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- Drug use, sexual risk behaviour and sexually transmitted infections among swingers: a cross-sectional study in The Netherlands. [JOURNAL ARTICLE]
- Sex Transm Infect 2014 Oct 23.
Recreational drug use has been found to be associated with high-risk sexual behaviour and with sexually transmitted infections (STI). This study is the first to assess the prevalence of drug use among swingers (heterosexuals who, as a couple, practise mate swapping or group sex, and/or visit sex clubs for couples), and its association with high-risk sexual behaviour and STI.We recruited individuals who self-identified as swingers and visited our STI clinic (from 2009 to 2012, South Limburg, The Netherlands). Participants (n=289; median age 45 years; 49% female) filled in a self-administered questionnaire on their sexual and drug use behaviour while swinging, over the preceding 6 months. We assessed associations between sexual behaviour, drug use and STI diagnoses (Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG), syphilis, HIV and hepatitis B) using logistic regression analyses.Overall, the prevalence of CT and/or NG was 13%. No other STIs were observed. Seventy-nine percent of swingers reported recreational drug use (including alcohol and use of erectile dysfunction drugs); 46% of them reported multiple drug use. Recreational drug use excluding alcohol and erectile dysfunction drugs (reported by 48%) was associated with high-risk behaviours in men and women. Drug use was independently associated with STI in female swingers, especially those who practice group sex.High rates of multiple drug use, as well as risky sexual behaviour and STIs among swingers, warrant paying more attention to this key population in prevention and care, as they are a risk group that is generally under-recognised and underserved in care.
- Evaluation of the SD BIOLINE HIV/syphilis Duo assay at a rural health center in Southwestern Uganda. [JOURNAL ARTICLE]
- BMC Res Notes 2014 Oct 22; 7(1):746.
Point-of-care tests have the capacity to improve healthcare delivery by reducing costs and delay associated with care. A novel point-of-care immunochromatographic test for dual diagnosis of both HIV and syphilis by detecting IgG, IgM and IgA antibodies to HIV, and specific and recombinant Treponema pallidum antigens has recently been developed, but has not been evaluated in rural field settings. We evaluated the performance of the SD Bioline Syphilis/HIV Duo (Duo) assay at a healthcare center in rural Uganda.A convenience sample of pregnant women attending Kinoni Health Centre IV from March to May, 2013 was enrolled. Venous blood was collected and centrifuged for plasma isolation. Samples were tested with the Duo assay and compared with the Treponema pallidum hemaglutination assay and paired HIV rapid antibody tests as the reference standards. The ease of use and time required for the Duo assay were also assessed by laboratory technicians.Two hundred twenty women were enrolled with a mean age of 25.00 years (SD 5.41). The sensitivity and specificity of the Duo assay were 100% (95%CI 79.0 - 100%) and 100% (95%CI 97.6 - 100.0) respectively, for syphilis, and, 100% (75.9 - 100%) and 99.5% (96.8 - 99.9%) respectively, for HIV. The duo kit was found to be faster and easier to use than the current HIV and syphilis testing techniques.The sensitivity and specificity of the SD Bioline HIV/Syphilis Duo test were excellent in a field setting in Uganda. The Duo assay should be further evaluated in alternate populations and with point-of-care specimens (e.g. whole blood from finger stick specimens), but shows promise as a tool for improved HIV and syphilis surveillance, diagnosis, and treatment in field settings.
- The increase of sexually transmitted infections calls for simultaneous preventive intervention for more effectively containing HIV epidemics in China. [Journal Article]
- BJOG 2014 Oct.:35-44.
To identify the priority public health challenges with respect to the development of multipurpose prevention technologies in China.Review of published literature, databases of state and local disease control agencies and unpublished data relating to HIV and other sexually transmitted infections (STIs).China.General and migrant populations.Review of published data, government reports and databases of China Disease Control agencies, and our unpublished studies.Reported STI incidence, particularly HIV, syphilis, chlamydia and genital herpes, and the migrant population with respect to disease transmission.We found that the reported STI incidence increases along with that of HIV and showed significant geographic overlap with HIV. Economic migrant workers may facilitate the spread of STIs, including HIV.To more effectively contain the HIV epidemic, it is imperative to develop preventive measures to simultaneously target HIV and other STIs. We recommend that the development of multipurpose prevention technologies in China should target HIV and STIs.
- Commentary on "syphilis in the Navy". [Journal Article]
- J R Nav Med Serv 2014; 100(2):131-5.
- A descriptive study of urethral discharge among men in Fiji. [Journal Article]
- N Z Med J 2014; 127(1404):48-52.
Urethral discharge is a common presentation of sexually transmitted infection (STI) in men and known pathogens include Neisseria gonorrhoeae and Chlamydia trachomatis. There are no published data of the burden of urethral discharge among men in Fiji.To evaluate urethral discharge among men to determine the incidence, the frequency of recurrence and reported at-risk behaviour.We conducted a retrospective, descriptive study of clinical records of all men presenting with urethral discharge to two major reproductive health clinics. Data collected included self-reported at-risk behaviours, results of abnormal syphilis serology and antibiotics prescribed. The frequency of recurrence in the following 1-2 years of initial presentation was determined along with microbiological findings from urethral swab in this group.A total of 748 males presented with urethral discharge to the clinic in one year. This represents an incidence rate of at least 295 per 100 000 adult males per year in the study population. Within the next 1-2 years of the initial presentation, 102 (14%) of these re-presented out of which 42 had urethral swab taken for etiological diagnosis. The commonest isolate was Neisseria gonorrhoeae. Results of syphilis tests were available for 560 (75%) of patients and 29 (5%) were positive. Recurrence was not associated with self-reported at-risk behaviours.The incidence of urethral discharge among males in Fiji is very high and prevention strategies are urgently needed.
- Human Immunodeficiency Virus Seroconversion and Associated Risk Factors among Pregnant Women Delivering at Bugando Medical Center in Mwanza, Tanzania. [Journal Article]
- Ann Med Health Sci Res 2014 Sep; 4(5):733-7.
Routine testing for human immunodeficiency virus (HIV) among pregnant women is done early during antenatal care (ANC) in Tanzania, but retesting for the women found negative is rarely done at term or during delivery.This study aimed at determining the magnitude and risk factors associated with HIV seroconversion among pregnant women delivering at Bugando Medical Center (BMC).This cross-sectional study was conducted from January to March 2013 involving 400 pregnant women who tested HIV negative during ANC. These were re-tested during delivery, and those found positive (and their babies) were given antiretroviral therapy (ART) prophylaxis. All exposed babies were tested by polymerase chain reactions (DNAPCR) at 1 month of age. Sociodemographic and clinical characteristics were collected using a structured questionnaire and patients' files. Data were analyzed using SPSS version 17.0 software.Of 400 pregnant women (mean age 26.4 [5.73] years) enrolled, HIV seroconversion was found in 5.3% (21/400). Upon multivariate logistic regression analysis, polygamous marriage (P < 0.001) and history of syphilis during ANC visit (P < 0.001) were found to be independent predictors of HIV seroconversion among pregnant women delivering at BMC. One of the 21 babies (4.8%) born of HIV seroconverted women was confirmed to be HIV infected.The high rate of HIV seroconversion found in this study implies that HIV re-testing should be an enduring exercise. This will allow timely provision of ART prophylaxis to HIV seroconverted women and their exposed babies and thus, prevent mother to child transmission of HIV.
- The Prevalence of HIV by Ethnic Group Is Correlated with HSV-2 and Syphilis Prevalence in Kenya, South Africa, the United Kingdom, and the United States. [Journal Article]
- Interdiscip Perspect Infect Dis 2014.:284317.
Background.This paper investigates two issues: do ethnic/racial groups with high HIV prevalences also have higher prevalences of other STIs? and is HIV prevalence by ethnic group correlated with the prevalence of circumcision, concurrency, or having more than one partner in the preceding year? Methods. We used Spearman's correlation to estimate the association between the prevalence of HIV per ethnic/racial group and HSV-2, syphilis, symptoms of an STI, having more than one partner in the past year, concurrency, and circumcision in Kenya, South Africa, the United Kingdom, and the United States.
Results.We found that in each country HSV-2, syphilis, and symptomatic STIs were positively correlated with HIV prevalence (HSV-2: Kenya rho = 0.50, P = 0.207; South Africa rho-1, P = 0.000; USA rho-1, P = 0.000, Syphilis: Kenya rho = 0.33, P = 0.420; South Africa rho-1, P = 0.000; USA rho-1, P = 0.000, and STI symptoms: Kenya rho = 0.92, P = 0.001; South Africa rho-1, P = 0.000; UK rho = 0.87, P = 0.058; USA rho-1, P = 0.000). The prevalence of circumcision was only negatively associated with HIV prevalence in Kenya. Both having more than one partner in the previous year and concurrency were positively associated with HIV prevalence in all countries (concurrency: Kenya rho = 0.79, P = 0.036; South Africa rho-1, P = 0.000; UK 0.87, P = 0.058; USA rho-1, P = 0.000 and multiple partners: Kenya rho = 0.82, P = 0.023; South Africa rho-1, P = 0.000; UK rho = 0.87, P = 0.058; USA rho-1, P = 0.000). Not all associations were statistically significant.
Conclusion.Further attention needs to be directed to what determines higher rates of partner change and concurrency in communities with high STI prevalence.
- [Bilateral coronary artery ostial stenosis in a patient with cardiovascular syphilis]. [Journal Article]
- Zhonghua Xin Xue Guan Bing Za Zhi 2014 Jul; 42(7):609-10.
- Primary syphilis in HIV-negative patients is on the rise in Greece: epidemiological data for the period 2005-2012 from a tertiary referral centre in Athens, Greece. [JOURNAL ARTICLE]
- J Eur Acad Dermatol Venereol 2014 Oct 20.
Epidemiological data on primary syphilis in Greece are limited.The purpose of the present study was to investigate the trends of the disease in Greece during the last few years and whether they are in accordance with the trends in other European countries and the United States of America.We conducted a retrospective analysis based on records of patients who visited the Sexually Transmitted Infections Unit of 'A. Sygros' Hospital in Athens, Greece, during the period 2005-2012. Our hospital is a tertiary referral centre for sexually transmitted infections covering an area of more than four million people, which is almost half the population of Greece. We documented the total annual number of patients, the male to female ratio, sexual orientation, patients' ethnic origin and education level.We reviewed the records of 1185 patients with a confirmed diagnosis of primary syphilis. The total number of patients with primary syphilis has risen from 111 in 2005 to 158 in 2012, an increase of 42.3%. The mean annual number is 148. The mean male to female ratio is 4.76 : 1, with a peak value of 8.50 : 1 in 2011. The majority of patients are of Greek origin, ranging from 67.4% to 87.2%. Within the male patients group, it seems that the percentage of men having sex with men has risen steadily from 2005 (20.7%) up to 2010 (59.1%) with a decline in 2012 (46.0%). The mean value over 8 years is 45.0%.Primary syphilis in Greece is on the rise. Τhe majority of our patients are Greek, despite immigrant influx. Men clearly outnumber women, representing more than 80% of the total number of patients. Furthermore, there seems to be a trend towards predominance of men having sex with men as the core group among male patients.
- [Changing times - changing diseases. Review of the neuropathological autopsy documentations at the Markusovszky University Teaching Hospital (1964-2014)]. [English Abstract, Journal Article]
- Orv Hetil 2014 Oct 1; 155(43):1722-8.
Nearly 6000 autoptic studies were carried out during the last 50 years at the Laboratory of Neuropathology, Markusovszky University Teaching Hospital, Hungary, Aim: The aim of the authors was to present those previously frequent and often fatal conditions that can be prevented or treated today.Retrospective analyses of the neuropathological documentations.Measles-related subacute sclerosing panencephalitis caused death in 13 cases, the last occurred in 1991. The mandatory vaccination against the causative virus has eliminated this severe neurological complication. Fourteen lives were lost due to herpes simplex encephalitis, including the last case seen in 1999. Feasibility of early diagnosis and the availability of acyclovir therapy resulted in better outcome without fatality. Tuberculous meningitis still occurred in most recent years, although only sporadically. Recognition of this condition is not straightforward due to its rarity, and considerations for this disease are often omitted from the routine differential diagnosis. The generally low mortality rates in tick borne encephalitis further dropped after the introduction of vaccination. Altogether only 8 such cases were documented. The last fatal cases of neurolues were seen in the 1990s. However, syphilis itself has not disappeared, and the number of cases with newly acquired infection continues to rise. The introduction of intrathecal methotrexate and radiotherapy made possible the prevention or effective treatment of meningeal leukosis. A careful coordination of these treatment modalities, however, is important as nervous system complications may develop in the form of disseminated necrotizing leukoencephalopathy that is also reflected in the records.The 50-year neuropathology documentation reflects changes in the occurrence of diseases, and it calls attention to those disorders which can be prevented or treated today, but may represent diagnostic challenges. Orv. Hetil., 2014, 155(43), 1722-1728.