Risk factors predictive of sexually transmitted infection diagnosis in young compared to older patients attending sexually transmitted diseases clinics

Case Report: Resolution of high grade anal squamous intraepithelial lesion with antibiotics proposes a new role for syphilitic infection in potentiation of HPV-associated ASCC

Introduction

Human Papillomavirus (HPV) is the primary risk factor for the development of anal intraepithelial neoplasia (AIN) and is a leading risk factor for anogenital squamous cell carcinoma (ASCC). Despite common shared risk factors for both HPV and syphilis, co-infection is not well documented, and the role of syphilitic infection in HPV-associated AIN and ASCC potentiation is not defined.

Case description/methods

A 72-year-old single male presented with complaints of mild rectal pain and intermittent rectal bleeding. A flexible sigmoidoscopy was performed, and a firm 4.5cm x 3cm perianal mass was detected and superficially biopsied. Pathology findings demonstrated evidence of a high grade squamous intraepithelial lesion (HGSIL, AIN II/III/AIS) with viral cytopathic effect, consistent with HPV infection. Much of the biopsied lesion showed acanthotic squamous mucosa with intraepithelial neutrophils and abundant submucosal plasma cells, suggesting possible syphilitic involvement. Subsequent immunohistochemical staining for p16 as a surrogate marker for HPV was positive, as was an immunohistochemical stain for spirochetes, supportive of co-infection with Treponema pallidum pallidum (T. pallidum), the causative agent in venereal syphilis. The patient was referred to an infectious disease specialist for syphilitic infection and was treated with penicillin with surprisingly complete resolution of the lesion. EUAs were performed 2- and 3-months following treatment without lesion recurrence. However, one year following diagnosis, a flexible sigmoidoscopy revealed a 5 mm recurrent HPV-related low-grade AIN 1 lesion at the dentate line.

Discussion

Resolution of the lesion by antibiotic treatment for syphilitic infection suggested that co-infection by T. pallidum may potentiate HPV-associated squamous cell carcinoma based on histological findings. Findings from this case, as well as a review of bacterial involvement and potentiation in various cancers, are reviewed here. Such findings offer new insight regarding the role of STI-associated bacteria and HPV co-infection in the establishment of AIN and may additionally propose new treatment modalities for ASCC.

Sexually Transmitted Diseases among Saudi Women: Knowledge and Misconceptions

The rate of sexually transmitted diseases is increasing globally. Thus, this study aimed to examine the Al akami female community's knowledge about the nature of sexually transmitted diseases and their associated factors. The STDs-Knowledge Questionnaire (STDs-KQ) was utilized to collect data from the female community (355) in Jeddah, Saudi Arabia. The data were analyzed using JMP Statistics for Windows, version 15. The significance level was set at 0.05. The study reported that participants had a relatively low understanding of STDs in acquisition, protection, prevention, and clinical signs and symptoms; only 33 (9%) had high knowledge scores (10-18), while 70% thought one virus caused all forms of STDs. Also, only 15% of the respondents knew the clinical features of the Chlamydia infection, and 18% identified the correct mode of its transmission. Also, older participants with clinical exposure had a higher knowledge score than young and single females, p < 0.05. A positive correlation between age and knowledge score was reported, r (354) = 0.339, p < 0.0001. The low knowledge scores were associated with marital status, age, and clinical exposure. Practical strategies to minimize literacy toward sexual education and increase the quality of sexual life must be promoted by educators and the academic curriculum.

Tubal factor infertility and its impact on reproductive freedom of African American women

In the past, the reproductive freedom of African American women was hindered by forced reproduction and sterilization campaigns. Unfortunately, these involuntary practices have now mostly been replaced by inequality because of disproportionate tubal factor infertility rates within African American communities. Our work aimed to describe the inequities in increased rates of pelvic inflammatory disease and tubal factor infertility as it relates to African American women. In addition, we highlighted the need for improved access to screening and treatment of sexually transmitted infections, access to barrier contraception, and health literacy related to the understanding and prevention of tubal factor infertility in African American women.