 52% in 2010 and azithromycin resistance decreased from 13% in 2009 to 5% in 2010. No resistance to spectinomycin was demonstrated. The MIC50 and MIC90 of gentamicin in the isolates remained at 8 mg/l in 2010.ConclusionsThe results from the first round of biannual testing have shown that isolates displaying decreased susceptibility to cefixime are rapidly increasing. This is a major concern as cefixime is a widely used, recommended therapy for gonorrhoea across Europe. Healthcare professions should be aware of cefixime treatment failures, particularly in light of the recent identification of treatment failures in Norway and the UK. The MICs of ceftriaxone need to be monitored continually to preserve this precious treatment option. Euro-GASP is currently being adjusted to allow for timely reporting and decentralised testing including representativeness and links to epidemiological data. All of which contribute to monitoring the ever changing gonococcus in timelier and more efficient ways, with the ultimate aim of treating infected individuals successfully.