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Heymans R, A Matser A, Bruisten SM, Heijman T, Geskus RB, Speksnijder AGCL, Davidovich U, de Vries HJC, Coutinho RA, Schim van der Loeff MF. Distinct Neisseria gonorrhoeae transmission networks among men who have sex with men in Amsterdam, The Netherlands. J Infect Dis 2012; 206:596-605. [PMID: 22693236 DOI: 10.1093/infdis/jis399] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Molecular typing was used to elucidate Neisseria gonorrhoeae transmission networks among men who have sex with men (MSM) in Amsterdam, the Netherlands. We determined whether clusters of patients infected with specific N. gonorrhoeae genotypes were related to various epidemiological characteristics. METHODS MSM (age ≥18 years) visiting the sexually transmitted infections (STI) clinic between July 2008 and August 2009 were eligible. After STI screening, participants completed a behavioral questionnaire concerning the previous 6 months. N. gonorrhoeae cultures were genotyped using multiple-locus variable-number tandem repeat analysis typing. RESULTS We obtained 278 N. gonorrhoeae-positive isolates from 240 MSM. Five large clusters (≥10 isolates), a unique sixth cluster (n = 9), and 8 smaller clusters (5-9 isolates) were identified. Prevalence of human immunodeficiency virus differed between clusters I and VI (P = .003), ranging from 27.8% to 100%. Receptive unprotected anal intercourse was frequently reported by MSM (51.8%) but did not differ significantly among clusters. Significant differences were identified concerning the participant's history of syphilis (P = .030), having met partners at a popular sex venue in Amsterdam (P = .048), and meeting partners outside Amsterdam (P = .036). CONCLUSIONS Distinct N. gonorrhoeae transmission networks were present in a mixed high-risk MSM population; concordance between clusters and epidemiological characteristics was present but not marked.
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Affiliation(s)
- Raymond Heymans
- Public Health Service (GGD) of Amsterdam, Cluster of Infectious Diseases, Department of Research, Postbox 2200, 1000 CE Amsterdam, The Netherlands
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Gallo P, Colucci A, Camoni L, Regine V, Luzi AM, Suligoi B. Social and behavioural characteristics of a sample of AIDS Help-Line users never tested for HIV in Italy. Eur J Public Health 2010; 21:627-31. [PMID: 20943995 DOI: 10.1093/eurpub/ckq151] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We conducted an anonymous cross-sectional telephone survey among persons who had never undergone HIV testing to determine their socio-demographic characteristics, behaviour, risk perception and reasons for not being tested. METHODS A questionnaire was administered to adult callers to the Italian National AIDS Help-Line who reported that they had never been tested for HIV. RESULTS The study sample consisted of 539 individuals. The individual who does not undergo testing is young (median age 30 years), male (85.5%), unmarried (79.0%), employed (70.1%) and with a high educational level (81.6%). More than two-thirds of the respondents had little or no perception of risk. Among persons who had more than one sexual partner, 47.0% do not use a condom. When dividing the respondents into two groups (i.e. high risk and lower risk), the results showed that the proportion of respondents with a high risk was higher among women (73.1%), among persons >35 years (76.3%) and among persons with a low educational level (77.8%). Individuals who had hadbeen seen in health-care facilities also reported high-risk behaviour. CONCLUSIONS The results indicate the socio-demographic characteristics, behaviours, risk perception and reasons for not being tested among a sample of callers to Italy's National AIDS Help-Line, and they confirm the necessity of gearing prevention activities towards heterosexuals and young adults with a low perception of risk.
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Affiliation(s)
- Pietro Gallo
- Dipartimento di Malattie Infettive, Parassitarie ed Immunomediate, Istituto Superiore di Sanità, Rome, Italy.
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van Ballegooijen WM, van Houdt R, Bruisten SM, Boot HJ, Coutinho RA, Wallinga J. Molecular sequence data of hepatitis B virus and genetic diversity after vaccination. Am J Epidemiol 2009; 170:1455-63. [PMID: 19910379 DOI: 10.1093/aje/kwp375] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The effect of vaccination programs on transmission of infectious disease is usually assessed by monitoring programs that rely on notifications of symptomatic illness. For monitoring of infectious diseases with a high proportion of asymptomatic cases or a low reporting rate, molecular sequence data combined with modern coalescent-based techniques offer a complementary tool to assess transmission. Here, the authors investigate the added value of using viral sequence data to monitor a vaccination program that was started in 1998 and was targeted against hepatitis B virus in men who have sex with men in Amsterdam, the Netherlands. The incidence in this target group, as estimated from the notifications of acute infections with hepatitis B virus, was low; therefore, there was insufficient power to show a significant change in incidence. In contrast, the genetic diversity, as estimated from the viral sequence collected from the target group, revealed a marked decrease after vaccination was introduced. Taken together, the findings suggest that introduction of vaccination coincided with a change in the target group toward behavior with a higher risk of infection. The authors argue that molecular sequence data provide a powerful additional monitoring instrument, next to conventional case registration, for assessing the impact of vaccination.
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Prevalence of infection with Neisseria gonorrhoeae or Chlamydia trachomatis in acute mucopurulent cervicitis. Arh Hig Rada Toksikol 2009; 60:197-203. [PMID: 19581214 DOI: 10.2478/10004-1254-60-2009-1916] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to determine the incidence of N. gonorrhoae (NG) and/or C. trachomatis (CT) in acute mucopurulent cervicitis (MPC). The study included 617 non-pregnant women with MPC, who had not been receiving any antimicrobial treatment. The average age of patients was 22.2 years. There were no statistically significant differences according to place of residence, education, and marital status. Samples for laboratory analysis were collected using a routine procedure; NG was identified using the cytochrome oxidase test and Gram staining. CT was isolated on McCoy cell culture and stained with Lugol solution. NG was isolated in three women (0.8%) and CT in 58 women (9.4%). Fifty-six of the CT-positive patients were nullipara and only two were unipara. All NG-positive patients were also nullipara. The mean number of sexual partners was 2.2 in all study subjects, 2.4 in CT-positive subjects, and 2.9 in NG-positive subjects. Vaginal discharge purity according to Schröder was significantly deteriorated in CT-positive patients (p=0.011). When asked about the use of contraceptives, as many as 32.7% patients answered that they did not use any protection, 39% women used the rhythm method and coitus interruptus, 20% were taking oral contraceptives, 6.1% used mechanical devices, and 1.9% used chemical protection. Previous acute and chronic pelvic inflammatory diseases correlated with MPC (p>0.01). Our statistical analysis suggests that chlamydial infection significantly reduces the purity of vaginal discharge, which is more pronounced in nulliparae. Pap smear was not specific enough to demonstrate chlamydial infection. In view of the MPC findings, the prevalence of CT and NG infection is low.
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Dodds JP, Johnson AM, Parry JV, Mercey DE. A tale of three cities: persisting high HIV prevalence, risk behaviour and undiagnosed infection in community samples of men who have sex with men. Sex Transm Infect 2007; 83:392-6. [PMID: 17472978 PMCID: PMC2659037 DOI: 10.1136/sti.2006.021782] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine the geographical variations in HIV prevalence (diagnosed and undiagnosed), use of sexual health services, sexually transmitted infections and sexual behaviour in a community sample of men who have sex with men in three cities in England, specifically London, Brighton and Manchester. METHODS Cross-sectional surveys of men visiting gay community venues in three large cities in England. Men self-completed a questionnaire and provided an anonymous oral fluid sample for HIV antibody testing. RESULTS HIV prevalence ranged from 8.6% to 13.7% in the three cities. Over one-third of HIV infection remained undiagnosed in all sites despite 69% of HIV-positive men reporting attending a genitourinary medicine clinic in the last year. Similar and high levels of risk behaviour were reported in all three cities. 18% of HIV-negative men and 37% of HIV-positive men reported unprotected anal intercourse with more than one partner in the last year. 20% of negative men and 41% of positive men reported an STI in the last year. CONCLUSIONS Across all cities, despite widespread availability of anti-retroviral treatment and national policy to promote HIV testing, many HIV infections remain undiagnosed. Data from this community sample demonstrate high levels of risk behaviour and STI incidence, especially among those who are HIV positive. Renewed efforts are needed to increase diagnosis and to reduce risk behaviour to stem the continuing transmission of HIV.
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Affiliation(s)
- Julie P Dodds
- Department of Primary Care and Population Science, Centre for Sexual Health & HIV Research, University College London, Mortimer Market Centre, Mortimer Market, London, UK.
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Ghosn J, Deveau C, Goujard C, Garrigue I, Saïchi N, Galimand J, Nagy Z, Rouzioux C, Meyer L, Chaix ML. Increase in hepatitis C virus incidence in HIV-1-infected patients followed up since primary infection. Sex Transm Infect 2006; 82:458-60. [PMID: 16923739 PMCID: PMC2563871 DOI: 10.1136/sti.2006.021493] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND An increase in the incidence of sexually transmitted infections and hepatitis C virus (HCV) infections in HIV-infected men who have sex with men (MSM) has recently been reported. OBJECTIVE To estimate HCV incidence and risk factors among HIV-1-infected patients followed up since primary HIV infection in the French PRIMO Cohort between 1996 and 2005. PATIENTS AND METHODS All patients with at least 18 months of follow-up were studied. HCV antibody tests were performed on baseline plasma samples and repeated on the latest available sample when negative at baseline. RESULTS In total, 402 patients with a median follow-up of 36 (range 18-104) months were eligible. HCV seroconversion was observed in 6 patients (4 men and 2 women), corresponding to an HCV incidence rate of 4.3 per 1000 person-years. Incidence rates in men and women were 3.5 and 7.8 per 1000 person-years, respectively. The incidence rate was 1.2 per 1000 person-years before January 2003 and 8.3 per 1000 person-years after January 2003 (p = 0.06). The classic risk factors for HCV infection were found in women (intravenous drug use, and body piercing), whereas the only identified risk factor for HCV acquisition was unsafe sex in the four men. CONCLUSIONS Increase in the incidence of acute HCV infection in recently HIV-infected patients confirms the shift in sexual behaviour in the recent years, especially in HIV-infected MSM. Repeated testing for HCV antibodies should be carried out in HCV-negative HIV-infected patients and specific recommendations about protected sex should be clearly provided.
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Affiliation(s)
- J Ghosn
- Laboratoire de Virologie, EA MRT 3620, Université René Descartes Paris5, CHU Necker-Enfants Malades, 149 Rue de Sèvres, 75015 Paris, France.
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Sethi G, Holden BM, Gaffney J, Greene L, Ghani AC, Ward H. HIV, sexually transmitted infections, and risk behaviours in male sex workers in London over a 10 year period. Sex Transm Infect 2006; 82:359-63. [PMID: 16916883 PMCID: PMC2563850 DOI: 10.1136/sti.2005.019257] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To describe changing characteristics of men who sold sex in London between 1994 and 2003. METHODS A baseline survey of 823 male sex workers attending a specialist clinic, plus follow up of 628 men for 1379 person years. RESULTS Men recruited earlier (1994 to 1996) were more likely than those recruited later (2000 to 2003) to be UK born and to self define as homosexual. Later recruits included more men from South/Central America and eastern Europe and a higher proportion reported regular female partners. Baseline prevalence of HIV was 9% (59/636), and multivariate analysis showed an associated with injecting drug use and unprotected sex with a casual partner. During follow up there were 49 incident cases of HIV. Survival analysis showed earlier recruitment (1994-6) to be associated with a higher incidence of HIV. The prevalence of gonorrhoea increased over time. CONCLUSIONS Men who sell sex are at risk of HIV and other STIs, but these risks do not appear to be directly linked to sex work. The changing demographics of these men is associated with different patterns of infection and poses challenges for service delivery.
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Affiliation(s)
- G Sethi
- Department of Genitourinary Medicine, St Mary's NHS Trust, Lambeth Palace Road London SE1, UK.
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Abraham S, Toutous-Trellu L, Pechère M, Hugonnet S, Liassine N, Yerly S, Rohner P, Ninet B, Hirschel B, Piguet V. Increased Incidence of Sexually Transmitted Infections in Geneva, Switzerland. Dermatology 2006; 212:41-6. [PMID: 16319473 DOI: 10.1159/000089021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Accepted: 05/23/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Focal outbreaks of sexually transmitted infections (STIs) such as syphilis and gonorrhoea have been reported in the large cities of Western Europe over the past few years. The aim of our study was to determine whether a similar trend is observed in Geneva and the situation with regard to HIV infection. METHODS We review the incidence of syphilis, gonorrhoea, Chlamydia trachomatis and HIV in Geneva from 1999 to 2004. RESULTS Figures indicate a steady and sustained increase in the incidence of syphilis, gonorrhoea and Chlamydia trachomatis in Geneva since 1999 that is maintained into 2004. As for HIV, the number of positive testings in Switzerland has stabilised and primary infection figures do not indicate an increase in newly acquired infections in Geneva. CONCLUSION The situation in Geneva is similar to that observed elsewhere in Western Europe and indicates the need of public health interventions.
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Affiliation(s)
- Shahnaz Abraham
- Department of Dermatology and Venereology, University Hospital of Geneva, Geneva, Switzerland
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Borgia P, Marinacci C, Schifano P, Perucci CA. Is peer education the best approach for HIV prevention in schools? Findings from a randomized controlled trial. J Adolesc Health 2005; 36:508-16. [PMID: 15901516 DOI: 10.1016/j.jadohealth.2004.03.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2003] [Accepted: 03/04/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the effectiveness of peer education when compared to teacher-led curricula in AIDS prevention programs conducted in schools in Rome, Italy. METHODS Eighteen high schools were randomly assigned to one of two prevention programs: one led by teachers and the other by peer leaders. A sample of students attending the last 2 years (n = 1295) completed pre and post-intervention questionnaires. Changes in sexual behaviors, knowledge, prevention skills, risk perception and attitudes were first evaluated within each intervention group. Afterwards, changes in knowledge, prevention skills, risk perception, and attitudes total scale scores (post-test scores minus pre-test scores) were compared between the two groups, through linear regression models, in order to control for confounders, taking into account the within-school correlation in score changes. As for sexual behaviors, number of sexual partners and frequency of condom use in the 3 months before post-test were compared by intervention group through ordinal regression models, also taking into account behaviors reported before pre-test. RESULTS For both groups, we observed significant improvements in skills, knowledge, attitudes and risk perception. The peer-led group showed a 6.7% (95% C.I. 1.9-11.5) scores greater improvement in knowledge, compared to the teacher-led group. In neither group were improvements observed in condom use or number of sexual partners. CONCLUSIONS The only apparent benefit of the peer-led intervention, compared to that led by teachers, was a greater improvement in knowledge of HIV. Neither of the interventions induced changes in sexual behavior. However, the role of possible biases and methodological problems must be considered when interpreting these results.
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Fenton KA, Mercer CH, Johnson AM, Byron CL, McManus S, Erens B, Copas AJ, Nanchahal K, Macdowall W, Wellings K. Reported sexually transmitted disease clinic attendance and sexually transmitted infections in britain: prevalence, risk factors, and proportionate population burden. J Infect Dis 2005; 191 Suppl 1:S127-38. [PMID: 15627223 DOI: 10.1086/425286] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND We examined attendance at sexually transmitted disease (STD) clinics and the prevalence, distribution, and associated demographic and behavioral factors of self-reported sexually transmitted infections (STIs) in a population survey of sexual attitudes and lifestyles. METHODS We analyzed data from stratified probability sample surveys obtained through the British National Surveys of Sexual Attitudes and Lifestyles (Natsal), which was undertaken in 1990 (n=13,765) and 2000 (n=11,161) among men and women aged 16-44 years. National STD surveillance data for 1999 were used to determine disease- and risk factor-specific proportionate population burden (PPB). RESULTS Between 1990 and 2000, the number of subjects who reported having attended an STD clinic during the past 5 years increased from 4.3% to 7.6% among men and from 3.3% to 6.6% among women. In 2000, 3.0% of men and 4.0% of women reported having received a diagnosis of an STI during the past 5 years; 77.6% of men and 60.3% of women with an STI had attended an STD clinic. Reported STI acquisition was independently associated with age, increasing numbers of sex partners, male homosexual partners, and partners from abroad (for women only). Of all reported STIs during the past 5 years (PPB, 10.2%), 10.2% were reported by the 2.9% of men who reported having had homosexual partners during the past 5 years. Of all reported STIs in the past 5 years (PPB, 41.6%), 41.6% were reported by the 4.0% of women who reported having > or =10 sex partners during that time. Analysis of national STI surveillance data showed that the PPB for new episodes of Chlamydia trachomatis diagnosed among homosexual men was 2.8%, that for gonorrhea was 17.4%, and that for syphilis was 32.1%. CONCLUSIONS Numbers and types of sexual partnerships remain the dominant individual and population risk factors for STI acquisition. Combined population behavior and surveillance data demonstrate the high PPB for STIs attributable to key risk factors. PPB may be a useful indicator of epidemic "phase" and may help target resources and guide prevention strategies.
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Affiliation(s)
- Kevin A Fenton
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK.
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Hamers FF, Downs AM. The changing face of the HIV epidemic in western Europe: what are the implications for public health policies? Lancet 2004; 364:83-94. [PMID: 15234861 DOI: 10.1016/s0140-6736(04)16594-x] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this review, we describe changes in dynamics of HIV transmission and shifts in affected populations in western Europe using HIV/AIDS surveillance data and published and unpublished reports. Despite substantial reductions in HIV-related morbidity and mortality since the introduction of highly active antiretroviral treatment, HIV continues to pose a major public health problem in western Europe. More than half a million people are living with an infection that remains incurable and requires costly lifelong treatment; many people remain unaware of their infection, and thousands of new infections continue to occur every year. Migrants from countries with a high prevalence of HIV/AIDS, notably sub-Saharan Africa, bear a disproportionate and increasing share of HIV throughout western Europe and, in most countries, account for the majority of heterosexually acquired HIV infections diagnosed in recent years. Prevention, treatment, and care must be adapted to reach migrant populations. Following a resurgence of risky sexual behaviour, HIV transmission may now be increasing among homosexual and bisexual men, and renewed safer sex campaigns are urgently needed.
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Affiliation(s)
- Françoise F Hamers
- EuroHIV, Department of Infectious Diseases, Institut de Veille Sanitaire, 12 rue du Val d'Osne, 94415 Saint-Maurice, France.
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Ghosn J, Pierre-François S, Thibault V, Duvivier C, Tubiana R, Simon A, Valantin MA, Dominguez S, Caumes E, Katlama C. Acute hepatitis C in HIV-infected men who have sex with men. HIV Med 2004; 5:303-6. [PMID: 15236621 DOI: 10.1111/j.1468-1293.2004.00225.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) is usually transmitted via the parenteral route, but there are widely discrepant findings on its possible sexual transmission. Thus there are no recommendations concerning protected sex for couples in which only one partner is HCV-infected. Whether HIV or other sexually transmitted diseases could favour HCV transmission remains unclear, but recent data suggesting an increasing incidence of acute HCV in HIV-infected men underline the major public health implications of this issue. CASE REPORTS Between June 2002 and July 2003, five HIV-infected homosexually active men presented with primary (n=4) and secondary (n=1) syphilis and concomitant abnormal liver function tests revealing acute asymptomatic HCV seroconversion. Other causes of acute viral hepatitis were inquired into and excluded. Highly at-risk sexual behaviour, including unprotected anal intercourse and unsafe oral sex, with concomitant syphilis, was found to be the only identifiable important risk factor for transmission of HCV. CONCLUSIONS Sexual transmission may be fuelling a significant increase in HCV seroconversions among HIV-infected men who have highly risky sexual behaviours. Given the recent data suggesting the spread of sexually transmitted infections among HIV-infected gay men, specific recommendations concerning safe sex are urgently needed.
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Affiliation(s)
- J Ghosn
- Département des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Pitié-Salpétrière, Paris, France.
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Abstract
OBJECTIVE The objectives of this study were to monitor epidemiologic trends in Neisseria gonorrhoeae (NG) infections and to assess antimicrobial resistance patterns of NG. METHODS RENAGO, a voluntary-based laboratory surveillance system, including private and public laboratories, was set up in France in 1986. Every NG strain isolated by the participating laboratories was sent to the National Reference Center, Institut Alfred Fournier, Paris, where susceptibility to 6 antibiotics was tested. These laboratories reported monthly numbers of positive NG isolates and associated epidemiologic data. Because the number of laboratories varied every year, the average number of NG isolates per laboratory per year was computed to monitor annual trends in gonorrhea incidence. RESULTS The average number of NG isolated per laboratory per year decreased steadily from 10.6 in 1986 to 0.6 in 1997 but then yearly increased and reached 1.9 in 2000. Increasing gonorrhea was observed mostly in men and in the Paris area. The proportion of rectal strains increased significantly from 0.9% in 1986 to 9.2% in 2000. From 1998 to 2000, 5.3% of the isolates had reduced susceptibility or were resistant to ciprofloxacin, 7.3% were PPNG strains and 27.4% were resistant to tetracycline, 18.5% had a reduced susceptibility to thiamphenicol, and 1 strain was resistant to the latter. Neither strain was resistant to ceftriaxone or to spectinomycin. CONCLUSION From 1998 to 2000, gonorrhea markedly increased in France and seemed to affect mainly gay men in Paris, which suggests relapses to risky sexual behaviors and highlights the need for strengthening prevention. During the same period, NG ciprofloxacin resistance has sharply increased and should be carefully monitored because of the wide use of ciprofloxacin single-dose treatment.
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Affiliation(s)
- Magid Herida
- Infectious Diseases Department, Institut de Veille Sanitaire, Saint-Maurice, France.
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Stolte IG, Dukers NHTM, Geskus RB, Coutinho RA, de Wit JBF. Homosexual men change to risky sex when perceiving less threat of HIV/AIDS since availability of highly active antiretroviral therapy: a longitudinal study. AIDS 2004; 18:303-9. [PMID: 15075549 DOI: 10.1097/00002030-200401230-00021] [Citation(s) in RCA: 191] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate longitudinally the association between highly active antiretroviral therapy (HAART)-related beliefs and the change from protected to unprotected anal intercourse with casual partners on an individual level. METHODS The study population included 217 HIV-negative homosexual men participating in the Amsterdam Cohort Study from September 1999 to May 2002, including five data waves with a 6-month interval. The selection criteria were: being under 31 years of age, having had anal sex with casual partners in the preceding 6 months, and participating in at least two data waves. Information was collected on the individual change from protected to unprotected receptive anal intercourse (URAI) and unprotected insertive anal intercourse (UIAI) and the level of agreement with different HAART-related beliefs. RESULTS The majority of men disagreed with the three treatment-belief factors that resulted from the principal component analysis: perceiving less HIV/AIDS threat since HAART, perceiving less need for safe sex since HAART, and perceiving high effectiveness of HAART in curing HIV/AIDS. Multivariate analyses revealed that the more men inclined to agree with the belief 'perceiving less HIV/AIDS threat', the more likely they were to change to URAI (adjusted OR 1.60; 95% CI 1.16-2.22). CONCLUSION Homosexual men are quite realistic about the effectiveness of HAART, the continued need for condom use, and the HIV/AIDS threat since HAART. However, a tendency towards agreement with 'perceiving less HIV/AIDS threat' was found to predict an individuals' change to URAI. This finding supports the hypothesis of a causal relationship between decreased HIV/AIDS threat since HAART and a change to URAI.
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Affiliation(s)
- Ineke G Stolte
- Cluster of Infectious Diseases, HIV and STI Research, Municipal Health Service, Amsterdam, The Netherlands.
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Murphy G, Charlett A, Jordan LF, Osner N, Gill ON, Parry JV. HIV incidence appears constant in men who have sex with men despite widespread use of effective antiretroviral therapy. AIDS 2004; 18:265-72. [PMID: 15075544 DOI: 10.1097/00002030-200401230-00016] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the trend in HIV incidence between 1995 and 2001 in men who have sex with men (MSM) attending sexually transmitted infection (STI) clinics in the UK. DESIGN The Serological Testing Algorithm for Recent HIV Seroconversion (STARHS) was applied to serum specimens from MSM attending 15 STI clinics collaborating in an HIV unlinked anonymous prevalence serosurvey. METHODS STARHS was performed on anti-HIV-1 positive specimens and HIV incidence rates determined. Specimens from MSM with previously diagnosed HIV or an AIDS defining condition were excluded. National data on uptake of antiretroviral therapy (ART), AIDS mortality and diagnoses of gonorrhoea in MSM were used to aid interpretation of the HIV incidence findings. RESULTS Of 43,100 specimens collected from MSM 3565 were anti-HIV-1 positive. Of these, 1645 were eligible and available for STARHS testing, of which 317 were deemed to come from recently acquired infections. The overall estimated annual incidence ranged from 1.5% (1999) to 3.3% (1996). In 2001 it was 2.45%, with a 3.1% incidence in London and 1.0% elsewhere. No significant trends in HIV incidence were found. CONCLUSIONS Despite the widespread use of ART there was no significant decline in HIV incidence. Individuals whose HIV infection has been diagnosed should be less infectious. However, over 20% of infections in MSM remain undiagnosed, many with acute STI, and this pool of unmanaged HIV infection may be an important driver of the ongoing epidemic. Initiatives to diagnose and treat a greater proportion of HIV infections may be the key to reducing HIV incidence in MSM.
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Affiliation(s)
- Gary Murphy
- Sexually Transmitted and Blood Borne Virus Laboratory, Health Protection Agency Specialist and Reference Microbiology Division, London, UK
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Desquilbet L, Deveau C, Goujard C, Hubert JB, Derouineau J, Meyer L. Increase in at-risk sexual behaviour among HIV-1-infected patients followed in the French PRIMO cohort. AIDS 2002; 16:2329-33. [PMID: 12441806 DOI: 10.1097/00002030-200211220-00014] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE With the current increase in sexually transmitted infections in industrialized countries, we assessed the characteristics and plasma viral load of HIV-1-infected patients reporting sexual behaviour at risk for HIV transmission (SBR). DESIGN The study population consisted of 223 patients with primary HIV-1 infection who were enrolled in the French PRIMO cohort between 1996 and 2001 and who had at least 3 months of follow-up. Patients were interviewed on condom use at each visit according to the partner (gender, steady versus casual nature, and HIV serostatus). SBR was defined as unprotected sex with partners of unknown or negative HIV serostatus. RESULTS Sixty-one SBR were reported by 43 patients. SBR with casual partners increased from 5.1% in 1998 to 21.1% in 2001-2002, after a fall between 1997 and 1998. Reporting of SBR was more frequent among patients with casual partners, those with asymptomatic or briefly (< or = 15 days) symptomatic primary infection, and those who had developed clinical lipodystrophy or signs of anxiety/depression. Eighty-six per cent of patients reporting SBR had previously initiated highly active antiretroviral therapy (HAART); plasma viral load was above the detection limit (200/500 copies/ml) in 41% of visits reporting an SBR. Viral load was similar in patients reporting SBR and other patients, suggesting that the patient's knowledge of his/her response to HAART was not a major determinant of subsequent SBR. CONCLUSION Our results confirm the recent increase in unsafe sex observed among HIV-infected individuals in industrialized countries. Levels of viral load of these individuals raise concern about the potential for re-emerging HIV epidemics.
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Affiliation(s)
- Loïc Desquilbet
- Service d'Epidémiologie - INSERM U 569, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
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Stolte IG, Coutinho RA. Risk behaviour and sexually transmitted diseases are on the rise in gay men, but what is happening with HIV? Curr Opin Infect Dis 2002; 15:37-41. [PMID: 11964904 DOI: 10.1097/00001432-200202000-00007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Increases in sexually transmitted diseases and sexual risk behaviour among men who have sex with men in the Western world have raised concern with regard to the HIV/AIDS epidemic in this group. The aim of this review is to give an overview of possible explanations for these alarming increases and to indicate what impact they might have on this epidemic.
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Affiliation(s)
- Ineke G Stolte
- Cluster of Infectious Diseases, AIDS Research, Municipal Health Service Amsterdam, Nieuwe Achtergracht 100, PO Box 2200, 1000 CE Amsterdam, The Netherlands
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Abstract
Two patients with alopecia syphilitica are presented. Moth-eaten alopecia is the most typical look of secondary syphilis on the scalp. With the decrease in syphilis cases in western countries, this rarer clinical manifestation tends to be misdiagnosed.
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Affiliation(s)
- A Friedli
- Department of Dermatology, DHURDV, University Hospital of Geneva, Switzerland
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Nicoll A, Hughes G, Donnelly M, Livingstone S, De Angelis D, Fenton K, Evans B, Gill ON, Catchpole M. Assessing the impact of national anti-HIV sexual health campaigns: trends in the transmission of HIV and other sexually transmitted infections in England. Sex Transm Infect 2001; 77:242-7. [PMID: 11463922 PMCID: PMC1744349 DOI: 10.1136/sti.77.4.242] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the impact of the sexual component of AIDS and HIV campaigns on transmission of HIV and other sexually transmitted infections (STIs). DESIGN Comparison of time series data. SETTING England, 1971-1999. OUTCOME MEASURES HIV transmission and diagnoses among men who have sex with men (MSMs), rates of attendances and specific STI diagnoses (per 100 000 total population) at genitourinary medicine (GUM) clinics. RESULTS Awareness of AIDS and campaigns in 1983-4 among homosexual men coincided with substantial declines in transmission of HIV and diagnoses of syphilis among MSMs. During general population campaigns in 1986-7 new GUM clinic attendances requiring treatment fell by 117/10(5) in men and 42/10(5) in women. Rates for gonorrhoea fell by 81/10(5) and 43/10(5) and genital herpes by 6/10(5) and 4/10(5), respectively. Previous rises in genital wart rates were interrupted, while rates of attendances not requiring treatment (the "worried well") increased by 47/10(5) and 58/10(5) for men and women, respectively. Since 1987 diagnoses of HIV among MSMs have not declined, averaging 1300-1400 annually. Following a period of unchanging rates there have been substantial increases in GUM attendances requiring treatment, notably for gonorrhoea, syphilis, and viral STIs since 1995. CONCLUSIONS Self help initiatives and awareness among homosexual men in 1983-4 contributed significantly to a fall in HIV transmission among MSMs, and the general campaigns of 1986-7 were associated with similar effects on all STI transmission. Both effects seem to have occurred through changing sexual behaviour, and probably contributed to the UK's low national HIV prevalence. Bacterial STI incidence has increased significantly since 1995 and there is no evidence that recent prevention initiatives have reduced HIV transmission among MSMs, hence sexual health initiatives need to be comprehensively reinvigorated in England.
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Affiliation(s)
- A Nicoll
- HIV and STI Division, Communicable Disease Surveillance Centre, London NW9 5EQ, UK.
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Stolte IG, Dukers NH, de Wit JB, Fennema JS, Coutinho RA. Increase in sexually transmitted infections among homosexual men in Amsterdam in relation to HAART. Sex Transm Infect 2001; 77:184-6. [PMID: 11402225 PMCID: PMC1744315 DOI: 10.1136/sti.77.3.184] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We investigated if a rise in rectal gonorrhoea and early syphilis among men who have sex with men (MSM) in Amsterdam coincided with the introduction of highly active antiretroviral therapies (HAART) in July 1996 and determined risk factors for these sexually transmitted infections (STI). METHODS Subjects were patients of the STI clinic of the municipal health service in Amsterdam. Surveillance data (1994-9) represented consultations (n=11 240) of MSM (n=6103). For analyses we used logistic regression. RESULTS Comparing the periods before and after the introduction of HAART, the infection rate for rectal gonorrhoea increased from 4% to 5.4% (p=.001) and for syphilis, from 0.5% to 0.8% (p = 0.050). Independent risk factors for rectal gonorrhoea (younger age, western nationality, and concurrent infection with another STI) and for early syphilis (non-western nationality and concurrent infection with rectal gonorrhoea) did not change after HAART became available. For rectal gonorrhoea, however, the infection rate increased only among men who had exclusively homosexual contacts (OR 1.38, p<0.01), compared with bisexual men. For early syphilis, the infection rate increased only among men of western nationality (OR 3.38, p<0.01) compared to men of non-western nationality. CONCLUSIONS Infection rates of rectal gonorrhoea and early syphilis increased, indicating a change in sexual behaviour, possibly as a result of the introduction of HAART. For now, it is important to find out how sexual behaviour is changing and to keep monitoring trends in STIs (including HIV) among MSM in Amsterdam.
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Affiliation(s)
- I G Stolte
- Division of Public Health and Environment, Municipal Health Service Amsterdam, The Netherlands.
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Affiliation(s)
- N Dupin
- Service de Dermato-Vénéréologie, Dispensaire Anti-vénérien, Hôpital Tarnier-Cochin, Paris, France
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