bluuebunny/crossref_metadata_2025_split huggingface dataset:
O5-S4.04 Targeted STD screening among high-risk men who have sex with men
Authors: Perkins R , Furness B , Hager M , McLaughlin R , Goforth J , Davies M 
Published: July 2011

BackgroundSubgroups of men who have sex with men (MSM) are at high risk for HIV infection and other viral and bacterial STDs. Since the mid-1990s, increased rates of early syphilis, gonorrhoea, and chlamydial infection and higher rates of unsafe sexual behaviours have been documented among MSM in the USA and virtually all industrialised countries.MethodsThe Gay Men's Health & Wellness (GMH&W) Clinic is a Tuesday and Thursday evening STD clinic for men at Whitman-Walker Clinic (WWC), a Washington, DC community health center specialising in HIV/AIDS care and lesbian, gay, bisexual, and transgender care. As an outreach of this bi-weekly clinic, WWC, Gilead Foundation, and the local HIV/AIDS, Hepatitis, STD, and TB Administration collaborated to provide STD screening in the Crew Club, the District's only bathhouse serving MSM, for ∼4 h each Tuesday night beginning July 2010. All participating men were offered HIV screening, syphilis screening, and nucleic acid amplification testing NAAT) for gonorrhoea and chlamydia of urine, pharyngeal, and rectal specimens.ResultsDuring the first 6 months of testing at the Crew Club, 173 unique clients were screened. Of those, five new HIV and 18 new syphilis cases were identified (Abstract O5-S4.04 table 1). In addition, two urethral, six pharyngeal, and two rectal gonorrhoeal infections were identified and five urethral, two pharyngeal, and 14 rectal chlamydial infections were identified. In comparison, during 2010, 2487 unique clients were tested at the GMH&W Clinic. Of those, 37 HIV and 189 syphilis cases were identified. In addition, 115 urethral and 89 rectal gonorrhoeal infections were identified and 139 urethral and 124 rectal chlamydial infections were identified. Pharyngeal results from the GMH&W Clinic were not yet available.Abstract O5-S4.04 Table 1Testing results, gay men's health & wellness clinic (2010) vs STD Screening at the Crew Club (July–December 2010)TestGMH&W clinicCrew clubTestsPositives% PositiveTestsPositives% PositiveHIV2747371.35%18973.70%Syphilis29691896.37%191189.42%Urethral GC17531156.56%18421.09%Pharyngeal GC2017N/A–18963.17%Rectal GC1138897.82%18321.09%Urethral CT17531397.93%18452.72%Pharyngeal CT2017N/A–18921.06%Rectal CT113812410.90%183147.65%ConclusionsA higher percentage of presumably asymptomatic clients tested positive for HIV and syphilis infections during STD screening in this non-traditional venue than during the diagnosis and routine screening that occurred at the clinic. Conversely, a higher percentage of clients, many of whom were symptomatic, tested positive for gonorrhoea and chlamydia during the GMH&W Clinic than during the Tuesday night outreach. This effort allows us to engage hard-to-reach men who may be among the core transmitters driving the HIV and syphilis epidemics in the DC area. Costs per HIV and syphilis cases detected need to be calculated /estimated for this fruitful outreach endeavour.
O5-S4.05 Introduction of a sexual health practice nurse increases STI testing among MSM in general practice
Authors: Chen M Y , Snow A F , Cummings R , Owen L , El-Hyak C , Hellard M E , Vodstrcil L , Fairley C K , Chen M Y 
Published: July 2011

IntroductionIncreased screening among MSM could improve STI control in this population; however published data on interventions that improve screening rates is limited. The aim of this study was to determine if introducing a sexual health practice nurse (SHPN) into a general practice clinic could increase HIV and STI testing among MSM who attend.MethodsIn October 2008, Melbourne Sexual Health Centre introduced a SHPN into a Melbourne general practice with a high caseload of MSM. We undertook an observational study comparing the proportion and STI tests undertaken in the 9 months before (Period 1), and after the SHPN was introduced (Period 2). Consistent with Australian national STI testing guidelines for MSM, complete testing was defined as HIV and syphilis serology, urine test and anal swab for chlamydia, pharyngeal and rectal swabs for gonorrhoea, from the same man on the same date. MSM were stratified and analysed according to HIV status. The Qui-Square Test for Independence was used to compare the difference in proportions of tests. In the case of syphilis tests among HIV positive MSM the median number of tests was compared using the Mann–Whittney U Test.ResultsAmong HIV negative MSM, the propotion of MSM tested, increased from Period 1 to Period 2 as follows; HIV from 57.8% to 66.2%; syphilis from 59.9% to 76.6%; urethral chlamydia from 67.7% to 75.8%; pharyngeal gonorrhoea 62.5% to 69.9%; and rectal gonorrhoea/chlamydia from 58.5% to 69.5% (all p<0.001). The proportion of episodes of complete tesing, also increased from 41.1% to 51.9% (p<0.001). Among HIV positive MSM, the proportion of MSM tested, increased from Period 1 to Period 2 as follows; urethral chlamydia from 66.5% to 80.2%, pharyngeal gonorrhoea 58.7% to 77.2% and rectal gonorrhoea/chlamydia from 55.3% to 75.3%, (all p<0.001). Prior to Period 1, the clinic had a policy of testing HIV positive MSM for syphilis with each three monthly routine HIV monitoring blood tests. Therefore, the median number of syphilis tests was the same in both study periods (median 2, range 0 to 6, p=0.817). The proportion of episodes of complete tesing, also increased from 32.3% to 56.2% (p<0.001).ConclusionThe introduction of a SHPN into general practice significantly increased HIV and STI testing among MSM. The magnitude of the effect of this intervention may be greater in MSM high case load general practices where the culture of STI testing is less well established.
O5-S4.06 Improving HIV screening at an urban STD clinic
Authors: Furness B W , Coursey J , Flemming T , Hess P , Sankar S , Elias N Kamanu 
Published: July 2011

BackgroundAt the end of 2006 (the most recent year that data are available), an estimated 1 106 400 persons in the USA were living with HIV infection, with 21% undiagnosed. In September 2006, the Centers for Disease Control & Prevention (CDC) released new guidelines recommending routine HIV screening of adults, adolescents, and pregnant women in health care settings and reducing barriers to HIV testing. According to the 2009 city report, 3% of Washington, D.C., residents were infected with HIV or AIDS - a figure that ranked as the highest in the nation and far exceeded the 1% benchmark at which a disease becomes a “generalised and severe” epidemic.MethodsIn July 2009, the SE STD Clinic, the only publicly funded STD clinic in Washington, DC, began providing opt-out HIV testing. All clients who were not previously known to be HIV infected and had not been tested in the previous 30 days were screened using the OraQuick ADVANCE Rapid HIV-1/2 Antibody Test. Disease Intervention Specialists (DIS) ceased pre-test counselling and written consent for HIV testing was incorporated into the general consent form.ResultsFrom July 2008 through June 2009, 9537 unique clients visited the SE STD Clinic, of which 5972 (62.6%) were screened for HIV, 2558 (26.8%) were deemed ineligible, and 1007 (10.6%) refused. Of those tested, 48 (0.8%) were positive—35 (72.9%) were new infections, 11 (22.9%) were previous positives, and 2 (4.2%) were false positives. From July 2009 through June 2010, 12 154 unique clients visited the SE STD Clinic, of which 9702 (79.8%) were screened for HIV, 2039 (16.8%) were deemed ineligible, and 413 (3.4%) refused. Of those ineligible, 1832 (89.8%) had been tested in the previous 30 days, 197 (9.7%) were previous positives, and 10 (0.5%) were listed as Other.” Of those tested, 89 (0.9%) were positive—59 (66.3%) were new infections, 25 (28.1%) were previous positives, 2 (2.2%) were false positives, and 3 (3.4%) were “Out of Jurisdiction.”Conclusion“Routinisation” of HIV screening among this high-risk population increased the percentage of clients tested, decreased the percentage of clients that were ineligible or refused screening and increased the number of new infections identified (0.37% vs 0.49%, respectively). From July 2009 through June 2010, 3730 more HIV tests were conducted (compared to July 2008 through June 2009) identifying 14 additional new HIV infections.”
O1-S03.06 Evidence of circulating macrolide resistance inMycoplasma genitaliuminfections and development of a rapid assay to detect resistance
Authors: Twin J , Bradshaw C , Garland S , Fairley C , Jensen J , Tabrizi S 
Published: July 2011

BackgroundMycoplasma genitalium(Mg) is a sexually transmitted bacterium causing urethritis, cervicitis and longer term sequelae such as pelvic inflammatory disease. At Melbourne Sexual Health Centre (MSHC), Australia, from December 2007 to December 2009, 111M genitaliuminfected patients (86 males/25 females) were treated with 1 g azithromycin with a cure rate of 69% (95% CI 60% to 77%). Resistance to macrolide antibiotics such as azithromycin occurs via mutations of the Mg 23S rRNA gene in response to exposure of sub-therapeutic doses of the drug. It is our hypothesis that the unacceptably high rate of treatment failures seen at this clinic is due to macrolide resistant Mg strains circulating in the community. To test this theory, we determined whether resistance was present in initial consult samples collected at MSHC, and we developed a rapid assay able to detect resistance during routine diagnostics.MethodsA subset of 83 Mg positive samples from patients taken prior to azithromycin was analysed in this study (62 males/20 females); 56 of these patients were subsequently cured by azithromycin and 27 cases failed azithromycin. DNA sequencing was then carried out to determine each respective 23S rRNA sequence type. A real-time PCR assay coupled with high resolution melt analysis was developed to detect the mutational changes in the Mg 23S rRNA gene, dubbed MARS (Macrolide Antibiotic Resistance Screen), and was tested against a panel of known macrolide resistant Mg isolates and the subset of samples from MSHC.ResultsIn total, 16/83 (19%) of the pre-treatment samples tested possessed 23S rRNA mutations conveying macrolide resistance; significantly more patients who failed 1 g azithromycin had pre-existing macrolide mutations (12/27; 44%) compared to those who were cured by 1 g azithromycin (4/56; 7%); p<0.0001 (Abstract O1-S03.06 table 1). The MARS assay that was developed was able to identify when a 23S rRNA mutation was present in 100% of these samples.Abstract O1-S03.06 Table 123S rRNA gene mutations present in a subset of 2007–2009 Mg positive samples from initial consult from MSHCSequence typePatients failing azithromycin, n=26 (%)Patients cured by azithromycin, n=56 (%)p ValueDetection with MARSDetection of any 23S rRNA gene mutation12 (44)4 (7)<0.0001100%A2059G730.01A2058G410.04A2059C1––Wild type1452<0.0001100%ConclusionsThis data shows compelling evidence that macrolide resistance is circulating in certain populations and is attributing to a significant level of treatment failures seen in an Australian sexual health clinic. The development of a rapid molecular assay to detect resistance provides the means for clinicians to choose a more appropriate second line treatment option such as moxifloxacin, and thereby reduce transmission of resistant strains and avoiding sequelae associated with persistent infection.
O1-S04.01 Increasing adolescent HIV prevalence in Northeastern Zimbabwe: evidence of long-term survivors of mother to child transmission
Authors: Eaton J , Takavarasha F , Gregson S , Hallett T , Mason P , Robertson L , Schumacher C , Nyamukapa C , Garnett G 
Published: July 2011

BackgroundLongitudinal data from eastern Zimbabwe suggested an increase in HIV prevalence among 15 to 17 year olds between 2005 and 2008. Prevalence increased from 1.2% to 2.6% among adolescent males and from 2.2% to 2.8% in females (see Abstract O1-S04.01 figure 1). This is surprising given a general trend of decreasing HIV prevalence in the past decade associated with a reduction in sexual risk behaviour. It is unknown whether the increase is the result of resurgence in risky sexual behaviour, or long-term survival of infants infected perinatally during the early 1990s when prevalence was increasing exponentially among pregnant women in ZimbabweAbstract O1-S04.01 Figure 1MethodsWe use data from the Manicaland HIV/STD Prevention Project collected between 2006 and 2008 to test hypotheses indicating whether adolescent HIV infections are likely sexually acquired or perinatally acquired. We use Fisher's exact test and relative risk regression to examine the association between adolescent HIV infection and (i) maternal mortality, (ii) adolescent sexual behaviour, and (iii) chronic illness.ResultsThere were 990 males and 972 females aged 15 to 17 years included in the cohort. Mothers of HIV positive adolescent males were more likely to be deceased than those of HIV negative males (RR 2.72, p <0.001). Mothers of HIV positive females were not more likely to be deceased, but were more likely to be HIV positive if still alive (RR 3.68, p <0.001). Among males there was no association between having had sex and HIV status. Sexually active females were more likely to be HIV positive (RR 2.44, p =0.042). During the period that adolescent prevalence increased, the proportion of adolescent males who reported having had sex reduced from 14% to 8% (p <0.001), and did not change in females. HIV positive adolescents were more likely to report recurring sickness or chronic illness, indicative of late-stage HIV infection.ConclusionsIncreasing HIV prevalence in adolescent males cannot be explained by a rebound in sexual risk behaviour and is likely attributable to long-term survivors of perinatal HIV transmission. Among females, both perinatal and sexual transmission account for adolescent HIV infections. These findings question the interpretation of HIV prevalence in young people as an indicator of recent trends in HIV incidence. They suggest an urgent need to prevent onward HIV transmissions by perinatally infected adolescents and the expansion of HIV testing and treatment to include young people.
O1-S01.02 The incidence of genitalChlamydia trachomatisin a cohort of young Australian women
Authors: Walker J , Fairley C , Bradshaw C , Tabrizi S , Chen M , Twin J , Taylor N , Donovan B , Kaldor J , Hocking J 
Published: July 2011

BackgroundChlamydia is a sexually transmitted infection that can cause serious upper genital tract infections, however, in Australia there are limited population data for chlamydia. Understanding the incidence of chlamydia will be important in the design of a chlamydia screening program in Australia.MethodWomen aged 16–25 years were recruited from sexual health clinics (SHC) and general practice clinics (GP) in South-Eastern Australia and consented to participate in longitudinal study over a 12-month period. Participants were requested to send back questionnaires and self-collected vaginal swabs through the post which were tested for chlamydia.ResultsOverall, 1116 women were recruited from 29 clinics; with a 79% retention rate.C trachomatisprevalence at baseline was 4.9% (95% CI: 2.9% to 7.0%) and incidence rate for the 12-month study period was 4.4 per 100 women-years (95% CI: 3.3% to 5.9%). PrevalentC trachomatiswas associated with having hadC trachomatispreviously [AOR: 2.0 (95% CI: 1.1% to 3.9%)], increased numbers of sexual partners [AOR: 6.4 (95% CI: 3.6% to 11.3%)] and unprotected sex [AOR: 3.1 (95% CI: 1.0% to 9.5%)]. Antibiotic use and older age were protective against having a prevalent infection ([AOR: 0.4 (95% CI: 0.2% to 1.0%)] and [AOR: 0.9 (95% CI: 0.8% to 1.0%)] respectively) and an incident infection ([AHR: 0.1 (95% CI: 0.0% to 0.6%)] and [AHR: 0.4 (95% CI: 0.2% to 0.8%)] respectively). IncidentC trachomatiswas also associated with more partners [AHR: 4.0 (95% CI: 1.9% to 8.6%)]. More than 20% of women withC trachomatishad a re-infection during the study [20.3% (95% CI: 11.6% to 31.7%)] with an infection rate of 20.0 (95% CI: 11.9% to 33.8%) per 100 women years. The median chlamydia organism load was 1.4×105/5цl and the most common serovar identified was serovar E (51.9%).ConclusionChlamydia is a common STI in young Australian women, and an incidence of 4.9 per 100 women years for chlamydia suggests annual testing is appropriate for a chlamydia screening program. The high re-infection rate indicates the importance of partner notification and re-testing 3 months after treatment.
O1-S04.04 Predictors of repeatChlamydia trachomatisand/orNeisseria gonorrhoeaeinfections among African-American adolescent females
Authors: Swartzendruber A , DiClemente R , Sales J , Brown J L , Rose E 
Published: July 2011

BackgroundYoung African-American females have the highest rates of Chlamydia (CT) and gonorrhoea (GC) in the US. Few studies have explored predictors of repeat STDs among this population. The objective was to identify predictors of repeat CT and/or GC infections among African-American adolescent females positive for at least one of these STDs at baseline.MethodsSociodemographic, psychosocial and sexual behaviour data were collected via ACASI at baseline and every 6 months for 2 years from 701 African-American females (15–19 years) enrolled in an HIV prevention trial. Vaginal swabs were self-collected at each visit and assayed for CT and GC using DNA amplification. Participants with a positive test result received directly observable single-dose antimicrobial treatment and risk-reduction counselling. Repeat infection was defined as a positive test result following a negative result or documented treatment. Among those who tested positive for CT and/or GC at baseline, bivariate and multivariable analyses compared study variables for those who did vs did not have a repeat infection during the 2-year follow-up.ResultsOf 615 (88%) participants with ≥1 follow-up test result, 122 (20%) had a positive CT and/or GC test result at baseline; 49 (40% of baseline positives and 8% of total) had a repeat infection during the study period. Of those with a repeat infection, 30 (61%) were positive at only one follow-up visit, 18 (37%) at two and 1 (2%) at three follow-up visits. In bivariate analyses, relative to those positive at baseline only, participants with repeat infection were less likely to have a boyfriend (71 vs 83%, p=0.043) and see themselves marrying their current boyfriend (57.1 vs 76.2%, p=0.05) and more likely to have had sex with a man who had sex with other men (8.2 vs 0%, p=0.013). Participants with repeat infection had higher mean impulsivity scores (p=0.027). Controlling for age and treatment assignment, greater impulsivity (AOR: 1.1, p=0.018) was associated with increased likelihood of a repeat infection and having a boyfriend (AOR: 0.21, p=0.006) with decreased likelihood of a repeat infection.ConclusionsRepeat CT and/or GC infections are common among African-American adolescent females. Among young African-American females who test positive for CT and/or GC, tailored interventions for more impulsive adolescents and those without a boyfriend may help prevent repeat infections.
O1-S05.03 Behavioural factors associated withBacterial vaginosis(BV) in women who have sex with women (WSW): the Women On Women's (WOW) Health Study
Authors: Bradshaw C , Bilardi J , Walker S , Vodstrcil L , Garland S , Hocking J , Chen M , Peterson S , Fehler G , Fairley C 
Published: July 2011

BackgroundWe are conducting a national 2 year cohort study in 400 Australian WSW to determine the behavioural and microbiological factors associated with prevalent and incident BV in women and their sexual partners. Data from the cross-sectional study will be presented.MethodsWSW were recruited using internet, festival and media-based promotion and were ineligible if they are postmenopausal, pregnant or had not had a female sex partner (FSP) in the last 18 months. Study-kits containing consent forms, questionnaires, swabs and slides were sent to participants and returned by post. At baseline, women self-collected three consecutive vaginal swabs and slides at weekly intervals and completed detailed demographic behavioural data via an online or paper-based questionnaire. Gram-stained self-collected vaginal smears (SCVS) were scored by the Nugent method. Women were classified as having prevalent BV if ≥1 slides had a Nugent score (NS) of 7–10, intermediate flora if ≥1 slides had a NS=4–6 and normal flora if all three slides had a NS=0–3. Univariate and multivariate analyses were performed using SPSS to examine the association between BV and behavioural practices.ResultsIn February 2011, 342 (86%) women had been recruited and 314 (92%) women had completed all cross-sectional requirements. Median age was 31 years (range 19–49), 309 (98%) reported a FSP in the last year, 253 (81%) had a current sexual partner (95% female) and 246 (78%) reported vaginal sex with a male in the past. The prevalence of BV was 29% (95% CI 20% to 38%) in women providing ≥1 SCVS. Two hundred and seventy-five (88%) women provided all three SCVS of which 178 (65%) had stable normal flora on all slides, 56 (20%) stable BV and 41 (15%) had unstable flora transitioning between ≥1 Nugent categories over the three slides. Multivariate analysis found that being a current smoker of cigarettes or marijuana (Adjusted OR AOR =2.2; 95% CI: 1.3% to 3.8%) and having >5 lifetime FSPs (AOR =1.8; 1.0 to 3.01) was significantly associated with prevalent BV. A borderline association with FSP receptive oral sex (AOR=3.2; 0.9 to 11.0) was evident. BV was not associated with increased age or numbers of male partners.ConclusionPrevalent BV is common (30%) in WSW and is strongly associated with smoking and increasing numbers of FSPs but not male partners. A high proportion of WSW had stable vaginal flora (85%) over a 3 week period. This study aims to advance our understanding of epidemiology of BV in WSW.