Sexually transmissible infections other than HIV

The literature discusses oral manifestations caused by sexually transmitted viruses: a narrative review

This review provides practical recommendations for dental practitioners in dealing with oral lesions associated with sexually transmitted diseases (STDs), offering clinically relevant insights to increase the awareness of these diseases in the mainstream of everyday practice. STDs are acquired through unprotected vaginal, anal or oral sex and are caused by more than 30 different types of bacteria, viruses and protozoa. Saliva, precum, semen, vaginal secretions and menstrual blood could be likely vehicles of infections and defensive barriers to infection by pathogenic microbes could be represented via intact mucosal membrane, the diluent function of saliva, and the antimicrobial action of salivary enzymes that collectively contribute to oral health and protection. STD, can directly and indirectly affect mucous membranes, manifesting with characteristic diagnostic signs and lesions. Given their potential oral manifestations, dental professionals need a comprehensive understanding of STD. The findings of this review lay a foundation for comprehending several STDs, emphasizing the importance of physicians as well dental practitioners being open to discussing sexuality issues with patients and providing appropriate therapeutic interventions.

Relationship of Exposure to Contradictory Information and Information Insufficiency to Decision-Making About HPV Vaccination Among South Korean College Women

In this study, we investigated how exposure to contradictory messages about the human papillomavirus (HPV) vaccine affects female South Korean college students' vaccination decisions. Specifically, we focused on the relationship between exposure to contradictory messages, current knowledge, and information insufficiency that may affect participants' confusion and decision-making about vaccination. A percentile bootstrap method and pairwise comparison tests in structural equation modeling were employed. Exposure to contradictory messages significantly and negatively affected current knowledge of the HPV vaccine. Although current knowledge significantly and negatively affected confusion around the vaccine, information insufficiency failed to predict it. The vaccine confusion significantly and positively affected decisional conflicts, which, in turn, decreased the behavioral intentions to vaccinate. Additionally, the results showed how the participants' altruistic orientations and perceived stigma moderated the associations among the variables. The findings have theoretical and practical implications for future research investigating the effects of vaccine-related information on young adult women's decision-making about vaccination, particularly in cultural contexts where the HPV vaccine uptake rates are low.

Mycoplasma genitalium and Other Reproductive Tract Infections in Pregnant Women, Papua New Guinea, 2015-2017

Much about the range of pathogens, frequency of coinfection, and clinical effects of reproductive tract infections (RTIs) among pregnant women remains unknown. We report on RTIs (Mycoplasma genitalium, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Treponema pallidum subspecies pallidum, bacterial vaginosis, and vulvovaginal candidiasis) and other reproductive health indicators in 699 pregnant women in Papua New Guinea during 2015–2017. We found M. genitalium, an emerging pathogen in Papua New Guinea, in 12.5% of participants. These infections showed no evidence of macrolide resistance. In total, 74.1% of pregnant women had >1 RTI; most of these infections were treatable. We detected sexually transmitted infections (excluding syphilis) in 37.7% of women. Our findings showed that syndromic management of infections is greatly inadequate. In total, 98.4% of women had never used barrier contraception. These findings will inform efforts to improve reproductive healthcare in Papua New Guinea.

Association of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Ureaplasma species infection and organism load with cervicitis in north Indian population

Cervicitis is predominantly caused by Neisseria gonorrhoeae and Chlamydia trachomatis, which accounts for almost half of all the cases of cervicitis. The role of newer organisms like Mycoplasma genitalium and Ureaplasma sp. and association of bacterial load with cervicitis are also not well established. So the study aimed to determine the relative frequency of these organisms and their load in association with cervicitis cases from north India. A case-control study involving 300 women was conducted using quantitative real-time PCR from endocervical swabs for identification of organisms and quantification of bacterial load. Among 150 cervicitis cases, C. trachomatis, N. gonorrhoeae, M. genitalium and Ureaplasma parvum were detected in 5 (3·3%), 10 (6·6%), 37(24·6%) and 47 (31·3%) respectively. Old age (<0·001, chi-squared test) and irregular menstrual cycles (<0·001, chi-squared test) were significantly associated with cervicitis. M genitalium was the only organism to be associated significantly with cervicitis with regard to age (<0·031) and symptoms like discharge (P < 0·033, chi-squared test) and dysuria (P < 0·044, chi-squared test) in multivariate analysis. Our finding suggests that the bacterial load of these organisms is not significantly associated with cervicitis. However, we found significant association of M. genitalium infection with clinical characteristics of cervicitis cases.

The Ballseye programme: a mixed-methods programme of research in traditional sexual health and alternative community settings to improve the sexual health of men in the UK

Background

Sexually transmitted infection (STI) diagnoses are increasing and efforts to reduce transmission have failed. There are major uncertainties in the evidence base surrounding the delivery of STI care for men.

Aim

To improve the sexual health of young men in the UK by determining optimal strategies for STI testing and care

Objectives

To develop an evidence-based clinical algorithm for STI testing in asymptomatic men; model mathematically the epidemiological and economic impact of removing microscopy from routine STI testing in asymptomatic men; conduct a pilot randomised controlled trial (RCT) of accelerated partner therapy (APT; new models of partner notification to rapidly treat male sex partners of people with STIs) in primary care; explore the acceptability of diverse venues for STI screening in men; and determine optimal models for the delivery of screening.

Design

Systematic review of the clinical consequences of asymptomatic non-chlamydial, non-gonococcal urethritis (NCNGU); case–control study of factors associated with NCNGU; mathematical modelling of the epidemiological and economic impact of removing microscopy from asymptomatic screening and cost-effectiveness analysis; pilot RCT of APT for male sex partners of women diagnosed withChlamydia trachomatisinfection in primary care; stratified random probability sample survey of UK young men; qualitative study of men’s views on accessing STI testing; SPORTSMART pilot cluster RCT of two STI screening interventions in amateur football clubs; and anonymous questionnaire survey of STI risk and previous testing behaviour in men in football clubs.

Settings

General population, genitourinary medicine clinic attenders, general practice and community contraception and sexual health clinic attenders and amateur football clubs.

Participants

Men and women.

Interventions

Partner notification interventions: APTHotline [telephone assessment of partner(s)] and APTPharmacy [community pharmacist assessment of partner(s)]. SPORTSMART interventions: football captain-led and health adviser-led promotion of urine-based STI screening.

Main outcome measures

For the APT pilot RCT, the primary outcome, determined for each contactable partner, was whether or not they were considered to have been treated within 6 weeks of index diagnosis. For the SPORTSMART pilot RCT, the primary outcome was the proportion of eligible men accepting screening.

Results

Non-chlamydial, non-gonococcal urethritis is not associated with significant clinical consequences for men or their sexual partners but study quality is poor (systematic review). Men with symptomatic and asymptomatic NCNGU and healthy men share similar demographic, behavioural and clinical variables (case–control study). Removal of urethral microscopy from routine asymptomatic screening is likely to lead to a small rise in pelvic inflammatory disease (PID) but could save > £5M over 20 years (mathematical modelling and health economics analysis). In the APT pilot RCT the proportion of partners treated by the APTHotline [39/111 (35%)], APTPharmacy [46/100 (46%)] and standard patient referral [46/102 (45%)] did not meet national standards but exceeded previously reported outcomes in community settings. Men’s reported willingness to access self-sampling kits for STIs and human immunodeficiency virus infection was high. Traditional health-care settings were preferred but sports venues were acceptable to half of men who played sport (random probability sample survey). Men appear to prefer a ‘straightforward’ approach to STI screening, accessible as part of their daily activities (qualitative study). Uptake of STI screening in the SPORTSMART RCT was high, irrespective of arm [captain led 28/56 (50%); health-care professional led 31/46 (67%); poster only 31/51 (61%)], and costs were similar. Men were at risk of STIs but previous testing was common.

Conclusions

Men find traditional health-care settings the most acceptable places to access STI screening. Self-sampling kits in football clubs could widen access to screening and offer a public health impact for men with limited local sexual health services. Available evidence does not support an association between asymptomatic NCNGU and significant adverse clinical outcomes for men or their sexual partners but the literature is of poor quality. Similarities in characteristics of men with and without NCNGU precluded development of a meaningful clinical algorithm to guide STI testing in asymptomatic men. The mathematical modelling and cost-effectiveness analysis of removing all asymptomatic urethral microscopy screening suggests that this would result in a small rise in adverse outcomes such as PID but that it would be highly cost-effective. APT appears to improve outcomes of partner notification in community settings but outcomes still fail to meet national standards. Priorities for future work include improving understanding of men’s collective behaviours and how these can be harnessed to improve health outcomes; exploring barriers to and facilitators of opportunistic STI screening for men attending general practice, with development of evidence-based interventions to increase the offer and uptake of screening; further development of APT for community settings; and studies to improve knowledge of factors specific to screening men who have sex with men (MSM) and, in particular, how, with the different epidemiology of STIs in MSM and the current narrow focus on chlamydia, this could negatively impact MSM’s sexual health.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme.

High Resistance to Azithromycin in Clinical Samples from Patients with Sexually Transmitted Diseases in Guangxi Zhuang Autonomous Region, China

Azithromycin is used as an alternative medicine in patients with syphilis who are intolerant to penicillin. Nevertheless, the report of treatment failure of azithromycin for patients with syphilis has raised concerns in China in the past years. In this study, 178 patients with early syphilis, who were treated in sexually transmitted infections clinics in four cities in Guangxi Zhuang Autonomous Region were enrolled to investigate the regional prevalence of Treponema pallidum strain resistant to azithromycin. Nested PCR was performed to amplify the 23S ribosomal RNA (23SrRNA) gene. The point mutation of A2058G in 23SrRNA, which confers Treponema pallidum resistance to azithromycin, was measured by endonuclease digestion of PCR amplification products using MboII. A2058G point mutation was detected in 91.0% (162/178; 95% CI, 86.8%, 95.2%) of the specimens, but no difference in prevalence of azithromycin resistance was found between the patients who had taken antibiotics before enrollment and the patients who had not (91.8% vs. 89.4%), nor between the patients with and without past sexually transmitted infections (87.1% vs. 93.1%). We concluded that azithromycin may not be suitable for syphilis as a treatment option in Guangxi Zhuang Autonomous Region because of the extremely high prevalence of resistance in the general syphilis population.

Predictors of the Sexual Well-being of Individuals Diagnosed with Herpes and Human Papillomavirus

Research suggests that having a sexually transmitted infection (STI) such as genital herpes and human papillomavirus (HPV) can negatively affect sexual well-being. However, there is little research examining factors associated with poorer sexual well-being among individuals with a STI. This study investigated the extent to which stigma experiences, individual characteristics, and STI characteristics were associated with multiple aspects of sexual well-being among individuals diagnosed with herpes and/or HPV. Participants were an average of 36 years old (SD = 11.58) and included 188 individuals with herpes and/or HPV who completed measures of sexual activity, sexual problems, and sexual cognitive-affective factors. The results showed that experiences of stigmatization were the most important predictors of sexual well-being. Participants who perceived were stigmatized by others as well as those who internalized negative social attitudes to a greater extent reported poorer sexual well-being across all dimensions, over and above individual and STI characteristics. The implications of these findings for sexual health professionals are discussed.

Kissing and hpv: honest popular visions, the human papilloma virus, and cancers

Kissing is among the multitude of functions of the lips [...]

Evaluation of syndromic management of sexually transmitted infections within the Kisumu Incidence Cohort Study

While laboratory aetiological diagnosis is considered the gold standard for diagnosis and management of sexually transmitted infections (STIs), syndromic management has been presented as a simplified and affordable approach for STI management in limited resource settings. STI signs and symptoms were collected using staff-administered computer-assisted personal interview and audio computer-assisted self-interview. Participants underwent a medical examination and laboratory testing for common STIs. The performance of syndromic management was assessed on the agreement between interviewing methods as well as accurate diagnosis. We screened 846 participants, of whom 88 (10.4%) received syndromic STI diagnosis while 272 (32.2%) received an aetiological diagnosis. Agreement between syndromic and aetiological diagnoses was very poor (overall kappa = 0.09). The most prevalent STI was herpes simplex virus type 2 and the percentage of persons with any STI was higher among women (48.6%) than men (15.6%, p < 0.0001). Agreement between audio computer-assisted self-interview and computer-assisted personal interview interviewing methods for syndromic diagnosis of STIs ranged from poor to good. Our findings suggest that syndromic management of STIs is not a sufficient tool for STI diagnosis in this setting; development and improvement of STI diagnostic capabilities through laboratory confirmation is needed in resource-limited settings.

Next revolution in the molecular theranostics of infectious diseases: microfabricated systems for personalized medicine

The molecular diagnosis of infectious diseases is currently going through a revolution sustained by the regulatory approval of amplification tests that have been shown to be equivalent or superior to existing gold standard methods. The recent approval of a microarray system for the pharmacogenomic profiling of cytochrome P450-mediated drug metabolism is paving the way to novel, rapid, sensitive, robust and economical microfabricated systems for point-of-care diagnostics, which are utilized closer and closer to the patient's bedside. These systems will enable the multiparametric genetic evaluation of several medical conditions, including infectious diseases. This forecoming revolution will position molecular theranostics in a broader integrated view of personalized medicine, which exploits genetic information from microbes and human hosts to optimize patient management and disease treatment.

Behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in high-income countries

BACKGROUND

Interventions to change behaviour among sex workers and their clients have been identified as a strategy to reduce HIV transmission. However, there has been no systematic review that has examined and summarized their effects.

OBJECTIVES

To identify and evaluate the effects of the studies performed on behavioural interventions to reduce the transmission of HIV infection among sex workers and their clients in high-income countries.

SEARCH METHODS

Electronic searches were undertaken using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and other databases between January 1980 and July 2010. Experts in the field were contacted to locate any other studies.

SELECTION CRITERIA

Randomised controlled trials or specified quasi-experimental designs with comparison groups that examined the effects of behavioural interventions aimed at reducing the risk of HIV or sexually transmitted infections (STIs) transmission among sex workers in high-income countries. We reviewed studies for outcome relevance and methodological rigor.

DATA COLLECTION AND ANALYSIS

Two reviewers independently applied the inclusion criteria to potential studies, and any disagreements were resolved by discussion. Studies were assessed for completeness of reporting and extracted data.

MAIN RESULTS

A total of four studies were included, comprising two randomised controlled trials and two quasi-experimental pretest-posttest trials with control groups involving 1795 participants. No trials reported HIV prevalence/incidence as outcomes.Overall, the effects of behavioural interventions for sex workers in high-income countries on STI incidence did not differ significantly among two studies using a random effects model (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.11 to 1.98). Only one study found that the self-reported STI prevalence in clients of female sex workers was statistically significant (RR 0.09, 95%CI 0.01 to 0.72, P=0.02). There was no significant difference after behavioural intervention for condom use. Two studies demonstrated the effectiveness of intervention for knowledge of HIV transmission among sex workers (RR 1.82, 95%CI 1.55 to 2.14) and clients of sex workers (RR 1.93, 95%CI 1.46 to 2.55).

AUTHORS' CONCLUSIONS

There is limited evidence from randomised controlled trials for the effectiveness of behavioural interventions to reduce the transmission of HIV infection among sex workers and their clients in high-income countries. Further randomised controlled trials are very likely to have important impacts on our confidence in the estimates of the effects, and are likely to change the estimates for effective interventions with outcomes of HIV incidence or prevalence and a variety of different settings among sex workers and their clients in high-income countries. Randomised controlled trials that test for the identification of effective interventions for HIV prevention with outcomes of biological endpoints, such as HIV incidence or prevalence, are needed for these neglected populations. More research is also needed for male or transgender sex workers and their clients in high-income countries.

Kissing: hullo hpv

There are at least 5 types of kisses, including ges-tural, cultural, osculum, basium, saviolum, and oro-genital.[...]

'About as comfortable as a stranger putting their finger up your nose': speculation about the (extra)ordinary in gynaecological examinations

In public health education, gynaecological examinations are presented as a routine and ordinary procedure. Medical research addressing women's reasons for screening reluctance emphasises underlying psychological categories of 'anxiety' and 'poor coping'. Minimal attention is paid to the effects of clinicians' interventions upon women's decision-making. Normalising promotes women's participation as speculum examinations are an essential part of many contemporary diagnostic and treatment procedures. In-depth email interviews were conducted with 26 women with diagnosis of either of the two commonest viral sexually transmitted infections, human papilloma virus and herpes simplex virus, and 12 sexual health clinicians. Data were analysed thematically. Findings indicate that women's screening compliance is influenced by clinicians' (in)attention to power relations, rapport-building, attentiveness to bodily (dis)comfort, technical skill and gender. Women's feedback is a valuable resource in devising interventions that may promote participation in examinations.

Low yield of anogenital examination among asymptomatic clients of an urban sexual health clinic

BACKGROUND

The use of self-collected specimens to test for sexually transmissible infections (STI) has reduced the opportunity for physical examination. Physical examination has been found to be of limited value in asymptomatic heterosexual women and men; however, prior studies have excluded higher risk populations. We performed a retrospective cross-sectional study to determine the diagnostic yield of physical examination among all clients attending our sexual health service.

METHODS

The Sydney Sexual Health Centre database was used to identify asymptomatic clients attending for the first time between January and June 2009. Demographic and behavioural data were extracted from the database for all clients. Medical records were then manually reviewed to determine the number and nature of diagnoses related to the examination and whether this varied by sex and sex of sexual partners.

RESULTS

Of the 590 clients included, 450 (76%) received anogenital examinations. Ten (2.2%; 95% confidence interval 1.1-4.1%) STI were found, including four cases of cervicitis, four of anogenital warts and two of molluscum. Nineteen (4.2%) other non-STI conditions were detected, mostly in heterosexual women and men who have sex with men (MSM).

CONCLUSION

Physical examination of asymptomatic clients attending our sexual health clinic was of limited value, even among higher risk individuals such as MSM. Sexual health clinics should direct resources currently used to examine clients towards increasing the STI testing rate.

Knowledge of sexually transmissible infections: a comparison of prisoners and the general population

The World Health Organization (WHO) has identified a failure to provide education for vulnerable populations such as prisoners as a contributing factor to the epidemic of sexually transmissible infections (STIs). Despite this recognition, little is known about prisoners' level of knowledge of STIs compared with the general population. Using computer-assisted telephone interviews, we compared a representative sample of 2289 Australian prisoners, aged 18–59 years from New South Wales and Queensland prisons with a representative community sample of 3536 participants from these two states. Prisoners had significantly better knowledge than the general community of chlamydia-related questions, while knowledge of herpes (genital and oral) was slightly better in the community sample. Prisoners who were aged over 25 years, not married, female, self-identified as either homosexual or bisexual and reported a history of STIs tended to have better STI knowledge levels. Despite their more disadvantaged backgrounds, prisoners demonstrated relatively good health literacy in relation to STIs. Ongoing education about the transmission risks of STIs for prisoners and the general community is needed.

A cognitive analysis of college students' explanations for engaging in unprotected sexual intercourse

Young adults, including college students, engage in high levels of unprotected sexual activity despite relatively high rates of HIV/STI and pregnancy-related knowledge. Little is known about the cognitive strategies that young people use to explain this inconsistency. The current study examined young people's explanations for engaging in unprotected sexual activity in their committed relationships. A total of 63 young adults (32 women and 31 men) completed daily diaries over a 3-week period, providing a total of 1,284 daily reports tracking their condom use and non-use during intercourse. Diary collection was followed by in-depth interviews designed to explore participants' decision-making regarding their participation in sexual intercourse unprotected against infection or unwanted pregnancy. Less than a quarter of the sample used condoms or oral contraceptives consistently. Participants primarily viewed condoms as a means of preventing pregnancy; few described disease prevention as a main motivation for their use. Analysis of the cognitions underlying explanations for condom and contraception non-use were classified as (1) general biased risk evaluation, (2) biased evidence evaluation, (3) endorsement of poor alternatives, (4) focus on spurious justifications, (5) dismissing risk, and (6) ignoring risk. Prevention interventions should incorporate methods to challenge young people to acknowledge personal risk and commit themselves to taking steps to reduce this risk.

The effect of syndromic management interventions on the prevalence of sexually transmitted infections in South Africa

OBJECTIVES

Few studies have assessed the effect of syndromic management interventions on the prevalence of sexually transmitted infections (STIs) at a population level. This study aims to determine the effect of syndromic management protocols that have been introduced in South Africa since 1994.

STUDY DESIGN

A mathematical model of sexual behaviour patterns in South Africa was used to model the incidence of HIV, genital herpes, syphilis, chancroid, gonorrhoea, chlamydial infection, trichomoniasis, bacterial vaginosis and vaginal candidiasis. Assumptions about health seeking behaviour and treatment effectiveness were based on South African survey data. The model was fitted to available STI prevalence data.

MAIN OUTCOME MEASURES

Reductions in STI prevalence due to syndromic management.

RESULTS

Between 1995 and 2005, there were significant reductions in the prevalence of syphilis, chancroid, gonorrhoea, trichomoniasis and chlamydial infection. In women aged between 15 and 49, syndromic management resulted in a 33% (95% CI: 23-43%) decline in syphilis prevalence, a 6% (95% CI: 3-11%) reduction in gonorrhoea prevalence, a 5% (95% CI: 1-13%) reduction in the prevalence of bacterial vaginosis and a substantial decline in chancroid. However, syndromic management did not significantly reduce the prevalence of other STIs. For all STIs, much of the modelled reduction in STI prevalence between 1995 and 2005 can be attributed to either increased condom usage or AIDS mortality.

CONCLUSIONS

Syndromic management of STIs can be expected to decrease the prevalence of curable STIs that tend to become symptomatic, but has little effect on the prevalence of STIs that are mostly asymptomatic.

Sampling for Chlamydia trachomatis infection - a comparison of vaginal, first-catch urine, combined vaginal and first-catch urine and endocervical sampling

The aim of the study was to evaluate the sensitivity of patients' self-sampled vaginal specimens, first-catch urine (FCU), combined vaginal/FCU specimens and endocervical specimens for detecting chlamydial infection in women. Women attending sexually transmitted disease clinics, youth clinics and a women's health clinic were enrolled. They self-collected a vaginal specimen with two swabs, which were placed into a sterile tube and into a tube containing a buffer medium, respectively. An FCU sample was collected and aliquoted into both an empty tube and the tube containing the vaginal swab. A clinician collected an endocervical swab. The samples were sent to laboratories for analysis using polymerase chain reaction testing and strand displacement amplification testing, respectively. The sensitivities calculated in all 171 Chlamydia trachomatis-infected women were equal for endocervical specimens (97.1%), vaginal specimens (96.5%) and combined vaginal/FCU specimens (95.3%), whereas the sensitivity for FCU was significantly lower (87.7%). The sensitivity of vaginal specimens for the detection of C. trachomatis is as high as that of combined vaginal/FCU specimens.

Increasing rates of quinolone-resistant Neisseria gonorrhoeae in Paris, France

BACKGROUND

Quinolone-resistant Neisseria gonorrhoeae (QRNG) rates are increasing worldwide.

OBJECTIVES

(i) To assess the rate of QRNG among patients referred to a venereology clinic in Paris between 2000 and 2004; and (ii) to assess associated epidemiological factors.

METHODS

Retrospective study of consecutive cases over 2000-2004. Indications and techniques of swabbing and culture were constant over 2000-2004. Susceptibility of N. gonorrhoeae was tested to six antibiotics: ciprofloxacin, amoxicillin, cefotaxime, tetracycline, erythromycin, and spectinomycin. Epidemiological data and anatomical site of N. gonorrhoeae infection were collected.

RESULTS

Annual numbers of cases decreased (P < 10(-4)) from 2000 (n = 41) to 2002 (n = 12), then increased (P < 10(-4)) in 2004 (n = 60). Anorectal gonorrhoea was more frequent in 2003-2004 (22.0%, n = 18/82) than in 2000-2002 (3.9%, n = 3/76). QRNG rates increased from the period 2000-2002 (1.3%) to 2003 (22.7%, P < 0.01), and 2004 (30.2%, P < 0.005). All QRNG strains had a minimal inhibitory concentration of ciprofloxacin > 1.0 mg/L, thus fitting the international definition of quinolone resistance. There were no significant changes in rates of N. gonorrhoeae resistance to the five other antibiotics. QRNG tended to be more frequent among men who have sex with men (MSM; 16.7% vs. 7.1%), HIV-infected patient (20.5% vs. 11.9%), and patients having more than five partners during the last year (24.4% vs. 17.1%), but statistical significance was not reached in multivariate analyses.

CONCLUSION

We recommend (i) avoiding fluoroquinolones as first-line treatment for N. gonorrhoeae infections in Paris; (ii) that first-line treatment relies on third-generation cephalosporins or spectinomycin; and (iii) reinforcing targeted screening and prevention of gonorrhoea, especially among HIV-positive patients and MSM.

Herpes simplex virus type 2 among Mexican high school adolescents: prevalence and association with community characteristics

BACKGROUND

We undertook this study to estimate the prevalence and correlates of herpes simplex virus type 2 (HSV-2) among Mexican adolescents in high school.

METHODS

This was a cross-sectional analysis using data that had been collected to evaluate a school-based HIV prevention intervention. As part of the final round of evaluation, capillary blood samples were taken from volunteers to test for antibodies to HSV-2. The effect of each school's seroprevalence on the probability of an individual being seropositive was estimated, and the results were grouped by town to evaluate the association between characteristics of the locality and student HSV-2 seroprevalence.

RESULTS

Dried blood spots were collected for 80% of the 1607 participants in the survey who reported that they were sexually active. Of these samples, 21% tested positive for HSV-2 antibodies, with no significant difference in prevalence between men and women. Seroprevalence among schools ranged from 0 to 57%. The number of sex workers registered in the locality was the most important covariate of seroprevalence, with each additional female sex worker (FSW) per 1000 women between 18 and 45 years of age in the town associated with an increase of 1% in the seroprevalence of HSV-2.

CONCLUSIONS

Characteristics of adolescents' micro-environments that influence their pool of potential sexual partners and the likelihood that these partners are HSV-2 positive may be more important predictors of the risk of STI infection than self-reported condom use.

Travel and sexually transmitted infections

Increasing population mobility and increasing frequency and variety of sexually transmitted infections (STI) are closely linked around the globe. Although all mobile populations are at increased risk for acquiring STIs, international travelers are the focus of this review. Several aspects of travel such as opportunity, isolation, and the desire for unique experiences all enhance the likelihood of casual sexual experiences while abroad. The situational loss of inhibition of travel can be markedly enhanced by alcohol and drugs. Several of the most important elements of the complex interaction between travel and STIs are discussed.

Risk of herpes simplex virus type 2 acquisition increases over early adulthood: evidence from a cohort study

DESIGN/ SETTING: A cohort study of 1037 people born in Dunedin, New Zealand, in 1972 or 1973.

PARTICIPANTS

At assessment at age 32 years, 884 participants (432 women and 452 men; 87.1% of the surviving cohort) provided both sera and information on sexual behaviour.

MAIN OUTCOME MEASURES

The proportion of participants with antibodies to HSV-2 infection at ages 26 and 32 years was measured, and the incidence rates from first coitus to age 26 years and from age 26 to 32 years calculated, adjusting for the number of sexual partners and same-sex contact in these age periods.

RESULTS

At age 32 years, 14.6% of men and 22.5% of women had antibodies to HSV-2. The incidence rates for men and women from first coitus to age 26 years were, respectively, 6.5 and 14.3 per 1000 person-years. The incidence rates for men and women from age 26-32 years, respectively, were 14.3 and 15.8 per 1000 person-years. When adjusted for sexual behaviour, the incidence rate ratio, comparing the older with the younger age periods, was 2.9 (95% confidence interval (CI) 1.7 to 4.9) for men and 2.0 (1.2 to 3.4) for women. The adjusted incidence rate ratio when comparing women to men from first coitus to age 26 years was 2.5 (1.6 to 4.0), and from age 26-32 years was 1.3 (0.78 to 2.2). A test for interaction indicated that men and women had different patterns of incidence over time (p = 0.039).

CONCLUSION

In the general population, the risk of acquiring HSV-2 infection seems to increase with age at least to the early 30s, and differences in risk of acquisition for women compared with men become less with age. Health promotion and treatment to control HSV-2 infection should be aimed at all ages, not just at the young.

Risk behaviors of 15-21 year olds in Mexico lead to a high prevalence of sexually transmitted infections: results of a survey in disadvantaged urban areas

BACKGROUND

Due to the fact that adolescents are more likely to participate in high-risk behaviors, this sector of the population is particularly vulnerable to contracting sexually transmitted infections (STIs) and resultant health problems.

METHODS

A survey was carried out among adolescents from poor homes in 204 small-urban areas of Mexico. Information was collected in relation to risk behaviors and socio-economic environment. A sub-group of the participants also provided blood and urine samples which were analyzed to detect sexually transmitted infections.

RESULTS

The presence of Chlamydia was detected in nearly 8% of participants who had stated that they were sexually active (18%) and approximately 12% were positive for herpes type 2-specific antibodies. For both, a greater proportion of girls resulted positive compared to boys. The presence of these biological outcomes of sexual risk behavior was associated with other risk behaviors (smoking), but not with self-reported indicators of protected sex (reported use of condom during most recent sexual activity).

CONCLUSION

The results presented in this study show a startlingly high prevalence of HSV-2 among sexually active Mexican adolescents in poor urban areas, suggesting that this group has participated to a great extent in risky sexual practices. The relationships between socioeconomic environment and adolescent risk behavior need to be better understood if we are to design preventive interventions that modify the determinants of risk behaviors.

Sex-work harm reduction

Sex work is an extremely dangerous profession. The use of harm-reduction principles can help to safeguard sex workers' lives in the same way that drug users have benefited from drug-use harm reduction. Sex workers are exposed to serious harms: drug use, disease, violence, discrimination, debt, criminalisation, and exploitation (child prostitution, trafficking for sex work, and exploitation of migrants). Successful and promising harm-reduction strategies are available: education, empowerment, prevention, care, occupational health and safety, decriminalisation of sex workers, and human-rights-based approaches. Successful interventions include peer education, training in condom-negotiating skills, safety tips for street-based sex workers, male and female condoms, the prevention-care synergy, occupational health and safety guidelines for brothels, self-help organisations, and community-based child protection networks. Straightforward and achievable steps are available to improve the day-to-day lives of sex workers while they continue to work. Conceptualising and debating sex-work harm reduction as a new paradigm can hasten this process.

Sexually Transmitted Disease Care in Managed Care Organizations

Most STD cases in the United States are managed in health sectors dominated by commercial and Medicaid MCOs. To sustain the recent declines in bacterial STD incidence in the United States and to control expansion of the prevalent viral STD, MCOs will need to contribute substantially to control efforts. Applied researchers and quality improvement specialists must work with clinicians, patients, and health systems to develop and scale-up interventions to improve STD prevention and control.

Risks and prevention of sexually transmissible infections among women who have sex with women

Health care providers working with women who have sex with women (WSW) have been ill-informed about a range of sexual health issues for these women. Pertinent issues include sexual behaviours that carry risks of sexually transmissible infection (STI), prevention strategies for safer sex and understanding experiences of abuse. A relative silence continues in all of these areas within the mainstream medical literature, textbooks, research and policy documents, which perpetuates medical ignorance. There is evidence that the prevalence of STIs among WSW is at least as high as among heterosexual women, if not higher among some sub-groups. Risk factors include the sex and number of sexual partners, minimal use of protected sexual behaviours and low levels of knowledge of STI prevention among WSW. Importantly, marginalisation leading to poorer mental health and experiences of abuse can combine to influence risk taking including substance abuse and risky sexual behaviours. Safe-sex guidelines and the need to recognise the impact of sexual abuse are presented.

Adnexitis und «Pelvic Inflammatory Disease»

Pelvic inflammatory disease and upper genital tract infection describe inflammatory changes in the upper female genital tract of any combination: endometritis, salpingitis, tubo-ovarian abscess, peritonitis in the small pelvis. The International Infectious Disease Society for Obstetrics and Gynecology recommends a revision of the CDC guidelines taking into account the type of germ or the triggering agent and the seriousness of the disease. Infections with Chlamydia trachomatis and Neisseria gonorrhoeae are increasing worldwide. They are one of the main causes of tubal sterility, chronic abdominal pain and ectopic pregnancies. More than 30% of the infections are subclinical and asymptomatic. Therefore it is most recommendable to generally screen young, sexually active women with any of the risks mentioned above. Antibiotic therapy should be started as early as possible, in case of doubt even probatively, and should cover a broad spectrum of germs. C. trachomatis and N. gonorrhoeae should be treated according to resistance testing. In uncomplicated cases, hospitalization is unnecessary, ambulant therapy is sufficient.

Management of pelvic inflammatory disease in adolescents

Pelvic inflammatory disease (PID) is highly prevalent among sexually active adolescent females. The major organisms are N gonorrhoeae and C trachomatis. Diagnosis is based on historical information and clinical findings. Early diagnosis and treatment effectively reduce the incidence of complications associated with PID. Highly effective treatment regimens are available and main antimicrobials used include quinolones, cephalosporins, metronidazole, doxycycline, and azithromycin. Delay or inadequate treatment is associated with long term sequelae including tubal infertility and chronic pelvic pain. Prevention efforts should be directed towards routine screening and treatment for sexually transmissible infections, public education and provision of resources for treatment and follow-up.