Sexually Transmitted Infections

Simms, I; Ward, H

doi: 10.1136/sti.2005.019349pmid: 16461590

Miller, R F; Ward, H

doi: 10.1136/sti.2006.ar2005pmid: N/A

Ward, H; Robinson, A J

doi: 10.1136/sti.2006.edfeb06pmid: 16461592

Brown, A E; Tomkins, S E; Logan, L E; LaMontagne, D S; Munro, H L; Hope, V D; Righarts, A; Blackham, J E; Rice, B D; Chadborn, T R; Tookey, P A; Parry, J V; Delpech, V; Gill, O N; Fenton, K A

Hesketh, T; Li, L; Ye, X; Wang, H; Jiang, M; Tomkins, A

doi: 10.1136/sti.2004.014043pmid: 16461594

Objective: To measure the prevalence of HIV and syphilis in migrant and urban workers in eastern China, and to determine their knowledge and attitudes towards HIV. Methods: A cross sectional survey involving dried blood spot testing and self completion questionnaires. Migrants and urban workers in 39 work units in two districts of Hangzhou, Zhejiang Province, were recruited. Respondents completed a questionnaire about knowledge and attitudes towards HIV. Testing for antibodies to HIV-1 and syphilis was carried out on dried blood spots using a gelatin particle agglutination technique. Results: Data were obtained from 4148 migrants and 2197 urban workers. There were no HIV infections detected in either the migrant or urban populations. Syphilis was detected, but the prevalence was not significantly different between urban workers (0.68%, 95% CI: 0.35 to 1.02) and migrant workers (0.48%, 95% CI 0.26 to 0.66, p = 0.07). 36% of the migrants had migrated with a partner, and 7% had also migrated with children. Urban workers were consistently more knowledgeable than migrants about HIV, but knowledge of the major modes of transmission was good in both groups. Traditional attitudes to sexual behaviour were still pervasive in both groups and attitudes towards individuals with HIV were generally intolerant. The use of sex workers appears rare and no more common in migrants than urban workers. Conclusion: At present HIV is probably not spreading in the internal migrant population in eastern China. Syphilis is a problem in both the migrant and urban populations. The tendency to migrate with partners makes migrants relatively low risk for engaging in casual sex.

Gilbart, V L; Mercer, C H; Dougan, S; Copas, A J; Fenton, K A; Johnson, A M; Evans, B G

doi: 10.1136/sti.2004.014191pmid: 16461595

Objective: To compare the prevalence of HIV risk behaviours reported by heterosexuals without major risks for HIV acquisition diagnosed with HIV in England, Wales, and Northern Ireland, with those of the heterosexual general population. Methods: Demographic and sexual behaviour data for heterosexuals (without major risks for HIV) aged 16–44 from the British National Surveys of Sexual Attitudes and Lifestyles in 1990 and 2000 were compared to 139 HIV infected individuals without major risks for HIV aged 16+ at diagnosis, interviewed between December 1987 and March 2003. Comparisons were made overall and separately for the early and late 1990s. Results: HIV infected heterosexual men without major risks were significantly more likely to report first heterosexual intercourse before age 16 (adjusted odds ratio (AOR): 2.75; 95% confidence interval (CI),1.65 to 4.57), while both HIV infected heterosexual men and women reported greater partner numbers (AOR: men 2.44; CI, 1.4 to 4.05; AOR women 2.17; CI, 1.28 to 3.66) and never using condoms (AOR: men 7.97; CI,4.78 to 13.3; AOR women 3.95; CI, 2.30 to 6.80) than the heterosexual general population. There is evidence to suggest that the two groups were more similar in their reporting of partner numbers in the late 1990s relative to the early 1990s. Conclusion: Heterosexual HIV infected individuals without major risks for HIV acquisition in England, Wales, and Northern Ireland are significantly more likely to report high risk sexual behaviours relative to the British heterosexual general population. However, these differences may have decreased over time, at least for the number of partners. Effective sexual health promotion, including the continued promotion of condom use, would impact on the rising rates of STI diagnoses and also prevent HIV transmission among the heterosexual general population.

Hamlyn, E; McAllister, J; Winston, A; Sinclair, B; Amin, J; Carr, A; Cooper, D A

doi: 10.1136/sti.2005.014662pmid: 16461596

Background/aims: Non-occupational HIV post-exposure prophylaxis (NPEP) is routinely prescribed after high risk sexual exposure. This provides an opportunity to screen and treat individuals at risk of concurrent sexually transmitted infections (STI). The aim of this study was to assess the efficacy of an STI screening programme in individuals receiving NPEP. Methods: STI screens were offered to all individuals receiving NPEP from March 2001 to May 2004. Screen results were compared to type of sexual exposure and baseline patient characteristics. Results: A total of 253 subjects were screened, representing 85% of the target population. All were men who have sex with men (MSM). Common exposure risks were receptive anal intercourse (RAI) in 61% and insertive anal intercourse (IAI) in 33%. 32 (13%) individuals had one or more STI. The most common STIs were rectal infections with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in 11 (4.5%) and six (2.5%) individuals, respectively. Subjects with rectal CT were significantly more likely to be co-infected with rectal NG (p<0.001). There was no association between the presence of a rectal STI and age or exposure risk. Only six (19%) individuals with an STI were symptomatic at screening. Conclusion: In this cohort of MSM receiving NPEP, high rates of concomitant STIs are observed highlighting the importance of STI screening in this setting.

Burckhardt, F; Warner, P; Young, H

doi: 10.1136/sti.2004.011882pmid: 16461597

Objective: To describe the impact of change from culture to more sensitive nucleic acid amplification testing (NAAT) tests on the detection of Chlamydia trachomatis in a genitourinary medicine (GUM) clinic population. Methods: Data were collected between January 1992 and December 2003 on results of C trachomatis tests on male and female attenders at the Lothian GUM clinic (n = 81 590). Routine diagnosis switched from culture to NAAT methods in September 1998. Association of test result with age, sex, year of test, and test type was analysed using logistic regression. Results: 6.1% (95% CI: 5.7% to 6.5%) of women and 7.1% of men (95% CI: 6.7% to 7.5%) tested positive with culture and 9.9% of women (95% CI: 9.4% to 10.3%) and 11.1% of men (95% CI: 10.7% to 11.5%) tested positive with NAATs. This corresponds to a 56% increase for men (95% CI: 47% to 66%) and 62% for women (95% CI: 50% to 67%). Logistic regression showed that a positive test result was strongly associated with test type with or without adjustment for year of test, sex, and young age. Conclusions: The significant increase in chlamydial infections detected following a change from culture to NAATs has important implications for interpretation of trends ascertained from surveillance data. Not all of this can be a direct effect of enhanced sensitivity and there may be indirect effects that improve ascertainment of existing infections. As more laboratories switch to NAATs similar patterns of stepwise increases in positive results are expected and trend analysis based on such surveillance data might thus show an artefactual rise in chlamydia infection rates. Accumulated surveillance data should therefore include timing of introduction of NAAT, so as to take account of under-ascertainment by previous methods.

Aguilar, L V; Lazcano-Ponce, E; Vaccarella, S; Cruz, A; Hernández, P; Smith, J S; Muñoz, N; Kornegay, J R; Hernández-Avila, M; Franceschi, S

doi: 10.1136/sti.2005.015131pmid: 16461598

Objective: To elucidate which anatomical sites need to be sampled to detect human papillomavirus (HPV) infection in the lower male genital tract. Method: In an HPV survey of Mexican soldiers (median age 24 years; range 16–50 years), a cell sample from 2 cm deep into the distal urethra (group 1; n = 168 men), or 0.5 cm deep into the meatus urethralis (group 2; n = 414 men) was collected, along with a sample from the external genitalia. The different samples were tested for 27 HPV types using a polymerase chain reaction based strip assay. Results: HPV DNA was detected more frequently in external genitalia samples (46.4%) than in the urethra (20.8%) or meatus samples (12.1%). Lack of samples from the urethra or meatus would have led to 5.1% and 1.5% false HPV negative results, respectively. The most frequently detected high risk HPV types (HPV 59, 52, 51, and 16) were similar in different sites, whereas low risk types were found rarely in urethra samples. Conclusions: The addition of cell samples from the meatus to those from external genitalia contributed negligibly to the evaluation of the prevalence of HPV in men. HPV detection was slightly improved by the addition of urethra samples, but the gain may not justify the discomfort of the procedure in large epidemiological studies.

Manavi, K; Young, H

doi: 10.1136/sti.2005.015354pmid: 16461599

Objective: To investigate the effect of time since last urination on chlamydial positivity rates in men. Methods: Prospective study on men attending a genitourinary medicine clinic who were asked for the last time of their urination before obtaining their urine sample for testing for Chlamydia trachomatis with the Cobas Amplicor polymerase chain reaction (PCR) assay. Results: Of the total of 1649 men studied, 621 (37.6% (95% CI 35.3% to 39.9%)) had a voiding interval of less than 2 hours. There was no statistical evidence of a difference in the positivity rate of chlamydial infection among men with a voiding interval of less than 2 hours (106/621, 17.1%) and that of men with a voiding interval of 2 hours or longer (170/1028, 16.5%); difference in proportions 0.5% (95% CI to 3.2% to 4.3%), p = 0.779. Conclusion: Voiding interval does not have a significant impact on the performance of the Cobas Amplicor PCR assay in men.