bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1-S2.46 Is group sex a setting for increased risk for HIV and other STI among HIV-negative men who have sex with men?
Authors: Heuker J , Stolte I , Davidovich U 
Published: July 2011

BackgroundTransmission of HIV and other Sexually Transmitted Infections (STI) is ongoing in Western populations of Men who have Sex with Men (MSM). The main indicator of sexual risk is unprotected anal intercourse (UAI) with casual sex partners. It was suggested that group sex might be a high risk setting for HIV and STI transmission. Aim of the present study is to identify differences in sexual risk behaviour and STI-rates among MSM engaging in group sex compared to one-on-one casual sex.MethodsWe used cross-sectional data derived through 6-monthly questionnaires and STI screening (infectious syphilis, gonorrhoea or Chlamydia) from the Amsterdam Cohort Studies (ACS) between December 2008 and December 2009. The study population (n=310) consisted of HIV-negative MSM who reported having engaged in both group sex and one-on-one sex (n=119) and MSM reporting one-on-one sex only (n=191). To identify differences in sexual risk behaviour and STI-rates between MSM engaging in group sex and one-on-one sex, we used χ2tests, Mann−Whitney U tests and logistic regression analyses, corrected for repeated measures.ResultsMSM engaging in both group sex and one-on-one sex had less anal intercourse (AI) during group sex (79/119; 66.4%) compared to during one-on-one sex (106/119; 89.1%). Moreover, they were less likely to have UAI during group sex compared to one-on-one sex (OR adj 0.44; 95% CI 0.26 to 0.74). Men engaging in one-on-one sex only reported less AI (129/191; 67.5 %), while UAI-levels were similar (OR adj1.47; 95% CI 0.82 to 2.62) compared to one-on-one sex of men who also engage in group sex. Drug use during sex was associated with UAI (OR adj1.78; 95% CI 1.03 to 3.09), independent of whether sex took place in a group sex or one-on-one sex setting. Finally, men engaging in group sex were more likely to be diagnosed with any STI (13.4% vs 5.1%; p=0.013) compared to men engaging in one-on-one sex only. For men engaging in one-on-one sex only, but not for men engaging in group sex, UAI was associated with being diagnosed with any STI (OR 8.44; 95 % CI 2.0 to 35.2).ConclusionsThe group sex setting might not pose a threat for HIV-infection in MSM, as UAI-rates were lower during group sex compared to one-on-one sex. However, although they did not report more UAI, men engaging in group sex had higher STI-rates than men engaging in one-on-one sex only. This indicates that men engaging in group sex practice other sexual techniques than AI that contribute to acquiring STI.
P1-S2.49 Chlamydia and gonorrhoea transmission among men who have sex with men in Amsterdam, is independent of network factors or partnership characteristics
Authors: Matser A , Heijman T , Geskus R , de Vries H , Fennema H , van der Loeff M S 
Published: July 2011

BackgroundPartnerships are essential for transmission of sexually transmitted infections (STI). Among MSM, variation in partnerships is common. We have analysed risk factors for STI by studying partnerships.MethodsThe study population was recruited from the STI outpatient clinic of the public health service of Amsterdam, the Netherlands. Inclusion criteria were male gender, having had sexual contact with men in the past 6 months, age ≥18 years, and understanding of written Dutch or English. Recruitment occurred from July 2008 to August 2009. Participants were screened for chlamydia (CT), gonorrhoea (NG), syphilis, and HIV (opting-out strategy). Participants completed a questionnaire including demographics and detailed questions about sexual behaviour in self-defined relationships with a steady partner and the last three other partners within the previous 6 months. Logistic regression analysis was used to identify risk factors for CT and NG.Results2731 MSM reporting 7397 partnerships were included; median age was 39 years (IQR 31–45). CT prevalence was 12.5% (n=342), NG prevalence was 11.1% (n=303), and CT/NG coinfection was found in 2.6% (n=71) of the MSM. Meeting partners online was common (53% met at least one of the partners online), but not associated with STI (CT—OR 1.2 95% CI 0.95 to 1.5 and NG—OR 1.2 95% CI 0.9 to 1.5), just as having concurrent partnerships (CT—OR 3.2 95% CI 0.4 to 23.6 and NG—OR 1.3 95% CI 0.3 to 5.6). In multivariable analysis, independent predictors of CT were having =5 known partners in the last 6 months (OR 1.7 95% CI 1.2 to 2.3), receptive unprotected anal intercourse (OR 2.1 95% CI 1.5 to 2.8), NG coinfection (OR 2.0 95% CI 1.5 to 2.8), and HIV coinfection (OR 1.8 95% CI 1.4 to 2.4). Independent predictors of NG were group sex (OR 1.5 95% CI 1.1 to 2.1), being in a different 10-year age category than the partner (OR 1.4 95% CI 1.04 to 1.8), CT coinfection (OR 2.1 95% CI 1.5 to 2.8), and HIV coinfection (2.2 95% CI 1.6 to 2.9). Age =45 years (OR 0.4 95% CI 0.2 to 0.6) and being bear type (OR 0.4 95% CI 0.2 to 0.9) were associated with lower NG risk.ConclusionsCT and NG infections are associated with positive HIV status and other STI coinfections. We confirmed the association between NG and CT and several known risk factors of the index patient; surprisingly, none of the partnership factors (eg, concurrency, meeting place, or partner's HIV status) , except age difference, were associated with NG or CT.
P1-S2.57 Using an online survey to investigate risk behaviours and social networks in a syphilis outbreak among men who have sex with men in Toronto
Authors: Shahin R , Rank C , Kinniburgh B , Jolly A , Al-Bargash D , Clarke B , Ofner M , Gilbert M L 
Published: July 2011

BackgroundAn outbreak of infectious syphilis among men who have sex with men (MSM) in Toronto began in 2002 and peaked in 2009 when 579 cases were reported. We developed an internet-based enhanced surveillance tool to investigate HIV coinfection, sexual risk behaviours, and social networks among a sample of cases in 2010.MethodsMales with infectious syphilis in Toronto from 15 April 2010 to 30 June 2010 were invited to complete a self-administered online survey. Data were collected on sexual partners, risk behaviours, condom use, and venues where respondents looked for sex partners in the 6 months before syphilis infection. We assessed key survey variables by HIV status, and carried out social network analyses to examine links between cases, sexual contacts and venues.ResultsOf 84 eligible cases, 46 were successfully contacted and 27 completed the survey. Three of 27 respondents (11%) identified sexual contacts and 16 (59%) reported having multiple sex partners during routine case follow-up. In the online survey, almost all men (n=26) reported at least one male sex partner in the six months before syphilis infection (median 5 partners; IQR 2–12). HIV prevalence among respondents was 70% (vs 35% among non-respondents, p<0.01). Predominant risk behaviours were anonymous sex (64%), group sex (56%), and 55% indicated participation in barebacking (63% of HIV-positive and 33% of HIV-negative men). Of 19 HIV-positive respondents, 17 (89%) had at least one HIV-positive partner; condom use with HIV-positive partners was low (16% and 28% used condoms all or most times during receptive and insertive anal sex, respectively). Among 25 cases who provided information on venues where they looked for sex partners, most sought partners online (88%), at bathhouses (60%) or bars (36%); 22 cases were linked by six common venues—three websites, two bathhouses and one bar.ConclusionsA substantial proportion of men in our sample reported multiple sex partners and low condom use. As respondents were predominantly HIV-positive MSM with seroconcordant sex partners, risk behaviours, venue attendance and patterns of condom use may not be representative of all MSM with syphilis in Toronto. Nevertheless, collection of behavioural data using an online survey allowed for enhanced descriptive analyses beyond the scope of routine surveillance. In addition to social network analyses, these data are useful to inform targeted prevention and control efforts.
P1-S2.63 Association between Age and STI among men who have sex with men (MSM) in Jamaica
Authors: Weir S , Figueroa P , Jones-Cooper C , Hylton-Kong T , Hobbs M , Rich K , Byfield L 
Published: July 2011

BackgroundIn 2007, 201 men who have sex with men were recruited at social venues and through peer referral in five urban areas of Jamaica for an exploratory study of the prevalence of sexually transmitted infection in the population and identification of risk factors.ObjectiveTo describe the association between age and current infection with HIV, syphilis, and chlamydia and explore reasons for the differences.MethodsMSM were invited to participate in a survey and testing. Urine and blood samples were collected at the time of the interview and later tested for evidence of HIV, syphilis, gonorrhoea and chlamydia. Men were given options about where to obtain results.ResultsOf the three infections, HIV had the strongest positive association with age; syphilis a weaker positive association; and chlamydia a weak negative association. Risk factors varied somewhat by age and infection see Abstract P1-S2.63 Figure 1. For example, not using a condom in the past 4 weeks was associated with chlamydia infection among MSM age 15−19 but not for older MSM. Having a main sexual partner was associated with HIV infection for MSM age 15−19 but not for older MSM.Abstract P1-S2.63 Figure 1ConclusionStrategies for prevention of transmission need to be aware of differences in risk by age and by infection.
P1-S3.03 Mortality among men who have sex with men seen in std clinic patients: high rates of suicide and low rates of anal cancer death
Authors: Glick S , Kerani R , Golden M 
Published: July 2011

BackgroundBecause men who have sex with men (MSM) are not identifiable at a population level, there are few data on cause-specific mortality rates among MSM. MSM are more likely to report suicide attempts than heterosexuals, but it is not known if suicide mortality is higher among MSM. Likewise, although anal cancer is more common among MSM than among heterosexuals, the absolute risk of anal cancer death among MSM is not known. We compared suicide and anal cancer mortality rates among MSM and heterosexual males and females in an STD clinic population.MethodsWe enumerated all Public Health-Seattle and King County STD Clinic attendees from 1993-2007 (n=86,807). Using 1993−2008 mortality data from Washington State (n=702 850), we identified STD clinic attendees who had died and their underlying cause of death. We calculated suicide and anal cancer mortality rates for MSM, heterosexual men, and women, and standardised these rates using the age, race, and gender distribution of King County residents (US Census, 2000). We calculated adjusted incidence rate ratios (IRR) among STD clinic attendees using Poisson regression. To compare mortality rates among STD clinic attendees to the general population, we calculated rates in King County.ResultsAmong STD clinic attendees, 14% were MSM, 52% were heterosexual men, and 34% were women. For the period between 1993 and 2008, we matched 1901 Washington state deaths to STD clinic attendees for an overall unadjusted mortality rate of 1.8 deaths per 1000 person-years. The standardised suicide mortality rate among MSM was 0.20 per 1000 person-years, compared with 0.11 among heterosexual men and 0.09 among all women. Adjusted for age and race, among STD clinic attendees, MSM were 1.6 times more likely to die from suicide than heterosexual men (IRRadj=1.6, 95% CI 1.02 to 2.61) and nearly four times more likely than women (IRRadj=3.9, 95% CI 2.14 to 7.24. The suicide mortality rate among MSM in the STD clinic was higher than the rate among all men in King County (standardised rate ratio=1.5), adjusted for age and race. We identified no deaths due to anal cancer in any subpopulation (95% CI 0 to 0.4 per 100 000 person-years).ConclusionsThese data suggest that, at least among STD clinic attendees, MSM are approximately twice as likely to die from suicide as heterosexual men, and these rates are higher than the general population. Anal cancer death rates among King County MSM appear to be low.
P1-S3.06 Prevalence and determinants ofNeiseria gonorhoeaand chlamydia infections among gynaecological patients with pelvic inflammatory disease at University Teaching Hospital, Lusaka
Authors: Yassa P 
Published: July 2011

MethodologyThis was a descriptive cross sectional study conducted on women presenting clinically with pelvic inflammatory disease to the outpatient department of obstetrics and gynaecology at University Teaching Hospital in Lusaka. Behavioural and demographic variable were collected through questionnaire. Endo-cervical smear was obtained and screened for gonorrhoea and Chlamydia using respective rapid test and gram stain for gonorrhoea.Results43 (37%) of a total 116 respondents had gonorrhoea but no Chlamydia was isolated. 114 (98.3) had sexual partners. 101 had steady sexual partners, 19 had casual partners and 9 had anonymous sexual partners with 37 (36.6%), 10 (52.6%) and 6 (66.7%) gonorrhoea isolation respectively. Some had multiple sexual partners. Gonorrhoea was isolated from 4 (28.6%) of the 14 respondents who had one new sexual partner, and all who had two or more sexual partners had gonorrhoea isolated. Gonorrhoea isolation in relation to frequency of sexual intercourse per week was as follows: once 1/13 (7.7%), twice 2/11 (18.2%), thrice 3/11 (27.3%) and more than three times 32/65 (49.2). Gonorrhoea was also higher in those who had sex with casual or anonymous sexual partner under influence of alcohol 6/11 (54.5%) or obtained anonymous sexual partner from Market, shopping canter 4/5 (80%), street, bar, disco, or night club 7/9 (77.8%). Gonorrhoea detection was as follows: 18/36 (50.0 %) for those with adnexial tenderness, 21/45 (46.7%) with inflamed cervix, 37/92 (40.2%) with lower abdominal tenderness and 32/87 (36.8%) with normally appearing cervix.ConclusionThe prevalence ofNeiseria gonorrhoeawas 37% detected. There was no Chlamydia isolated. Low socio-economic status and young age were the higher risk. The sexual risk behaviours associated were; the number of casual or anonymous sexual partners, and non-use of condoms. Lower abdominal pain and tenderness with cervical motion and adnexial tenderness were the major sign.
P1-S3.11 Factors associated with death among infants with neonatal herpes reported in New York City, 2006−2010
Authors: Schillinger J , Handel S , Washburn K , Klingler E , Blank S , Pathela P 
Published: July 2011

BackgroundNeonatal herpes simplex virus infection (nHSV) has a high case fatality rate. In New York City (NYC), healthcare providers (HCP) and laboratories report nHSV to the Health Department; incidence is highest among infants born to black non-Hispanic (NH), and young women. We analysed nHSV cases to identify factors associated with death.MethodsnHSV cases in infants <60 days were investigated by HCP interview and abstraction of labour and delivery, outpatient, inpatient, vital records. Bivariate and multivariate models estimated associations between death and demographic, clinical, and provider factors.ResultsDuring 2006−2010, 71 laboratory-confirmed nHSV cases were reported; 43/71 (55%) were male, 29/71 (41%) HSV type 1, 28/71 (39%) HSV type 2, and 14/71 (20%) untyped. Among 58 cases with recorded maternal race/ethnicity, 19 (33%) were white NH, 25 (43%) were black NH, and 15 (26%) were Hispanic. Fourteen of the 71 (20%) cases died; 10 of the deaths (71%) were among infants born to black NH women. There was a significant association between death and disseminated disease (vs skin/eye/mucous membrane, central nervous system, or congenital infection) (OR 25.8, 95% CI 4.5 to 148.9), black NH maternal race (OR 10.0, 95% CI 2.4 to 41.0), preterm birth (OR 7.1, 95% CI 1.9 to 26.5), age <7 days at first symptom (OR 5.8, 95% CI 1.5 to 23.3), maternal age <26 (OR 3.02, 95% CI 0.8 to 10.86), vaginal delivery (OR 0.2, 95% CI 0.1 to 0.8), and presence of infant herpes lesions (OR 0.2, 95% CI 0.04 to 0.6). Infant sex, fever, viral type, admitting hospital type (academic vs non-academic), illness within 24 h of birth, and duration rupture of membranes were not associated with death. After adjusting for preterm birth, black NH maternal race remained associated with a significantly higher risk for death (OR 7.2 95% CI 1.6—to 31.4, p=0.009). Disseminated disease also remained significantly associated with death after adjusting for preterm birth, and age at first symptom (OR 26.6, 95% CI 3.6 to 196.5, p=0.001).ConclusionsOur data suggest a significant racial disparity in nHSV fatality, only partly explained by preterm births among black NH mothers. Further investigation should examine if care-seeking or provider characteristics contribute to these disparities. Black NH maternal race may be a marker for recently acquired herpes infection, with a high organism load at delivery. Disseminated disease is strongly, and independently, associated with fatality.
P1-S4.11 The use of the historical limits method of outbreak surveillance to retrospectively detect a syphilis outbreak among American Indians in Arizona
Authors: Winscott M , Betancourt A , Ereth R 
Published: July 2011

BackgroundIn April 2007, an Indian Nation located in Southern Arizona declared an outbreak of syphilis among its tribe members. The Arizona Department of Health Services Sexually Transmitted Diseases Control Program (ADHS STDCP) was first alerted by the tribe about the increase in syphilis cases during January 2007, 6 months after the occurrence of the first case in the outbreak. At the time, the ADHS STDCP did not have a method in place to monitor surveillance data for the detection of an outbreak of any sexually transmitted disease occurring within the state.MethodsIn January 2009, the Arizona Department of Health Services STD Control Program developed a syphilis outbreak detection system based upon a Historical Limits Comparison Method (HLCM) to monitor reported syphilis-related labs. The Southern Arizona Indian Nation outbreak was then retrospectively evaluated using the state surveillance database and the HLCM outbreak detection system.ResultsRetrospective analysis of the HLCM system of the syphilis outbreak in Arizona indicates that, had this system been in place at the outset of the outbreak, the ADHS STDCP would have been alerted to the increase in syphilis-related labs reported from the tribal Indian Health Service centers between 10 and 12 weeks earlier.ConclusionsThe use of the HLCM system of syphilis outbreak detection in Arizona would have alerted the state health department earlier to an increase in syphilis cases occurring on the tribal lands in Southern Arizona. Earlier awareness of the increase in cases would have allowed for earlier intervention and collaboration with the tribe to control the outbreak. The ADHS STDCP has since instituted this method of outbreak detection among identified high morbidity or high risk surveillance sites for both syphilis and gonorrhoea.
P1-S4.12 Using neighbourhood-level population data to guide gonorrhoea intervention, MontrÉal, QuÉbec, Canada, 2002−2009
Authors: Khalil N , Allard R 
Published: July 2011

BackgroundThe reported incidence rate of gonorrhoea has more than doubled between 2000 and 2010 in Montréal, increasing in both genders and all age groups; however, it was particularly high in females aged 15 to 24. As the reasons for the increases among young women are not fully understood, we wanted to determine whether neighbourhood-level population characteristics were associated with incidence rates among them, to help target intervention strategies.MethodsIncident gonorrhoea cases were female residents of Montréal, aged 15 to 24, who met Québec's provincial gonorrhoea surveillance definition, with a notification date between 2002 and 2009. The unit of analysis was neighbourhoods—111 non-administrative boundaries defined by the Montréal Public Health Department, by grouping census tracts to maximise homogeneity of population characteristics. The dependent variable was the neighbourhood gonorrhoea incidence rate based on all reported cases and the neighbourhood population, for females aged 15 to 24; the independent variables included material and social deprivation indices, their combination and components, and ethnic origin. Adjusted incidence rate ratios (IRR) were estimated by negative binomial regression after exponentiation of the regression coefficients and show the change in the incidence of gonorrhoea for each unit increase in the independent variable. In the final model, independent variables were normalised to facilitate comparison of their IRR which represents the change in gonorrhoea incidence rate associated with an increase of one SD in the percentage of residents of a given ethnic origin.ResultsA total of 837 cases were reported (cumulative incidence rate 5.6 per 100 000). Higher proportions of three ethnic origin groups were associated with higher neighbourhood gonorrhoea rates, even when deprivation indices were considered (Abstract P1-S4.12 table 1).Abstract P1-S4.12 Table 1Population characteristics associated with gonorrhoea rates among female residents of Montréal aged 15–24, 2002–2009Independent variableIncidence Rate Ratio (95% CI)p value% of the population whose origin is African1.34 (1.20 to 1.49)0.000% of the population whose origin is Aboriginal1.32 (1.19 to 1.46)0.000% of the population whose origin is Caribbean1.19 (1.07 to 1.33)0.001ConclusionsCustomary methods for gonorrhoea surveillance consider individual characteristics of cases as risk factors for disease. However, gonorrhoea is clustered in neighbourhoods that have high proportions of African, Aboriginal and Caribbean populations. The ecological approach used in this study suggests that certain phenomena exist at the population level that may not exist at the individual level, which can be used to target population-level prevention programs.