bluuebunny/crossref_metadata_2025_split huggingface dataset:
S15.4 Re-emergence of lymphogranuloma venereum in Europe and the public health response
Authors: Ward H , de Vries H J C , van de Laar M 
Published: July 2011

BackgroundIn January 2004, public health officials in the Netherlands noted an outbreak of cases of lymphogranuloma venereum (LGV) among men who have sex with men (MSM). Since then a number of outbreaks and cases have been reported from European countries, North America and Australia. The re-emergence of LGV in this population remains poorly understood yet may have important health consequences.MethodsSeveral EU countries have reported newly diagnosed cases of LGV to The European Surveillance System and a number of additional countries have reported LGV cases to the Epidemiological Information System on STI (hosted by ECDC). We have synthesised evidence from these surveillance reports together with results of clinical and epidemiological studies to better describe transmission and inform the public health response.ResultsAn increasing trend of LGV has been reported in several Western European countries. In areas with well-established surveillance, LGV has become a significant and persistent infection in MSM. In the UK, there was a rapid rise in cases from 2009 to 2010, while in Amsterdam numbers continue to fluctuate. The European outbreaks appear to be caused by a single LGV variant (L2b) that has been around for several decades, having been detected in rectal swabs from MSM in San Francisco in 1981. The resurgence of LGV over the past decade is closely linked to the overlapping HIV epidemic which it may in turn fuel. A systematic review of 13 descriptive studies showed the prevalence of HIV in LGV cases ranging from 67% to 100%; compared to MSM with non-LGV chlamydia, there was a significant association between HIV and LGV (OR 8.19, 95% CI 4.68 to 14.33). It is likely that changes in sexual behaviour, including serosorting and unprotected anal sex, and an increase in the size of the HIV positive population, may have created the conditions for an explosive LGV outbreak after decades of quiescence.ConclusionThe on-going LGV epidemic shows no signs of waning and requires a robust public health response. Primary prevention should be developed for MSM with HIV, together with awareness campaigns for the wide range of clinicians who may see men with symptoms. In addition, improved diagnostic methods are needed to allow widespread screening could reduce the infectious pool; they would also allow a better picture of the epidemic to be obtained from countries with limited diagnostic facilities.
S2.3 Screening high-risk populations using rapid syphilis tests: the importance of social and cultural contexts
Authors: Chen X S , Yin Y P , Wei W H , Peeling R 
Published: July 2011

BackgroundSyphilis has made a dramatic resurgence in China during the past 2 decades with an increasing prevalence in high-risk groups. Screening of syphilis in the populations is critical for control of the disease.MethodsA rapid syphilis test (RST) was introduced into STD services among patients attending STD clinics and existing outreach services to female sex workers (FSW) in Liuzhou and Jiangmen, China to test the feasibility of same-day test and treatment (STAT) and same-day test and referral (STAR) strategies. The STAT and STAR rates were evaluated regarding the different STD providers and outreach teams, respectively.ResultsOf 7283 patients from 3 STD clinics in Liuzhou—one public health clinic, one private reproductive health clinic and one general hospital clinic who were screened with a non-treponemal test, TRUST, and RST for syphilis, 291 (4.0%) had active syphilis, but only 69.8% of infected cases accepted the STAT. The acceptance rate was different between clinics, with 54.2% in public health clinic, 71.8% in reproductive health clinic and 100.0% in general hospital clinic. During the outreach services provided by the CDC intervention team (CIT), STD clinic team (SCT) and reproductive health clinic team (RCT), 75% of FSWs accepted to be tested with RST in sex work venues. Of 2780 FSWs screened with RST, 199 (7.2%) were positive and were referred to designated clinics for further testing and treatment. However, success in referring RST positive FSWs to designated clinics were significantly different between outreach teams. RCT had the highest referral rate (85.7%) followed by SCT (70.6%) and CIT (26.7%). Focus groups discussions among providers and high-risk populations regarding the introduction of RST indicated that social and cultural contexts were related to the successful introduction of RST among these populations. Trust of the target population in the clinics and outreach team was related to the acceptability of STAT and STAR. Belief in the results of a free RST test, confidentiality of syphilis status, social stigma, medical cost at the designated clinics for further test and treatment, and time spent for clinic visit were the main concerns of FSWs, especially in the referral advice.ConclusionsFeasibility in introduction of STAT and STAR among high-risk groups is encouraging but the barriers still exist. Social and cultural contexts are important and should be considered when RST is introduced as one of strategies for prevention and control of syphilis in China.
S2.4 New technologies to support STI screening and syndromic management in resource-limited settings
Authors: Peeling R 
Published: July 2011

BackgroundHigh quality tests for detection of STIs are available but they are neither affordable nor available to patients in resource-limited settings. For patients presenting with STI symptoms, WHO recommends the use of syndromic management in settings where laboratory services are not available. As most STI patients tend to have few or no symptoms, tests to screen for STIs is important for guiding treatment and prevention of onward transmission. However, in resource-limited settings, patients often have to travel long distances to reach a clinic with STI services, and many fail to return for test results and treatment after the initial visit.MethodsIn recent years, increased investment in the development of novel diagnostic technologies has resulted in advances that have made it possible to provide STI-testing at all healthcare settings. The development of multiplex tests to support screening and STI syndromic management in resource-limited settings is an urgent priority.ResultsExciting new technologies may soon transform how STIs can be diagnosed in resource-poor settings in the next few years. Among them are duplex antigen/antibody tests that can be used for STI syndromes and rapid lateral flow tests that can be used with oral fluid instead of blood for syphilis and HIV. Nucleic acid amplified tests that are designed as integrated platforms providing sample- in- answer-out convenience and random access will soon be available for the detection of genital chlamydial and gonococcal infections. Simple isothermal nucleic acid amplification technologies are available for detection of bacterial and viral STIs in 15–60 min, using simple equipment that can be run on solar energy or batteries. A mathematical model developed by Aledortet al(2006) estimated that a test for syphilis that requires no laboratory infrastructure could save more than 201 000 adjusted lives and avert 215 000 stillbirths. A similar test could save approximately 4 million DALYs, avert more than 16.5 million incident gonorrhoea and chlamydial infections and prevent more than 212 000 HIV infections.ConclusionsRecent investments in the development of point-of-care diagnostics for infectious diseases have produced novel technologies that can support STI screening and syndromic management in resource-limited settings. Quality assurance and implementation research are needed to ensure optimal uptake and full impact of these novel technologies in resource-limited settings.
P1-S1.10 Microbiological surveillance for sexually transmitted infections in Windhoek and Oshakati, Namibia (2007)
Authors: Tobias S , Shonhiwa S , Norbert F , Oke O , Ndjavera C , Chikukwa S , Radebe F , Lewis D 
Published: July 2011

BackgroundA microbiological survey was undertaken to enable review of Namibia's syndromic management-based STI treatment guidelines (1999).MethodsThis Government-approved survey took place at Katutura Health Centre (Windhoek) and Oshakati Intermediate Hospital over 9 months in 2007. Consecutive patients with urethral discharge (UDS), vaginal discharge (VDS) and genital ulcer (GUS) syndromes gave verbal consent to provide anonymous samples for the following tests—(i) real-time PCR (RT-PCR) forNeisseria gonorrhoeae(NG),Chlamydia trachomatis(CT),Trichomonas vaginalis(TV),Mycoplasma genitalium(MG) (UDS, urethral swabs; VDS, endocervical swabs) (ii) RT-PCR detection of herpes simplex virus (HSV),Treponema pallidum(TP),Haemophilus ducreyi(HD),Chlamydia trachomatisL1-L3 (LGV) (ulcer swabs), (iii) Giemsa staining of ulcer smears for granuloma inguinale (GI), (iv) Gram staining of vaginal smears for Candida (CA) and bacterial vaginosis (BV), (v) NG culture and determination of ciprofloxacin and ceftriaxone minimum inhibitory concentrations (MIC) by E test (urethral swabs), and (vi) HIV ELISA (blood). All patients were provided with STI syndromic treatment, offered same-day HIV counselling and testing, and partner notification was discussed. Data analysis was performed in STATA v10 and the χ2test used to assess difference by survey site.Results199 UDS, 200 VDS and 199 GUS episodes were surveyed among 598 patients (293, Windhoek; 305, Oshakati). The relative prevalence of pathogens/conditions by syndrome was—(i) UDS—NG 87% (173), CT 9% (18), TV 5% (9), MG 2% (4), (ii) VDS—NG 5% (9), CT 8% (15), TV 15% (29), MG 4% (8), BV 65% (127), CA 17% (33), and (iii) GUS—HSV 49% (97), TP 3% (5), LGV 2% (2), GI 0.5% (1), HD 0% (0). Syndrome-specific HIV prevalence was 36% (62) for UDS, 29% (57) for VDS and 53% (91) for GUS. Ciprofloxacin resistance (MIC=1) was detected in 28 (24%) of 118 viable NG isolates; all isolates were deemed susceptible to ceftriaxone. Ciprofloxacin resistance was significantly higher in Oshakati compared to Windhoek (48% vs 5%, p<0.001).ConclusionsThe survey highlighted the importance of gonorrhoea, genital herpes, HIV-coinfection and, in Oshakati, the high prevalence of ciprofloxacin resistant NG. As a result of this survey, Namibia's STI guidelines were revised in 2008 by adding acyclovir to existing GUS treatment and replacing ciprofloxacin with oral cefixime as treatment for presumptive gonorrhoea.
P1-S2.45 Clusters ofNeisseria gonorrhoeaeinfected patients are not linked to HIV infection within the homosexual population in Amsterdam, the Netherlands
Authors: Heymans R , Bruisten S , Matser A , Heijman T , de Vries H , van der Loeff M S 
Published: July 2011

BackgroundSexual risk behaviour increased since the introduction of antiretroviral treatment against HIV-1. Consequently, since the mid-90s the gonorrhoea transmission was raised posing a serious public health problem especially among men who have sex with men (MSM). We examined if separate sexual networks exist of HIV-infected and of HIV-negative MSM in relation to transmission of gonorrhoea. Using molecular typing ofNeisseria gonorrhoeae(NG) we aimed to identify clusters of patients with specific NG strains and examined possible linkage to HIV infection and other characteristics.MethodsFrom July 2008 to August 2009, MSM visiting the Amsterdam outpatient clinic were recruited for a network study concerning sexually transmitted infections (STI). Inclusion criteria were age ≥18 years, homosexual contact in the preceding 6 months, and giving informed consent. After screening for STI the participants answered questions regarding sexual behaviour, meeting places, and characteristics of sexual partners (up to 4 sex partners). Only patients with an anal or genital NG infection (n=246) were included in the current analysis. NG cultures were amplified and genotyped using a published NG-MLVA typing method.ResultsIncluded patients (median age 36 years, IQR 30−42) were predominantly Dutch (83%). Coinfections with chlamydia (28%) and HIV (48%) were common. Hierarchical cluster analysis of 246 MLVA profiles classified 152/246 MSM in 13 large clusters (5 to 36 patients) indicating the circulation and ongoing transmission of different NG strains in this population. In three clusters a significantly (p<0.001) higher proportion of NG isolates had decreased susceptibility to cefotaxime. HIV infected MSM were older than HIV negative MSM and were evenly distributed over the NG clusters (see Abstract P1-S2.45 figure 1). There were no significant differences in age, nationality, nor in other coinfections between the various NG clusters.Abstract P1-S2.45 Figure 1GGD.ConclusionsNG-MLVA revealed clusters of MSM reflecting distinct NG transmission networks in the Amsterdam population. As no NG clusters were identified that consisted predominantly of HIV infected or HIV negative MSM, it appears that there are no separate HIV infected and HIV negative sexual networks in the Amsterdam MSM population connected to gonorrhoea transmission.
P1-S2.51 Sexually transmitted HCV in MSM in Montreal
Authors: Thomas R , Vezina S , Machouf N , O'Brien R , Huchet E , Longpré D , Lavoie S , Milne M , Asselin F , Trottier B 
Published: July 2011

MethodsA retrospective analysis of the clients who attend the “Gay Screening Clinic” (GSC) at Clinique medical l'Actuel (Montreal, Canada) between May 2009 and April 2010 was conducted.ResultsAmong the 1010 patients included in the analyses we found five cases of new HCV infection which seems to be acquired by sexual transmission. All of them were male and MSM, none of the cases had previous history of IDU, but three reported having had sexual relation with IDU partners. All of them were previously vaccinated for Hepatitis A and B and screened for HIV. None of them were coinfected with HIV, but one was coinfected with Syphilis and one with Gonorrhoea. Patients infected with HCV were older than non HCV patients (37 years vs 32 years) and had a higher number of sexual partners during the last 12 months (16 part. vs 9 for the non HCV patients). One of the HCV cases reported not having anal intercourse, two reported having had occasional unprotected anal intercourse and two reported always using condom for anal intercourse.ConclusionsAs in other urban centers, cases of sexually transmitted HCV had also been found in Montreal. This prevalence of 0.5% is very low compared to our HIV population in which the prevalence of sexually transmitted HCV is 3%. The particularity of MSM with recently acquired HCV by sexual transmission seems to be related to their engagement in sexual relation with high number of concurrent partners.
P1-S2.52 Risk factors for STIs among MSM attending a sexually transmitted disease clinic in Montreal, Canada
Authors: Machouf N , Thomas R , O'Brien R , Vezina S , Longpré D , Legault D , Milne M , Fafard J , Trottier B 
Published: July 2011

BackgroundOften STIs are not diagnosed and not treated because people don't have access to appropriate healthcare screening facilities and to care. At Clinique l'Actuel (Montreal, Canada) we developed Gay Screen Clinic (GSC) as a new concept giving rapid access to men who have sex with men (MSM) to an appointment for STI screening. We then assessed the extend and risk factors of STIs in a population of men having sex with men (MSM) attending the GSC.MethodsWe did a retrospective analysis of the last 1000 attendees to the GSC at Clinique l'Actuel in 2009−2010. Multivariable analyses were conducted to identify the factors associated with history of STIs.ResultsParticipants were all MSM with a mean age of 32 years (ranged from 18 to 70 y). In total, 50% (n=506) of them self reported history of STIs and 236(24%) of them had a positive sexual health screen at this visit. STI diagnoses included genital herpes (n=105, 14 %), condylomes (n=79, 8%), syphilis (n=43, 5%), chlamydia infection (n=32, 3%), HIV (n=10, 1%), Gonorrhoea (n=9, 1%) and HCV (n=5, 1%). 32% of the attendees had sexual relations in bath houses and 43% with anonymous contacts. In multivariate analyses, past history of STI was significantly associated with higher age (OR=1.02, p=0.001), higher number of sexual partners in the last 12  months (OR=1.02, p=0.015), having sexual contact in bath houses (OR=1.46, p=0.021) and with unknown partners met through internet or in backrooms (OR=1.53, p=0.004), using recreational drugs (OR=2.01, p=0.001) and having only male partners (OR=1.60, p=0.023) rather than male and female sexual partners.ConclusionsSTIs were common among non HIV MSM attending the GSC in Montreal. Even after many years of prevention campaign MSM still have high risk sexual behaviour. Physician should routinely enquire about drug use of their patients in order to prevent new STIs. Targeting specific sexual networks is needed to be more effective.
P1-S1.11 Prevalence ofTrichomonas vaginalis, chlamydia and gonorrhoea in women at the Miami-Dade County Health Department STD Clinic
Authors: Tookes H , Hirsch N , Diaz C , Ponomareva O , Castro J G 
Published: July 2011

BackgroundMiami, Florida, has the highest rate of HIV diagnoses in the USA (70.3 per 100 000 people), accounting for 1218 of the 41 269 incident HIV cases nationwide (2008). AlthoughTrichomonas vaginalis(TV) infection has been associated with an increased risk of HIV acquisition in women, the prevalence of TV in Miami is unknown due to lack of routine screening and low sensitivity testing methods. The purpose of this study is to establish a prevalence of TV in women seeking services at the Miami-Dade County Health Department Downtown STD Clinic compared to the prevalence of routinely screened STDs, gonorrhoea (GC) and Chlamydia (CT).MethodsThis study analyses baseline data from the Miami site of Project AWARE which is a multi-centre randomised clinical trial that seeks to test the effectiveness of risk reduction counselling in preventing sexually transmitted infections including HIV among HIV-negative persons. Eligibility criteria for Project Aware included negative or unknown HIV status, age of 18, and ability to provide informed consent. We recruited 251 women aged 18–64 for STD screening. The screen included FDA-approved Aptima GC/CT NAAT (nucleic acid amplification test) and a newly validated Aptima TV NAAT. Specimens were collected by vaginal swab performed either by a clinician or the patient. Additionally, we report the TV diagnoses given the current clinic protocol in which only symptomatic women received a wet mount analysed by light microscopy. We use descriptive statistics to report the prevalence of GC, CT and TV (as diagnosed by NAAT and wet mount) in our clinic.ResultsOf the 251 women in our study, 163 high-risk populations. Received a wet mount. By wet mount, we found a 9% prevalence of TV in our patients. Comparatively, when all 251 patients were screened using NAAT, the TV prevalence was 20%. The prevalence of CT was 14% and GC was 6%.ConclusionsTV is the most prevalent STD in patients in our clinic which draws upon high-risk individuals in urban Miami. TV infections were greater than CT, often believed to be the most prevalent STD in our population. Further, the routine screening using the TV NAAT detected 27 cases of TV that would have been undiagnosed given current clinic protocol. Since Miami, FL has the highest prevalence of HIV in the country and TV infection has been linked to new HIV infection, we believe that routine TV screening by NAAT should be instituted in high-risk populations.
P1-S2.58 The role of venues in structuring STI and risk networks among men who have sex with men
Authors: Drumright L , Weir S , Frost S 
Published: July 2011

BackgroundVenues (eg, bars, the Internet) are believed to structure STI risk networks, however it is difficult to separate “risky places” from “risky people”, as venues are comprised of the people who attend them. To determine how venues may structure HIV/STI risk, we analysed data collected within social meeting places with “causal inference” statistical approaches, which aim to mimic randomising individuals to venues.MethodsBetween 11/2007 and 3/2009, we visited 14 venues in San Diego, California, previously identified as places where men meet male sexual partners. 660 male patrons were interviewed anonymously by computer assisted self interview; 609 reported having ever had sex with a man. We analysed associations between the interview venue and participants' demographics, self-reported HIV and STI status, risk behaviours, and drug use. We used a marginal structural model to test associations between HIV/STI and venue, weighting by age, ethnicity, education, number of sexual partners in the past year, and number of HIV+ individuals known, in order to control for collinearity between venue and these patron characteristics.ResultsThe mean age of MSM was 34 yrs; 55% reported white, 24% Hispanic, and 8% African American ethnicity; 89% reported at least some college education. 35% reported history of STI and 13% reported that they were HIV-infected. The median number of lifetime male partners reported was 30, with 15% reporting unprotected receptive anal sex with at least five partners in the past 12 months. 39% reported ever meeting a sexual partner at the venue of interview. In univariate analyses, the 14 venues differed significantly by participants' reported age, ethnicity, number of lifetime male partners, past STI infection, HIV+ status, number of HIV+ individuals known, and finding partners at that venue. In multivariable analyses using marginal structural models, after controlling for participants characteristics, venues demonstrated significant structuring of HIV+ status, past STI, and methamphetamine (see Abstract P1-S2.58 figure 1).Abstract P1-S2.58 Figure 1ConclusionsWe demonstrated significant population structure in demographics, social networks, and HIV and STI status among MSM, which may assist in targeted surveillance and prevention. Interview venue may be associated with HIV, STIs and risk behaviours, separate from commonly collected individual-level data. In order to ensure successful in'terventions, a more thorough mechanistic understanding of how risky venues “emerge is needed.”