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Miao L, Xu L, Wang M, Xiong F, Zou L, Zhang Y, Weng M, Zeng H. Study on the influence of syphilis on the outcome of frozen-thawed embryo transfer in infertility patients. Heliyon 2024; 10:e29342. [PMID: 38628734 PMCID: PMC11019224 DOI: 10.1016/j.heliyon.2024.e29342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024] Open
Abstract
Objective In this study, the effect of in vitro Fertilization-Embryo Transfer (IVF-ET) on the clinical outcome of patients with syphilis infertility during resuscitation cycle. Methods A retrospective single-center method was adopted. This study included 4430 pairs of infertile patients who underwent syphilis detection. The influence of the syphilis freeze-thaw embryos transplantation outcome was studied in the patients with infertility by comparing the general clinical characteristics of patients (age, years of infertility, body mass index (BMI), basal follicle stimulating hormone (FSH), serum basal estradiol (Estradiol, E2), transplanted intimal thickness, the number of embryos transferred) and the clinical pregnancy (biochemical pregnancy rate, clinical pregnancy rate, implantation rate, live birth rate and abortion rate). Results Firstly, in the clinical outcome of one frozen-thawed embryos transfer, the live birth rate of the woman's syphilis-infected group was lower than that of the uninfected group (71.3 % vs. 50.0 %), while the abortion rate was higher than that of the uninfected group (7.8 % vs. 26.7 %), and there was a statistical difference (P < 0.05), and there was no statistical difference in other indicators between other groups (P > 0.05). Secondly, in the clinical outcome of two frozen-thawed embryos transfers, the biochemical pregnancy rate (61.3 % vs. 28.6 %) and clinical pregnancy rate (42.9 % vs. 14.3 %) of the group which was infected with syphilis alone were lower than those of the uninfected group (P < 0.05), and other indicators among the other groups showed no statistical difference (P > 0.05). Thirdly, in the clinical outcomes of frozen-thawed embryos transfer three times or more, there was no significant difference in the clinical indicators between the syphilis infertility patients and the non-infected infertility patients (P > 0.05). Conclusion When the syphilis infertility patients and the non-infected infertile patients underwent IVF-ET treatment for the first time, the live birth rate and abortion rate of the syphilis group were significantly different (P < 0.05). In the outcome of two transplants, the biochemical pregnancy rate and clinical Pregnancy rates were significantly reduced so patients with syphilis infertility who undergo IVF-ET should be informed about the risk of adverse clinical outcomes.
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Affiliation(s)
- Lixia Miao
- Wuxi Maternity and Child Health Care Hospital, Affiliated Women’s Hospital of Jiangnan University, Wuxi, 214002, Jiangsu, China
| | - Lishuang Xu
- Wuxi Maternity and Child Health Care Hospital, Affiliated Women’s Hospital of Jiangnan University, Wuxi, 214002, Jiangsu, China
| | - Min Wang
- Wuxi Maternity and Child Health Care Hospital, Affiliated Women’s Hospital of Jiangnan University, Wuxi, 214002, Jiangsu, China
| | - Fang Xiong
- Wuxi Maternity and Child Health Care Hospital, Affiliated Women’s Hospital of Jiangnan University, Wuxi, 214002, Jiangsu, China
| | - Lian Zou
- Wuxi Maternity and Child Health Care Hospital, Affiliated Women’s Hospital of Jiangnan University, Wuxi, 214002, Jiangsu, China
| | - Yun Zhang
- Wuxi Maternity and Child Health Care Hospital, Affiliated Women’s Hospital of Jiangnan University, Wuxi, 214002, Jiangsu, China
| | - Meiling Weng
- Wuxi Maternity and Child Health Care Hospital, Affiliated Women’s Hospital of Jiangnan University, Wuxi, 214002, Jiangsu, China
| | - Huiming Zeng
- Wuxi Maternity and Child Health Care Hospital, Affiliated Women’s Hospital of Jiangnan University, Wuxi, 214002, Jiangsu, China
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Qquellon J, Vargas SK, Eguiluz M, Vasquez F, Durand D, Allan-Blitz LT, Konda KA, Ochoa TJ, Caceres CF, Klausner JD. Extra-genital Neisseria gonorrhoeae infections with genetic mutations conferring ciprofloxacin resistance among men who have sex with men and transgender women in Lima, Peru. Int J STD AIDS 2023; 34:245-250. [PMID: 36637128 PMCID: PMC9950594 DOI: 10.1177/09564624221147326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/07/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND The increasing prevalence of drug-resistant Neisseria gonorrhoeae (NG) infections has caused great concern. Ciprofloxacin remains the empiric antimicrobial recommended to treat NG infections in Peru disregarding the susceptibility profile of circulating NG strains. We report the prevalence of individuals infected with NG strains presenting mutations in the gyrA gene that confers ciprofloxacin resistance. METHODS We conducted a descriptive study assessing extragenital swab samples collected from a cohort of men who have sex with men and transgender women in Lima, Peru. Anal and pharyngeal NG positive swabs for Aptima Combo 2 assay (Hologic Inc., USA) were used for DNA extraction. We performed TaqMan real time PCR assays to detect a point mutation at codon Ser91 of the gyrase A (gyrA) gene. RESULTS From 156 individuals who had at least one positive sample for NG reported by the Aptima assay, 80 individuals had at least one amplified DNA for the gyrA gene. We found that 67 of them (84.0%) were infected with a gyrA-mutated NG strain at the Ser91 codon. CONCLUSIONS We report a high prevalence of gyrA mutation conferring ciprofloxacin resistance among individuals with extragenital NG infection. Empirical treatment of NG needs to be urgently updated in Peru in concordance with international guidelines.
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Affiliation(s)
- Jazmin Qquellon
- Center for Interdisciplinary
Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - Silver K Vargas
- Center for Interdisciplinary
Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano
Heredia, Lima, Peru
- School of Public Health and
Administration, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - Maria Eguiluz
- Center for Interdisciplinary
Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - Francesca Vasquez
- Center for Interdisciplinary
Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - David Durand
- Instituto de Medicina Tropical
“Alexander Von Humboldt”, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - Lao-Tzu Allan-Blitz
- Division of Global Health Equity,
Department of Medicine, Brigham and Women’s
Hospital, Boston, MA, USA
| | - Kelika A Konda
- Center for Interdisciplinary
Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano
Heredia, Lima, Peru
- Division of Infectious Diseases,
David Geffen School of Medicine, University of
California, Los Angeles, CA, USA
| | - Theresa J Ochoa
- Instituto de Medicina Tropical
“Alexander Von Humboldt”, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - Carlos F Caceres
- Center for Interdisciplinary
Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - Jeffrey D Klausner
- Department of Population and Public
Health Sciences, Keck School of Medicine, University of Southern
California, Los Angeles, CA, USA
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Kojima N, Siebert JC, Maecker H, Rosenberg-Hasson Y, Leon SR, Vargas SK, Konda KA, Caceres CF, Klausner JD. The Application of Cytokine Expression Assays to Differentiate Active From Previously Treated Syphilis. J Infect Dis 2021; 222:690-694. [PMID: 32189000 DOI: 10.1093/infdis/jiaa127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/17/2020] [Indexed: 01/05/2023] Open
Abstract
To investigate the role of serum cytokine assays to distinguish between active from treated syphilis among serofast patients, we recruited individuals into a prospective cohort study. Participants underwent routine syphilis screening. We selected specimens from a majority cohort of serofast participants with treated and active syphilis. We analyzed specimens with a 62-cytokine multiplex bead-based enzyme-linked immunosorbent assay. Cytokines, brain-derived neurotrophic factor and tumor necrosis factor β, were most predictive. We built a decision tree that was 82.4% accurate, 100% (95% confidence interval, 82%-100%) sensitive, and 45% (18%-75%) specific. Our decision tree differentiated between serum specimens from serofast participants with treated syphilis versus active syphilis.
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Affiliation(s)
- Noah Kojima
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | | | - Holden Maecker
- Human Immune Monitoring Center, Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, California, USA
| | - Yael Rosenberg-Hasson
- Human Immune Monitoring Center, Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, California, USA
| | - Segundo R Leon
- School of Medical Technology, Universidad Privada San Juan Bautista, Lima, Peru
| | - Silver K Vargas
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kelika A Konda
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos F Caceres
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, Peru
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Osias E, Hung P, Giacani L, Stafylis C, Konda KA, Vargas SK, Reyes-Díaz EM, Comulada WS, Haake DA, Haynes AM, Caceres CF, Klausner JD. Investigation of syphilis immunology and Treponema pallidum subsp. pallidum biology to improve clinical management and design a broadly protective vaccine: study protocol. BMC Infect Dis 2020; 20:444. [PMID: 32576149 PMCID: PMC7309211 DOI: 10.1186/s12879-020-05141-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/08/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The syphilis epidemic continues to cause substantial morbidity and mortality worldwide, particularly in low- and middle-income countries, despite several recent disease control initiatives. Though our understanding of the pathogenesis of this disease and the biology of the syphilis agent, Treponema pallidum subsp. pallidum has improved over the last two decades, further research is necessary to improve clinical diagnosis and disease management protocols. Additionally, such research efforts could contribute to the identification of possible targets for the development of an effective vaccine to stem syphilis spread. METHODS This study will recruit two cohorts of participants with active syphilis infection, one with de novo infection, one with repeat infection. Whole blood specimens will be collected from each study participant at baseline, 4, 12, 24, 36, and 48 weeks, to track specific markers of their immunological response, as well as to compare humoral reactivity to Treponema pallidum antigens between the two groups. Additionally, we will use serum specimens to look for unique cytokine patterns in participants with early syphilis. Oral and blood samples, as well as samples from any syphilitic lesions present, will also be collected to sequence any Treponema pallidum DNA found. DISCUSSION By furthering our understanding of syphilis pathogenesis and human host immune response to Treponema pallidum, we will provide important data that will help in development of new point-of-care tests that could better identify active infection, leading to improved syphilis diagnosis and management. Findings could also contribute to vaccine development efforts.
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Affiliation(s)
- Ethan Osias
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Phoebe Hung
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Chrysovalantis Stafylis
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Kelika A Konda
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.,Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silver K Vargas
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - E Michael Reyes-Díaz
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - W Scott Comulada
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - David A Haake
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.,Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Austin M Haynes
- Department of Medicine, Division of Allergy and Infectious Diseases, and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Carlos F Caceres
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
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Allan-Blitz LT, Konda KA, Vargas SK, Wang X, Segura ER, Fazio BM, Calvo GM, Caceres CF, Klausner JD. The development of an online risk calculator for the prediction of future syphilis among a high-risk cohort of men who have sex with men and transgender women in Lima, Peru. Sex Health 2019; 15:261-268. [PMID: 30021680 DOI: 10.1071/sh17118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/24/2017] [Indexed: 12/22/2022]
Abstract
Background Syphilis incidence worldwide has rebounded since 2000, particularly among men who have sex with men (MSM). A predictive model for syphilis infection may inform prevention counselling and use of chemoprophylaxis. METHODS Data from a longitudinal cohort study of MSM and transgender women meeting high-risk criteria for syphilis who were followed quarterly for 2 years were analysed. Incidence was defined as a four-fold increase in rapid plasma reagin (RPR) titres or new RPR reactivity if two prior titres were non-reactive. Generalised estimating equations were used to calculate rate ratios (RR) and develop a predictive model for 70% of the dataset, which was then validated in the remaining 30%. An online risk calculator for the prediction of future syphilis was also developed. RESULTS Among 361 participants, 22.0% were transgender women and 34.6% were HIV-infected at baseline. Syphilis incidence was 19.9 cases per 100-person years (95% confidence interval (CI) 16.3-24.3). HIV infection (RR 2.22; 95% CI 1.54-3.21) and history of syphilis infection (RR 2.23; 95% 1.62-3.64) were significantly associated with incident infection. The final predictive model for syphilis incidence in the next 3 months included HIV infection, history of syphilis, number of male sex partners and sex role for anal sex in the past 3 months, and had an area under the curve of 69%. The online syphilis risk calculator based on those results is available at: www.syphrisk.net. CONCLUSIONS Using data from a longitudinal cohort study among a population at high risk for syphilis infection in Peru, we developed a predictive model and online risk calculator for future syphilis infection. The predictive model for future syphilis developed in this study has a moderate predictive accuracy and may serve as the foundation for future studies.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles CA, 90095, USA
| | - Kelika A Konda
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles CA, 90095, USA
| | - Silver K Vargas
- Centre for Interdisciplinary Studies in Sexuality, AIDS and Society, Cayetano Heredia University, Av. Honorio Delgado 430, San Martín de Porres, 15102, Peru
| | - Xiaoyan Wang
- Department of General Internal Medicine and Health Services Research, University of California Los Angeles, 911 Broxton Avenue, Los Angeles, CA, 90095, USA
| | - Eddy R Segura
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles CA, 90095, USA
| | - Boris M Fazio
- Centre for Interdisciplinary Studies in Sexuality, AIDS and Society, Cayetano Heredia University, Av. Honorio Delgado 430, San Martín de Porres, 15102, Peru
| | - Gino M Calvo
- Centre for Interdisciplinary Studies in Sexuality, AIDS and Society, Cayetano Heredia University, Av. Honorio Delgado 430, San Martín de Porres, 15102, Peru
| | - Carlos F Caceres
- Centre for Interdisciplinary Studies in Sexuality, AIDS and Society, Cayetano Heredia University, Av. Honorio Delgado 430, San Martín de Porres, 15102, Peru
| | - Jeffrey D Klausner
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles CA, 90095, USA
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6
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Kojima N, Siebert JC, Maecker H, Rosenberg-Hasson Y, Leon SR, Vargas SK, Konda KA, Caceres CF, Klausner JD. Cytokine expression in Treponema pallidum infection. J Transl Med 2019; 17:196. [PMID: 31186010 PMCID: PMC6558693 DOI: 10.1186/s12967-019-1947-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/03/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Current syphilis tests cannot distinguish between active and past syphilis among patients with serofast rapid plasma reagin (RPR) titers. We investigated whether cytokine profiles might provide insight in the differentiation of active and treated syphilis. METHODS We collected quarterly serum samples from participants at risk for incident syphilis in a prospective cohort study of men and male-to-female transgender women. We defined incident syphilis as a new RPR titer ≥ 1:8 or a fourfold increase from a prior RPR titer and a positive Treponema pallidum particle agglutination assay. We measured cytokine expression using a 63-multiplex bead-based Luminex assay (eBiosciences/Affymetrix, San Diego, California, USA). We used tertile bins and Chi square tests to identify differences in proportions of cytokines between samples from patients with active and treated syphilis. We constructed a network of cytokine profiles from those findings. We used R software (R version 3.4.1, R, Vienna, Austria) to fit models. RESULTS We identified 20 pairs of cytokines (out of 1953 possible pairs) that differed between active and treated syphilis. From those, we identified three cytokine networks of interest: an Eotaxin-Rantes-Leptin network, a Mig-IL1ra-Trail-CD40L network, and an IL12p40-IL12p70 network. CONCLUSIONS Differences in cytokine profiles are present among men and male-to-female transgender women with active and treated syphilis. Cytokine assays may be a potentially useful tool for identifying active syphilis among patients with serologic syphilis reactivity.
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Affiliation(s)
- N Kojima
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | | | - H Maecker
- Human Immune Monitoring Center, Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, 94305, USA
| | - Y Rosenberg-Hasson
- Human Immune Monitoring Center, Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, 94305, USA
| | - S R Leon
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, USA
| | - S K Vargas
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, USA
| | - K A Konda
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, USA
| | - C F Caceres
- Laboratory of Sexual Health and Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, USA
| | - J D Klausner
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, 90024, USA
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Vargas SK, Konda KA, Leon SR, Brown B, Klausner JD, Lindan C, Caceres CF. The Relationship Between Risk Perception and Frequency of HIV Testing Among Men Who Have Sex with Men and Transgender Women, Lima, Peru. AIDS Behav 2018; 22:26-34. [PMID: 29313193 PMCID: PMC6149521 DOI: 10.1007/s10461-017-2018-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
HIV infections in Peru are concentrated among men who have sex with men (MSM) and transgender women (TW). HIV testing rates among them remain low, delaying entrance into care. We assessed the prevalence of frequent HIV testing (at least every 6 months) and associated factors among 310 MSM and TW who attend sexual health clinics in Lima, Peru, and who reported that they were HIV seronegative or unaware of their status. Only 39% of participants tested frequently, and 22% had never tested; 29% reported that they were at low or no risk for acquiring HIV. Reporting low or no risk for acquiring HIV was associated with frequent testing (adjusted prevalence ratio [aPR] = 1.53, 95% CI 1.13-2.08); those reporting unprotected anal sex were less likely to test frequently (aPR = 0.66, 95% CI 0.50-0.87). HIV prevalence was 12% and did not vary by risk perception categories. This at-risk population tests infrequently and may not understand the risk of having unprotected sex.
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Affiliation(s)
- S K Vargas
- Laboratory of Sexual Health, Center for Interdisciplinary Research on Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.
- Laboratorio de Salud Sexual, Laboratorios de Investigación y Desarrollo (LID), Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru.
| | - K A Konda
- Program in Global Health, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Unit of Health, Sexuality and Human Development, Center for Interdisciplinary Research on Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - S R Leon
- Laboratory of Sexual Health, Center for Interdisciplinary Research on Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - B Brown
- Center for Healthy Communities, School of Medicine, University of California Riverside, Riverside, CA, USA
| | - J D Klausner
- Program in Global Health, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - C Lindan
- Department of Epidemiology and Biostatistics, Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - C F Caceres
- Unit of Health, Sexuality and Human Development, Center for Interdisciplinary Research on Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
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Laboratory Evaluation of a Smartphone-Based Electronic Reader of Rapid Dual Point-of-Care Tests for Antibodies to Human Immunodeficiency Virus and Treponema pallidum Infections. Sex Transm Dis 2018; 44:412-416. [PMID: 28604483 DOI: 10.1097/olq.0000000000000628] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Dual point-of-care tests for antibodies to human immunodeficiency virus (HIV) and Treponema pallidum allow for same-day testing and treatment and have been demonstrated to be cost-effective in preventing the adverse outcomes of HIV infection and syphilis. By recording and transmitting data as they are collected, electronic readers address challenges related to the decentralization of point-of-care testing. METHODS We evaluated a smartphone-based electronic reader using 201 sera tested with 2 dual rapid tests for detection of antibodies to HIV and T. pallidum in Los Angeles, USA, and Lima, Peru. Tests were read both visually and with the electronic reader. Enzyme immunoassay followed by Western blot and T. pallidum particle agglutination were the reference tests for HIV and T. pallidum, respectively. RESULTS The sensitivities of the 2 rapid tests for detection of HIV were 94.1% and 97.0% for electronic readings. Both tests had a specificity of 100% for detection of HIV by electronic reading. The sensitivities of the 2 rapid tests for detection of T. pallidum were 86.5% and 92.4% for electronic readings. The specificities for detection of T. pallidum were 99.1% and 99.0% by electronic reading. There were no significant differences between the accuracies of visual and electronic readings, and the performance did not differ between the 2 study sites. CONCLUSIONS Our results show the electronic reader to be a promising option for increasing the use of point-of-care testing programs.
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Treponema pallidum pallidum Genotypes and Macrolide Resistance Status in Syphilitic Lesions among Patients at 2 Sexually Transmitted Infection Clinics in Lima, Peru. Sex Transm Dis 2017; 43:465-6. [PMID: 27322050 DOI: 10.1097/olq.0000000000000465] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the circulating genotypes and the frequency of macrolide-resistance patterns among Treponema pallidum pallidum DNA isolated from syphilitic lesions from patients who attended 2 sexual health clinics in Lima, Peru. We implemented and used a molecular typing scheme to describe local T. pallidum pallidum strains. Among 14 specimens, subtype 14d/f was the most prevalent strain in 7 fully typed T. pallidum DNA specimens obtained from men who have sex with men and transgender women presenting with chancre-like lesions. No macrolide-resistance mutations were found in T. pallidum DNA from 10 lesions.
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Demographics, Behaviors, and Sexual Health Characteristics of High Risk Men Who Have Sex With Men and Transgender Women Who Use Social Media to Meet Sex Partners in Lima, Peru. Sex Transm Dis 2017; 44:143-148. [PMID: 28178111 DOI: 10.1097/olq.0000000000000566] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) and transgender women (TW) in Peru bear a disproportionate burden of human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). In a context of quickly expanding communication technology, increasing numbers of MSM and TW are using social media applications to seek sex partners. Understanding social media users and their sex partnering practices is needed to update HIV and STI prevention programming. METHODS In Lima, Peru, 312 MSM and 89 TW from 2 STI clinics underwent HIV and STI testing and participated in a survey of demographics, behaviors, sexual health, and social media practices. χ, t tests, and Wilcoxon Mann-Whitney tests were used to compare those with and without recent social media sex partners. RESULTS Men who have sex with men with social media sex partners were younger, more educated, and more likely to identify as gay. They were significantly more likely to report greater numbers of sex partners, including anonymous sex partners; sex in higher-risk venues, orgies, and have rectal Neisseria gonorrhoeae or Chlamydia trachomatis infection. Transgender women with social media sex partners were also younger, more likely to participate in sex work, and have a lower rate of rapid plasma reagin positivity or history of syphilis. Participants reported using several social media sites including sexual hook-up applications, websites for gay men, pornographic websites, and chat sites, but the most common was Facebook. CONCLUSIONS Prevention strategies targeting Peruvian MSM and TW who use social media are needed to address higher-risk sexual behavior and the high burden of STIs.
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Allan-Blitz LT, Konda KA, Calvo GM, Vargas SK, Leon SR, Segura ER, Caceres CF, Klausner JD. High incidence of extra-genital gonorrheal and chlamydial infections among high-risk men who have sex with men and transgender women in Peru. Int J STD AIDS 2017; 29:568-576. [PMID: 29183269 DOI: 10.1177/0956462417744098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extra-genital Neisseria gonorrhoeae and Chlamydia trachomatis infections are associated with antimicrobial resistance and HIV acquisition. We analyzed data from a cohort of men who have sex with men (MSM) and transgender women followed quarterly for two years in Peru. Incident cases were defined as positive N. gonorrhoeae or C. trachomatis nucleic acid tests during follow-up. Repeat positive tests were defined as reinfection among those with documented treatment. We used generalized estimating equations to calculate adjusted incidence rate ratios (aIRRs). Of 404 participants, 22% were transgender. Incidence rates of rectal N. gonorrhoeae and C. trachomatis infection were 28.1 and 37.3 cases per 100 person-years, respectively. Incidence rates of pharyngeal N. gonorrhoeae and C. trachomatis infection were 21.3 and 9.6 cases per 100 person-years, respectively. Incident HIV infection was associated with incident rectal (aIRR = 2.43; 95% CI 1.66-3.55) N. gonorrhoeae infection. Identifying as transgender versus cisgender MSM was associated with incident pharyngeal N. gonorrhoeae (aIRR = 1.85; 95% CI 1.12-3.07) infection. The incidence of extra-genital N. gonorrhoeae and C. trachomatis infections was high in our population. The association with incident HIV infection warrants evaluating the impact of rectal N. gonorrhoeae screening and treatment on HIV transmission.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- 1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA
| | - Kelika A Konda
- 1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA.,2 Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gino M Calvo
- 2 Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.,3 Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silver K Vargas
- 2 Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.,3 Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Segundo R Leon
- 3 Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eddy R Segura
- 1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA
| | - Carlos F Caceres
- 2 Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- 1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA.,4 Department of Epidemiology, Fielding School of Public Health, 12222 University of California Los Angeles , USA
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12
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Herrera MC, Konda KA, Leon SR, Brown B, Calvo GM, Salvatierra HJ, Caceres CF, Klausner JD, Deiss R. Do Subjective Alcohol Screening Tools Correlate with Biomarkers Among High-Risk Transgender Women and Men Who Have Sex with Men in Lima, Peru? AIDS Behav 2017; 21:253-261. [PMID: 29043467 PMCID: PMC7392030 DOI: 10.1007/s10461-017-1933-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Alcohol abuse can influence sexual risk behavior; however, its measurement is not straightforward. This study compared self-reported alcohol use, via the AUDIT and CAGE, with levels of phosphatidylethanol (Peth), a phospholipid biomarker that forms with chronic, heavy drinking, among high-risk MSM and TW in Lima, Peru. Chi square, Fisher's exact, Wilcoxon ranksum tests compared the instruments. Receiver operating curves determined sensitivity and specificity of the self-reported measures. Among 69 MSM and 17 TW, PEth was positive for 86% (95% CI 77-93%) of participants, while 67% reported binge-drinking in the last 2 weeks. The AUDIT classified 25% as hazardous drinkers while CAGE identified 6% as problem drinkers. Self-reported binge drinking was more sensitive than the AUDIT for PEth positivity (71% vs. 27%, p = 0.022). Among high-risk MSM and TW in Lima, validated, self-report measures of alcohol abuse underestimated biological measures. Further research correlating bio-markers and self-reported alcohol abuse measures is needed.
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Affiliation(s)
- M C Herrera
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
- Department of Pediatrics, University of California, San Francisco, CA, USA.
| | - K A Konda
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
- Center for Interdisciplinary Research in Sexuality, Society, and AIDS, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - B Brown
- Department of Social Medicine and Population Health, UCR School of Medicine, Riverside, CA, USA
| | - G M Calvo
- Center for Interdisciplinary Research in Sexuality, Society, and AIDS, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - H J Salvatierra
- Alberto Barton Health Center, Health Directorate of Callao, Lima, Peru
| | - C F Caceres
- Center for Interdisciplinary Research in Sexuality, Society, and AIDS, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J D Klausner
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - R Deiss
- Division of Global Public Health, UCSD School of Medicine, San Diego, CA, USA
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13
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Joseph Davey D, Kojima N, Konda KA, Gupta P, Leon SR, Calvo GM, Caceres CF, Klausner JD. Transient aortitis documented by positron emission tomography in a case series of men and transgender women infected with syphilis. Sex Transm Infect 2017; 93:551-555. [PMID: 28866636 DOI: 10.1136/sextrans-2017-053140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/02/2017] [Accepted: 05/06/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Syphilis infection persists globally contributing to preventable and treatable morbidity and mortality. How extensive early syphilis disseminates is unknown. To better understand the relationship between early syphilis infection and inflammation over time, our study enrolled six individuals recently infected with syphilis for sequential positron emission tomography (PET) scans. METHODS We evaluated a case series of six individuals with high syphilis titres (two secondary, two early latent and two latent, unknown duration, but with high titre) who received sequential PET scans to assess inflammation over time and its response to treatment. RESULTS At time of PET scan, four of the six individuals were co-infected with HIV. One of the four was not on antiretroviral therapy and three of the four were not virally suppressed (viral load of >400 copies/mL). Baseline rapid plasma reagin (RPR) titres ranged from 1:64 to 1:256 (four of the six participants had prior non-reactive RPR results). Five of the six participants had mild to intense hypermetabolic PET scan activity consistent with cervical (n=5), axillary (n=4), inguinal (n=5) and retroperitoneal (n=1) adenopathy. Mild hypermetabolic activity in the thoracic aortic wall, suggesting aortitis, was present among the same five participants and resolved within 30 days for four of the five participants and 60 days for the other participant. However, widespread lymphadenopathy remained present in PET scans up to 3 months following treatment in two participants. We did not find any abnormal PET scan activity of the central nervous system. CONCLUSION We found abnormal aortic wall PET scan activity suggesting aortitis to be common in a case series of patients with early syphilis. In research settings, PET scans may be a sensitive tool to monitor inflammation associated with syphilis.
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Affiliation(s)
- Dvora Joseph Davey
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.,Division of Infectious Disease, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Noah Kojima
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kelika A Konda
- David Geffen School of Medicine, University of California, Los Angeles, California, USA.,Unit of Health, Sexuality and Human Development, Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Pawan Gupta
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Segundo R Leon
- Unit of Health, Sexuality and Human Development, Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gino M Calvo
- Unit of Health, Sexuality and Human Development, Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos F Caceres
- Unit of Health, Sexuality and Human Development, Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.,Division of Infectious Disease, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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14
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Kojima N, Park H, Konda KA, Joseph Davey DL, Bristow CC, Brown B, Leon SR, Vargas SK, Calvo GM, Caceres CF, Klausner JD. The PICASSO Cohort: baseline characteristics of a cohort of men who have sex with men and male-to-female transgender women at high risk for syphilis infection in Lima, Peru. BMC Infect Dis 2017; 17:255. [PMID: 28399798 PMCID: PMC5387233 DOI: 10.1186/s12879-017-2332-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 03/21/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) and male-to-female transgender women (transwomen) are disproportionately at risk of syphilis infection in Peru. METHODS From 2013 to 2014, MSM and transwomen seeking human immunodeficiency virus (HIV) or sexually transmitted infection (STI) testing and/or treatment were recruited into a 2-year observational cohort study to determine predictors of recently acquired syphilis infection (defined as a rapid plasma reagin [RPR] titer ≥1:16 and a reactive treponemal antibody test) in Lima, Peru. At baseline, interviewers collected sociodemographic, behavioral, and medical characteristics from participants. All cohort participants were tested for syphilis, HIV, Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG) infection. Using cross-sectional analyses, bivariate and multivariate models were used to determine factors associated with recently acquired syphilis infection and calculate adjusted prevalence ratios. RESULTS We recruited 401 participants, 312 MSM and 89 transwomen, with median ages of 29.0 and 32.5 years old (interquartile ranges: 23.3, 37.4 and 27.2, 39.5, respectively). The prevalence of recently acquired syphilis infection at baseline was 16.8% for MSM and 6.7% for transwomen. Among MSM and transwomen, 30.1 and 33.7% were infected with HIV, 18.6 and 24.7% were infected with CT, and 14.2 and 19.1% were infected with NG, respectively. Co-infection rates among MSM with recently acquired syphilis infection included: 44.2% with HIV, 40.4% with CT (32.7% with anal CT and 7.7% with pharyngeal CT), and 19.2% with NG (11.5% with anal NG and 7.7% with pharyngeal NG). Co-infection rates among transwomen with recently acquired syphilis infection included: 66.7% with HIV, 0% with CT, and 16.7% with anal NG. In multivariate analysis among the entire cohort, recently acquired syphilis infection was independently associated with younger age (adjusted prevalence ratio [aPR] = 0.96, 95% confidence interval [CI] = 0.93-0.99), receptive role during anal sex (aPR = 2.56, 95% CI = 1.05-6.25), prior HIV diagnosis (aPR = 1.70, 95% CI = 1.11-2.61), anal CT or NG infection (aPR = 1.69, 95% CI = 1.09-2.60), and prior syphilis diagnosis (aPR = 3.53, 95% CI = 2.20-5.68). CONCLUSIONS We recruited a cohort of MSM and transwomen who had a high prevalence of recently acquired syphilis infection in Lima, Peru. Recently acquired syphilis infection was associated with socio-demographic characteristics, sexual risk, and sexually transmitted co-infections.
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Affiliation(s)
- Noah Kojima
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
| | - Hayoung Park
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
| | - Kelika A. Konda
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Dvora L. Joseph Davey
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA USA
| | - Claire C. Bristow
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA USA
| | - Brandon Brown
- Center for Healthy Communities, University of California Riverside, Riverside, CA USA
- Epicentro Salud, Lima, Peru
| | - Segundo R. Leon
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silver K. Vargas
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gino M. Calvo
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos F. Caceres
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D. Klausner
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA USA
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15
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Masuda N, Holme P. Toward a Realistic Modeling of Epidemic Spreading with Activity Driven Networks. TEMPORAL NETWORK EPIDEMIOLOGY 2017. [PMCID: PMC7123080 DOI: 10.1007/978-981-10-5287-3_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Models of epidemic spreading are widely used to predict the evolution of an outbreak, test specific intervention scenarios, and steer interventions in the field. Compartmental models are the most common class of models. They are very effective for qualitative analysis, but they rely on simplifying assumptions, such as homogeneous mixing and time scale separation. On the other end of the spectrum, detailed agent-based models, based on realistic mobility pattern models, provide extremely accurate predictions. However, these models require significant computing power and are not suitable for analytical treatment. Our research aims at bridging the gap between these two approaches, toward time-varying network models that are sufficiently accurate to make predictions for real-world applications, while being computationally affordable and amenable to analytical treatment. We leverage the novel paradigm of activity driven networks (ADNs), a particular type of time-varying network that accounts for inherent inhomogeinities within a population. Starting from the basic incarnation of ADNs, we expand on the framework to include behavioral factors triggered by health status and spreading awareness. The enriched paradigm is then utilized to model the 2014–2015 Ebola Virus Disease (EVD) spreading in Liberia, and perform a what-if analysis on the timely application of sanitary interventions in the field. Finally, we propose a new formulation, which is amenable to analytical treatment, beyond the mere computation of the epidemic threshold.
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Affiliation(s)
- Naoki Masuda
- Department of Engineering Mathematics, University of Bristol, Bristol, United Kingdom
| | - Petter Holme
- Institute of Innovative Research, Tokyo Institute of Technology, Yokohama, Japan
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16
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Abstract
Positron emission tomography (PET) has been used to aid in diagnosis of inflammatory and infectious disease. We describe the case of a patient with early latent syphilis with increased metabolic activity along the aorta detected via PET, suggesting probable aortitis. Three months after treatment, the PET showed apparent resolution of the aortitis.
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17
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Billings JD, Joseph Davey DL, Konda KA, Bristow CC, Chow J, Klausner JD, Cáceres CF. Factors associated with previously undiagnosed human immunodeficiency virus infection in a population of men who have sex with men and male-to-female transgender women in Lima, Peru. Medicine (Baltimore) 2016; 95:e5147. [PMID: 27759645 PMCID: PMC5079329 DOI: 10.1097/md.0000000000005147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 09/06/2016] [Accepted: 09/26/2016] [Indexed: 11/25/2022] Open
Abstract
The aim of the study was to identify factors associated with undiagnosed human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) and male-to-female transgender women in Lima, Peru.We analyzed characteristics of 378 MSM and transgender women recruited from 2 sexually transmitted infection (STI) clinics in Lima, Peru. Descriptive analyses compared: (A) HIV-uninfected, (B) previously undiagnosed HIV-infected, and (C) previously diagnosed HIV-infected participants. Multivariable logistic regression models identified: (1) correlates of previously undiagnosed HIV-infection among participants thought to be HIV-uninfected (B vs A); and (2) correlates of previously undiagnosed HIV-infection among HIV-infected participants (B vs C). Subanalysis identified correlates of frequent HIV testing among participants thought to be HIV-uninfected.Among participants, 31.0% were HIV-infected; of those, 35.0% were previously undiagnosed. Among participants thought to be HIV-uninfected (model 1), recent condomless receptive anal intercourse and last HIV test being over 1-year ago (compared to within the last 6-months) were associated with increased odds of being previously undiagnosed HIV-infected (adjusted odds ratio [aOR] = 2.43, 95% confidence interval [95%CI] = 1.10-5.36; aOR = 2.87, 95%CI = 1.10-7.53, respectively). Among HIV-infected participants (model 2), recent condomless receptive anal intercourse was again associated with previously undiagnosed HIV-infection (aOR = 2.54, 95%CI = 1.04-6.23). Achieving post-secondary education and prior syphilis infection were associated with lower odds of having previously undiagnosed HIV-infection (aOR = 0.35, 95%CI = 0.15-0.81; aOR = 0.32, 95%CI = 0.14-0.75, respectively).Reporting semiannual testing was associated with higher educational attainment, identifying as a transgender woman, or reporting a history of syphilis (aOR = 1.94, 95%CI = 1.11-3.37; aOR = 2.40, 95%CI = 1.23-4.70; aOR = 2.76, 95%CI = 1.62-4.71, respectively). Lower odds of semiannual testing were associated with recent condomless insertive anal intercourse or reporting a moderate or high self-perceived risk of acquiring HIV (aOR = 0.56, 95%CI = 0.33-0.96; aOR = 0.32, 95%CI = 0.18-0.59 and aOR = 0.43, 95%CI = 0.21-0.86, respectively).In our study, undiagnosed HIV-infection was associated with recent condomless receptive anal intercourse, infrequent HIV testing, lower education, and absence of prior syphilis diagnosis. Infrequent HIV testing was associated with lower education, not identifying as transgender, recent condomless insertive anal intercourse, absence of prior syphilis diagnosis, and higher self-perceived risk of HIV. Further efforts to decrease HIV transmission and increase HIV-serostatus awareness should be directed towards effectively promoting condom use and frequent HIV testing, integrated with STI management.
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Affiliation(s)
| | - Dvora L. Joseph Davey
- David Geffen School of Medicine at University of California Los Angeles
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA
| | - Kelika A. Konda
- David Geffen School of Medicine at University of California Los Angeles
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Claire C. Bristow
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA
| | - Jeremy Chow
- David Geffen School of Medicine at University of California Los Angeles
| | - Jeffrey D. Klausner
- David Geffen School of Medicine at University of California Los Angeles
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA
| | - Carlos F. Cáceres
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
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18
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Bustamante MJ, Konda KA, Joseph Davey D, León SR, Calvo GM, Salvatierra J, Brown B, Caceres CF, Klausner JD. HIV self-testing in Peru: questionable availability, high acceptability but potential low linkage to care among men who have sex with men and transgender women. Int J STD AIDS 2016; 28:133-137. [PMID: 26826160 DOI: 10.1177/0956462416630674] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
HIV status awareness is key to prevention, linkage-to-care and treatment. Our study evaluated the accessibility and potential willingness of HIV self-testing among men who have sex with men (MSM) and transgender women in Peru. We surveyed four pharmacy chains in Peru to ascertain the commercial availability of the oral HIV self-test. The pharmacies surveyed confirmed that HIV self-test kits were available; however, those available were not intended for individual use, but for clinician use. We interviewed 147 MSM and 45 transgender women; nearly all (82%) reported willingness to perform the oral HIV self-test. However, only 55% of participants would definitely seek a confirmatory test in a clinic after an HIV-positive test result. Further, price may be a barrier, as HIV self-test kits were available for 18 USD, and MSM and transgender women were only willing to pay an average of 5 USD. HIV self-testing may facilitate increased access to HIV testing among some MSM/transgender women in Peru. However, price may prevent use, and poor uptake of confirmatory testing may limit linkage to HIV treatment and care.
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Affiliation(s)
- Maria Jose Bustamante
- 1 Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kelika A Konda
- 1 Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru.,2 Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles CA, USA
| | - Dvora Joseph Davey
- 3 Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Segundo R León
- 1 Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gino M Calvo
- 1 Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru.,4 Epicentro Salud, Lima, Peru
| | | | - Brandon Brown
- 6 Center for Healthy Communities, Division of Clinical Sciences, UCR School of Medicine, Riverside, CA USA
| | - Carlos F Caceres
- 1 Unit of Health, Sexuality and Human Development, and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- 2 Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles CA, USA.,3 Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA, USA
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19
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Allan-Blitz LT, Leon SR, Bristow CC, Konda KA, Vargas SK, Flores JA, Brown BJ, Caceres CF, Klausner JD. High prevalence of extra-genital chlamydial or gonococcal infections among men who have sex with men and transgender women in Lima, Peru. Int J STD AIDS 2016; 28:138-144. [PMID: 26846151 DOI: 10.1177/0956462416630909] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chlamydia trachomatis and Neisseria gonorrhoeae are among the most common sexually transmitted bacterial infections in the world. Data are limited, however, on the burden of extra-genital chlamydial and gonococcal infections among men who have sex with men and transgender women in Lima, Peru. Data were gathered from self-collected anal or pharyngeal swabs from participants in Lima, Peru, and analyzed via cross-sectional methods. Prevalence ratios for the association between extra-genital infection with socio-demographic and sexual behaviors were determined. Overall, 127 (32.8%) participants had anal or pharyngeal infections. On multivariate modeling, anal infection was positively associated with practicing both receptive and insertive anal sex, when compared to insertive alone (PR = 2.49; 95% CI = 1.32-4.71), and negatively associated with any antibiotic use in the prior three months (PR = 0.60; 95% CI = 0.39-0.91). Pharyngeal infection was negatively associated with age greater than 30 years compared to 18-30 years (PR = 0.54; 95% CI = 0.30-0.96), and positively associated with gender identity of transgender women (PR = 2.12; 95% CI = 1.20-3.73). This study demonstrates considerable burden of extra-genital chlamydial and gonococcal infections among men who have sex with men and transgender women in Lima, Peru.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- 1 David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Segundo R Leon
- 2 Laboratory of Sexual Health, Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,3 Department of Global Health, University of Washington, Seattle, WA, USA
| | - Claire C Bristow
- 4 Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Kelika A Konda
- 5 Department of Medicine, University of California Los Angeles, CA, USA
| | - Silver K Vargas
- 2 Laboratory of Sexual Health, Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan A Flores
- 2 Laboratory of Sexual Health, Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Brandon J Brown
- 6 Division of Clinical Sciences, Center for Healthy Communities, School of Medicine, University of California Riverside, CA, USA
| | - Carlos F Caceres
- 2 Laboratory of Sexual Health, Unit of Health, Sexuality and Human Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- 1 David Geffen School of Medicine, University of California Los Angeles, CA, USA.,5 Department of Medicine, University of California Los Angeles, CA, USA
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20
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Laboratory Evaluation of a Point-of-Care Downward-Flow Assay for Simultaneous Detection of Antibodies to Treponema pallidum and Human Immunodeficiency Virus. J Clin Microbiol 2016; 54:1922-1924. [PMID: 27147725 DOI: 10.1128/jcm.00637-16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/02/2016] [Indexed: 11/20/2022] Open
Abstract
Combining the detection of syphilis and HIV antibodies into one point-of-care test integrates syphilis screening into already existing HIV screening programs, which may be particularly beneficial in settings such as antenatal care. Using the INSTI Multiplex downward-flow immunoassay, we tested 200 stored serum samples from high-risk patients enrolled in a longitudinal study on HIV infection and syphilis in Peruvian men who have sex with men and transgender women. This rapid assay detected HIV and Treponema pallidum serum antibodies with sensitivities of 100% (95% confidence interval [CI], 95.9% to 100%) and 87.4% (95% CI, 81.4% to 92.0%), respectively, and specificities of 95.5% (95% CI, 89.9% to 98.5%) and 97.0% (95% CI, 84.2% to 99.9%), respectively (n = 200). The sensitivity for syphilis antibody detection was higher in patients with a rapid plasma reagin titer of ≥1:8 (97.3%) than in those with a titer of ≤1:4 (90%) or a nonreactive titer (66.7%).
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Herrera MC, Konda KA, Leon SR, Deiss R, Brown B, Calvo GM, Salvatierra HJ, Caceres CF, Klausner JD. Impact of alcohol use on sexual behavior among men who have sex with men and transgender women in Lima, Peru. Drug Alcohol Depend 2016; 161:147-54. [PMID: 26896169 PMCID: PMC4807690 DOI: 10.1016/j.drugalcdep.2016.01.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/26/2016] [Accepted: 01/26/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Alcohol use disorders (AUDs) may enhance the likelihood of risky sexual behaviors and the acquisition of sexually transmitted infections (STIs). Associations between AUDs with condomless anal intercourse (CAI) and STI/HIV prevalence were assessed among men who have sex with men (MSM) and transgender women (TW) in Lima, Peru. METHODS MSM and TW were eligible to participate based on a set of inclusion criteria which characterized them as high-risk. Participants completed a bio-behavioral survey. An AUDIT score ≥8 determined AUD presence. Recent STI diagnosis included rectal gonorrhea/chlamydia, syphilis, and/or new HIV infection within 6 months. Prevalence ratios (PR) were calculated using Poisson regression. RESULTS Among 312 MSM and 89 TW, 45% (181/401) had an AUD. Among those with an AUD, 164 (91%) were hazardous/harmful drinkers, and 17 (9%) had alcohol dependence. Higher CAI was reported by participants with an AUD vs. without, (82% vs. 72% albeit not significant). Reporting anal sex in two or more risky venues was associated with screening AUD positive vs. not (24% vs. 15%, p=0.001). There was no difference in recent STI/HIV prevalence by AUD status (32% overall). In multivariable analysis, screening AUD positive was not associated with CAI or recent STI/HIV infection. CONCLUSIONS In our sample AUDs were not associated with CAI or new HIV infection/recent STI. However higher prevalence of CAI, alcohol use at last sex, and anal sex in risky venues among those with AUDs suggests that interventions to reduce the harms of alcohol should be aimed toward specific contexts.
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Affiliation(s)
- M C Herrera
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - K A Konda
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - S R Leon
- Partners in Health, Director of Research, Lima, Peru
| | - R Deiss
- Division of Global Public Health, UCSD School of Medicine, San Diego, CA, USA
| | - B Brown
- Division of Clinical Sciences, Center for Healthy Communities, University of California, Riverside, CA, USA
| | - G M Calvo
- Unit of Health, Sexuality and Human Development, School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - H J Salvatierra
- Alberto Barton Health Center, Health Directorate of Callao, Lima, Peru
| | - C F Caceres
- Unit of Health, Sexuality and Human Development, School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J D Klausner
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Laboratory Evaluation of a Dual-Path Platform Assay for Rapid Point-of-Care HIV and Syphilis Testing. J Clin Microbiol 2015; 54:492-4. [PMID: 26659215 DOI: 10.1128/jcm.03152-15] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/04/2015] [Indexed: 11/20/2022] Open
Abstract
We assessed the laboratory performance of the Chembio dual-path platform HIV-syphilis rapid immunodiagnostic test and electronic reader for detection of HIV and Treponema pallidum antibodies in 450 previously characterized serum specimens. For visual or electronic reader HIV antibody detection, the sensitivity was 100% and the specificity was 98.7%. For visual T. pallidum antibody detection, the test sensitivity was 94.7% and the specificity was 100.0%; with the electronic reader, the sensitivity was 94.7% and the specificity was 99.7%.
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Wang J, Zhao X, Yuan P, Fang T, Ouyang N, Li R, Ou S, Wang W. Clinical Outcomes of In Vitro Fertilization among Chinese Infertile Couples Treated for Syphilis Infection. PLoS One 2015. [PMID: 26208116 PMCID: PMC4514756 DOI: 10.1371/journal.pone.0133726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
To compare the clinical outcomes of infertile patients with and without syphilis after in vitro fertilization and embryo transfer (IVF-ET), in this case-control study, 320 infertile couples were enrolled and divided into syphilis (n = 160) and control groups (n = 160). The primary IVF outcomes were the clinical pregnancy rate and the birth of a healthy baby. All syphilis patients received the standard anti-syphilis treatment before undergoing IVF/ICSI. Our results showed that the endometrial thickness of the syphilis group was greater than that of the control group following hCG injection (16.9±5.4 vs. 13.0±4.7 mm, P<0.001). The numbers of normally fertilized eggs and normally cleaved fertilized eggs and the implantation rate were 6.8±4.8, 6.3±4.7 and 24.2%, respectively, for the syphilis group and 8.3±4.6, 8.1±4.6 and 34.4%, respectively, for the control group, and these values were significantly different between the groups. The clinical pregnancy rate was lower in the syphilis group compared with that in the control group (43.8% vs. 55.6%, P = 0.03). Lower offspring birth weight was observed in the infected male group compared with those in the infected female (2.7±0.4 vs. 3.0±0.4 kg, P = 0.01) and infected couple groups (2.7±0.4 vs. 3.1±0.5 kg, P = 0.007). Therefore, syphilis infection reduces the clinical pregnancy rate after IVF/ICSI.
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Affiliation(s)
- Jing Wang
- Reproductive Medicine Center, Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Xi Road, Guangzhou 510120, P. R. China
| | - Xiaomiao Zhao
- Reproductive Medicine Center, Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Xi Road, Guangzhou 510120, P. R. China
| | - Ping Yuan
- Reproductive Medicine Center, Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Xi Road, Guangzhou 510120, P. R. China
| | - Tingfeng Fang
- Reproductive Medicine Center, Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Xi Road, Guangzhou 510120, P. R. China
| | - Nengyong Ouyang
- Reproductive Medicine Center, Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Xi Road, Guangzhou 510120, P. R. China
| | - Ruiqi Li
- Reproductive Medicine Center, Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Xi Road, Guangzhou 510120, P. R. China
| | - Songbang Ou
- Reproductive Medicine Center, Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Xi Road, Guangzhou 510120, P. R. China
| | - Wenjun Wang
- Reproductive Medicine Center, Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Xi Road, Guangzhou 510120, P. R. China
- * E-mail:
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Rizzo A, Frasca M, Porfiri M. Effect of individual behavior on epidemic spreading in activity-driven networks. PHYSICAL REVIEW. E, STATISTICAL, NONLINEAR, AND SOFT MATTER PHYSICS 2014; 90:042801. [PMID: 25375543 DOI: 10.1103/physreve.90.042801] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Indexed: 05/03/2023]
Abstract
In this work we study the effect of behavioral changes of individuals on the propagation of epidemic diseases. Specifically, we consider a susceptible-infected-susceptible model over a network of contacts that evolves in a time scale that is comparable to the individual disease dynamics. The phenomenon is modeled in the context of activity-driven networks, in which contacts occur on the basis of activity potentials. To offer insight into behavioral strategies targeting both susceptible and infected individuals, we consider two separate behaviors that may emerge in respiratory syndromes and sexually transmitted infections. The first is related to a reduction in the activity of infected individuals due to quarantine or illness. The second is instead associated with a selfish self-protective behavior of susceptible individuals, who tend to reduce contact with the rest of the population on the basis of a risk perception. Numerical and theoretical results suggest that behavioral changes could have a beneficial effect on the disease spreading, by increasing the epidemic threshold and decreasing the steady-state fraction of infected individuals.
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Affiliation(s)
- Alessandro Rizzo
- Department of Mechanical and Aerospace Engineering, New York University Polytechnic School of Engineering, Six MetroTech Center, Brooklyn, New York 11201, USA
| | - Mattia Frasca
- Dipartimento di Ingegneria Elettrica, Elettronica e Informatica Università degli Studi di Catania, Viale A. Doria 6, 95126 Catania, Italy
| | - Maurizio Porfiri
- Department of Mechanical and Aerospace Engineering, New York University Polytechnic School of Engineering, Six MetroTech Center, Brooklyn, New York 11201, USA
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