bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1-S5.13 Recreational drug use during sex is associated with STI among clients of a large STI outpatient clinic in Amsterdam, The Netherlands
Authors: Heiligenberg M , Wermeling P , van Rooijen M , Urbanus A , Prins M , Coutinho R , Schim van der Loeff M 
Published: July 2011

BackgroundPrevious studies have shown that recreational drug use is associated with high-risk sexual behaviour and STI. Little is known about the relationship between the use of specific recreational drugs during sex, sexual behaviour and the risk for any STI (chlamydia (CT), gonorrhoea (NG) and/or syphilis) or the three STI separately in heterosexual men, men having sex with men (MSM) and women. We assessed the prevalence of recreational drug use during sex, and assocations of drug use during sex with high-risk sexual behaviour and STI.MethodsAttendees of the STI clinic of the Public Health Service of Amsterdam were interviewed during three waves of a bi-annual anonymous survey (2008–2009) about sexual behaviour in the preceding 6 months (number of steady and casual sex partners, condom use during vaginal or anal sex) and specific recreational drug use just before or during sex in the preceding 6 months (cannabis, XTC, poppers, heroine, cocaine, GHB, apomorfine, amphetamine, methylamphetamine, mushrooms, ketamine and explosion). Participants were tested for CT, NG and syphilis. Associations between drug use during sex and high-risk sexual behaviour and STI were analysed using multivariable logistic regression analyses. Analyses were done separately for heterosexual men, men who have sex with men (MSM) and women.ResultsIn total, 1012 heterosexual men, 749 MSM and 1254 women participated in this study. Of these, 11.7% had CT, 3.5% NG and 1.4% syphilis. Recreational drug use during sex in the previous 6 months was reported by 22.5% of heterosexual men, 52.7% of MSM and 15.6% of women. In all three groups, drug use during sex was associated with unprotected vaginal and anal sex and more casual sex partners. In multivariable analyses among MSM, adjusting for age, ethnicity, educational level and sexual behaviour, poppers use was associated with any STI (adjOR 1.8, 95% CI 1.2 to 2.6) and with NG (adjOR 2.6, 95% CI 1.6 to 4.2), and GHB use with syphilis (adjOR 2.3, 95% CI 1.0 to 5.0). In multivariable analyses among women, GHB use was associated with any STI (adjOR 4.7, 95% CI 1.8 to 12.2) and CT (adjOR 3.5, 95% CI 1.1 to 11.4). In heterosexual men, drug use during sex was not associated with STI.ConclusionsSTI clinic clients frequently report recreational drug use during sex and this is associated with high-risk sexual behaviour in heterosexual men, MSM and women. The use of drugs during sex is associated with STI in MSM and women, but not in heterosexual men.
P1-S5.16 Investigating self-reported level of condom use and condom use in last act among high-risk groups in Southern India
Authors: Pickles M , Adhikary R , Mainkar M ,   R S P, Deering K , Verma S , Boily M C , Vickerman P , Alary M 
Published: July 2011

BackgroundMeasuring consistent condom use (CCU) is crucial in understanding the trajectory of the HIV epidemic and in evaluating HIV preventive interventions that promote condom use. We examine how one measure of CCU varies across different populations, and compare it to condom use in the last sex act.MethodsUsing data from cross-sectional behavioural and biological surveys (2005–2007), we compare responses concerning self-reported level of condom use and condom use in the last act by female sex workers (FSWs), their clients, and men who have sex with men (MSM) in districts from Andhra Pradesh, Maharashtra and Tamil Nadu states in India. For FSWs/clients, the question related to sex with occasional clients/FSWs. For MSM, the question was for non-commercial, non-regular male partners. The time period was unspecified. Levels of condom use were defined as every time", “most of the time/sometimes”, and “never”. We define CCU as those who reply “every time”.Results95.2% of all FSWs reported using a condom in the last act, compared to 72.9% of clients and 80.0% MSM. However, only 36.7% of clients and 29.6% of MSM reported CCU compared to 80.0% of FSWs. Abstract P1-S5-16 table 1 shows condom use in the last act stratified by reported level of condom use. For all populations reporting CCU “always”, condom use in the last act was >98%. Of those who reported “most of the time/sometimes”, there was a significant difference between condom use in the last act between clients and the other groups (χ2test, p<0.001), with clients using condoms less frequently. Condom use in the last act among those who “never” use a condom was low (<3%).Abstract P1-S5.16 Table 1Results from IBBA surveys in Andhra Pradesh, Maharashtra and Tamil Nadu statesReport using a condom “every time”Report using a condom “sometimes/most of the time”Report using a condom “never”Used a condom in last sex actReport using a condom “every time”Report using a condom “sometimes /most of the time”Report using a condom “never”FSW80.00% (4010)19.01% (953)0.96% (93)98.28%87.20%2.08%Client36.67% (1667)48.20% (2191)15.13% (688)98.50%75.58%2.03%MSM29.63% (621)63.63% (1648)12.39% (321)99.36%88.17%1.25%ConclusionsCCU may not accurately reflect number of acts protected by condoms. Among males in particular, dividing condom users into CCU and non-CCU neglects many who almost always use condoms, and so will still have a high degree of protection. These individuals are an important group to consider when evaluating the effect of changes in condom use on the HIV epidemic, especially among MSM. HIV prevention programmes should try to identify reasons explaining lower CCU among MSM and clients who already use condoms “most of the time/sometimes”, and endeavour to increase consistency within this group.
P1-S5.25 Acyclovir and transmission of HSV-2 from HSV-2/HIV-1 dually infected persons
Authors: Mujugira A , Margaret A , Celum C , Lingappa J , Baeten J , Fife K , De Bruyn G , Bukusi E , Corey L , Wald A 
Published: July 2011

BackgroundDaily suppressive therapy with valacyclovir reduces the risk of sexual transmission of HSV-2 in healthy HSV-2 serodiscordant heterosexual couples by 48%. Whether suppressive therapy reduces HSV-2 transmission from persons who have both HIV-1 and HSV-2 is unknown.MethodsWithin a randomised trial of daily acyclovir 400 mg bid in African HIV-1 serodiscordant couples, in which the HIV-1 infected partner was HSV-2 seropositive, we identified partnerships in which the HIV-1 susceptible partners were HSV-2 seronegative. Cox proportional hazards analysis was used.ResultsWe followed 911 HIV-1 and HSV-2 serodiscordant couples for a median of 18 months (IQR 3, 24). For 112 couples (12%), the HIV-1/HSV-2 infected partner was male, of whom 37% (34/91) were circumcised. 68 HSV-2 seroconversions were observed (an incidence of 5.1 per 100 person-years): 40 in the acyclovir group and 28 in the placebo group (HR 1.4, 95% CI 0.8 to 2.2; p=0.2). In a multivariate analysis of HSV-2 susceptible women, hormonal contraception (HR 3.84, 95% CI 1.32 to 11.14, p=0.013) and having an uncircumcised male partner (HR 8.91, 95% CI 1.17 to 67.85, p=0.035) were significant risk factors for HSV-2 acquisition. Among HSV-2 susceptible men, younger age was the only significant HSV-2 risk factor (p=0.014).ConclusionsSuppressive acyclovir therapy did not decrease the risk of HSV-2 transmission within HSV-2-serodiscordant couples in which the HSV-2-seropositive partner also had HIV-1 infection. Hormonal contraceptive use and lack of male circumcision in the HIV-1/HSV-2 dually infected male partners increased the risk of HSV-2 acquisition among initially HSV-2 seronegative women.
P1-S5.26 Better-understanding of the dynamics of gonorrhoea and chlamydia through analysis of coinfection
Authors: Turner K , White P , Garnett G , Gay N , Low N , Althaus C ,   Partner Notification Group
Published: July 2011

BackgroundCoinfection with gonorrhoea and chlamydia occurs frequently. It is well known that the proportion of gonorrhoea-infected individuals who also have chlamydia is higher than the proportion of chlamydia-infected people who also have gonorrhoea. This difference has implications for the detection and management of infections and might simply reflect the higher prevalence of chlamydia than gonorrhoea in the general population. The objective of this study was to explore the characteristics of chlamydia–gonorrhoea coinfection in a transmission dynamic model and determine whether levels of coinfection might give insights into hard-to-measure behavioural parameters such as mixing patterns.MethodsWe designed a simple transmission dynamic model to capture gonorrhoea and chlamydia dynamics within a heterosexual population. We fitted the model to empirical surveillance data (Gonococcal Resistance Antimicrobials Surveillance Programme, GRASP) about levels of infection and the NATSAL 2000 sexual behaviour survey. The baseline prevalence of chlamydia was 2.6%. We tested whether the model replicated the observed prevalence of coinfection. We then extended the model to improve its realism and capture potential interactions including cotreatment, cotransmission, short term acquired immunity or changes in symptom severity or susceptibility.ResultsThe best fitting model predicts a gonorrhoea prevalence of between 0.4 and 0.7% and of those with gonorrhoea 15% (men) and 17% (women) also have chlamydia, compared with empirical estimates of 28% (men) and 38% (women). Of those with chlamydia, 3.0% and 2.6% of men and women are coinfected with gonorrhoea. The model also predicts an increasing prevalence of coinfection with increasing sexual activity.ConclusionsA trend of increasing coinfection with increasing sexual activity is observed in the empirical data for men, but not women: the highest risk women with gonorrhoea have lower levels of chlamydia then the moderate activity women. The best fitting models underestimate the level of coinfection observed. Cotreatment and temporary immunity to chlamydia do not appear sufficient to explain the differences between the model and observations. Differences in coinfection levels are a complex phenomenon that do not just reflect differences in population prevalence and are not captured by the simplest models.
P1-S5.27 Low prevalence of asymptomatic STI in HIV-infected heterosexual males and females, visiting an HIV outpatient clinic in the Netherlands
Authors: Heiligenberg M , van der Loeff M S , de Vries H , Geerlings S , Prins M , Prins J 
Published: July 2011

BackgroundIn the Netherlands no guidelines exist for routine STI screening of HIV-infected patients. In a study in two academic hospitals in the Netherlands, 16% of HIV-infected MSM in HIV care had an asymptomatic STI, making regular STI screening in this group appropriate. It is unclear whether regular STI screening should also be considered for HIV-infected heterosexual men and women. Therefore, we studied the prevalence of, and factors associated with asymptomatic STI in a representative group of HIV positive heterosexual men and women.MethodsHIV-1 infected heterosexual patients visiting the HIV outpatient clinic of the Academic Medical Center in Amsterdam, the Netherlands, were screened for STI during a routine visit. Patients spontaneously reporting symptoms compatible with STI were excluded.Chlamydia trachomatis(CT) andNeisseria gonorrhoeae(NG) were tested by PCR on throat swabs, vaginal or anal self swabs and urine samples, depending on gender and sexual behaviour. Hepatitis B virus (HBV) and hepatitis C virus (HCV) serology were performed and patients were screened for syphilis by TPHA and RPR. Participants were interviewed by a trained interviewer about sexual risk behaviour in the previous 6 months.ResultsBetween October 2007 and June 2008, 248 men and women (median age 41 years, range 18–82) were included. 56% was female and 42% had Dutch ethnicity, the main other ethnicities were Ghanese, Surinamese/Antillean and Sub-Saharan African. The Abstract P1-S5.27 table 1 shows sexual behaviour of participants in the preceding 6 months. Reported history of STI in the last 6 months was 2%, and lifetime history of STI (non-HIV) was 49%. 29% of participants had had STI testing in the preceding 6 months, and 64% had an STI test more than 6 months ago. Only four patients (1.6%) had an asymptomatic STI. Two women were diagnosed with vaginal CT, 1 man with urethral CT and a female intravenous drug user with a history of syphilis had a new syphilis infection. We also identified one hitherto undiagnosed HCV infection; this was in a male intravenous drug user without a history of sex with men; we did not classify this as an STI.Abstract P1-S5.27 Table 1Sexual behaviour of HIV-infected heterosexual males and females visiting an HIV outpatient clinic in the Netherlands, 2007–2008Sexual behaviour+/total%Did not have sex in last 6 months65/19733.0Had 1 sexual partner last 6 months110/19360.1Had 2 or more sexual partners last 6 months19/1939.8Had casual sexual partner(s) in last 6 months24/19312.4Had unprotected vaginal sex in last 6 months46/19320.7Had unprotected anal sex in last 6 months4/1932.0ConclusionsIn this population of HIV-1 infected heterosexual patients in care for HIV infection high risk sexual behaviour is rare and asymptomatic STI are uncommon. Our study results suggest that routine screening in asymptomatic heterosexual patients is currently not needed.
P1-S5.37 Evolution of sexual networks over time in Manitoba, Canada
Authors: Jolly A 
Published: July 2011

BackgroundRecent increases in bacterial STI in Canada and the resurgence of syphilis require further investigations into the transmission of STI. Specifically, adaptation of sexual networks and sexually transmitted pathogens to prevention efforts such as screening and partner notification have been proposed as a major factor in persistence of STI. We investigate the size and morphology of sexual networks generated by routinely collected contact tracing data for gonorrhoea, chlamydia and syphilis for the whole province of Manitoba, at three time points; 1990–1992; 1997–1998, and last, from 2002 to 2003.MethodsWe compared the sizes of the components in which cases and contacts were connected by sexual intercourse at the three time points, and cross matched chart numbers of the cases from 1990–1992 with those from 1997–1998 in order to identify which individuals were active within specific networks 8–10 years later. We reviewed the changes in the networks along with the rates over time in order to assess the epidemic phases of the pathogen and their possible effects on the networks.ResultsFrom 1990 to 1992, 20 223 cases were available for analysis; from a 6-month period in 1997–1998, 4544 cases and contacts were available, and last for 2002–2003; 8746 cases and contacts were available over 2 years. For the first 3-year period, components ranged from 1 to 2166; in 1997–1998; from 1 to 82 people, and from 1 to 33 people in 2002–2003. The giant component decreased by an order of magnitude over time as a proportion of all components, consisting of 9.4% of the population in the first time period, 1.8% in the second, and 0.4% (Abstract P1-S5.37 figure 1). Twenty people who had chlamydia or gonorrhoea in 1990–1992 had subsequent STIs every 2–3 years up to an including 1997–1998. They were significantly younger than other cases, (means 17.81, 23.27, p=0.0002) and were more likely to be of North American Indian ancestry (OR14.22, p<0.0001). They did not differ by area of residence or gender and the sizes of the components in which all cases and contacts were connected by sexual intercourse in 1997/98 were similar to those in which the 20 long term repeaters were active.Abstract P1-S5.37 Figure 1Evolution of sexual networks over time in Manitoba, Canada A) Pruned largest component, n=2, 166, 1990–1992, B) Largest component n=82, 1997–1998 and C) largest component n=33, 2003–2004.ConclusionsThe existence of 20 young, First Nations people who had STI at least every 2–3 years from 1990–1998 provides evidence that the STD core group likely consists of some of the same people over a 7–9-year period, who by virtue of their repeated infections contribute disproportionately to STI transmission. The decrease in size of the large components together with decreases in STI supports the hypothesis that eco-niches of STI adapt to control programs over time.
P1-S5.40 Sex cells: a pilot study investigating cell phone-based sexual networks among men who have sex with men in South India
Authors: Thompson L H , Shaw S , Deering K , Reza-Paul S , Lorway R 
Published: July 2011

BackgroundA high HIV prevalence (19–32%) has been reported among men who have sex with men (MSM) in South India. Indeed, sexual networks play a central role in the spread of HIV in these communities but have rarely been studied because of intense social stigma and methodological and ethical challenges. Although cell phones are commonly used among MSM to contact sexual partners in India, few studies have explored the formation of such sexual networks. This study sought to understand the structure, context and evolution of cell phone-based sexual networks of MSM in three South Indian cities.MethodsSampling frames in the three cities were established using MSM contacts stored in the cell phones of community-based researchers (CBRs). Study participant “seeds” were randomly selected from these social networks. Seeds were asked to recruit their sexual partners, who completed surveys about their sexual practices with regular partners and 7-day partners. Network diagrams were constructed using non-nominal codes linking study participants.ResultsCell phone contacts represent a useful resource for constructing social networks. Preliminary results indicate the diversity of sexual networks and sexual practices within these networks.ConclusionsNew community-based methods of exploring sexual networks were assessed, and sexual practices, partner concurrency, and risk behaviours were explored. This information can be used to tailor more specific services for MSM in these communities. As this methodology sampled from social networks, more hidden “individuals who do not access health services were included in the study.”
P1-S5.41 Quantifying the contribution of re-infection within partnerships to persistent spread of Chlamydia
Authors: Kretzschmar M , Schmid B , Low N , Heijne J 
Published: July 2011

BackgroundMany studies show that people testing positive and treated for genital chlamydia infection are at high risk of a repeat infection in the first year after treatment. Repeat infection can come from treatment failure, a new partner, or from within an existing partnership if the partner was not treated. Partnerships can therefore form a reservoir of chlamydia infections that might affect the effectiveness of population screening programs. It is not known how much reinfection within partnerships contributes to the persistent spread of chlamydia in heterosexual populations.MethodsWe derive an expression for the basic reproduction number of an SIS infection in a population with long term monogamous partnerships. The basic reproduction number contains an explicit term quantifying the contribution of re-infection within partnerships to the overall reproduction number. The derivation is then extended to include partner notification and treatment. Finally, the model is extended to include two types of partnerships with differing average duration.ResultsFor small recovery rates and low transmission probabilities reinfection plays a minor role in sustaining chlamydia transmission. However, there is an optimal combination of duration of infection and transmission probability for which reinfection contributes substantially to keeping chlamydia endemic in a population. We discuss the functional dependency of the basic reproduction number on these parameters. Using a more complex model numerical scenarios were simulated showing that partner notification prevents a large proportion of re-infections.ConclusionsThe effect of screening depends, in part, on whether or not it succeeds in moving the basic reproduction number away from the transmission optimum via reinfection. This can be achieved either by choice of the screening interval or by rescreening those individuals who tested positive in a first screening test. There is an optimal time interval for retesting that minimises the basic reproduction number. The precise numerical value depends on partnership durations and transmission probabilities.
P1-S5.44 STD rates in the eight Americas: “Disparities in the burden of syphilis, gonorrhoea, and chlamydia across race and county”
Authors: Chesson H , Owusu-Edusei K , Kent C , Aral S 
Published: July 2011

BackgroundThe purpose of this study was to examine rates of three STDs (primary and secondary syphilis, gonorrhoea, and chlamydia) in eight subpopulations (known as the eight Americas) defined by a small number of sociodemographic and geographical characteristics.MethodsA list of the race-county combinations comprising each of the eight Americas was obtained from the corresponding author of the original eight Americas project, which examined disparities in mortality rates across the eight Americas. Using county-level STD surveillance data, we calculated syphilis, gonorrhoea, and chlamydia rates (new cases per 100 000) for each of the eight Americas.ResultsSTD rates varied substantially across the eight Americas. STD rates were generally lowest in America 1 (Asian and Pacific Islanders in selected counties) and America 2 (Northland low-income rural white) and highest in America 6 (Black Middle America), America 7 (Southern low-income rural black), and America 8 (High-risk urban black) see Abstract P1-S5.44 Table 1.Abstract P1-S5.44 Table 1STD rates (new cases per 100 000) in the Eight Americas, 2008AmericaPrimary and secondary syphilisGonorrhoeaChlamydia1. Asian1.414.5100.62. Northland low-income rural white0.39.2125.53. Middle America2.730.0172.44. Low-income whites in Appalachia and the Mississippi Valley1.123.8139.45. Western Native American2.980.9820.76. Black Middle America14.5475.31,063.67. Southern low-income rural black15.3482.21,109.48. High-risk urban black25.3507.21,155.9ConclusionsThe disparities in STD rates we observed across the eight Americas were akin to the disparities in mortality rates and life expectancy reported by the authors of the original eight Americas study. Although disparities in STDs across the eight Americas are generally similar to the well-established disparities in STDs across race/ethnicity, the grouping of US race-counties into the eight Americas does offer additional insight into disparities in STDs in the USA. The high STD rates we found for Black Middle America relative to Middle America are consistent with the assertion that sexual networks and social factors are more important drivers of racial disparities in STDs than differences in sexual behaviours.