Sexually Transmitted Infections

Goodyear, M D E

doi: 10.1136/sti.2007.029397pmid: 18184689

Goon, P; Sonnex, C

doi: 10.1136/sti.2007.025478pmid: 18212186

Genital warts are the commonest viral STI in the UK, and the incidence continues to rise. Diagnosing, treating and advising patients about this infection remain a large part of the work in any department of GU Medicine. This article reviews and provides the levels of evidence currently available on data about genital warts, and is primarily to advise and guide clinicians when faced with commonly asked questions in the clinic.

Macdonald, N; Elam, G; Hickson, F; Imrie, J; McGarrigle, C A; Fenton, K A; Baster, K; Ward, H; Gilbart, V L; Power, R M; Evans, B G

doi: 10.1136/sti.2007.027946pmid: 18003707

Sudarshi, D; Pao, D; Murphy, G; Parry, J; Dean, G; Fisher, M

doi: 10.1136/sti.2007.026963pmid: 17971369

Objective:To investigate the extent to which primary HIV infection (PHI) presents to healthcare providers and the degree to which it is unrecognised.Methods:All individuals diagnosed with having recent HIV infection between 2003 and 2005 were identified (based on the following criteria: an evolving antibody response, negative HIV test within 18 months or a serological testing algorithm for recent HIV seroconversion). Symptoms of PHI and previous presentation to other healthcare providers were ascertained from HIV clinic notes and laboratory records (a single laboratory performing all of the HIV tests in the area).Results:Of the 108 subjects, 103 (95%) were male and 93 (86%) were men who had sex with men. A total of 76 of the 108 individuals (70%) reported symptoms of seroconversion. Of these, 40 (53%) presented to a healthcare provider during the symptomatic period. Of these, 21 (52%) were diagnosed with having PHI at first presentation. In the 19 patients (48%) in which a diagnosis of having PHI was not made at first presentation, 15 were seen in primary care, 3 in accident and emergency, and 1 in genitourinary medicine (GUM).Conclusions:The diagnosis of PHI is often missed. Individuals in high-risk groups need to be informed to access healthcare when they experience symptoms of seroconversion. Non-HIV/GUM healthcare providers (especially primary care) may benefit from training in case recognition to improve rates of diagnosis.

Friedman, S R; Bolyard, M; Sandoval, M; Mateu-Gelabert, P; Maslow, C; Zenilman, J

doi: 10.1136/sti.2007.026815pmid: 17728340

Objectives:To determine infection patterns of sexually transmitted infections that facilitate HIV transmission among HIV-discordant couples.Methods:112 initial respondents were recruited in an impoverished neighbourhood of Brooklyn, New York. Their sexual (and injection) partners were recruited in up to four additional network sampling waves for a final sample of 465 persons aged 18 years or older. After separate informed consent had been obtained, blood and urine were collected and tested for HIV, type-specific antibodies to herpes simplex virus (HSV-2), syphilis, chlamydia and gonorrhoea.Results:Of 30 HIV-discordant partnerships, five were same-sex male partnerships and 25 were opposite-sex partnerships. No subjects tested positive for syphilis or gonorrhoea. Two couples were chlamydia-discordant. For HSV-2, 16 couples were double-positive, eight discordant, four double-negative, and two comprised a HSV-2-negative with a partner with missing herpes data.Conclusions:HSV-2 was present in 83% of the HIV-discordant couples, chlamydia in 7%, and syphilis and gonorrhoea in none. HSV-2 is probably more important for HIV transmission than bacterial sexually transmitted diseases because it is more widespread. Even given the limited generalisability of this community-based sample, there seems to be an important HIV-prevention role for herpes detection and prevention activities in places where HIV-infected people are likely to be encountered, including sexually transmitted disease clinics, HIV counselling and testing programmes, prisons, needle exchanges, and drug abuse treatment programmes. The effects of HSV-suppressive therapy in highly impacted groups should also be investigated.

Lyytikäinen, E; Kaasila, M; Koskela, P; Lehtinen, M; Patama, T; Pukkala, E; Tasanen, K; Surcel, H-M; Paavonen, J

doi: 10.1136/sti.2007.027409pmid: 17911135

Objectives:To study Chlamydia trachomatis seroprevalence trends and geographical distribution over time in Finland.Materials and methods:First pregnancy serum samples were retrieved from the Finnish Maternity Cohort serum bank for the subcohort of 8000 women stratified by calendar years (1983–1989, 1990–1996, 1997–2003) and age at time of sample withdrawal (14–22 and 23–28 years). C trachomatis antibodies were determined using standard major outer membrane protein peptide ELISA. The spatiotemporal variation of C trachomatis seroprevalence rates was visualised by a series of maps.Results:A decreasing C trachomatis seroprevalence trend from 1983 to 2003 was seen for both women under 23 years of age (20.8% to 10.6%) and 23–28-year-old women (19.1% to 12.5%). Constant clusters were seen around the largest cities and in eastern Finland although seroprevalence rates were generally decreasing throughout the country.Conclusions:Only a few population-based serological studies have been undertaken on C trachomatis epidemiology over time. In Finland the seroprevalence of C trachomatis is decreasing all over the country, albeit with small clusters remaining.

Rogers, S M; Miller, W C; Turner, C F; Ellen, J; Zenilman, J; Rothman, R; Villarroel, M A; Al-Tayyib, A; Leone, P; Gaydos, C; Ganapathi, L; Hobbs, M; Kanouse, D

doi: 10.1136/sti.2007.027029

Alexander, S; Ison, C

doi: 10.1136/sti.2007.026880pmid: 17855488

Background:A new variant C trachomatis (nvCT) strain has been recently isolated in Sweden, which has a 377 bp deletion in a portion of the plasmid that is the target area for some C trachomatis nucleic acid amplification tests (NAATs). Consequently, these platforms generate false negative results when presented with this strain.Objective:To determine if nvCT is present in England and Wales.Methods:Specimens which had been determined to be C trachomatis positive using an unaffected platform were tested for the presence of the deletion using an in-house nested PCR assay which generated a 253 bp fragment in new variant strains and a 630 bp fragment in wild-type strains. The specimens tested could be divided into two main groups: (a) 933 specimens sourced from patients attending both genitourinary medicine services and the National Chlamydia Screening Programme were forwarded from eight key laboratories within England and Wales; (b) 179 specimens were sourced from men who have sex with men and forwarded from 30 clinics throughout the UK.Results:A total of 1112 specimens were screened for the presence of the 377 bp deletion. An in-house PCR method showed that 1066 were wild-type strains. Forty-six strains failed to generate an amplicon and were therefore untypable. This is consistent with differences in the analytical sensitivity of different NAATs and probably reflective of low C trachomatis DNA load. No nvCT strains were identified.Conclusion:Currently, there is no evidence that nvCT is present in England and Wales. However, screening and prevalence studies are continuing and UK clinicians and microbiologists should remain vigilant for suspicious, negative results.

Creighton, S; Tariq, S; Perry, G

doi: 10.1136/sti.2007.026443pmid: 17901086

Background:Female sex workers are a heterogeneous group and recent reports of declining incidence of sexually transmitted infections (STIs) do not apply to all populations. This is an observational study of street-based sex workers attending an inner-London genitourinary (GU) clinic between 1 July 2006 and 31 January 2007.Methods:In July 2006 the local sex worker outreach project developed a weekly drop-in for street-based sex workers. From the drop-in, sex workers were fast tracked to attend a range of dedicated health services, including the GUM clinic.Results:The outreach team made contact with 120 street-based sex workers in the borough. 40 of these attended the drop-in and 25 attended the GU clinic. 8 had tuberculosis. There were frequent reports of recent recreational drug use, unprotected sex with clients and no reliable contraception. 7 were pregnant, 6 were HIV positive and 12 had positive syphilis serology. A further 17 STIs were identified.Conclusions:There was a high frequency of HIV, syphilis, other bacterial STIs and unwanted pregnancy among sex workers attending this clinic. There were considerable amounts of other physical ill health in this group, with frequently reported risky sexual behaviour. This study demonstrates the need for targeted development work to meet the multifactorial needs of these women.

Tucker, J D; Ren, X

doi: 10.1136/sti.2007.027235pmid: 18212187

Tens of thousands of commercial sex workers in China are administratively detained each year in female re-education through labor (RTL) centres for moral education and vocational training. Recent increases in syphilis and heterosexual HIV make tailored HIV prevention efforts for sex workers increasingly important in many regions of China. However, RTL centres focused on detaining commercial sex workers have not traditionally been linked to sexually transmitted infections (STI)/HIV programmes. The stigma of being incarcerated and selling sex complicates STI/HIV prevention for these women. Incarcerated sex workers represent a particularly marginalised HIV risk group that has been excluded from domestic and international HIV programmes to date. Although several laws and administrative decrees provide a legal mandate for sex worker STI/HIV testing, treatment and rights, there is still substantial variation in how laws are implemented. Creating devoted medical services and legal aid for incarcerated sex workers is important in curbing the spread of heterosexual HIV and other STIs in China. Recent legal and social developments suggest that China’s RTL system will be transformed in the near future, gaining momentum for reform that could improve the sexual and human rights of incarcerated sex workers.