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O'Byrne P, Musten A, Orser L, Inamdar G, Grayson MO, Jones C, Francoeur M, Lachance S, Paulin V. At-home HIV self-testing during COVID: implementing the GetaKit project in Ottawa. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:587-594. [PMID: 33999399 PMCID: PMC8127455 DOI: 10.17269/s41997-021-00505-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 03/09/2021] [Indexed: 11/17/2022]
Abstract
Setting In March 2020, COVID-19 shuttered access to many healthcare settings offering HIV testing and there is no licensed HIV self-test in Canada. Intervention A team of nurses at the University of Ottawa and Ottawa Public Health and staff from the Ontario HIV Treatment Network (OHTN) obtained Health Canada’s Special Access approval on April 23, 2020 to distribute bioLytical’s INSTI HIV self-test in Ottawa; we received REB approval on May 15, 2020. As of July 20, 2020, eligible participants (≥18 years old, HIV-negative, not on PrEP, not in an HIV vaccine trial, living in Ottawa, no bleeding disorders) could register via www.GetaKit.ca to order kits. Outcomes In the first 6 weeks, 637 persons completed our eligibility screener; 43.3% (n = 276) were eligible. Of eligible participants, 203 completed a baseline survey and 182 ordered a test. These 203 participants were an average of 31 years old, 72.3% were white, 60.4% were cis-male, and 55% self-identified as gay. Seventy-one percent (n = 144) belonged to a priority group for HIV testing. We have results for 70.9% (n = 129/182) of participants who ordered a kit: none were positive, 104 were negative, 22 were invalid, and 2 “preferred not to say”; 1 participant reported an unreadiness to test. Implications Our results show that HIV self-testing is a pandemic-friendly strategy to help ensure access to sexual health services among persons who are good candidates for HIV testing. It is unsurprising that no one tested positive for HIV thus far, given the 0.08% positivity rate for HIV testing in Ottawa. As such, we advocate for scale-up of HIV self-testing in Canada.
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Affiliation(s)
- Patrick O'Byrne
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada. .,Infectious Diseases and Sexual Health Services, Ottawa Public Health, Ottawa, Canada.
| | | | - Lauren Orser
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada.,Infectious Diseases and Sexual Health Services, Ottawa Public Health, Ottawa, Canada
| | | | - Marie-Odile Grayson
- Infectious Diseases and Sexual Health Services, Ottawa Public Health, Ottawa, Canada
| | - Clay Jones
- Ontario HIV Treatment Network, Toronto, Canada
| | - Megan Francoeur
- Infectious Diseases and Sexual Health Services, Ottawa Public Health, Ottawa, Canada
| | - Sarah Lachance
- Infectious Diseases and Sexual Health Services, Ottawa Public Health, Ottawa, Canada
| | - Vickie Paulin
- Infectious Diseases and Sexual Health Services, Ottawa Public Health, Ottawa, Canada
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O'Byrne P. Considerations for Research on Sexually Transmitted Infections (STIs): Reflections of an STI Clinician-Researcher. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1863-1873. [PMID: 32424802 DOI: 10.1007/s10508-020-01726-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 06/11/2023]
Abstract
Sexually transmitted infections (STIs) have been explored in various sexual subgroups. While excellent, these analyses have primarily occurred from uniquely biologic, epidemiologic, or sociologic perspectives. Missing from these discussions has been in-depth presentations of the dynamics of STI transmission from all three viewpoints simultaneously. In this paper, I present information about STI transmission for each STI, including considerations of prevalence, and then review the STI research and of the concept of risk. I then apply these three considerations to a fictitious case study to show their importance and utility. I close by arguing that this information could strengthen future sociologic reviews of STIs and sexual health by helping such researchers include more nuanced understandings about STIs.
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Affiliation(s)
- Patrick O'Byrne
- School of Nursing, University of Ottawa, Ottawa, K1R 5H9, ON, Canada.
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The Need and Desire for Mental Health and Substance Use-Related Services Among Clients of Publicly Funded Sexually Transmitted Infection Clinics in Vancouver, Canada. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25:E1-E10. [PMID: 30444755 DOI: 10.1097/phh.0000000000000904] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Sexually transmitted infections (STI) and mental health and substance use (MHSU) disorders all occur at elevated rates in sexual and gender minorities. These overlapping epidemics, or syndemics, are exacerbated by challenges these same populations face in accessing sexual/gender minority-affirming services. Many publicly funded STI clinics are a low barrier and provide sexual minority-competent care. These sites therefore may be uniquely situated to address clients' MHSU-related needs. OBJECTIVE We characterize the need and desire for MHSU services among STI clinic clients. DESIGN, SETTING, PARTICIPANTS We conducted a waiting room survey at 6 STI clinics in Metro Vancouver, Canada. MAIN OUTCOME MEASURES We calculated the proportion of clients with self-reported unmet MHSU needs in the previous 12 months and, among these clients, barriers to accessing MHSU services and desire for MHSU services within the STI clinic. We also examined social disparities in barriers to accessing MHSU services. RESULTS Among 1115 respondents-65% of whom were sexual minorities-39% reported a recent need for MHSU-related care, most frequently in relation to anxiety (29%), depression (26%), substance use (10%), or suicide ideation (7%). Seventy-two percent of this group had not yet talked to a provider about their concern. Common barriers included shame (26%) and inability to afford the service (24%). Eighty-three percent of clients with unmet MHSU needs indicated that they were comfortable discussing MHSU concerns with an STI clinic provider, and 94% expressed desire to receive MHSU assessments, referrals, or counseling in the STI clinic. Sexual and gender minorities and those attending a suburban clinic were more likely to report barriers to accessing MHSU services. CONCLUSIONS More than a quarter of STI clinic clients report unmet MHSU health care needs; moreover, these clients report high levels of comfort with and desire to discuss MHSU concerns with STI clinic providers. Sexually transmitted infections clinics are thus opportune sites for syndemic service integration.
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OʼByrne P. Recommended screenings for chlamydia and gonorrhea: A Canadian guidelines review. Nurse Pract 2020; 44:35-41. [PMID: 30672865 DOI: 10.1097/01.npr.0000552681.53898.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chlamydia and gonorrhea are the most commonly diagnosed bacterial sexually transmitted infections (STIs), and both are increasing in incidence. Because these STIs are often asymptomatic and found at extragenital sites, such as the pharynx and rectum, it is important that clinicians know when and how to screen for them. This article reviews recent updates to Canadian screening guidelines, including the evidence that led to updates on this topic.
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Affiliation(s)
- Patrick OʼByrne
- Patrick O'Byrne is an associate professor and NP at the University of Ottawa School of Nursing in Ottawa, Ontario, Canada
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O'Byrne P. Party Drug Use Among Gay Men: Expanding Contemporary Understandings for Nursing Practice. Res Theory Nurs Pract 2019; 32:296-310. [PMID: 30567840 DOI: 10.1891/1541-6577.32.3.296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The extant literature about party drug use among gay men primarily produces a list of negative health sequelae that correlate with using these substances. Missing from the current research are explorations about why people consume party drugs. In other words, researchers have not systematically collected people's narratives about "what they get out of" party drugs. METHODS Using Deleuze's and Bataille's work, exploratory semistructured interviews were undertaken with gay men who reported attending circuit parties, using party drugs, and engaging in condomless sex. RESULTS Seventeen men fit the study inclusion criteria and engaged in an interview. Two main themes emerged: party drugs were used to achieve desired sensations, and party drugs provided respite. The findings suggested that the relationships between party drugs and condomless sex are not necessarily causal. CONCLUSION It is important for nurses to differentiate the competing uses of pleasure seeking and respite, and design and provide interventions based on each patient's or patient groups' reasons for using party drugs.
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Affiliation(s)
- Patrick O'Byrne
- Associate Professor, University of Ottawa, Faculty of Health Sciences School of Nursing, Ottawa, Ontario
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O'Byrne P. Population Health and Social Governance: A Review, an Update, Some Clarifications, and a Response. QUALITATIVE HEALTH RESEARCH 2019; 29:731-738. [PMID: 30547724 DOI: 10.1177/1049732318815686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Critical theory is a paradigm that promotes viewpoints that are alternative and, at times, contrary to mainstream beliefs and dictates. In 2012, I adopted this perspective to review the role of ethnography and surmised that the data which arise from this research approach, which I described as an in-depth study of cultures, can be used to discipline and control these groups. In this edition of Qualitative Health Research, another author has critiqued this position. In this article, I review this critique, reiterate my position, update the data I used for my 2012 article, and highlight how I navigate what I feel is a tension between critical theory and practice.
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Campbell CK, Lippman SA, Moss N, Lightfoot M. Strategies to Increase HIV Testing Among MSM: A Synthesis of the Literature. AIDS Behav 2018; 22:2387-2412. [PMID: 29550941 DOI: 10.1007/s10461-018-2083-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
More than 30 years into the HIV epidemic, men who have sex with men (MSM) continue to be disproportionately impacted. It is estimated that worldwide nearly half of MSM infected with HIV are unaware of their status, making HIV testing along with early linkage to care crucial to HIV prevention efforts. However, there remain significant barriers to HIV testing among MSM, due largely to complex issues of layered stigma that deter MSM from accessing traditional, clinic-based testing. We conducted a review and synthesis of the literature on strategies to increase uptake of HIV testing among MSM. We found that social network-based strategies, community-based testing, HIV self-testing, and modifications to the traditional clinic-based model can effectively reach a subset of MSM, but success was often context-specific and there are significant gaps in evidence. We provide recommendations for increasing HIV testing rates and status awareness among MSM.
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Affiliation(s)
- Chadwick K Campbell
- Center for AIDS Prevention Studies, University of California San Francisco, UCSF Mail Code 0886, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA.
| | - Sheri A Lippman
- Center for AIDS Prevention Studies, University of California San Francisco, UCSF Mail Code 0886, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA
| | - Nicholas Moss
- Division of Communicable Disease Control & Prevention, Alameda County Public Health Department, Oakland, CA, USA
| | - Marguerita Lightfoot
- Center for AIDS Prevention Studies, University of California San Francisco, UCSF Mail Code 0886, 550 16th Street, 3rd Floor, San Francisco, CA, 94158-2549, USA
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Tanner Z, Lachowsky N, Ding E, Samji H, Hull M, Cescon A, Patterson S, Chia J, Leslie A, Raboud J, Loutfy M, Cooper C, Klein M, Machouf N, Tsoukas C, Montaner J, Hogg RS. Predictors of viral suppression and rebound among HIV-positive men who have sex with men in a large multi-site Canadian cohort. BMC Infect Dis 2016; 16:590. [PMID: 27769246 PMCID: PMC5073906 DOI: 10.1186/s12879-016-1926-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/12/2016] [Indexed: 01/25/2023] Open
Abstract
Background Gay, bisexual and other men who have sex with men (MSM) are disproportionately affected by HIV in Canada. Combination antiretroviral therapy has been shown to dramatically decrease progression to AIDS, premature death and HIV transmission. However, there are no comprehensive data regarding combination antiretroviral therapy outcomes among this population. We sought to identify socio-demographic and clinical correlates of viral suppression and rebound. Methods Our analysis included MSM participants in the Canadian Observational Cohort, a multi-site cohort of HIV-positive adults from Canada’s three most populous provinces, aged ≥18 years who first initiated combination antiretroviral therapy between 2000 and 2011. We used accelerated failure time models to identify factors predicting time to suppression (2 measures <50 copies/mL ≥30 days apart) and subsequent rebound (2 measures >200 copies/mL ≥30 days apart). Results Of 2,858 participants, 2,448 (86 %) achieved viral suppression in a median time of 5 months (Q1–Q3: 3–7 months). Viral suppression was significantly associated with later calendar year of antiretroviral therapy initiation, no history of injection drug use, lower baseline viral load, being on an initial regimen consisting of non-nucleoside reverse-transcriptase inhibitors, and older age. Among those who suppressed, 295 (12 %) experienced viral rebound. This was associated with earlier calendar year of antiretroviral therapy initiation, injection drug use history, younger age, higher baseline CD4 cell count, and living in British Columbia. Conclusions Further strategies are required to optimize combination antiretroviral therapy outcomes in men who have sex with men in Canada, specifically targeting younger MSM and those with a history of injection drug use.
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Affiliation(s)
| | - Nathan Lachowsky
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,School of Public Health & Social Policy, University of Victoria, Victoria, Canada.,Centre for Addiction Research British Columbia, University of Victoria, Victoria, Canada
| | - Erin Ding
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Hasina Samji
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Mark Hull
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Angela Cescon
- Northern Ontario School of Medicine, Sudbury, Canada
| | - Sophie Patterson
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Jason Chia
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Alia Leslie
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Toronto General Research Institute, University Health Network, Toronto, Canada
| | - Mona Loutfy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada.,Maple Leaf Medical Clinic, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Curtis Cooper
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Marina Klein
- Faculty of Medicine, McGill University, Montreal, Canada.,The Montreal Chest Institute, McGill University Health Centre, Montreal, Canada
| | | | | | - Julio Montaner
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Robert S Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada. .,Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada. .,Faculty of Health Sciences, Simon Fraser University, BLU 9512, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
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Spatz Friedman D, O'Byrne P, Roy M. Comparing those diagnosed early versus late in their HIV infection: implications for public health. Int J STD AIDS 2016; 28:693-701. [PMID: 27538724 DOI: 10.1177/0956462416664674] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Routine HIV surveillance cannot distinguish between recent and older infections: HIV-positive individuals reported soon or long after infection are both considered new diagnoses from a surveillance perspective, notwithstanding the time since infection. This lack of specificity makes it difficult to understand the jurisdiction-specific trends in HIV epidemiology needed for prevention planning. Previous efforts have been made to discern such timing of infection, but these methodologies are not easily applied in a public health setting. We wished to develop a simple protocol, using routinely collected information, to classify newly diagnosed infections as recent or older, and to enumerate and characterize recent versus older infections. Applying our methodology to a review of HIV cases reported between January 2011 and December 2014, we classified 62% of cases; one-third of these were recent infections. Although men who have sex with men (MSM) and persons from HIV-endemic countries (HEC) disproportionally accounted for new HIV diagnoses, the dynamics of HIV transmission within these groups differed dramatically: MSM accounted for the majority of recent infections, whereas persons from HEC accounted for the majority of older infections. Among older infections, one-quarter were previously unaware of their infection. Categorizing cases in this manner yielded greater, jurisdiction-specific understanding of HIV, and guides subpopulation-specific interventions.
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Affiliation(s)
| | - Patrick O'Byrne
- 2 Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON Canada
| | - Marie Roy
- 3 Healthy Sexuality and Risk Reduction Unit, Ottawa Public Health, Ottawa, ON Canada
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O'Byrne P, MacPherson P, Roy M, Orser L. Community-based, nurse-led post-exposure prophylaxis: results and implications. Int J STD AIDS 2016; 28:505-511. [PMID: 27405581 DOI: 10.1177/0956462416658412] [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
HIV medications can be used as post-exposure prophylaxis to efficaciously prevent an HIV-negative person who has come into contact with HIV from becoming HIV-positive. Traditionally, these medications have been available in emergency departments, which have constituted a barrier for the members of many minority groups who are greatly affected by HIV transmission (i.e. gay, bisexual and other men who have sex with men, and persons who use injection drugs). From 5 September 2013 through 4 September 2015, we sought to increase the use of HIV post-exposure prophylaxis by having registered nurses provide these medications, when indicated, in community clinics in Ottawa, Canada. We undertook a chart review of patients who accessed services for HIV post-exposure prophylaxis in this period. Over the two years of data collection, 112 persons requested HIV post-exposure prophylaxis and 64% (n = 72) initiated these medications. Most (93%, or n = 67, of the 72 initiations) were among men, with 88% (n = 59) of these men reporting same sex sexual partners. Among these 58 men, 31% (n = 18) had sexual contact with other men known to be HIV-positive. Among women (n = 8), five initiated post-exposure prophylaxis: three after needle-sharing contact or sexual contact with a male partner who reportedly shared needles, and two after unprotected vaginal sex with a male partner known to be HIV-positive. Overall, no one was diagnosed with HIV at the four-month HIV testing follow-up, although six persons were diagnosed with HIV from the baseline HIV testing, and an additional four were diagnosed with HIV during routine HIV testing one year after completing post-exposure prophylaxis. In total, nine persons in our sample were thus diagnosed with HIV during the study period, which accounted for 9.4% (n = 10 of 106) of all reported HIV diagnoses in Ottawa during this time. We conclude that nurse-initiated HIV post-exposure prophylaxis can be an effective way to provide HIV prevention services to persons who are at high-risk for HIV.
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Affiliation(s)
| | | | - Marie Roy
- 3 Ottawa Public Health, Healthy Sexuality and Risk Reduction Unit, Canada
| | - Lauren Orser
- 3 Ottawa Public Health, Healthy Sexuality and Risk Reduction Unit, Canada
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O'Byrne P, MacPherson P, DeLaplante S, Metz G, Bourgault A. Approach to lymphogranuloma venereum. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:554-558. [PMID: 27412206 PMCID: PMC4955081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To review the literature about lymphogranuloma venereum (LGV) and to provide an overview and discussion of practice guidelines. SOURCES OF INFORMATION The terms Chlamydia trachomatis and lymphogranuloma venereum were searched separately in PubMed. Empirical studies, practice reviews, and clinical guidelines were included. All reference lists were reviewed for additional articles. MAIN MESSAGE Since 2003, there has been a resurgence of LGV among men who have sex with men in many Western countries, including Canada. Although LGV is a serovar of Chlamydia trachomatis (serovar L), it can invade regional lymph nodes, and consequently presents with different symptoms than the other subtypes of chlamydia (serovars A through K). Specifically, LGV transitions through 3 phases: a painless papule or ulcer at the site of inoculation; invasion of the regional lymph nodes, which can present with an inguinal or rectal syndrome; and irreversible destruction of lymph tissue. In contrast, chlamydia serovars A to K exclusively produce superficial mucosal infections. Lymphogranuloma venereum also requires a different treatment regimen than other chlamydia serovars. CONCLUSION In light of the current resurgence of LGV, its unique symptoms and clinical course, and its requirement for a different treatment than other chlamydia serovars, it is important for primary care providers to recognize when LGV should be included as an appropriate differential diagnosis.
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Affiliation(s)
- Patrick O'Byrne
- Associate Professor of Nursing at the University of Ottawa in Ontario.
| | | | | | - Gila Metz
- Medical Director of the Ottawa Public Health Sexual Health Centre
| | - Andree Bourgault
- Nurse practitioner at the Ottawa Public Health Sexual Health Centre
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